Mental Health Exam 2 Review

Define Stress Response

Physiological response to a stressor to help an individual respond quickly to a threatening situation

Psychological Stressors

Loss of self-esteem, grief, fear 

Physiological Stressors

Hot/cold environment, pain, illness, hunger 

Psychosocial Stressors

Divorce, death of spouse or child, trauma, moving, change in job 

Autonomic Nervous System

Subdivision of the Peripheral Nervous System

Regulates involuntary body functions & aims to maintain homeostasis

2 branches - SNS & PNS

Sympathetic Nervous System (SNS)

Brain & Spinal Cord

Activates Fight-or-Flight Response

Parasympathetic Nervous System (PNS)

Rest & Digest Response

Conserves energy & returns body to calm/balanced state after fight-or-flight response

Define Fight-or-Flight Response

Acute stress response by SNS & endocrine system due to a perceived threat

Physiological Symptoms of Fight-or-Flight (7)

HR & BP increases

Blood flow to muscle increases

Pupils constrict

RR increases

Sweating

Blood glucose rises

Cortisol, adrenaline, & nonadrenaline is released. 

Psychological Symptoms of Fight-or-Flight Response (4)

Increased alertness, focus, & vigilance

Fear, anxiety, anger

Faster reaction

Impaired judgment

Threat passes (Fight-or-Flight)

PNS & Hypothalamus restore balance

Prolonged Stress (Fight-or-Flight)

Systems remain active = harmful effects on body

Hypertension

Heart Failure

Define General Adaptive Syndrome GAS

Physiologic response to stress resulting in anxiety

GAS Stages

Alarm

Resistance

Exhaustion

Alarm Stage (GAS)

Client is exposed to stress (fight-flight-freeze-fawn);

HR increase, cortisol is released increasing energy & heightened acuity to navigate stressor

Resistance Stage (GAS)

Body attempts to stabilize & repair after alarm stage

ANS begins to downregulate but remains in state of alert

If stressor resolves & there is no impairment in body’s self-regulation the stress response system will return to baseline 

Exhaustion Phase (GAS_

Body is depleted of energy reserves & unable to self-regulate

Prone to injury & illness

Negative Risk Factors for Mediating Stress (12)

• Feeling a lack of control 

• Hopelessness 

• Negative self-talk 

• Internalizing/Externalizing problems or situations 

• Racism 

• Reduced social interactions/negative interactions 

• Trauma 

• Poverty 

• Adverse Childhood Experiences (ACES) 

• Discrimination

• Genetics 

• Substance Use 

Protective Factors for Mediating Stress (8)

• Perception of control 

• Hardiness 

• Realistic expectations 

• Healthy lifestyle 

• Positive, safe-secure work, home & school environment 

• Positive-Secure relationships & parental bonding 

• Connection to culture & beliefs 

• Spiritual Practices 

Define Eustress

Good Stress

Short-term, motivating, enhances performance

(exams, marriage). 

Define Distress

Bad Stress

Chronic/negative stress, depletes energy, impairs health

(grief, job loss). 

Maladaptive Coping

Negative or passive ways of coping with a percieved stressor

Alcohol, drugs, overreating, social withdrawal

Avoidant Coping

Passive

Ignoring Stressor

Adaptive Coping

Positive & Constructive ways to deal with stressor

Yoga, meditation, mantras, therapy

Problem-Focused Coping

Planning to manage stressor & take action

Adaptive

Emotional-Focused Coping

Expressing feelings, humor, seeking support, positive reframing

Adaptive

Define Individual Factors in Mediating Stress

Personal traits that influence how someone experiences & manages stress (fixed & changeable)

Shape Stress Response

Define Perception

How an individual interprets a situation, event, or stressor. 

Positive perception builds resilence & confidence

Define Attitude

A person’s mental or emotional stance toward something, often shaped by beliefs, values, & experiences

Define Temperament

Biological aspect of personality shown through energy, mood, emotional response, & willingness to explore. 

Define Personality

Unique traits, values, & behaviors that shape how a person adjusts to life & relates to others

Define Personality Trait

Sustained characteristics formed by patterns of behavior, attitude, feeling, & habit. 

Influence Coping Strategies

Big 5 Personality Traits

Neuroticism vs. Emotional Stability

Extroversion vs. Introversion

Openness to Experience vs. Closeness to Experiences

Conscientiousness vs. Lack of Direction

Agreeableness vs. Antagonism

Neuroticism vs. Emotional Stability

Tendency toward anxiety & moodiness VS. calmness & resilience. 

Extroversion vs. Introversion

Outgoing, social, energetic VS. reserved, quiet, reflective. 

Openness to Experience vs. Closeness to Experiences

Curious, creative, open-minded VS. conventional, resistant to change. 

Conscientiousness vs. Lack of Direction

Organized, responsible, goal-oriented VS. careless, impulsive. 

Agreeableness vs. Antagonism

Kind, cooperative, empathetic VS. critical, unkind, or oppositional. 

