PSYCHIATRIC NURSING Definition of Terms: I.

Basic Concepts of Mental Health and Psychiatric Nursing Personality - is the sum total of all INHERITED and ACQUIRED physical, mental and emotional traits of a person as this interact with the environment in a unique and distinctive way. Psychiatric Nursing A specialized area of nursing practice employing theories of human behavior as its science and purposely use of self as its art . (ANA, 2000) Includes the continuous and comprehensive services necessary for the promotion of optimal mental health, prevention of mental illness, health maintenance, management and referral of mental and physical health problems, the diagnosis and treatment of mental disorders and their sequela, and rehabilitation the diagnosis and treatment of human response to actual or potential mental health problems . a specialized area of nursing practice that uses the theories of human behavior as its scientific framework and requires the purposeful use of self as it s art of expression. (Isaac and Shives, 2002). an interpersonal process that strives to promote and MAINTAIN BEHAVIORS which contributes to integrate functioning. It employs THEORIESOF HUMAN BEHAVIOR as its SCIENCE and PURPOSEFUL USE OF SELF as its ART. .. it is directed toward both PREVENTIVE and CORRECTIVE impacts on mental disorders and their sequelae and is concerned with the PROMOTION OF OPTIMUM MENTAL HEALTH for society, individual who live within it . (Gail Stuart). Basic Principles of Psychiatric Nursing 1. Accept and respect people as individuals regardless of their behavior. 2. Limit or reject the individual s inappropriate behavior without rejecting the individual. 3. Recognize that all behavior has meaning and is meeting the needs of the performer regardless of how distorted or meaningless it appears to others (masturbation) 4. Accept the dependency needs of individuals while supporting and encouraging moves towards independence. 5. Help individuals set appropriate limits for themselves or set limits for them when they are unable to do so. 6. Encourage individuals to express their feelings in an atmosphere free of reappraisal or judgment. 7. Recognize how feelings affect behaviors and influence relationship. 8. Recognize that individuals need to use their defenses until other defenses can be substituted (COPING MECHANISM). COPING MECHANISM a. Problem Solving Process - Confrontation- Ask the client b. Cognitively Focused Coping Mechanism- it has something to do with the conditioning of the mind. Technique on how to do CFCM (1) Appraise Factor- to from or give an opinion of somebody s merit s or quality (2) Devalue Factor c. Emotion Focused Coping Mechanism

- DEFENSE MECHANISM (you are just trying to protect your ego) d. Spiritual Focused Coping Mechanism 9. Recognize that individuals frequently respond to the behavioral expectations of others; family, peers, authority and etc 10. Recognize that all individuals have potential for movement toward higher levels of emotional health (every individual is unique and has the desire to GROW and to BECOME). 3 LEVELS OF PSYCHIATRIC NURSING (Levels of Health) I. Primary Objective: PROMOTION & PREVENTION A. Client and Family Teaching (Health Teaching) 1.Teaching adolescent in preventing contracting STDs CHLAMYDIA: #1 STD in the Philippines #1 Sign: Greenish & purulent urethral discharge PID (Pelvic Inflammatory disease) #1 cause of sterility in #1 Drug of choice Erythromycin 2nd drug of choice Cephalosporin

women

2. Teaching pregnant women relaxation techniques Objective: to prevent complication in labor, fetal distress, perineal laceration (also can be prevented by Kegel s exercise) Stage I of labor (LAT-CAP) L atent C - chest breathing A ctive A - bdominal breathing T ransitional P - ant blow breathing 3. Teaching couples on contraceptives BON (Barrier, Oral Contraceptive, Natural) Barrier - CONDOM Oral - Artificial Natural - not for M A M (Malnourished, Anemics & Menses irregular) 4. Conducting rape prevention classes is an example of primary level of prevention. B. Herbal Medicines C. Psychosocial Support family/friends/peers Needs most support (ASA): Addicts, Suicidal, Alcoholics, Suicide = Major depression, despair, hopeless, powerless Prone: Male Age bracket prone for suicide #1. Adolescent (identity crisis) 2. Elderly (ego-despair) 3. Middle age men (40 y.o. above) 4. Post partum depression (7days/2-4 weeks) D. Giving Vaccines II. Secondary : Screening, Diagnosis & Immediate Treatment A. Screening > Denver Development Screening Test (DDST) #1 test for PDD/ MMDST Pervasive Development Disorder (PPD) 1. Autism: Age of onset (3 y.o.) 2. ADHD: Age of onset (6 y.o.) Diet: Finger Food (high caloric, high CHO) Rx: Ritalin (Methylphenidate); dextroamphetamine (Dexedrine) 3. Conduct disorder: Age of onset (6 y.o.) B. Suicide Prevention / Intervention Impending signs of Suicide 1. Sudden elevation of mood/sudden mood swings

