Mental Health Exam 3

what are somatic symptom disorders

characterized by physical sx --> suggesting a medical disease but w/o a identifiable cause

what is somatization

psychological and emotional expression of stress through physical sx

- instead of anxiety/depression/etc --> see HA, back or chest pain, etc

what are our somatic sx and related disorders (4)

- somatic symptom disorder

- conversion disorder

- illness anxiety disorder

- factious disorder

what is the definition of somatic sx disorder

focus on somatic (physical) sx like pain or fatigue to the point of EXCESSIVE concern, preoccupation, and fear

- health-related quality of life severely impaired; clients see sx as threatening, harmful, etc

what does somatic sx disorder look like (4)

- multiple somatic sx that cannot be explained medically

- psychosocial distress, frequent hospital visits

- persistently high level of anxiety about health or sx

- excessive time and energy devoted to these sx or concerns

what is the defintion of illness anxiety disorder

extreme worry and fear about the possibility of having a disease; this worry leads to frequent self-scanning for signs of illness

what does illness anxiety disorder look like (3)

- preoccupation with having or acquiring a serious illness; thoughts about illness may be intrusive and hard to dismiss

- high anxiety level about health; client easily alarmed, extremely conscious of bodily sensations

- chronic and relapsing; sx can become amplified during times of increased stress

what is the definition of conversion disorder

functional neurological disorder; neurological sx in the absence of neurological diagnosis

- deficits in voluntary movement, numbness, loss of vision/hearing, episodes resembling epilepsy

what else can be seen with conversion disorder (3)

- emotional stressors are transferred to physical sx

- many show a lack of emotional concern about sx

- psychiatric comorbidity present in 74% of clients

what is the definition of factitious disorder

deliberately fabricating sx, or self-inflicting injury with the goal of assuming the sick role

- imposed on self: self-inflicted harm

- imposed on another (by proxy): harm to another person

what are the other parts of factitious disorder (4)

- under CONSCIOUS control (despite other somatic disorders)

- individuals consciously conceal the true nature of alleged illness (deception)

- contrived illness may be physical or psychiatric

- also identified as "Munchausen syndrome"

what can psychological factors do to medical conditions

can increase the risk of medical disease OR magnify and adversely affect a medical condition

what is associated with negative health outcomes

- loneliness and weak interpersonal connections

- adverse childhood experiences (ACEs)

- childhood trauma is consistently linked with physical disorders later in life

what are nursing dx for somatic symptoms disorders

ineffective coping (somatic sx disorder)

chronic pain (somatic sx disorder)

fear of having a serious disease (illness anxiety disorder)

disturbed sensory perception (conversion disorder)

self-care deficit (conversion disorder)

what are the S/S of the nursing dx of difficulty coping

- ineffective coping strategies

- insufficient access to social support

- insufficient problem-solving skills

- inability to meet role expectations

what are the outcomes for difficulty coping

- improved coping

- identifies effective coping patterns

- identifies alternate coping strategies

- uses support system

what are the S/S of the nursing dx of pain, acute or chronic

- presence of secondary gains by adoption of sick role

what are the outcomes for pain, acute or chronic

- reduced pain

- recognize associated sx of pain

- reports pain control

what are S/S of the nursing dx of impaired socialization

- absence of support system

- disabling condition

- preoccupation with own thoughts

- family and friend alienated by physical obsessions

what are the outcomes for impaired socialization

- improved socialization

- identifies support system

- willing to call on others for assistance

- identifies a support group

what are the S/S of the nursing dx of chronic low self-esteem

- nonassertive behavior

- exaggerates negative feedback about self

- excessive seeking of reassurance

- repeatedly unsuccessful in life events

what are the outcomes for chronic low self-esteem

- improved self-esteem

- verbalizes positive regard for self

- describes self as successful

- strong beliefs that decisions and actions control health outcomes

what does therapeutic interventions do for somatic symptom disorders

address ways to help the client have needs met without resorting to somatization

what do clients with somatic symptom disorders have issues with and need training on?

