mental health chp 1, 18, 19 (week 3)

What are the levels of anxiety?

- Mild

- Moderate

- Severe

- Panic

What is mild anxiety?

- Normal response to stressors (not debilitating)

- Heightens awareness

- Increases productivity

- Patient is still teachable when they have this

What is moderate anxiety?

- Perceptual field (peripheral vision) diminishes

- Attention span decreases

- Increased restlessness

- Needs assistance with problem solving

What is severe anxiety?

- Perceptual field GREATLY diminishes

- Attention span is limited

- Physical and emotional symptoms can happen

- Difficult to teach them

What are physical symptoms of anxiety?

- Shortness of breath

- Tachycardia

- Palpitations

- Sweaty

- Tremors

What are emotional symptoms of anxiety?

- Frustrated

- Upset

- Crying

What is panic level anxiety?

- Cannot focus on even one detail around them (not teachable)

- Can lead to psychosis (psychotic breakdown)

- Unable to teach them at all

What are ego defense mechanisms?

- Can be used consciously or subconsciously

- Does not indicate that there is a mental illness

- Defend from any feelings of anxiety

- Used to decrease anxiety

What is compensation?

Focusing on strengths to make up for weaknesses

What is denial?

Refusing to accept the reality of a situation

What is displacement?

Taking negative emotions and focusing on an innocent target

What is identification?

Adapting beliefs and behaviors of another person

What is intellectualization?

Looking at things logistically and separating emotions (talking it out in your head)

What is undoing?

Trying to reverse and cancel something bad the person did

What is projection?

Putting your flaws and negative (insecurities) onto other people- not necessarily innocent targets

What is rationalization?

Justifying behavior to make it look okay

What is reaction formation?

Expressing opposite feelings from what they really feel about something or someone

What is regression?

Reverting to a previous developmental phase in response to a stressor

What is repression?

Subconscious blocking of unwanted thoughts and feelings ("revisiting")

What is suppression?

Conscious blocking of unwanted thoughts and feelings ("suspending")

What is sublimation?

Taking unacceptable thoughts and channeling that energy into another output

What is stress?

External pressure brought on to the person (fairly temporary)

What is anxiety?

Feeling of discomfort, apprehension, or dread from some kind of imminent danger (normal to feel anxious)

When does anxiety become abnormal?

It's blown out of proportion and interferes with daily functioning

What is panic?

Sudden overwhelming feeling of terror or impending doom

Why is panic the most severe state of anxiety?

Starts involving behavioral, physical, and cognitive symptoms

What are symptoms of panic?

- Palpitations

- Sweating

- Shortness of breath

- Feeling dizzy

- Detachment

What is panic disorder?

Panic attacks are recurrent and unpredictable usually lasting a few minutes (rarely last a few hours)

What is the onset of panic disorder?

Late 20s

What is generalized anxiety disorder?

Persistent, unrealistic, and excessive anxiety and worry for at least six months (difficult to control worrying)

When can generalized anxiety disorder begin?

Childhood or adolescence

What are symptoms of generalized anxiety disorder?

- Restlessness or feeling on edge all the time

- Pacing

- Easily fatigued

- Difficulty concentrating or mind going blank

- Irritability

- Muscle tension

- Sleep disturbance

What is social anxiety disorder?

Excessive fear of situations where a person might do something embarrassing or be perceived negatively by others

What is the onset of social anxiety disorder?

Late childhood and early adolescence

What is a phobia?

An irrational fear of a special thing resulting in actively avoiding the feared object

What is agoraphobia?

- Fear of being in open places due to feeling vulnerable and unable to get help

- Person cannot leave home without being accompanied by someone

What are the main agoraphobia interventions?

- Show support and promote independence

- Exposure therapy

What are obsessions?

Intrusive thoughts that are recurrent and stressful, person knows the thoughts are irrational but keep acting on it

What are compulsions?

Intrusive actions that the person HAS to perform to calm down

What is obsessive compulsive disorder (OCD)?

Obsessions and/or compulsions are done to the point where it becomes pathological (to relieve anxiety)

What are obsessive compulsive disorder (OCD) hospitalization considerations?

After the patient is hospitalized for a while (medication is stabilized), stop their behavior because they are supposed to be getting better

What is trichotillomania?

- Hair pulling disorder

- Results in hair loss

- Pulling out hair gives a sense of gratification

What is hoarding disorder?

- Persistent difficulties getting rid of an item regardless of how valuable it is

- They'll keep buying things and hoard them (it's impossible to walk around the house)

What is body dysmorphic disorder?

Person thinks part of their body is defective to the point where they think about or have multiple surgeries (often found in cosmetic or dermatological settings)

What are general interventions for anxiety?

- Safety (narrow perceptual field)

- Low stimuli enviorment

- Approach them in a calm manner

- Stay with the patient (safety and support)

- Give simple directions

- Teach coping strategies and stressor identification when ready

- Cognitive behavioral therapy

-Psychopharmacology

What is the main anti-anxiety agents/anxiolytics?

Benzodiazepines (-pams and -lams) can be given PRN especially when feeling anxious

What should be monitored when administering anti-anxiety agents/anxiolytics?

respiratory depression

fall risk bc of sedation

What are non-benzodiazepines used as anti-anxiety agents/anxiolytics?

- Buspirone (Buspar): long lag period but not abused like benzodiazepines

- Hydroxyzine (Vistaril or Atarax)

What are off label medications for anxiety?

- SNRI (specifically Venlafaxine): watch blood pressure

- Gabapentin (also for pain)

- Antihistamines

- Antihypertensives (specifically Propranolol and Clonidine)

What is trauma?

Extremely distressing experience that causes severe emotional shock and can have long lasting psychological effects

What is post traumatic stress disorder (PTSD)?

Multi-system response triggered by an extremely traumatic event

What are symptoms of post traumatic stress disorder (PTSD)?

- Sustained high level of anxiety or arousal

- Re-experiencing the trauma

- General feeling of numbness

What is acute stress disorder?

Symptoms begin one month following the trauma (if symptoms last longer it can escalate into PTSD)

What are trauma and stressor-related disorder interventions?

- Cognitive behavioral therapy

- Group therapy

- Prolonged exposure therapy

What are the parts of prolonged exposure therapy?

1. Education on how treatment will go

2. Deep breathing to relax

3. Imagined exposure through repeated discussion about trauma

4. Exposure to real world situations

What are psychopharmacology interventions for post traumatic stress disorder (PTSD)?

- Antidepressants

- Anxiolytics

- Antihypertensives (Propranolol)

what is adjustment disorder?

- maladaptive responses to failure or a difficult situation

- stressor must be present

- can go away after 6 months or when stressor is over