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examples of stimulants

•amphetamines, meth, speed, uppers, ice, cocaine, caffeine, bath salts, nicotine.

Alcohol withdrawal

•Occurs within 4 to 12 hours of cessation of or reduction in heavy and prolonged use

Generalized anxiety disorder

•Anxiety itself is the expressed symptom

•Worry about everything

Mental health

•Can be defined as the ability to:

–Be flexible

–Take responsibility for own actions

–Form close relationships

–Make appropriate judgments

–Solve problems

–Cope with daily stress

–Have a positive sense of self

Mental illness

•Maladaptive responses to stressors from internal or external environment

When does mental illness occur

when a person struggles to:

–Think

–Feel

–Make sound judgments

–Adapt

–Cope with reality

–Form personal relationships

Etiology of mental illness

•Etiologies

–Caused by a variety of biological, genetic, and environmental factors

–Can be categorized as a brain disease

–Social and Cultural Environments

–Spirituality and Religion

•Need to rule out a physical illness first

•Diagnostic tests/psychological tests

Mental health status exam

•Appearance & behavior

•Level of awareness & reality orientation

•Thinking/content of thought

•Memory

•Speech and ability to communicate

•Mood and affect

•Judgment

•Perception

DSM-V

•Published by APA and used as diagnostic tool

•Classifies mental illness, presents guidelines, and diagnostic criteria.

Coping

the way one adapts psychologically, physically, and behaviorally to a stressor

Effective coping

•adapting to a situation to decrease stress

Ego defense mechanisms

•Denial

•Rationalization

•Compensation

•Displacement

Ineffective coping

overuse of defense mechanisms

Ways nurses can help with coping

Use therapeutic communication; be aware of non-verbal comm. also

Neurodevelopmental disorders

A variety of disorders where the symptoms usually first become evident during infancy, childhood or adolescence. Disorders of brain function.

Examples of neurodevelopmental disorders

mild, moderate, severe, profound intellectual disorders, autism disorders, ADHD, learning disorders, tic disorders (Tourette’s), etc.

Autism is characterized by

•abnormal brain dev. & function; hereditary component & environmental risk factor

Signs and symptoms of autism

deficits in social communication & interaction and restricted /repetitive behaviors, difficulty with relationships; may be overly dependent on routines

Schizophrenia

•A serious disorder of thought and association

•Inability to distinguish between what is real and unreal as well as hallucinations, delusions, and social isolation; poor self-esteem may be present; difficulty focusing

•Often begins during adolescence or young adulthood, develops over time

4 phases of schizophrenia

Schizoid personality, prodromal, schizophrenia, residual phase

Positive symptoms of schizophrenia

•reflect and “excess” or distortion of normal functioning

•Hallucinations

•Illusions

•Delusions

\-disorganized speech, clanging, neologisms, echolalia, word salad

Hallucinations

false sensory perceptions (auditory, visual, taste, smell, touch); auditory and visual most common

Illusions

mistaken perceptions of reality

Delusions

fixed, false beliefs that cannot be changed by logic or factual proof

neologisms

a newly coined word or expression.

clanging

person uses words together because of how they sound, regardless of whether the sentence makes sense

Negative symptoms of schizophrenia

Deficit in functioning

Flat affect, alogia, avolition, anhedonia, and social isolation

alogia

lack of speech

avolition

 lack of motivation or ability to do tasks or activities that have an end goal

anhedonia

reduced ability to experience pleasure

Pathophysiology and etiology of schizophrenia

Causes combination of neurobiological and environmental factors; brain disease

Could be genetic predisposition

Some have excess levels of dopamine, loss of gray matter, and enlarged ventricles

environmental factors that may lead to schizophrenia

central nervous system damage during childbirth, infections, and substance abuse

Mood disorders

the main symptoms is extreme changes or instability in mood and affect

mood disorders with both highs and lows

bipolar disorder

moods disorders with no highs

depression

psychoanalytic theory for mood disorders

people who have suffered loss in their lives at risk for depression

cognitive theory for mood disorders

people perceive events and situations differently and this may lead to depression.  Some people exaggerate bad things

Biological theory for mood disorders

there are genetic links and neurotransmitter dysfunctions that lead to depression. Could be due to hormonal issues as well.