- difficulty communicating emotional needs (can describe physical sx but unable to verbalize feelings)

- assertiveness training

what is body-oriented psychological therapy (BOPT)

fosters symbolic enactments of trauma to explore alternative coping strategies

what is dialectical behavior therapy (DBT)

skills to target emotional dysregulation, distress tolerance, and interpersonal conflicts

what does cognitive-behavioral therapy focus on?

trauma!

anxiety

feelings of apprehension, uneasiness, uncertainty, or dread from a real or perceived threat

- EMOTIONAL response

- normal healthy reaction ; necessary for survival

fear

reaction to a specific danger

- COGNITIVE response

what are our anxiety disorders (5)

- generalized anxiety disorder (GAD)

- panic disorder

- social anxiety disorder (social phobia)

- specific phobias

- seperation anxiety disorder

what is mild anxiety

not usually a problem; comes from day-to-day living

- sharpens senses, motivates action

- increases the perceptual field

what is moderate anxiety

anxiety increases; it diminishes the perceptual field

- less alert to events in environment

- more direction to problem-solving

- increased restlessness & muscle tension

what is severe anxiety

overwhelming anxiety; difficulty completing simple tasks

- physical: HA, palpitations, insomnia

- emotional: dread and horror

what is panic

most intense state of anxiety; terror and physical sx feel life-threatening

- may lose contact with reality

- marked dysregulated behavior

what are the defenses against anxiety

adaptive use of defense mechanisms: helps lower anxiety and achieve goals

maladaptive use of defense mechanisms: when one or several are used in excess, particularly immature defenses

seperation anxiety disorder

developmentally inappropriate levels of concern over being away from a significant other

- fear that something horrible will happen

- distracts from activities, causes sleep disturbances

what are the sx of seperation anxiety

physical sx; GI disturbances and HA

when is separation anxiety a normal part of infant development

peak: 8 months - 18 months

- declines after 18 months

phobia

persistent, irrational fear of a specific object, activity, or situation

- leads to the avoidance of things

specific phobia (and example of agoraphobia)

excessive or unreasonable fear when in the presence of, or anticipation of, a specific object or situation

- agoraphobia: fear of being in places or situations from which escape might be difficult, or help might not be available

social anxiety disorder

aka social phobia: anxiety or fear provoked by exposure to a social or performance situation

- people avoid such situations

- if they are unable to avoid them: clients endure the situation w/ anxiety and emotional distress

social anxiety disorder sx in small children and adolescents

small children: mute or nervous

adolescents: paralyzed by fear of speaking in class or interacting with peers

panic disorder

client experiences panic attacks: sudden onset of extreme apprehension or fear, associated w/ feelings of impending doom

- functioning is suspended

- may believe they are losing their minds or having a heart attack

what else might someone with panic disorder experience

preoccupied with the possibility of future episodes; they avoid pleasurable and adaptive activities, experiences, and obligations

generalized anxiety disorder

characterized by excessive anxiety and worry

- anxiety/worry or physical sx cause clinically significant distress or impairment in social, occupational, or other areas of functioning

what are the general symptoms of GAD (4)

- difficult to control the worry

- restlessness, feelings on edge

- difficulty concentrating

- sleep disturbances, easily fatigued

what is big about anxiety's general assessment in nursing

determine whether anxiety is the PRIMARY problem (like anxiety disorder) or SECONDARY to another cause (like a medical condition or substance use)

what are nursing dx for anxiety related disorders

- anxiety (moderate, severe, panic)

- impaired coping

what do nurses want to do with anxiety-related disorders (4)

- evaluates the effective use of coping mechanisms in the past

- uses relaxation exercises to initiate a relaxation response

- applies new behaviors to manage anxiety

- considers alternatives and activities that may relieve feelings of inner tension

what are outcomes related to anxiety (nursing dx)

reduced anxiety

- monitor intensity of anxiety

- use relaxation techniques

- decreases environmental stimuli as needed

- controls anxiety response

- maintains role performance

what are outcomes related with impaired coping (nursing dx) (5)

improved coping

- identifies ineffective coping patterns

- asks for assistance

- seeks information about illness and tx

- identifies multiple coping strategies

- modifies lifestyle as needed

what are specific nursing interventions for anxiety (8)

- provide calm presence

- teach coping strategies & assist w/ problem-solving

- intervene in unhealthy defense mechanisms

- cognitive restructuring

- teach relaxation techniques

- health teach (reducing caffeine!!)

- provide physical outlets

- pharmacotherapy

what are specific nursing interventions with panic attacks (6)

PSYCHIATRIC EMERGENCIES

- do not leave client alone

- remain calm, stay w/ patient

- clear, concise instructions, speak calmly

- administer medications (as ordered!)

