Appendix A Brief Psychiatric Rating Scale Patient’s
name____________________________
Date________________ Interviewer’s
name____________________________
Hospital____________________________
Ward________________
admission____________________________ Date of Reprinted with permission from Lukoff, D., Liberman, R. P., & Nuechterlein, K. H. (1986). Symptom monitoring in the rehabilitation of schizophrenic patients. Schizophrenia Bulletin, 12(4), 578–602. 2625
Appendix B Simpson-Angus Rating Scale 1. GAIT: The patient is examined as he or she walks into the examining room; the gait, the swing of the arms, and the general posture all form the basis for an overall score for this item. This is rated as follows: 0. Normal 1. Diminution in swing while the patient is walking 2. Marked diminution in swing with obvious rigidity in the arm 3. Stiff gait with arms held rigidly before the abdomen 4. Stooped shuffling gait with propulsion
and retropulsion 2. ARM DROPPING: The patient and the examiner both raise their arms to shoulder height and let them fall to their sides. In a normal subject, a stout slap is heard as the arms hit the sides. In the patient with extreme Parkinson’s syndrome, the arms fall very slowly. 0. Normal, free fall with loud slap and rebound 1. Fall slowed slightly with less audible contact and little rebound 2. Fall slowed, no rebound 3. Marked slowing, no slap at all 4. Arms fall as though against resistance, as though through glue 3.
SHOULDER SHAKING: The subject’s arms are bent at a right angle at the elbow and are taken one at a time by the examiner who grasps one hand and also clasps the other around the subject’s elbow. The subject’s upper arm is pushed to and fro, and the humerus is externally rotated. The degree of resistance from normal to extreme rigidity is scored as follows: 0. Normal 1. Slight stiffness and resistance 2. Moderate stiffness and resistance 3. Marked rigidity with difficulty in passive movement 4. Extreme stiffness and rigidity with almost a frozen shoulder 4. ELBOW
RIGIDITY: The elbow joints are separately bent at right angles and passively 2626 extended and flexed, with the subject’s biceps observed and simultaneously palpated. The resistance to this procedure is rated. (The presence of cogwheel rigidity is noted
separately.) Scoring is from 0 to 4, as in the Shoulder Shaking test. 0. Normal 1. Slight stiffness and resistance 2. Moderate stiffness and resistance 3. Marked rigidity with difficulty in passive movement 4. Extreme stiffness and rigidity with almost a frozen shoulder 5. FIXATION OF POSITION OR WRIST
RIGIDITY: The examiner holds the wrist in one hand and the fingers in the other hand, with the wrist moved to extension, flexion, and both ulnar and radial deviation. The resistance to this procedure is rated as in Items 3 and 4. 0. Normal 1. Slight stiffness and resistance 2. Moderate stiffness and resistance 3.
Marked rigidity with difficulty in passive movement 4. Extreme stiffness and rigidity with almost a frozen shoulder 6. LEG PENDULOUSNESS: The patient sits on a table with the legs hanging down and swinging free. The ankle is grasped by the examiner and raised until the knee is partially extended. It is then allowed to fall. The resistance to falling and the lack of swinging form the basis for the score on this item. 0.