What disorders experience depression symptoms (that are not depression)

schizophrenia or drug side effects or overuse.

Depressive disorders

•Episodic condition

•Interferes with social or occupational functioning

symptoms of depressive disorders

\-Depressive mood

\-adhedonoia

\-Significant wt. loss or gain (>5% in a month)

•  Increase/decrease appetite

•  Disturbed sleep pattern

•  increased fatigue or loss of energy

•  Decreased ability to think/remember/concentrate

•  Feelings of guilt or hopelessness

•  Indecisiveness

•  Suicidal Ideation

Mild depression

may deny or anger, guilt, hopeless, sad, tearful, self-blame, decreased or increased appetit

moderate depression

•helpless, powerless, difficulty experiencing pleasure, sluggish, slow speech, self destructive, decreased personal hygiene, dec. energy, suicidal ideation

Severe depression

intensified S & S, total despair, delusional thinking, strong desire for suicide

Other types of depression

•Substance-induced

•Senescence

•Postpartum

•Seasonal

•Premenstrual dysphoric

Bipolar disorder

Mania and extreme depression

More severe than major depression

Depressed longer, relapse more often, more depressive symptoms, delusions, hallucinations, commit suicide more, more hospitalizations and overall more disability

Common signs of bipolar disorder

•excessive high moods (lasting at least 1 week)

•  increased energy, activity and restlessness

•  decreased need for sleep

•  grandiosity ( unrealistic belief in powers)

•  extreme irritability/distractibility 

•  poor judgment

•  rapid speech/flight of ideas

•  obnoxious/provocative behavior

•  risk taking behaviors (sex, substance abuse, shopping spree)

What does stress produce

anxiety (which can be good)

Stressor

any person or situation that produces an anxiety response; different for each person

Anxiety

the uncomfortable feeling of dread that happens in response to extreme or prolonged periods of stress

Types of anxiety

Mild, moderate, severe, panic

Free-floating anxiety

can’t pinpoint the cause

Signal anxiety

response to a known stressor

Mild anxiety

seldom a problem; prepares for action

Moderate anxiety

decreased attention span and ability to concentrate

severe anxiety

attention span extremely limited; difficulty completing simple tasks and behavior aimed at relieving the anxiety

Panic disorders

most intense, often no trigger, increased HR, sweaty, SOB, chest pain, fear of losing control/doom, palpitations

Panic episodes are recurrent and unpredictable

Psychoanalytical theory for anxiety

anxiety is a conflict between id and our conscience

Biological theory for anxiety

lack of neurotransmitters, body doesn’t adapt to stress

What is needed for an anxiety diagnosis

a thorough physical exam

Most common anxiety disorder

specific phobias

phobia

•Irrational fears of distinct objects or situations

•Irrational fear which causes impairment in functioning

•Person is aware and the fact that it is irrational but unable to gain control over the stressor

Social anxiety disorder

characterized by persistent fear of behaving or performing in a way that will be humiliating or embarrassing to the person.

Symptoms of generalized anxiety disorder

restless, feel on edge, shaking, palpitations, dry mouth, N/v, easily frightened, hot flashes, chills muscle aches, polyuria, difficulty swallowing, excessive attention to stimuli

OCD

Is an anxiety disorder with obsessions and compulsions

Obsessions

recurrent & persistent thoughts, urge, or images

compulsions

excessive or unrealistic repetitive act that the individual feels driven to perform in response to the obsession

Hoarding

persistent difficulty discarding or parting with possessions regardless of their value

Body dysmorphic disorder

exaggerated belief that the body is deformed or defective in some manner

Trichotillomania

recurrent pulling out of one’s hair and causes hair loss; impulse is preceded by tension and pulling hair is gratifying

Trauma and stressor-related disorders

Disorders that occur following exposure to an identifiable stressor or an extreme traumatic event.