- provide structure, ensure safety

- decrease environmental stimuli

what are the treatment modalities for anxiety (4)

- pharmacotherapy

- antidepressants/antianxiety/other classes

- psychological therapies

- behavioral therapy/cognitive-behavioral therapy

antidepressants drugs

SSRIs; 1st line tx for most anxiety-related disorders

- paroxetine, fluoxetine, escitalopram, sertraline

- teaching: 6 weeks for anxiety to work, sexual dysfunction

SNRI; another 1st line tx

- venlafaxine

- teaching: dose-dependent HTN

anti-anxiety drugs (1/2)

benzodiazepines; potentiate the inhibitory effects of GABA

- rapid onset of action

- risk dependence & withdrawal; used for short periods of time

- SE: sedation, ataxia, decreased cognitive function

not recommended in pt w/ comorbid substance abuse

anti-anxiety drugs (2/2)

buspirone; serotonin 5 HT partial agonist

- does NOT cause dependence

- takes 2-4 weeks for effects

- not recommended w/ impaired hepatic or renal function

- SE: dizziness, nausea, HA

other medications for anxiety (4)

antihistamines (hydroxyzine, diphenhydramine): non-addictive alternatives to benzos; used in clients with substance use problems

beta-blockers: reduce physical sx by slowing HR & reducing blushing in social anxiety disorder

anticonvulsants (gabapentin, pregabalin): some benefit in GAD and social anxiety disorder

antipsychotic: used to tx severe sx of anxiety disorders

what are psychological therapies for anxiety (4)

- modeling

- systematic desensitization

- flooding

- cognitive-behavioral therapy

what is modeling

therapist acts as a role model, demonstrating appropriate behavior in a feared situation

what is systematic desensitization

client is gradually introduced to a feared object or experience through a series of steps, from least frightening to most frightening

what is flooding

method exposes the client to a large amount of an undesirable stimulus to extinguish the anxiety responses

what is cognitive-behavioral therapy

includes cognitive restructuring, psychoeducation, muscle relaxation, self-monitoring for sx, vivo (real-life) exposure to feared objects or situations

what are our obsessive-compulsive disorders (5)

- obsessive compulsive disorder (OCD)

- body dysmorphic disorder (BDD)

- hoarding disorder

- trichotillomania

- excoriation disorder

obsessive-compulsive disorder

recurrent obsessions or compulsions that are severe enough to be time-consuming or cause marked distress or significant impairment

- obsessions

- compulsions

what are obsessions

excessive, unwanted, intrusive, and persistent thoughts, impulses, or images causing anxiety and distress --> unable to be expunged by logic

what are compulsions

repeatedly performed behaviors in a ritualistic fashion

- attempt to prevent or relieve anxiety & distress caused by obsessions

what are some examples of obsessions and compulsions (5)

- concerns w/ dirt, germ exposure, fears of illness = cleaning rituals

- fears of harm befalling self or others = checking

- need for symmetry, order, exactness = repeating behaviors

- need to save or hoard = ordering or arranging

- excessive moral, religious, or sexual concerns

body dysmprphic disorder

characterized by the exaggerated belief that the body is deformed or defective in some specific way

- if true defect is present, the person's concern is unrealistically exaggerated and grossly excessive

what else is there about body dysmorphic disorder (2)

- beliefs are NOT delusions; individual is aware that their beliefs are exaggerated

- preoccupated w/ imagined defective body part; leads to obsessive thinking and compulsive behavior

hording disorder

persistent difficulty discarding possessions; accumulate belongings that may have little or no value

- prevents people from leading a normal life

what else is there to hording disorder (2)

- problem can progress to the point where the home is uninhabitable, unsafe or unsanitary conditions

- individuals who hoard may or may not be aware of the problem and how it has consumed their lives

trichotillomania (4)

recurrent pulling out of one's hair

- results in noticable hair loss (small patches to completely naked skin)

- most unaware of the behavior

- pain of hair pulling = reducing stress/anxiety

- common sites: scalp, eyebrows & eyelashes

excoriation disorder (2)

compulsive skin-picking disorder; can be used to deal with stress and relieve anxiety, or others can engage without thinking about it

- typically confined to face; but can be skin/nails/scabs

- complications: pain, sores, scars, infections

what is tx modalities for OCD (3)