The legs swing freely 1. Slight diminution in the swing of the legs 2. Moderate resistance to swing 3. Marked resistance and damping of swing 4. Complete absence of swing 7. HEAD DROPPING: The patient lies on a well-padded examining table, and the head is raised by the examiner’s hand. The hand is then
withdrawn, and the head is allowed to drop. In the normal subject, the head will fall upon the table. The movement is delayed in extrapyramidal system disorder, and in extreme parkinsonism, it is absent. The neck muscles are rigid, and the head does not reach the examining table. Scoring is as follows: 0. The head falls completely, with a good thump as it hits the table 1. Slight slowing in fall, mainly noted by lack of slap as the head meets the table 2. Moderate slowing in the fall, quite noticeable to the eye 2627 3. The head falls stiffly and slowly 4. The head does not reach the examining table 8. GLABELLA TAP: The subject is told to open the eyes wide and not to blink. The glabella region is tapped at a steady, rapid speed. The number of times the patient blinks in succession is noted: 0. 0 to 5 blinks 1. 6 to 10 blinks 2. 11 to 15 blinks 3. 16 to 20 blinks 4. 21 or more blinks 9. TREMOR: The patient is observed walking into the examining room and then is reexamined for this item: 0. Normal 1. Mild finger tremor, obvious to sight and touch 2. Tremor of hand or arm occurring spasmodically 3. Persistent tremor of one or more limbs 4. Whole body tremor 10. SALIVATION: The patient is observed while talking and then asked to open the mouth and elevate the tongue. The following ratings are given: 0. Normal 1. Excess salivation to the extent that pooling takes place if the
mouth is open and the tongue raised 2. When excess salivation is present and might occasionally result in difficulty in speaking 3. Speaking with difficulty because of excess salivation 4. Frank drooling
Scoring: Each item is rated on a five-point scale, with 0 meaning the complete absence of the condition and 4 meaning the presence of the condition in extreme form. The score is obtained by adding the items and dividing by 10. Reprinted with permission from Simpson, G. M., & Angus, J. W. S. (1970). A rating scale for extrapyramidal side effects. Acta Psychiatrica Scandinavica, 212(Suppl.), 11–19. 2628 2629
Appendix C Abnormal Involuntary Movement Scale (AIMS) 2630 aActivated movements. Source: Guy, W. (1976). ECDEU: Assessment manual for psychopharmacology (DHEW Publication No. 76-338). Washington, DC: Department of Health, Education, and Welfare, Psychopharmacology Research Branch. 2631 Appendix D Simplified Diagnoses for Tardive Dyskinesia (SD-TD) PREREQUISITES—The three prerequisites are as follows. Exceptions may occur. 1. A history of at least 3 months’ total cumulative neuroleptic exposure. Include amoxapine and metoclopramide in all categories below as well. 2.
SCORING/INTENSITY LEVEL. The presence of a TOTAL SCORE OF FIVE OR ABOVE. Also, be alert for any
change from baseline or scores below five that have at least a “moderate” (3) or “severe” (4) movement on any item or at least two “mild” (2) movements on two items located in different body areas. 3. Other conditions are not responsible for the abnormal involuntary movements. DIAGNOSES—The diagnosis is based upon the current exam and its relation to the last exam. The diagnosis can shift depending upon (a) whether movements are present or not, (b) whether movements are present for 3 months or more (6 months if on a semiannual assessment schedule), and (c) whether neuroleptic dosage changes occur and affect movements. NO TD—Movements are not present on this exam or movements are present, but some other condition is responsible for them. The last diagnosis must be NO TD, PROBABLE TD, or WITHDRAWAL TD. PROBABLE TD—Movements are present on this exam. This is the first time they are present, or they have never been present for 3 months or more. The last diagnosis must be NO TD or PROBABLE TD. PERSISTENT TD—Movements are present on this exam, and they have been present for 3 months or more with this exam or at some point in the past. The last diagnosis can be any except NO TD. MASKED TD—Movements are not present on this exam, but this is due to a neuroleptic dosage increase
or reinstitution after a prior exam when movements were present. Also, use this conclusion if movements are not present due to the addition of a 2632 nonneuroleptic medication to treat TD. The last diagnosis must be PROBABLE TD, PERSISTENT TD, WITHDRAWAL TD, or MASKED TD. REMITTED TD— Movements are not present on this exam, but PERSISTENT TD has been diagnosed and neuroleptic dosage increase or reinstitution has occurred. The last diagnosis must be PERSISTENT TD or REMITTED TD. If movements reemerge, the diagnosis shifts back to PERSISTENT TD. WITHDRAWAL TD—Movements are not seen while receiving neuroleptics or at the last dosage level but are seen within 8 weeks following a neuroleptic reduction or discontinuation. The last diagnosis must be NO TD or WITHDRAWAL TD. If movements continue for 3 months or more after the neuroleptic dosage reduction or discontinuation, the diagnosis shifts to PERSISTENT TD. If movements do not continue for 3 months or more after the reduction or discontinuation, the diagnosis shifts to NO TD.
Source: Sprague, R. L., & Kalachnik, J. E. (1991).
