Mental Health Exam 3

Anxiety disorder risk factors

Trauma, genetic predisposition, family background, brain chemistry, and lifestyle factors can contribute.

Common psychological manifestations of anxiety

Apprehension, restlessness, irritability, anticipation of the worst, and avoidance.

Common physical manifestations of anxiety

Increased heart and respiratory rates, sweating, fatigue, gastrointestinal disturbances, and sleep disruption.

Separation anxiety disorder

Developmentally inappropriate, excessive fear or anxiety about separation from an attachment figure.

Selective mutism

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

Specific phobia

Irrational fear of a particular object or situation.

Social anxiety

Marked fear of social situations, often involving concerns about embarrassment or rejection.

Agoraphobia

Marked fear of places or situations where the person feels vulnerable or unsafe (ex: closed spaces, open spaces, leaving home alone)

Panic disorder

Recurrent, usually unexpected panic attacks accompanied by concern or avoidance.

Generalized anxiety disorder

Uncontrollable, excessive worry lasting at least six months.

Obsessive-compulsive disorder

Intrusive obsessions accompanied by compulsive behaviors intended to control distress.

Hoarding disorder (an OCD disorder)

Difficulty discarding possessions, causing distress and clutter that impairs functioning.

Body dysmorphic disorder (an OCD disorder)

Preoccupation with perceived physical flaws or defects.

Trichotillomania (an OCD disorder)

Repeated, intentional hair pulling that may provide gratification or relief.

Excoriation disorder (an OCD disorder)

Repeated skin picking that results in lesions.

Mild anxiety

First exposed to stressor, low anxiety level --> increased awareness and peak problem-solving ability, often with restlessness.

Mild anxiety Physical Characteristics

Tension-relief is characterized by nail-biting, foot-tapping, or fidgeting → restless

Moderate anxiety

Narrowed attention and reduced concentration, with problem-solving still possible.

Moderate Anxiety Physical Characteristics

Increased vital signs as the sympathetic nervous system is activated, trouble sleeping

Severe anxiety

Distorted perception and severely limited problem-solving, often with somatic complaints.

Severe Anxiety Physical Characteristics

Severe somatic complaints, a sense of impending doom, withdrawal, loud speech, and nausea → overwhelmed, acting out, unsure what to do

Panic-level anxiety

Terror and inability to process the environment or respond to stimuli.

GAD versus OCD

GAD involves broad everyday worry; OCD involves intrusive obsessions and often compulsions.

Transdiagnostic approach

Focuses on shared processes and risk factors across multiple mental health disorders (the DSM-5!!!)

Positive childhood experiences

Safe relationships and supportive friendships may protect against effects of adverse experiences.

Adverse Childhood Experiences

Children and youth who don't feel close to their parents/caregivers and feel like they can't talk to them about their feelings, children and youth with few or no friends, & families with inconsistent discipline and/or low levels of parental monitoring and supervision

Does ACES or PCE affect anxiety & OCD?

Both

Fluoxetine mechanism

Inhibits serotonin reuptake, increasing serotonin availability in the synaptic cleft.

Fluoxetine patient teaching

Improvement may take two to six weeks; do not discontinue abruptly.

Fluoxetine safety monitoring

Monitor for increased anxiety initially and suicidal ideation, especially in young people.

Fluoxetine adverse effects

Nausea, insomnia, sexual dysfunction, weight changes, and serotonin syndrome.

Trauma exposure

Direct exposure, witnessing, learning about trauma to loved ones, or occupational re-exposure may precipitate disorders.

Childhood trauma without protective factors

Can disrupt development and functioning and increase chronic health and trauma-disorder risks.

PTSD intrusion in children under six

Upsetting memories or flashbacks may be expressed through play.

PTSD avoidance in children under six

Avoid reminders, more frequent negative feelings, reduced expression

PTSD intrusion after age six

Unwanted memories, nightmares, flashbacks, or distress and physical reactivity to reminders.

PTSD avoidance after age six

Avoidance of trauma-related thoughts, feelings, or external reminders.

Gabor Maté's definition of trauma

An internal psychic or physical wound resulting from an experience.

Dissociative disorder risk factors

Trauma, childhood abuse, family dysfunction, and certain comorbid disorders may contribute.

Dissociative amnesia

Inability to recall important personal information, usually associated with trauma or stress. Can be from a period of time, about specific details, or generalized.

Dissociative fugue

Subtype of dissociative amnesia characterized by sudden, unexpected travel away from home or customary work locations, with an inability to recall one's past and confusion about personal identity or the adoption of a new identity.

Somatic symptom disorder

Distressing physical symptoms accompanied by disproportionate thoughts, feelings, or behaviors.

Somatic symptom disorder duration

Associated thoughts, behaviors, and disruptions persist for six months or more.

Factitious disorder

Intentional falsification or induction of symptoms without an external reward.

Factitious disorder examples

Drink chemicals and complain they are sick on purpose, often have new manifestations following negative test results

Factitious disorder imposed on another

A person falsifies or induces symptoms in someone else.

Functional neurological disorder

Neurological manifestations occur without an identifiable medical cause.

Functional neurological manifestations

May involve altered voluntary movement or sensation, including weakness, paralysis, or numbness.

Pseudocyesis

A false pregnancy that may occur with an extreme desire to become pregnant - a type of functional neurological disorder

Personality disorder risk factors

Genetic vulnerability and environmental factors such as childhood trauma or instability.

Diathesis-stress model

Predisposing vulnerability combined with environmental stressors contributes to personality disorder development.