Define Hardiness

Mindset of control, commitment & viewing challenges as oppurtunities

Factors that play a role in stress mediation (4)

Genetics & Neurodevelopment

Lifestyle - Risk vs protective factors

Cultural

Spirituality & Religion

Define Defense Mechanisms

Unconscious/conscious self-protection methods to reduce effects of stress, fear & anxiety

Help individual cope & adapt 

Can be adaptive & maladaptive

Define Altruism

Transforming feelings & emotions by helping someone who is experiencing something similar

Define Conversion

Unconscious process that transforms stress into physical symptoms

Define Compensation

Strengthening one area to make up for weakness in another.

Define Denial

Refusing to accept reality. 

Define Dissociation

Disconnecting from reality or memory to escape stress. 

Define Displacement

Redirecting anger/thoughts about stressor to a less threatening target

Define Identification

Assuming the characteristics of another individual 

Define Intellectualization

Concealing or processing emotions by means of excessive intellectual analysis or activity

Define Projection

Attributing one’s own feelings to others

Lying child accuses parent of lying

Define Rationalization

Using excuses or logic to justify behavior or emotions. 

Define Reaction Formation

Acting opposite to true feelings. 

Define Regression

Return to childish behavior when stressed 

Define Repression

Unconsciously blocking painful thoughts or memories. 

Define Splitting

Inability to accept an individual can have both good/poor aspects, beliefs in all “bad” or all “good"

Define Sublimation

Channeling negative feelings into positive & constructive actions

Going for a walk after feeling anxious

Define Supression

Consciously avoiding unwanted thoughts or feelings. 

Define Undoing

Trying to “make up” for a mistake with the opposite behavior.

Stress Management & Relaxation Techniques (8)

Adjust Expectations

Biofeedback

Deep Breathing

Positive Self-Talk

Guided Imagery

Mindfulness Mediation 

Journaling

Environment - dim lights, low noise

Therapeutic Communication - Nurse Listening Skills (13)

• Active Listening

• Silence

• Providing Leads – Directs conversation 

• Focused Questions 

• Open-Ended Questions 

• Exploration 

• Clarifying 

• Paraphrasing

• Reflection 

• Touch 

• Presence 

• Refocusing 

• Summarizing 

Nontherapeutic Communication (11)

• Close-ended Questions 

• Why questions 

• Giving advice/opinions 

• Automatic Response  

• False Reassurance 

• Arguing/Disagreeing 

• Defensive Response 

• Judgmental Response 

• Minimizing Client Feelings 

• Changing the Subject 

• Focusing on Self 

Define Anxiety

Feelings of worry, fear, or nervousness in a threatening situation/stressor

Often based on future/anticipated threats

Anxiety Becomes a Disorder When (4) -

• Occur at inappropriate times/situations. 

• Frequency increases.  

• Intensity affects a person’s ability to function. 

• Duration becomes increasingly prolonged. 

Levels of Anxiety (4)

Mild

Moderate

Severe

Panic

Define Mild Anxiety (3)

Restless, seeking attention, requiring approval/reassurance, increase in questioning & voicing concerns

Ability to function is heightened, thinking is more focused & senses become elevated

Allows student to study for exam more effectively

Define Moderate Anxiety (2)

On edge, easily frustrated, increased restlessness, unable to sleep, difficulty concentrating, increased worry

Tossing & turning at thought of losing job

Define Severe Anxiety (4)

Overwhelmed with stressors & coping mechanism no longer effective

Intense anxiety, increased restlessness, decreased cognition; emotional response heightened (anger/irritability);

Cannot respond to others, complete simple tasks, intense feeling of dread or doom

Parent suddenly loses a child & is unsure of what to do

Define Panic

Overwhelmed with terror reaching point of exhaustion

No longer able to process environmental stimuli, communicate verbally, detached from reality, risk of self-harm

Becoming stuck in elevator between floors

Anxiolytics (Antianxiety) Drugs

Benzodiazepines

Buspirone

Benzodiazepines

Examples - alprazolam, diazepam, lorazepam

Action - Enhances GABA binding & causing influx of dopamine (increases dependence risk)

Use - Anxiety, alcohol withdrawal, sedation

Adverse Effects - CNS Depression, sedation, poor concentration, impaired memory, paradoxical response (agitation, hallucinations, seizures)

Teaching - Fall risk, avoid alcohol (increases sedation), dependence & tolerance risk, addiction 

Buspirone

Class - Partial Serotonin Agonist & Weak Dopamine Antagonist 

Action - acts on serotonin & some dopamine; reduces anxiety w/o CNS depression/dependence

Use - Chronic Anxiety

Adverse Effects - sedation, nausea, headaches, dizziness

Teaching - 2-4 weeks for full effects

Anxiety Manifestations (8)

• Apprehensive or nervous 

• Restlessness 

• Irritability 

• Anticipating worst result 

• Watching for what causes anxiety 

• Avoidance of cause 

• Difficulty concentrating

• Physiological – increased HR, RR, sweating, fatigue, GI upset, sleep disruptions 