2. Giving away of prized possessions 3. Delusion of Omnipotence (divine powers) Used by SS (Suicidal, Schizophrenia) 4. When the patient verbalizes that the 2nd Gen TCA is working. 5. less than 2-4 wks (telling a lie) Suicide Interventions: 1. One-on-one supervision and monitoring 2. No suicide contract 24 hrs monitoring - Patient is required to verbalize suicidal ideas 3. Non metallic/plastic/sharp objects: ex. belts, curtains 4. Avoid dark places C. Case Finding (Epidemics)/Contact Tracing (STDs) D. Crisis Intervention Objective: To return the client to its normal functioning or pre crisis level. Duration: (4-6 wks) Disorganization is a phase in the crisis state which is characterized by the feelings of great anxiety and inability to perform activities of daily living A patient in crisis is passive and submissive, so the nurse needs to be active and should direct the patient to activities that facilitate coping. Types of Crisis: 1. Developmental Maturation Crisis - Adolescence (identity crisis) - Mid-life crisis; - Pregnancy - Parenthood 2. Situational / Accidental crisis - Most common: Death of a loved one NSG DX: Ineffective Individual Coping/ Denial - ex. murder, abortion , rape and fire 3. Adventitious calamity, disaster ex. World War I & II, epidemic, tsunami In a DISASTER 1st assess/survey the scene E. Emergency drugs and antidotes III. Tertiary Objective: Rehabilitation, which start upon admission A. Occupational Therapy - Usually use behavior modification for PDD (Pervasive Developmental Disorders), anorexia & depression - Also use fine motor rehabilitation for Post M.I. & Post CVA B. Vocational Skills (Entrepreneur skills) C. Aftercare Support follow-up. Needed by: addicts & residual schizophrenia due to remission & exacerbation INTERDISCIPLINARY TEAM PRIMARY ROLES Psychiatrist: The psychiatrist is a physician certified in psychiatry by the American Board of Psychiatry and Neurology, which requires 3-year residency, 2-years of clinicaln practice, and completion of an examination. The primary function of the psychiatrist is diagnosis of, mental disorders and prescription of medical treatments. Psychologist: The clinical psychologist has a doctorate (Ph.D.) in clinical psychology and is prepared to practice therapy, conduct research, and interpret psychological tests. Psychologists may also participate in the design of therapy programs for groups of individuals.

Psychiatric nurse: The registered nurse gains experience in working with clients with psychiatric disorders after graduation from an accredited program of nursing and completion of the licensure examination. The nurse has a solid foundation in health promotion, illness prevention, and rehabilitation in all areas, allowing him or her to view the client holistically. The nurse is also an essential team member in evaluating the effectiveness of medical treatment, particularly medications. Registered nurses who obtain a master s degree in mental health may be certified as clinical specialist or licensed as advanced practitioners, depending on individual state nurse practice acts. Advanced practice nurses are certified to prescribe drugs in many states. Psychiatric social worker: Most psychiatric social workers are prepared at the master s level, and they are licensed in some states. Social workers may practice therapy and often have the primary responsibility for working with families, community support, and referral. Occupational therapist: Occupational therapist may have an associate degree (certified occupational therapy assistant) or a baccalaureate degree (certified occupational therapist). Occupational therapy focuses on the functional abilities of the client and ways to improve client functioning such as working with arts and crafts and focusing on psychomotor skills. Recreation therapist: Many recreation therapists complete a baccalaureate degree, but in some instances persons with experience fulfill these roles. The recreation therapist helps the client to achieve a balance of work and play in his or her life and provides activities that promote constructive use of leisure or unstructured time. Vocational rehabilitation specialist: Vocational rehabilitation includes determining clients interests and abilities and matching them with vocational choices. Clients are also assisted in job-seeking and job-retention skills, as well as pursuit of further education if that is needed and desired. Vocational rehabilitation specialists can be prepared at the baccalaureate or master s level and may have different levels of autonomy and program supervision based on their education.