- pharmacotherapy

- brain-based therapies

- psychological therapies

pharmacotherapy for OCD

SSRIs: fluoxetine, fluvoxamine, paroxetine, sertraline

TCAs: clomipramine

- EBP w/OCD --> cardiotoxic w/ OD

brain-based therapies for OCD

deep brain stimulation as a adjunct to medications in treatment resistant OCD

psychological therapies for OCD (2)

exposure & response prevention: client learns to lengthen the time between rituals until urge fades away

flooding: method exposes client to undesirable stimulus to extinguish the responde

personality definition

totality of emotional and behavioral characteristics somewhat particular to a specific person

- remain somewhat stable and predictable over time

personality disorder definition

occur when personality traits become rigid and inflexible, and contribute to maladaptive patterns of behavior, impairment in functioning, and lead to distress

what do individuals w/ personality disorders display challenges with (4)

- self-identity

- self-direction

- problems w/ empathy

- intimacy within relationships

what is there to know about personality development (4)

personality development occurs in response to biological and psychological influences and endures over time

- heredity

- temperament

- experiential learning

- social interaction

what are our Cluster A personality disorders (3) and what do they exhibit

exhibit odd or eccentric behaviors

- paranoid

- schizoid

- schizotypal

what are our Cluster B personality disorders (4) and what do they exhibit

exhibit dramatic, emotional, or erratic behavior

- antisocial

- borderline

- histrionic

- narcissistic

what are our Cluster C personality disorders and what do they exhibit

exhibit anxious, insecure, or fearful behavior

- avoidant

- dependent

- obsessive-compulsive

Cluster A: Paranoid Personality disorder, characterized by

long-standing distrust and suspiciousness of others

- believe others want to exploit, harm, or deceive them as a result

what do Paranoid Personality Disorder clients present as... (3)

- hypervigilant, "testing" the honesty of others

- over-sensitive, misinterprets cues in the environment

- difficulty in relationships due to jealousy, controlling behaviors, and unwillingness to forgive

what is the primary defense mechanism of Paranoid Personality Disorders

projection: assigning one's own unrecognized feelings to others

what is the nursing care for Paranoid Personality Disorders (4)

- appointments and schedules should be strictly adhered to by nurses

- use simple language; neutral affect (too friendly = suspicion)

- set limits on the client's threatening behaviors

- group setting useful for improving social skills

what is the treatment modality for Paranoid Personality Disorder (2)

- psychotherapy is the first line of treatment

- individual therapy focuses on the development of trusting relationships

Cluster A: Schizoid Personality Disorder characterized by

lifelong pattern of social withdrawal, detachment from social relationships

- lacks desire for or enjoyment of close relationships (IF they have relationships, it's primarily family like parent or sibling)

what does Schizoid Personality Disorder present as (4)

- prefers solitary activities over social interactions

- emotionally detached with few friendships

- cold, aloof, indifferent to others

- shy, anxious, or uneasy

what is the nursing care for Schizoid Personality Disorder (3)

- respect clients' need for social isolation (don't come on too quickly or too hard)

- stay neutral (avoid being too "nice" or "friendly")

- tend to be introspective (makes them good candidates for psychotherapy)

what is the treatment modalities for Schizoid Personality Disorder (2)

- psychotherapy (primary tx)

- group therapy (good follow-up)

there is no medication, but antidepressants can treat depressive symptoms; antipsychotics can help with emotional expressiveness

Cluster A: Schizotypal Personality Disorder is characterized by

odd, unusual behavior, but does not decompensate to the level of schizophrenia

- odd beliefs, magical thinking, bizarre fantasies, or superstitions

what does Schizotypal Personality Disorder present as (4)

- inappropriate emotions; unusual speech patterns

- blunted affect

- struggles w/ social interactions (aloof and socially withdrawn)

- identified as both a personality disorder and part of the schizophrenia spectrum

what is the nursing care for Schizotypal Personality Disorder (4)

- individuals usually avoid tx (because they are socially anxious and somewhat paranoid)

- strange beliefs and peculiar thoughts may be part of clients life

- help identify cognitive distortions

- goal to provide supportive care (difficulty w/ therapeutic relationships)

what is the treatment modality for Schizotypal Personality Disorder

- psychotherapy (1st line)

- some may benefit from low-dose antipsychotics

Cluster B: Histrionic Personality Disorder, characterized by

excitable, dramatic, and extroverted behavior

- excessively emotional, self-dramatizing

Histrionic Personality disorder also presents as... (4)

- attention-seeking; often behaving flirtatiously or provocatively

- shallow and exaggerated emotions

- struggles to form meaningful relationships

- overestimates the intimacy of relationships