Mental Health Exam 3

what is normal anxiety?

Healthy response to stress that is essential for survival

what are the s/s mild anxiety?

restlessness, increase motivation, irritability

what are the s/s of moderate anxiety?

agitation, muscle tightness

what are the s/s of severe anxiety?

inability to function, ritualistic behavior, unresponsive

what are the s/s of panic anxiety?

distorted perception, loss of rational thought, immobility

what is separation anxiety disorder?

excessive fear or anxiety when separated from an individual to which the client is emotionally attached

what are some expected findings and physical manifestations of separation anxiety disorder?

EF:disrupts the ability to participate in routine daily activities
PM: headaches, nausea, vomiting, sleep disturbances

what is a specific phobia?

irrational fear of an object or situation

how might someone decrease the anxiety from a specific phobia?

alcohol or other substances

What is agoraphobia?

extreme fear of certain places where the client feels vulnerable or unsafe

what will someone with agoraphobia do?

avoid the places and this could interfere with maintaining employment or ADL's

what is social anxiety disorder?

excessive fear or social or performance

what might a client with social phobia do?

report physical manifestations actual or factitious in attempt to avoid social situations

what is panic disorder?

recurrent panic attacks that can last from about 15-30 mins

what kind and how many symptoms (at once) are present in someone with panic disorder?

Four or more are usually present: palpitations, SOB, choking/smothering, chest pain, nausea, feelings of depersonalization, fear of dying, chills or hot flashes

What is generalized anxiety disorder?

uncontrollable, excessive worry for at least 6 months.

what does generalized anxiety do to a client?

Causes significant impairment in one or more areas of functioning (work-related duties)

what does generalized anxiety look like in a patient? (s/s)

restlessness, muscle tension, avoidance of stressful activities, increase time and effort in preparing activities that are stressful, procrastination in decision making, sleep disturbances

What is obsessive compulsive disorder?

intrusive thought of unrealistic obsessions and tries to control these thoughts with compulsive behaviors such as repetitive cleaning.

what can obsessive compulsive disorder do to someones life?

Impair social and occupational functioning

What is hoarding disorder?

has difficulty parting with possessions(regardless of value), resulting in extreme stress and functional impairment.

what can hoarding do to a persons life?

Social and occupational impairment often leading to unsafe living environment

who is more likely to develop a hoarding disorder?

males

what is body dysmorphic disorder?

preoccupation with perceived flaws or defects in physical appearance. Mirror checking or comparison to others.

what are some of the risk factors for anxiety disorders?

- anxiety and obsessive-compulsive disorders: more likely in females
-hoarding disorders: higher in males
-genetic & neurobiological link
-Substance use or withdrawal from alcohol

can some adverse effects mimic anxiety disorders?

yes

which acute medical conditions can increase the risk for anxiety?

Hyperthyroidism or pulmonary embolism

what screening tools do you used for anxiety disorders?

-Hamilton rating scale for anxiety
-Panic disorder severity scale
-Hoarding scale self-report

what are some nursing care that can be done for anxiety disorder?

-structure interview to keep in the present
-assess for substance abuse disorder & SI risk
-stay w the client when anxiety is at the worst
-provide milleu therapy
-instill hope but try not

What is milleu therapy for anxiety disorders?

Safe environment, protection from self-harm, daily activities, participation

(might not be only specific to anxiety)

should you try to educate a patient during an anxiety attack?

no wait till it subsides

What kind of medications should you give to treat anxiety disorders?

SSRIs, SNRIs,
AntiAnxiety meds: Benzo (diazepam) short term. & buspirone (long term)
Anticonvulsants: good mood stabilizers for a client with anxiety

what SSRIs are used to treat anxiety and OCD?

sertraline or paroxetine

what SNRIs are used to treat anxiety?

Venlafaxine or duloxetine

what are some common anti anxiety meds?

Benzodiazepines (diazepam) short term. & buspirone (long term)

why do we give anticonvulsants?

good mood stabilizers for a client with anxiety

what are the therapeutic procedures for anxiety disorders?

cognitive behavioral therapy (CBT), behavioral therapies

what is cognitive behavioral therapy?

uses cognitive reframing to help the client identify negative thoughts that produce anxiety, examine the cause, and develop supportive ideas that replace negative self-talk.

what are the different types of behavioral therapies?

relaxing training, modeling, systemic desensitization, flooding, response prevention, thought stopping

what is modeling?

allows the client to see a demonstration of appropriate behavior in a stressful situation. Imitate behavior

what is systemic desensitization?

mastering relaxation techniques, then exposed to increasing levels of anxiety stimulus

what is flooding?

exposing the client to a great deal of undesirable stimulus in an attempt to turn off the anxiety response. Useful with phobias.

what is response prevention?

focuses on preventing a client from performing a compulsive behavior with the intent that anxiety will diminish

what is thought stopping?

teaches the client to say "stop" when negative thoughts or compulsive behaviors arise and substitute for a positive thought. The goal is that with time, the client uses the command silently.

what are some client education for anxiety?