Mental Health - The state in the interrelationship of INIDVIDUAL and his ENVIRONMENT in which the PERSONALITY STRUCTURE is relatively stable, and the ENVIRONMENTAL STRESSES are within its absorptive capacity. The state where a person feels physically well, his thoughts are organized, his feelings, emotions are well modulated, and his behaviors are well coordinated and appropriate. He feels part of a group and is able to perform his role within it.

CHARACTERISTICS OF A MENTALLY HEALTHY INDIVIDUAL 1. Perception is realistic- Ability to test assumptions about the world by empirical thought; includes social sensitivity (empathy) 2. Autonomy - Involves self- determination, self- responsible for decisions, balance between dependence and independence, and acceptance of the consequences of one s action - He feels part of the group and is able to perform his role and duties within it 3. Self-acceptance- He/she feels part of the group/family class 4. Integrative capacity (thoughts are organized)- Ability to integrate negative and positive experiences to his or her personality. 5. Towards growth, development and self actualization 6. Insights/Full of insights 7. Balance- emotions , feelings, behaviors are well modulated , organized, coordinated and appropriate - Joy and pain are balance 8. Environmental mastery- guaged frustration tolerance - Psychological resilience

Mental Illness is any disease or condition affecting the brain that influence the way a person thinks, feels, behaves and/or relates to others and to his surroundings resulting in an impairment in the ability to function psychologically, socially, occupationally or interpersonally . Mental Disorder a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress or disability or with significantly increased risk of suffering death, pain, disability or an important loss of freedom . CLASSIFICATION OF MENTAL DISORDER - According to symptoms and clinical features 1. Mood Disorders- Affective Disorder Characteristics: Extreme sadness : Elation (euphoria, overjoyed) : Fluctuating feelings : Mild to extreme periods of extreme happiness to extreme sadness Disorders: D-depression B- Bipolar disorders S- Seasonal Affective Disorder 2. Thought disorder Characteristics: Distortion: Thinking : Sensory Perception- Hallucinations, delusions, illusions Disorder: Schizophrenia 3. Anxiety Disorders Characteristics: E- excessive fear U- Uncontrolled fear D- Dread (feeling of being terrorized, frightened, apprehended) N- Nervousness to certain situations Disorder: G- Generalized Anxiety Disorder P- panic disorder P- Post Traumatic Stress Disorder S- Social Anxiety disorder O- Obsessive Compulsive Disorder S- specific phobias 4. Personality disorder Characteristics: extreme rigid and inflexible personality traits : Maladaptive patterns of behavior and thinking Disorder: P- Paranoid personality Disorders O- Obsessive personality Disorder H- Histrionic Personality Disorder A- Antisocial Personality Disorder B- Borderline Personality Disorder 5. Eating Disorder Characteristics: B- Behaviors towards food and weight E- Emotions towards food and weight A- Abnormal attitudes towards food and weight Disorder: A- Anorexia Nervosa B- Bulimia Nervosa 6. Impulse Control Disorder Characteristics: I- Inability to resist urges/urges or impulses that are potentially harmful to self and others Disorders: C- Compulsive Gambling P- Pyromania or starting fire K- Kleptomania 7. Cognitive Disorder- comprehension, understanding of the individuals is affected Disorder: Alzheimer s Disease 8. Developmental Disorder M- Mental Retardation A- Attention deficit Disorder

