Unit 5 Mental Health

Types of Stress

• acute: most common, short period of time

• episodic acute: self-inflicted, constant worry

• chronic: sustained and wearing

management of stress

• primary prevention: WELLNESS, positive attitude, health education, nutrition

• secondary prevention: screening tools to assess stress level

Anxiety

an adaptive response to stress; emotional response to anticipation of danger

• it is subjective, yet can be objectively measured physically and psychologically

• necessary force for survival

4 Levels of Anxiety

• mild: seldom a problem, increases motivation

• moderate: perceptual field begins to diminish

• severe: perceptual field diminishes greatly, concentrate on only 1 thing

• panic: most intense, unable to focus, may loose contact with reality

General Anxiety Disorder

• chronic, unrealistic, and excessive anxiety and worry

• out of proportion to the situation

• interferes with life

• sx’s: irritable, restlessness, diff. sleeping

Obsessive-Compulsive Disorder

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

• obsessions: recurrent thoughts/impulses that are intrusive

• compulsions: ritualistic behavior or thoughts to reduce distress

OCD Nursing Care

• help determine triggers to rituals

• initially allow time for rituals while being non-judgmental

• structured schedule and gradually limit time for rituals

GAD and OCD Client/Family Education

• nature of the illness

• causes of anxiety or OCD

• symptoms of the disorder

• management of the illness → meds (effects, time to take effect), stress, support services (groups, psychotherapy)

personality disorders info

personality influences the way in which a person perceives and relates to the environment and are quite stable over time

• personality disorders occurs when these traits become rigid and inflexible and contribute to maladaptive patterns of behavior

3 clusters of personality disorders

• cluster a: odd and eccentric

• cluster b: dramatic, emotional, or erratic

• cluster c: anxious or fearful

borderline personality disorder

state of crisis with frequent mood swings → thriving or chaos

• impulsive: gambling or promiscuity

• clinging and distancing behaviors

• splitting → all good or all bad

antisocial personality disorder

• guiltless → feel laws do not apply

• exploits and manipulates others for personal gain

• low frustration tolerance

• sociopath or psychopath

post-traumatic stress disorder

reaction to an extreme trauma, sx longer than one month

treat with exposure therapy or eye movement desensitization and reprocessing

• re-experiencing the traumatic event

• sustained high level of anxiety or arousal

• amnesia to certain aspects of the trauma

• anger and aggression

adjustment disorder

stress reactions to more “normal” events

• characterized by a maladaptive reaction to an identifiable stressor that results in the development of clinically signif. emotional symptoms

• sx’s occur within 3 months of the stressor and last no longer than 6 months

types of adjustment disorders

• with depressed mood

• with anxiety

• with mixed anxiety and depressed mood

• with disturbance of conduct

• with mixed disturbance of emotions and conduct

• related to bereavement

patient/family education for PTSD and adjustment

• orient to unit, explain rules and privileges, and how they are obtained or lost

• explain activity groups and resources available

• involve pt and family in goal setting

paranoid personality disorder

long term pattern of distrust and suspicion of other, even with no evidence

• sx: holds grudges, quick to feel attacked, interprets neutral comments as insults

• treatment: psychotherapy to build trust and CBT

schizoid personality disorder

intense discomfort and lack of interest in social relationships

• sx: no desire to form relationships, displays very few emotions

• treatment: CBT, group therapy

schizotypal personality disorder

intense discomfort in forming relationships due to eccentric behavior

• sx: magical thinking, exhibit strong/unusual emotions, severe social anxiety

• treatment: CBT, social skills training, antidepressants/psychotics

histrionic personality disorder

pervasive pattern of excessive emotionality and attention-seeking behavior

• sx: dramatic, inappropriately seductive behavior, shallow, rapid shifting emotions

• treatment: psychotherapy

narcissistic personality disorder

unreasonably high sense of one’s importance, seek attention/admiration

• sx: grandiose, lack of empathy, reject diagnoses, calculated presented image

• treatment: talk therapy, CBT

avoidant personality disorder

social inhibition, feelings of inadequacy, and extreme sensitivity to criticism or rejection

• sx: wants relationships but afraid of rejection, low self-esteem

• treatment: CBT, meds for anxiety (SSRIs)

dependent personality disorder

intense need to be taken care of, submission and fear of abandonment

• sx: hard time making decisions, low self-confidence, clingy behavior

• treatment: CBT, group/couple therapy

panic disorder

recurrent, unexpected panic attacks with concern about future attacks

• sx: palpitations, sensations of SOB, fear of dying, attacks last min.-hours

• treatment: CBT, SSRIs

social anxiety

everyday interactions cause significant anxiety and self-consciousness with fear of being scrutinized

• sx: anxiety in anticipation of event, fear of talking with strangers, being center of attention, tachycardia

• treatment: CBT

somatic symptom disorder

focusing on physical symptoms that it causes major distress making it hard to function

• sx: persistent distress for >6 months, complaint is pain, fatigue, muscle weakness

• treatment: psychotherapy and antidepressants

dissociative identity disorder

coexistence of 2+ distinct personality states w/ unique behaviors/memories

• sx: mem. loss, dissociation, switching between identity states

• treatment: CBT, medications

phobias

intense and persistent fear that can be directed towards an object or situation

• sx: immediate anxiety response when exposed to phobia, present for more than 6 months, tachycardia, sweating, SOB, nausea

• treatment: exposure therapy, CBT, relation techniques

Types of Benzodiazepines

• Lorazepam (ativan)

• Alprazolam (xanax)

• Clonazepam (klonopin)

• Diazepam (valium)

Benzodiazepines

• uses: relief of anxiety, sedation, scheduled or prn → SHORT TERM

• side effects: dependency, confusion, memory impairment

• teaching: take as prescribed, do not use with narcotics/alcohol

Type of Non-Benzodiazepines

Buspirone (BuSpar)

Non-Benzodiazepines

• uses: relief of anxiety

• side effects: nausea, headache, dizziness, restlessness, does not cause dependency → LONG TERM

Other Classes for Anxiety

• antidepressants

• antihistamines → hydroxyzine

• anticonvulsants

• beta-blockers & antihypertensives → Clonidine

• antipsychotics