Reliability, validity, and a total score cutoff for the Dyskinesia Identification System Condensed User Scale (DISCUS) with mentally ill and mentally retarded populations. Psychopharmacology Bulletin, 27(1), 51–
58. 2633 Appendix E Hamilton Rating Scale for Depression The scale is designed to measure the severity of illness of patients already diagnosed as suffering from depressive illness. It is obviously not a diagnostic instrument because that requires much more information (e.g., previous history, family history, precipitating factors). As far as possible, the scale should be used in the manner of a clinical interview. The first time, the interview should be conducted in a relaxed, free, and easy manner, giving the patients time to unburden themselves and giving them the opportunity to speak of their problems and ask whatever questions they wish. It may then be necessary to obtain further information by asking them questions. At subsequent assessments, the interview can be briefer and more to the point. An observer rating scale is not a checklist in which each item is strictly defined. The raters must have sufficient clinical experience and judgment to be able to interpret the patients’ statements and reticence about some symptoms and to compare them with other patients. They should use all sources of information (e.g., from relatives and nurses). The scale consists of 17 items, the scores of which are summed to give a total score. These are four other items, one of which (diurnal variation) is excluded on the grounds that it is
not an additional burden on the patient. The last three are excluded from the total score because they occur infrequently, although information on them may be useful for other purposes. The method of assessment is simple. For some symptoms, it is difficult to elicit such information as will permit full quantification. If present, score 2; if absent, score 0; and if doubtful or trivial, score 1. For those symptoms where more detailed information can be obtained, the score of 2 is expanded into 2 for mild, 3 for moderate, and 4 for severe. In case of difficulty, the raters should use their judgment as clinicians. Source: Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry, 23, 56. 2634 2635
Appendix F Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar) 2636 This assessment for monitoring withdrawal symptoms requires approximately 5 minutes to administer. The maximum score is 67 (see instrument). Patients scoring less than 10 do not usually need additional medication for withdrawal. Source: Sullivan, J. T., Sykora, K., Schneiderman, J., Naranjo, C. A., & Sellers, E. M. (1989). Assessment of alcohol withdrawal: The revised Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA-Ar). British Journal of Addiction, 84, 1353–1357. 2637 Glossary A absorption:
Movement of drug from the site of administration into plasma. acetylcholine (ACh): An important neurotransmitter associated with cognitive functioning, and disruption of cholinergic mechanisms damages memory in animals and humans. acetylcholinesterase (AChE): Key enzyme that inactivates the neurotransmitter acetylcholine. AChE is found in high concentrations in the brain and is one of two cholinesterase enzymes capable of breaking down ACh. acetylcholinesterase inhibitors (AChEIs): Mainstay of pharmacologic treatment of dementia; these drugs inhibit AChE, resulting in an enhancement of cholinergic activity. AChEIs have been shown to delay the decline in cognitive functioning but generally do not improve cognitive function once it has declined; therefore, it is important that this medication be started as soon as the diagnosis is made. active listening: Focusing on what the patient is saying in order to interpret and respond to the message in an objective manner, while using techniques such as open-ended statements, reflection, and questions that elicit additional responses from the patient. acute stress disorder (ASD): A mental disorder characterized by persistent, distressing stress related symptoms that last between 2 days and 1 month and that occur within 1 month
after a traumatic experience. adaptability: Capacity of a person to survive and flourish. adaptive inflexibility: Rigidity in interactions with others, achievement of goals, and coping with stress. addiction: A chronic, relapsing, and treatable brain disorder that results from the prolonged effects of exposure of the brain to drugs (substances or chemicals). addictive substances: There are 10 classes of addictive substances referred to in the DSM-5: alcohol; caffeine; cannabis (marijuana); hallucinogens (with separate categories for phencyclidine [PCP] [or similarly acting arylcyclohexylamines] and other hallucinogens); inhalants; opioids; sedatives, hypnotics, and anxiolytics; stimulants; tobacco (nicotine); and other (or unknown) substances. 2638 adherence: A patient’s maintenance of the therapeutic regimen; includes self-administering medications as prescribed, keeping appointments, and following other treatment suggestions; it exists on a continuum and can be conceived of as full, partial, or nil. adverse reactions: Unwanted medication effects that may have serious physiologic consequences. affect: An expression of mood manifest in a pattern of observable behaviours. affective blunting: Flat or blunted emotion. affective instability: Rapid and extreme shifts in mood, erratic