9. Substance Related Disorders- Disorders: Alcohol Abuse , D Drug Abuse 10. Dissociative Disorder Characteristics: D- Disturbance in memory C- Changes in consciousness, identity and general awareness Disorder: D- Dissociative Identity Disorder/Multiple Personality Disorder D depersonalization F- Fugue A- Amnesia 11. Somatoform disorder or Psychogenic Disorders Characteristics: Presence of physical symptoms without medical cause Disorder: Conversion, Hypochondriasis 12. Sexual and Gender Disorders Characteristics: abnormalities in sexual desire, performance and behavior Disorder: S- Sexual Dysfunction G- Gender Identity Disorder P- Paraphilias 13. Factitious Disorder Characteristics: false physical and or emotional symptoms Disorder: Munchausen s syndrome Munchausen s syndrome by proxy 14. Other disorder- Tic disorders, Sleep disturbance CAUSES OF MENTAL ILLNESS - Cause/causes of mental illness is still unknown. - Some says mental illness is often multifactorial in origin MULTIFACTORIAL- the causation o M.I. can be traced to a combination of genetic, biological, psychological and environmental factor. 1. BIOLOGICAL - Neurotransmitter are either be lacking or overflowing (a) Increased dopamine---- depression (b) Decreased Serotonin---- depression (c) Decreased Norepinephrine/moradrebergic--- Depression---Mania (d) GABA--- Anxiety (e) Dcreased Ach--- Alzheimer s (f) Decreased Dopamine--- Parkinsonism a. HEREDITY- mental illness tend to run in families more often in persons with relatives who have mental illness - It can be caused by one or more genes that are responsible on how a person thinks or acts in the formation of a person s temperament. b. INFECTION- certain infections have been linked with the development of mental illness or its symptoms. - Infections may trigger or cause a worsening of an already existing mental disorder c. PRENATAL- impairment of normal brain development (a) Alcohol- results to FAS due to maternal alcohol abuse (b) Hypothyroidism- causes MR d. BRAIN DYSFUNCTION/BRAIN INJURY- example: Head Trauma- associated with mental disorder such as AMNESIA. e. CONSTITUTIONAL LIABILITIES/PHYSICAL DISABILITIES - amputation and Blindness f. ENDOCRINE IMBLANCES- research shows that DEPRESSED client has Increased TSH TYPICAL SIGNS AND SYMPTOMS OF MENTAL ILLNESS I. Consciousness- the state of awareness of each individual Apperception- perception modified by one s own emotion Sensorium- state of functioning of the special senses A. Disturbances in Consciences: 1. Confusion- disturbance of orientation as to time, place or person

2. Clouding of consciousness- incomplete clear mindedness with disturbance in perception and attitudes 3. Delirium- Bewildered, restless, confused, disoriented reaction with and hallucination 4. Coma- profound degree of unconsciousness 5. Coma Vigil- coma I n which eyes remain open B. Disturbance in attention: amount of effort exerted in focusing in certain portions of an experience: 1. Distractibility- inability to concentrate attention 2. Selective Inattention- blocking out of things that generate anxiety C. Disturbance in suggestibility: complaint and uncritical responses to an idea or influence 1. Folie a deux- communicated emotional illness between 2 to 3 persons e.g. husband and wife both become psychotic with similar or complimentary syptomatology 2. Illusion- a misinterpreted sensory perception 3. Hypnosis- artificially induced modification of consciousness II. Affect- emotional feeling or tone A. Disturbance in Affect: Inappropriate affect- disharmony of affect and ideation B. Pleasurable Affect: 1. Euphoria- heightened feeling of psychological well being inappropriate to apparent events 2. Elation- air confidence and enjoyment associated with increased motor activity 3. Exaltation- intense elation with feelings of grandeur 4. Ecstasy- feeling of intense rapture of emotions C. Unpleasurable Affects: 1. Depression- psychological feelings of sadness 2. Grief or mourning- sadness appropriate to a real loss D. Other Affects: 1. Anxiety- feeling of apprehension due to unconsciousness conflicts 2. Fear- anxiety due to consciously recognized and realistic danger 3. Agitation- marked restlessness and psychomotor responses 4. Tension- condition arising out of the mobilization of the psychological resources to meet a threat, physically involves an increase in muscle tone and other emergency changes - psychologically is characterized by feelings of strain, uneasiness and anxiety 5. Panic- acute intense attack of anxiety associated with personality disorganization 6. Free floating anxiety- pervasive fear not attached to any idea 7. Apathy- dulled emotional tone associated with detachment or indifference - absence of emotion 8. Ambivalence- co-existence of 2 impulses towards the same thing in the same person at the same time 9. Depersonalization- feeling or unreality concerning one s self or one s environment 10. Aggression- forceful directed action that may be verbal or physical - a behavior aimed at destroying someone or something 11. Derealizatrion- distortion of spatial relationship so that the environment becomes Unfamiliar. 12. Mood swings- oscillation between periods of euphoria and depression or anxiety III. Motor Behavior (conation) - the capacity to initiate action or motor disturbances that concerns the basic striving of a person as expressed through his behavior. Disturbance in Conation: 1. Echolalia- psychopathological repeating of words of one person by another 2. Echopraxia- repetition of another person s action or gestures 3. Waxy flexibility- conditions in which the muscles are waxy or semi-rigid, tending to maintain the limbs in any position in they are placed 4. Command automatism- automatic following or suggestion 5. Automatism- automatic responses of an acts representative of unconscious symbolic activity 6. Catalepsy- temporary loss of muscle tone and weakness precipitated by variety of emotional states