Types of Anxiety Disorders (7)

Separation Anxiety

Selective Mutism

Phobias

Social Anxiety

Agoraphobia

Generalized Anxiety Disorder

Substance Induced Anxiety Disorder

Define Seperation Anxiety (3)

• Developmentally inappropriate & excessive anxiety upon separation from those to whom they are attached 

• Reluctant to leave who they are attached to 

• Nightmares & physical manifestations of distress 

Define Selective Mutism (3)

• Consistent failure to speak in specific social situations where speaking is expected 

• Not able to speak during school even when spoken to 

• Affects achievement academically/socially & Interferes with regular communication 

Define Phobias (2)

• Experiencing fear & anxiety upon exposure to a specific object or situation 

• Examples – Animals, Heights, Blood, Bugs 

Define Social Anxiety (3)

• Experiencing fear & anxiety upon exposure to social situations 

• Thoughts ruminate on being humiliated, rejected, or offending others 

• Examples – meeting new people, being observed eating, performing in front of others. 

Define Panic Attacks (5)

• Distinct & extreme periods of physiologic & psychologic hyperarousal 

• Unexpected & occur for no apparent reason 

• Avoidance of causes that may trigger attack 

• Worry another attack will occur 

• Attacks are time limited with a peak in intensity of fear & anxiety 

Define Agoraphobia (4)

• Experiencing fear & anxiety related to travel or location  

• Examples - Closed spaces (elevator), open spaces (park), leaving home alone 

• Fear not being able to escape, being embarrassed, being incapacitated 

• Result of this disorder is avoiding the situation or requiring others to navigate the situation. 

Define Generalized Anxiety Disorder (3)

• Excessive anxiety in response to numerous situations & circumstances 

• Causes – work, school, relationship, performing in front of others. 

• Anxiety experienced almost daily & interferes with individual’s life 

Define Substance-Induced Anxiety Disorder

Manifestations of anxiety in relation to exposure or withdrawal from substance 

Define Adverse Childhood Experiences (ACES)

Specific forms of physical/emotional abuse, neglect, & household dysfunction

Linked to mental illness & premature death. 

How do ACES affect mental health? (3)

• Disrupt brain & organ development 

• Increase risk for stress-related disorders & cognitive impairment 

• Lifelong problems with learning, behavior, physical & mental health 

Define Positive Childhood Experiences (PCES)

Experiences that enhance a child’s life

Improved mental & physical outcomes

ACES & PCES Relationship

PCE does not cancel out ACE but may provide symptomatic protection

Nurse should assess for both

ACE Risk Factors (5)

• Youth who don’t feel close to caregivers & feel they cannot communicate to them about their feelings 

• Youth with few to no friends

• Caregivers who were abused/neglected as children 

• Young caregivers, single parents, low income, low education level

• Families with inconsistent discipline &/or low levels of parental supervision 

PCE Correlating Factors (4)

• Families who create safe, stable, nurturing relationships & children have a consistent family life where they are safe, taken care of & supported 

• Children with positive friendships & peer networks 

• Caregivers with college degrees & steady employment 

• Caregivers engage in parental supervision & enforcement of rules. 

Define Anticipatory Grief (3)

Grief that occurs before an expected loss;

Common with terminal illness & starting with shock and trauma.

Families grieve changes while loved one is still alive, which can prolong & intensify grief leading to complicated grief 

Define Disenfranchised Grief

Grief not socially or culturally accepted, leaving the person unable to openly mourn.

Stigma & lack of support cause isolation, emotional distress, & higher risk of depression or suicide.

Define Complicated Grief

Intense, prolonged grief that disrupts daily life and doesn’t resolve naturally. 

Define Traumatic Grief

A severe form of separation distress that usually occurs following the sudden & unexpected death of a loved one, resulting in shock & numbness 

Define Prolonged Grief

Grief that persists far beyond expected timeframes, delaying healing & recovery

Linked to depression, anxiety, PTSD, self-harm

Unable to function & consistently obsessing over loss

Prolonged Grief Criteria

Adults - Grief lasting > 12 months

Children/Adolescents - Grief lasting > 6 months

5 Stages of Grief

Denial

Anger

Bargaining 

Depression

Acceptance

Describe Denial (stages of grief)

Shock or disbelief & refusing to accept the loss

Avoidance, confusion, shock & fear

Describe Anger (stages of grief)

Frustration or resentment directed at self, others, or situation

Describe Bargaining (stages of grief)

Attempting to make deals or find ways to reverse or delay the loss

Overwhelmed, helpless, & hostile

Describe Depression (stages of grief)

Deep sadness, mourning or hopelessness about the reality of the loss

Involves struggling to find meaning, reaching out to others, telling one’s story

Describe Acceptance (stages of grief)

Coming to terms with the loss and finding a way to move forward.

Define Grief Informed Care

A care approach recognizing grief as a form of trauma, shaped by the client’s social & cultural context.