emotional responses to situations, and intense sensitivity to criticism or perceived slights; one of the core characteristics of borderline personality disorder. affective lability: Abrupt, dramatic, unprovoked changes in the types of emotions expressed. afferent: Toward the central nervous system or a particular structure. affinity: Degree of attraction or strength of the bond between a drug and its receptor. aggression: Behaviours or attitudes that reflect rage, hostility, and the potential for physical or verbal destructiveness; usually occurs if the person believes someone is going to do him or her harm. agitation: Inability to sit still or attend to others, accompanied by heightened emotions and tension. agnosia: Failure to recognize or identify objects despite intact sensory function, or a disturbance in executive functioning (ability to think abstractly, plan, initiate, sequence, monitor, and stop complex behaviour). agonists: Chemicals producing the same biologic action as the neurotransmitter. agoraphobia: Anxiety about being in places from which escape might be difficult or embarrassing, or about being in places in which help may not be readily available if a panic attack should occur. akathisia: A medicationrelated, involuntary movement disorder characterized by the inability to sit still; may be experienced as
“jitteriness” without obvious motor behaviour. alexithymia: Inability to experience and communicate feelings consciously. allodynia: Lowered pain threshold. allostasis: Adaptive processes that maintain homeostasis through the production of various brain and peripheral stress-related chemicals and promote adaptation to perceived threat or 2639 stress. alogia: Brief, empty verbal responses; often referred to as poverty of speech. ambivalence: Presence and expression of two opposing forces, leading to inaction. amino acids: Building blocks of proteins that have different roles. Amino acids function as neurotransmitters in as many as 60% to 70% of synaptic sites in the brain. amygdala: A bulblike structure attached to the tail of the caudate and often considered part of the limbic system. anger: An affective state experienced as the motivation to act in ways that warn, intimidate, or attack those who are perceived as challenging or threatening. anhedonia: Inability to gain pleasure from activities. anorexia nervosa: A life-threatening eating disorder characterized by refusal to maintain body weight appropriate for age, intense fear of gaining weight or becoming fat, a severely distorted body image, and refusal to acknowledge the seriousness of weight loss. antagonists: Chemicals blocking the biologic
response at a given receptor site. anticholinergic crisis: A potentially life-threatening medical emergency that occurs as a result of overdose or sensitivity to drugs with anticholinergic properties. anxiety: Apprehension or dread in response to internal or external stimuli perceived to be a threat that can be experienced in physical, emotional, cognitive, and/or behavioural ways. anxiolytics: Drugs that reverse or diminish anxiety. apathy: Reactions to stimuli that are decreased, along with a diminished interest and desire. aphasia: Alterations in language ability. apraxia: Impaired ability to execute motor activities despite intact motor functioning. assertiveness: A set of behaviours and a communication style that is open, honest, direct, and confident that enables the expression of emotions, including anger, in a manner that assumes responsibility. assessment: A purposeful, systematic, and dynamic process in the nurse’s relationship with individuals in his or her care. It involves the collection, validation, analysis, synthesis, organization, and documentation of client health–illness information. attachment: Emotional bond between the infant and parental figure. attention: A complex mental process that involves the ability to concentrate on one activity to the exclusion of others, as well as the ability to sustain focus. 2640
attention
deficit hyperactivity disorder (ADHD): Neurodevelopmental disorder of childhood. Core symptoms include inattention, hyperactivity and impulsivity. autism spectrum disorder: A neurodevelopmental disorder that is distinguished by a marked impairment of development in social interaction and communication with a restrictive repertoire of repetitive activity and interest. automatic thoughts: Spontaneous words and images generated in a particular situation that may be illogical and/or difficult to stop. autonomic nervous system: Part of the nervous system that regulates involuntary vital functions including cardiac muscle, smooth muscles, and glands. It is composed of the sympathetic and parasympathetic systems. autonomy: Concept that each person has the fundamental right of selfdetermination. avolition: Inability to complete projects, assignments, or work. B basal ganglia: One set of structures in each hemisphere; areas of grey matter containing many cell bodies or nuclei. behaviour modification: A specific, systematized behaviour therapy technique that can be applied to individuals, groups, or systems. behaviour therapy: Interventions that reinforce or promote desirable behaviours or alter undesirable ones. behaviourism: A paradigm shift in understanding human behaviour that
was initiated by Watson, who theorized that human behaviour is developed through a stimulus–response process rather than through unconscious drives or instincts. beneficence: The ethical principle of “try to do good”; promote benefit. bereavement: The objective event or occurrence of having suffered a loss. best practice guidelines (BPGs): Broad or specific recommendations for health care based on the best current evidence. bibliotherapy: The use of books and other reading materials to help individuals cope with various life stressors. binge eating: Episodes of uncontrollable, ravenous eating of large amounts of food within discrete periods of time, usually followed by feelings of guilt that result in purging. binge eating disorder: Binge eating disorder is a clinical eating disorder characterized by 2641 frequent consumption of very large amounts of food, coupled with feelings of being out of control, ashamed and disgusted by the eating behaviour, and experiencing high body dissatisfaction. As an eating disorder, it is more common than anorexia nervosa and bulimia nervosa. bioavailability: The amount of the drug that actually reaches systemic circulation; affected significantly by the route by which a drug is administered. biogenic amines: Small molecules manufactured in the neuron that contain an amine