7. Exhibitionism- a display of the body of its parts for the purpose of attracting attention 8. Stereotype- persistent and inappropriate repetition of phrases, gestures or acts 9. Negativism- frequent opposition to suggestion 10. Mannerisms- stereotype voluntary movements 11. Verbigeration- meaningless repetition of words 12. Overactivity: a. Hyperactivity (hyperkinesis) - restless, aggressive, destructive activity b. Tic- spasmodic, repetitive motor movements c. Sleepwalking (somnambulism) - motor activity during sleep d. Compulsion- uncontrollable impulse to perform an act or activity (a) Dipsomania- compulsion to drink alcohol (b) Egomania- pathological self pre-occupation (c) Erotomania- pathological preoccupation with sex (d) Kleptomania- compulsion to steal (e) Megalomania- pathological sense of power (f) Monomania- pre-occupation with a single object (g) Nymphomania- excessive need for coitus in female (h) Satyriasis- excessive need for coitus in male (i) Trichotilomania- nervous habit involving the pulling of hair (j) Ritual- automatic activity compulsive in nature, emotional in origin 13. Hypoactivity- decreased activity or retardation as in psychomotor retardation, slowing of psychological and physical functioning 14. Others: a. Copralalia- obtaining sexual pleasure from using filthy language b. Fetishism- adoring or loving something which serves as a substitute for the original love object such as hanky, panty, glove, etc . IV. Thinking- goal directed flow of ideas, symbols and association initiated by a problem or task and leading towards reality-oriented conclusions; when a logical sequence occurs, thinking is normal. A. Disturbance in Form of Thinking 1. Dereism- mental activity not concordant with logic or experience 2. Autistic Thinking- thinking that gratifies unfulfilled desires but has no regard for reality B. Disturbance in Structure of Association 1. Neologism- new words created by the patients for psychological reasons 2. Word salad- incoherent mixture of words and phrases 3. Tangentially- inability to have goal directed association of thoughts; patients never gets from starting point to desired goal 4. Incoherence- running together of thoughts with no logical connection, resulting in disorganization 5. Perseveration- psychological repetition of the same word or idea in response to different questions 6. Condensation- fusion of various concepts into one 7. Irrelevant answer- answer which is not in harmony with questions asked C. Disturbance in Speed of Association: 1. Flight of ideas- rapid verbalizations so that there is a shifting from one idea to another 2. Blocking- involuntary inhibition of recall, ideation or communication, including sudden stoppage of speech, unconscious in origin 3. Clang association- words similar in sounds words similar in sound but mot in meaning call up new thoughts 4. Pressure of Speech- voluble speech difficult to interrupt 5. Volubility-(logorrhea) copious, coherent, logical speech D. Disturbances in type of associations 1. Motor Aphasia- disturbance of speech due to organic brain disorder in which understanding remains but ability. 2. Sensory Aphasia- loss of ability to comprehend the meaning of words or use objects 3. Nominal Aphasia- difficulty in finding the right name for an object 4. Syntactical Aphasia- inability to arrange words in logical sequence E. Disturbance in Content of Thought