-Monitor for manifestations of anxiety
-Evaluate coping mechanisms that work and do not work for controlling the anxiety and learn new methods.
-Uses of alternative stress relief and coping mechanisms might increase medication effectiveness and decrease the need for medication.

what are trauma and stressor related disorders stemmed from?

Clients can develop a trauma- or stressor- related disorder following exposure to an extreme stressor (military combat or interpersonal violence).

what are the specific disorders?

acute stress disorder (ASD), posttraumatic stress disorder (PTSD), adjustment disorder

What is acute stress disorder (ASD)?

exposure to traumatic events causes anxiety, detachment, and other manifestations about the event for at least 3 days but not more than 1 month.

what is posttraumatic stress disorder (PTSD)?

exposure to traumatic events cause anxiety, detachment, and other manifestations for longer than 1 month to years.

what is adjustment disorder?

a stressor triggers a reaction causing changes in mood and/or dysfunction in performing activities. Less severe than ASD and PTSD.

What are the dissociative disorders?

Depersonalization/derealization disorder, Dissociative amnesia, Dissociative fugue, Dissociative identity disorder (DID)

what is depersonalization/derealization disorder?

-temporary change in awareness displaying depersonalization, derealization, or both.

What does depersonalization mean?

-the feeling that a person is observing one's own personality from a distance.

What does derealization mean?

the feeling that outside events are unreal.

what are the expected findings of depersonalization/derealization disorder?

reports of feeling detached from one's own body or of feeling that one's personal environment is unreal

what is dissociative amnesia?

inability to recall personal information related to traumatic or stressful events.

what are the expected findings of dissociative amnesia?

lack of memory that can range from name or date of birth to the client's entire lifetime.

what is dissociative fugue?

one travels to a new area and is unable to recall their own identity.

what is dissociative identity disorder (DID)?

displays more than one distinct personality, with a stressful event participating in the change from one personality to another.

what are the expected findings of dissociative identity disorder (DID)?

display of 2 or more personalities, very distinct from one another.

what are the risk factors of ASD, PTSD, and adjustment disorder?

-Exposure to traumatic event or experience (motor vehicle, sexual assault)
-Exposure to trauma experienced during a natural disaster (fire, storm)
-Living through a traumatic event experienced by a close friend/family (airplane crash)
-PTSD is a risk factor for other disorders including dissociative disorders, anxiety, depression, and substance use disorders.

what are the risk factors for ASD and PTSD?

-Severity of the trauma
-Individual vulnerabilities
-Insufficient treatment following the trauma
-Intrusive findings: presence of memories, flashbacks, dreams about the traumatic event
-Memories of the event recur involuntarily and are distressing to the client
-Flashbacks: dissociative reactions where the client feels the traumatic event is recurring in the present
-Night time dreams related to the traumatic event
-Avoidance of people, places, events that bring back reminders of the traumatic event
-Trying to avoid thinking about the event

what are the expected findings of someone with mood and cognitive alterations for ASD and PTSD?

Anxiety or depressive disorders, anger/irritability, decreased interest in activities, guilt, detachment from others, inability to experience positive emotions such as love, dissociative manifestations such as amnesia, derealization, depersonalization

what are the expected findings of someone with behavioral manifestations for ASD and PTSD?

Aggression, irritability, angry responses, hyper-vigilance with heightened startle responses, sleep disturbances such as insomnia, destructive behavior such as suicidal thoughts or thoughts of harming others.

what are some risk factors for adjustment disorder?

-Pattern of life-long difficulty accepting change
-Learned pattern of difficulty with social skills or coping strategies which, when a stressor occurs, can trigger a stress response out of proportion to the stressor.

what are the expected findings for adjustment disorder?

-Depression, Anxiety , Changes in behavior
-Arguing with others, driving erratically

what are the risk factors for dissociative disorder?

-Traumatic life event
-childhood abuse or trauma
-more common in children

what are the diagnostic procedures for ASD, PTSD, and adjustment disorders?