group. These include dopamine, norepinephrine, and epinephrine (all synthesized from the amino acid tyrosine); serotonin (from tryptophan); and histamine (from histidine). biologic markers: Physical indicators of disturbances within the central nervous system that differentiate one disease state from another. bio/psycho/social/spiritual geriatric mental health nursing assessment: The comprehensive, deliberate, and systematic collection and interpretation of bio/psycho/social/spiritual data that are based on the special needs and problems of older adults to determine current and past health, functional status, and human responses to mental health problems, both actual and potential. bio/psycho/social/spiritual model: Consists of separate but interacting domains that can be understood independently but that are mutually interdependent with the other domains. biotransformation (metabolism): The process by which a drug is altered, often broken down into smaller substances known as metabolites. body dissatisfaction: The belief that one’s current body size differs from a highly valued ideal body size and that this difference deserves negative appraisal and may be expressed through comments including “I feel too fat/too gross.” body image: Self-perception of one’s body. Extreme discrepancy between body image and
others’ perceptions of one’s body indicates a body image distortion. body image distortion: When the individual perceives his or her body disparately from how the world or society views it. boundaries: The defining limits of individuals, objects, or relationships. boundary violation: Behaviour by a professional that has violated the limits (what is and is not permitted) in a professional–client relationship. bradykinesia: An extrapyramidal condition characterized by a slowness of voluntary movement and speech. 2642 brainstem: Area of the brain containing the midbrain, pons, and medulla, which continues beneath the thalamus. breach of confidentiality: Release of patient information without the patient’s consent in the absence of legal compulsion or authorization to release information. Broca’s area: A section of the left frontal lobe of the brain thought to be responsible for the articulation of speech. bulimia nervosa: An eating disorder in which the individual engages in recurrent episodes of binge eating and compensatory behaviour to avoid weight gain through purging methods such as self-induced vomiting or use of laxatives, diuretics, enemas, or emetics or through nonpurging methods such as fasting or excessive exercise. bullying: Persistent physical or psychological harm that is intentionally inflicted on an individual who feels
unable to avoid or stop the harm. burnout: Psychological exhaustion, detachment, and loss of sense of accomplishment related to chronic workrelated stress. butyrylcholinesterase (BuChE): A nonspecific cholinesterase found in the brain and especially in the glial cells. Both acetylcholinesterase and BuChE work in the gastrointestinal tract. If these enzymes are inhibited, the breakdown of acetylcholine will be delayed, resulting in an increase in acetylcholine activity. C case management: Problem-solving and coordinating services for the patient to ensure continuity of services and overcome system rigidity, fragmentation of services, misuse of facilities, and inaccessibility. catatonic excitement: Hyperactivity characterized by purposeless activity and abnormal movements like grimacing and posturing. central sulcus: Posterior boundary of the frontal lobe that separates it from the parietal lobe. cerebellum: Part of the brain that is responsible for controlling movement and postural adjustments; it receives information from all parts of the body. cerebrospinal fluid: Cushioning fluid that circulates around the brain beneath the arachnoid layer in the subarachnoid space; it is colourless and contains sodium chloride and other salts. chemical restraints: Use of medication to control patients or manage
behaviour. cholecystokinin: A neuropeptide found in high levels in the cerebral cortex, hypothalamus, and amygdala; it is also excreted by the gastrointestinal system in response to food intake, 2643 which is believed to play a role in the control of eating and satiety by controlling the release of dopamine. chronobiology: Study and measure of time structures or biologic rhythms. circadian rhythm (cycle): From the Latin circa and dies, meaning “about a day”; refers to a biologic system that fluctuates or oscillates in a pattern that repeats itself in about a day. circumstantiality: Occurs when an individual takes a long time to make a point because his or her conversation is indirect and contains excessive and unnecessary detail. clang association: Repetition of word phrases that are similar in sound but in no other way, for example, “right, light, sight, might.” classical conditioning: A learning situation in which an unconditioned stimulus initially produces an unconditioned response; over time, a conditioned response is elicited for a specific stimulus (Pavlov). clearance: Total amount of blood, serum, or plasma from which a drug is completely removed per unit of time. clinical domain outcome statements: Statements that indicate a reduction in symptoms of illness or cure of a specific mental illness. closed