1. Delusions- firm belief opposed to reality but maintained in spite of strong evidence to the contrary a. Delusion of grandeur- exaggerated conception of one importance b. Delusion of persecution- false belief that one is being persecuted, mistreated or interfered with one s enemies, often found in schizophrenic c. Delusion of interference- false beliefs that the behavior of others refers to oneself; derived from ideas of being talked about by others d. Delusion of self-accusations- false feeling of remorse, regret or repentance e. Delusion of control- false belief of that one is being controlled by others f. Delusions of Infidelity- false belief derived from pathological jealousy that one s lover is unfaithful g. Paranoid Delusions- excessive or irrational suspiciousness and distrustfulness of others, characterized by systemized delusions that others are out to get them or spying on them h. Somatic delusions- beliefs that one s body or parts of one s body are diseased or distorted i. Thought Broadcasting- delusion about thought are aired to the outside world j. Thought insertion- delusions that thought are placed into the mind by outside people or influence 2. Trend or Preoccupation of thought- centering of thought contents around a particular idea, associated with strong affective tone 3. Hypochondriasis- exaggerated concerns about one s health that is not based on real organic pathology 4. Magical thinking- beliefs that thinking equates with doing, characterized by lack of realistic relationship between cause and effect 5. Nihilistic ideas- thought of non-existence and hopelessness, severe depression 6. Obsession- pathological persistence of irresistible thought feelings or impukses that cannot be eliminated from consciousness by logical effort 7. Phobias- exaggerated and invariably pathological dread of some specific type of stimulus or situation (a) Acrophobia- dread of high places (b) Agoraphobia- dread of open spaces (c) Algophobia- dread or pain (d) Claustrophobia- dread of closed space (e) Xenophobia- dread of strangers (f) Zoophobia- dread of animals V. Perception- awareness of objects and relations that follows stimulation of peripheral sense organs A. Disturbance associated with organic brain disease such as agnosia: e.g. Agnosia- inability to recognize and interpret the significance of sensory impression B. Disturbance associated with Hysteresia- illnesses characterized by emotional conflict; the use the defense mechanism conversion; and the development of physical symptoms involving the voluntary muscles or special sense organs. 1. Hysterical anesthesia- loss of sensory modalities resulting from emotional conflicts 2. Macropsia- state where objects appear larger than they are 3. Micropsia- state in which object appear smaller than they are C. Hallucinations- false sensory perception not associated with real external stimuli 1. Hypnagogic hallucination- false sensory perception occurring midway between falling asleep and being awake - it may be visual, auditory, olfactory and gustatory 2. Auditory hallucination- false sensory perception 3. Visual hallucination- false visual perception 4. Olfactory hallucination- false perception of smell 5. Gustatory hallucination- false perception of taste 6. Tactile hallucination- false perception of touch 7. Kinesthetic hallucination- false perception of movements or sensation, as from the amputated limb (phantom pain) VI. Memory- function by which information stored in the brain is later recalled to consciousness A. Disturbance in memory 1. Amnesia- partial or total inability to recall past experiences 2. Paramnesia- falsification of memory by distortion of recall a. False reconnaissance- false recognition b. Retrospective falsification- recollection of a true memory to which the patient adds false details c. Confabulation- Unconscious filling of gaps in memory by imagined or true experiences that patients believed that have no basis in fact

d. De javu- illusion of visual recognition which a new situation is incorrectly regarded as a repetition of a previous memory e. Deja Entendu- illusion of auditory recognition f. Jamais yu- false feeling in unfamiliarity with real situation one has experienced VII. Intelligence- the ability to understand, recall, mobilizes, and integrates constructively previous learning in meeting with social and vocational performance A. Mental retardation- organically caused of lack of intelligence to such degree that there is interference with social and vocational performance Classifications: Obsolescent terms: Mild- IQ of 50-70 Idiot- mental age less than 3 Moderate- IQ of 35-49 Imbecile- mental age of 3-7 years Severe- IQ 20-34 Moron- mental age of eight or more Profound- IQ of below 20 B. Dementia- Organic loss of mental Functioning VIII. Other possible signs of psychotic problems: 1. Anaclitic Depression- a deprivational reaction in infants separated from their mothers in the second half of the first years of life. The reaction is characterized by: a. Apprehension g. insomia b. crying i. anorexia c. withdrawal j. gross retardation and growth and development d. psychological slowing e. dejection f. stupor 2. Encoporesis- the involuntary passage of feces 3. Enuresis- involuntary passage of urine 4. Perversion- a maladjustment in which the sexual object or method of deriving sexual gratification deviates from the accepted social pattern 5. Pica- the habitual ingestion of substances that have no nutritional value IX. Other psychiatric terms: Extrapyramidal Effect- side effects of an antipsychotic medication with results that resemble the symptoms of Parkinson s disease Korsakoff s Psychosis- a chronic mental illness usually associated with the use of alcoholism characterized by polyneuritis, reduced intellectual capacities, and the marked use of confabulation to compensate for memory loss Lucid Interval- a remission of symptoms in mental illness when the patients reasoning and judgment appear to be normal for a brief period Tardive Dyskinesia- a serious side effects of antipsychotic medications characterized by buccolinguomasticatory triad of head, jaw and facial movement, athetoid and choreiform movement of the extremities and tonic contractions of the back and neck muscles Withdrawal syndrome- constellation of behaviors that occur when use of an abused substance terminated. Behaviors are specific to the abused substance