-Screening tools (PTSD screen)
-Screening test for anxiety
-Asking about suicidal ideation
-MSE

what are the diagnostic procedures for dissociative disorder?

-Physical assessment, electroencephalogram, and x-ray
-Screening to rule out substance use
-MSE

what medications will be used for ASD and PTSD?

-Antidepressants can decrease depression and relieve anxiety
-Paroxetine and Sertraline (SSRIs)
-Venlafaxine (SNRIs)
-Mirtazapine
-Amitriptyline (TCAs)
-Prazosin
-Propranolol

why is propranolol used to treat ASD & PTSD?

decrease elevated vitals and manifestations of anxiety, panic, hypervigilance, and insomnia

why is prazosin used to treat ASD & PTSD?

decrease manifestations of hypervigilance and insomnia

what are the therapeutic procedures used to treat stressor and trauma related disorders?

-Cognitive-behavioral therapy
-Prolonged exposure therapy
-Psychodynamic psychotherapy
-Eye movement desensitization and reprocessing
-Group or family therapy
-Crisis intervention
-Somatic therapy for dissociative disorders
-Hypnotherapy
biofeedback/needback

what are psychotic disorders?

Schizophrenia spectrum disorder and other psychotic disorders affect thinking, behavior, emotions, and the ability to perceive reality.

what are the types of psychotic disorders?

Schizophrenia, Schizotypal Personality Disorder, Delusional Disorder, Brief psychotic Disorder, Schizophreniform Disorder, Schizoaffective Disorder, Substance-induced psychotic Disorder, Psychotic or catatonic disorder not otherwise specified

What is schizophrenia?

psychotic thinking or behavior present for at least 6 months, areas of functioning including school/work and self-care are impaired

What is schizotypal personality disorder?

impairments of personality (self and interpersonal) functioning. Impairment is not as severe with schizophrenia

what is delusional disorder?

delusional thinking for at least 1 month, self or interpersonal functioning is not markedly impaired.

what is brief psychotic disorder?

psychotic manifestations for 1 day to 1 month in duration

What is schizophreniform disorder?

manifestations similar to schizophrenia but the duration is 1-6 months and social/occupational dysfunction might not be present.

what is schizoaffective disorder?

the client's disorder meets the criteria for both schizophrenia and depressive or bipolar disorder

what is substance-induced psychotic disorder?

experience psychosis due to substance intoxication or withdrawal, manifestations are more severe.

what is psychotic or catatonic disorder not otherwised specified?

exhibits psychotic features or bizarre behaviors or a significant change in motor diagnosis with another specific psychotic disorder.

what does positive symptoms mean?

symptoms that are not normally present

What are the positive symptoms of psychotic disorders?

Hallucinations, delusions, alterations in speech, bizarre behavior (walking backwards)

what does negative symptoms mean?

absence of things not normally present (harder to treat)

What are the negative symptoms of psychotic disorders?

-affect: usually blunted or flat (expression does not change)
-Alogia: poverty of thought or speech
-Anhedonia: lack of pleasure or joy
-Avolition: lack of motivation in activities or hygiene
-Anergia: lack of energy

what are some expected cognitive findings for psychotic disorders?

Disordered thinking, inability to make decisions, poor problem-solving ability, difficulty concentrating to perform tasks, short term memory deficits, impaired abstract thinking

what are some expected affective findings for psychotic disorders?

manifestations involving emotions such as hopelessness, unstable or rapidly changing mood

what are some expected findings for psychotic disorders?

-positive & negative symptoms
-alterations in thought, speech, perception
-ideas of reference
-persecution
-grandeur
-somatic delusions
-jealousy
-being controlled
-thought broadcasting
-thought insertion
-thought withdrawal
-religiosity
-magical thinking

what are alterations in thought?

false fixed beliefs that cannot be corrected by reasoning and are usually bizarre

What are ideas of reference?

misconstrues trivial events and attaches personal significance to them such as believing that other who are planning a mean are talking about them

what are somatic delusions?

believes that there body is changing in an unusual way, like growing a this arm

what is magical thinking?

believes actions or thought are able to control a situation of affect others, such as wearing a certain that makes them invisible to others

what is religiosity?

obsessed with religious beliefs

What are some alterations in speech?

associative looseness, neologisms, echolalia, clang association, world salad

what is associative looseness?

inability to concentrate on a single thought. Can progress to flight of ideas

What is neologisms?

made up words that have meaning only to the client

what is echolalia?

the client repeats words that are spoken to him/her

what is clang association?

meaningless rhyming of words