group: A group in which all the members begin at one time. New members are not admitted after the first meeting. cognition: A system of multiple brain processes, such as perception, reasoning, judgment, intuition, and memory, that allow one to be aware of oneself and one’s surroundings. cognitive restructuring: A process in which cognitions (automatic thoughts, intermediate and core beliefs) are identified, analyzed, and modified to effect positive change in mood and behaviour. cognitive schema (core beliefs): Basic beliefs so fundamental that they are accepted as absolute truths; assist in evaluating and assigning meaning to events and influence subsequent affective and behavioural responses. cognitive–behavioural model: A model of perception that includes emotion, cognition, environment, and physical and psychological factors. cognitive–behavioural therapy: Psychotherapy focused on identifying, analyzing, and ultimately changing the habitually inflexible and negative cognitions about oneself, others, and the world that contribute to distress and problematic behaviours. collaborative mental health care: Care that is provided from different specialties, disciplines, 2644 or sectors that work together to offer complementary services and mutual support. collaboration: The process of
working together toward common goals; clientcentred care. collective trauma: When a traumatic event is experienced by a significant proportion of a given social group; it can have long-term consequences for the social group beyond its additive effect on individuals such that social norms, dynamics, functioning, and structure of the group may be modified. communication triad: A technique used to provide a specific syntax and order for patients to identify and express their feelings and seek relief. The “sentence” consists of three parts: (1) an “I” statement to identify the prevailing feeling, (2) a nonjudgmental statement of the emotional trigger, and (3) a statement of what the person would like differently or what would restore comfort to the situation. community treatment orders (CTOs): A type of mandatory outpatient treatment, usually initiated by a physician, that can require an individual with a mental illness who does not meet provincial involuntary admission criteria to comply with stipulated treatment. comorbidity (comorbid): Disease that coexists with the primary disease. compassion fatigue: Disengagement on the part of caregiving professionals; frequently equated with burnout. compassionate release: Parole by exception for incarcerated offenders, allowed under the
Corrections and Conditional Release Act, and considered on an individual basis (e.g., for palliative care due to a terminal illness). competence: The degree to which the patient is able to understand and appreciate the information given during the consent process; the patient’s cognitive ability to process information at a specific time; the patient’s ability to gather and interpret information and make reasonable judgments based on that information to participate fully as a partner in treatment. competency: Capability of acting appropriately and effectively in a role. It involves the use of internal resources (e.g., knowledge, skills, attitudes) and external resources (e.g., policies, the interprofessional team, research). comprehensive family assessment: Collection of all relevant data related to family health, psychological well-being, and social functioning to identify problems for which the nurse can generate solutions with the family and enhance family strengths. compulsions: Behaviours that are performed repeatedly, in a ritualistic fashion, with the goal 2645 of preventing or relieving anxiety and distress caused by obsessions. concordant: Used in genetics to indicate that both members of twins have the same trait. concrete thinking: Lack of abstraction in thinking, in which people are unable to understand punch lines,
metaphors, and analogies. concurrent disorders: The term used when an individual has at least one substance-related or addictive disorder co-occurring with at least one other mental disorder. confabulation: False memories, perceptions, or beliefs that are the consequence of neurologic dysfunction or damage. confidentiality: An ethical duty of nondisclosure; the patient has the right to disclose personal information without fear of it being revealed to others. conflict resolution: A specific type of counselling in which the nurse helps the patient resolve a disagreement or dispute. content themes: Repetition of concerns or feelings that occur within the therapeutic relationship. Themes may emerge as symbolic representations of fears. continuum of care: Is a comprehensive system of services and programs spanning the range from mental health promotion and illness prevention to very specialized services designed to match the needs of the individuals and populations with the appropriate care and treatment, which vary according to levels of service, structure, and intensity of care. coping: An individual’s constantly changing cognitive and behavioural efforts to manage specific external or internal demands that are appraised as taxing or exceeding the individual’s resources. corpus callosum: Functional link between
the two hemispheres of the brain, made up of a thick band of fibres. cortex: Outer surface of the mature brain. cortical dementia: A type of dementia that is characterized by amnesia, aphasia, apraxia, and agnosia. counselling interventions: Specific timelimited interactions between a nurse and a patient, family, or group experiencing intermediate or ongoing difficulties related to their health or well-being.
countertransference: The nurse’s reactions to a patient that are based on the nurse’s unconscious needs, conflicts, problems, and views of the world. It can significantly interfere with the nurse–patient relationship.