Cluster A personality disorders

- Characterized by odd or eccentric patterns

- Paranoid Personality disorder

- Schizoid Personality Disorder

- Schizotypal personality disorder

Paranoid personality disorder

Pervasive distrust and suspicion of others' motives without evidence, perceive threats

Nursing care for paranoid personality disorder

Maintain boundaries and communicate honestly and transparently.

Schizoid personality disorder

Social detachment and restricted emotional expression in interpersonal settings.

Nursing care for schizoid personality disorder

Respect personal space and avoid forcing socialization.

Schizotypal personality disorder

Interpersonal discomfort marked by acute discomfort with, and reduced capacity for, close relationships with cognitive or perceptual distortions and eccentric behavior (odd beliefs, magical thinking, social anxiety, eccentric behavior).

Nursing care for schizotypal personality disorder

Use reality-based communication without directly challenging beliefs.

Cluster B personality disorders

- Characterized by dramatic, emotional, or erratic patterns

- Antisocial Personality Disorder

- Borderline Personality Disorder

- Histrionic Personality Disorder

- Narcissistic Personality Disorder

Antisocial personality disorder

Pervasive disregard for and violation of others' rights with deceitfulness, lack or remorse, failure to conform, and consistent irresponsibility.

Nursing care for antisocial personality disorder

Prioritize safety, consistent boundaries, and limit setting.

Borderline personality disorder

Instability in relationships, self-image, and emotions, with marked with a fear of abandonment, emotional instability, self-harm behaviors, and impulsivity.

Nursing care for borderline personality disorder

Assess suicide risk and emotional regulation and maintain consistent staff communication.

Histrionic personality disorder

Pervasive pattern of excessive emotionality and attention seeking with dramatic behavior and shallow emotions.

Histrionic personality disorder Nursing Prioritieis

Maintain boundaries, model good behavior, and encourage appropriate behavior

Narcissistic personality disorder

Grandiosity, need for admiration, and lack of empathy.

Narcissistic personality disorder Nursing Priorities

Avoid power struggles, model good behvaior, and maintain professional boundaries

Cluster C personality disorders

- Characterized by anxious or fearful patterns

- Avoidant personality disorder

- Dependent Personality Disorder

- Obsessive-Compulsive Disorder

Avoidant personality disorder

Social inhibition, feelings of inadequacy, and sensitivity to negative evaluation.

Avoidant personality disorder Nursing Priorities

Build trust and encourage gradual socialization

Dependent personality disorder

Excessive need for care, leading to submissive behavior, inability to make decisions, and separation fears.

Dependent personality disorder Nursing Priorities

Encourage independence and promote decision‑making skills

Obsessive-compulsive personality pattern

Preoccupation with orderliness, perfectionism, rigidity, and control at the expense of flexibility.

Obsessive-compulsive Personality Nursing Priorities

Avoid power struggles and provide structured environment

Personality disorder nursing assessment

Assess functioning, coping, comorbidity, willingness to change, and social support.

Therapeutic presence

Empathetic support helps clients process emotions while maintaining boundaries.

Cognitive behavioral therapy

Helps clients change behavior by changing thinking.

Cluster A Disorders Goals

Focus on finding and maintaining interpersonal relationships

Cluster B Disorders Goals

Focus on teaching the clients to set limits on dramatic and inappropriate behaviors --> emotional regulation + safety and maintaining appropriate boundaries

Electroconvulsive therapy

Electrical stimulation induces brief seizures for clients who may have treatment-refractory depression.

Transcranial magnetic stimulation

Magnetic pulses stimulate focal cerebral cortex areas without anesthesia & not as invasive as ECT

Vagus nerve stimulation

An implanted stimulator activates the vagus nerve.

Deep brain stimulation

Surgically implanted electrodes stimulate underactive brain regions.

Light therapy

May help clients experiencing seasonal affective (depression) disorder.

St. John's wort safety

Do not take it with selective serotonin reuptake inhibitors.

ECT preparation

Discontinue benzodiazepines as directed and maintain NPO status for six to eight hours.

ECT seizure observation

A lower-leg blood pressure cuff allows the team to observe great-toe seizure activity.

ECT effective seizure duration

45 to 60 seconds

Suicide risk factors

Previous self-harm, mental illness, substance use, limited support, life changes, personal relationship problems, sexual violence, stigma, and access to lethal means.

Groups at higher suicide risk

Veterans, rural residents, men, teenagers, and native-Americans.

Age at higher risk for suicude

under 19 or over 45

Major depressive disorder symptom threshold

Five or more symptoms during the same two-week period, representing a change in functioning with at least one being a depressed mood and one being loss of interest or pleasure

Major depressive disorder mood symptoms

Depressed mood AND loss of interest or pleasure are core symptoms and MUST be present, significant unintentional weight loss/or gain, agitation, fatigue, sense of worthlessness, diminished ability to think, concentrate, or make decisions, recurrent thoughts of death

Bipolar I disorder

Associated with extremely high levels of mania.

Bipolar II disorder

Less intense mania and more profound depression than bipolar I.

SAD PERSONS scoring

One point is assigned for each listed suicide risk factor.

SAD PERSONS score of 0-2

Can discharge home with follow-up

SAD PERSONS score of 7-10

Hospital admission

SAD PERSONS Meaning

S sex male

A age

D depression

P previous attempt

E ethanol

R rational thinking loss

S social supports lacking

O organized plan

N no partner

S sickness (major or chronic)

Serotonin syndrome manifestations (SHIVERS)

Shivering

Hyperreflexia

Increased Temperature

Vital Sign Abnormalities (tachycardia, tachypnea, labile BP)

Encephalopathy

Restlessness

Sweating