PTSD

people who have fought in wars, been raped or survived violent storms or acts are susceptible to this

Signs and symptoms of stressor related disorders

flashbacks, recurrent/intrusive dreams/nightmares, intense distress with similar situations, social withdrawal, low self-esteem, changes in relationships, depression, chemical dependency

Dissociative disorders

Group of disorders where there is altered mind-body connections R/T stress or anxiety. There is a disturbance of or alteration in, functions of consciousness, memory and identity.

Dissociative amnesia

inability to recall important personal information usually of a traumatic or stressful nature

Dissociative fugue

sudden wandering , unable to recall one’s past, may assume new identity

Dissociative identity disorder

existence of 2 or more personalities in a single person

Somatic symptoms and related disorders

•Disorders characterized by physical symptoms suggesting medical disease, but without demonstrable organic pathology to account for them. Symptoms vague or exaggerated chronic disorder with symptoms beginning before age 30

•Anxiety and depression occur

•Periods of remission and exacerbatio

•Drug abuse and dependence common

Factitious Disorders

•People tend to be ill to get emotional needs met and attain the status of patient.

–AKA- munchausen syndrome

–Factitious Disorder by proxy-presents another victim as ill

Neurocognitive disorders

•Clinically significant defect in cognition or memory with a change in previous level of functioning

•Delirium-disturbance in attention and awareness and change in cognition-develops over a short period of time

Causes of neurocognitive disorders

infection, head trauma, migraines, high fever, seizures, stroke, substance withdrawal, taking multiple meds that interact with one another or cause toxicity

Personality disorders

•Personality traits are something we are born with or develop early in life

• characterized by inflexible and maladaptive personality traits that are either a source of subjective distress or a cause of significant impairment in social functioning.

•Exhibit common problematic behaviors that create difficulty in daily living

•Manipulation

Narcissism

•self-centered behavior person feels they don’t need to obey rules/authority; impulsive behavior

Narcissistic personality disorder

•persona has an exaggerated sense of self worth; lack empathy

Borderline personality disorder

•always in a state of crisis, unstable relationships, self-image, and affect, impulsive, intense fear of abandonment, anger , irritable, often self-mutilate and recurrent suicidal gestures and threats

Histrionic personality disorder

•“dramatic”, self-esteem depends on the approval of others, overwhelming desire to be noticed and behave dramatically

Antisocial personality disorder

disregard for and violation of rights of others; lack empathy and remorse; failure to conform to societal norms, impulsive, aggressive, often intelligent

Gender dysphoria

•Occurs when there is a discrepancy between biological gender and one’s expressed gender.

•More common in males

•One theory due to testosterone levels, family dynamics, family dysfunction

Issues related to human sexuality and paraphilic disorders

•Repetitive or preferred sexual fantasies or behaviors that involve:

–Non human objects

–Suffering or humiliation of oneself or one’s partner

–Nonconsenting persons

Exhibitionistic disorder

sexual arousal by exposing one’s genitals

Fetishistic disorder

arousal with non-living objects or non-genital parts

Pedophilia

sex. arousal with pre-puberty children

transvestic disorder

sex arousal when dresses in clothing of opposite gender

Voyeuristic disorder

”peeping tom”, aroused by watching someone undress

Addiction

•repeated compulsive use of a substance that continues despite negative consequences

tolerance

•condition in which increased amounts of a substance are needed over time to achieve same effect as previously obtained with smaller doses

Physical withdrawal syndrome

a physiological response to the abrupt stopping or reduction of a substance used . Withdrawal symptoms are specific to the substance used.

Commonly abused substances

•Alcohol,Caffeine, Cannabis, Hallucinogens, Inhalants, Opioids, Sedative-hypnotics, Stimulants, Tobacco

Substance use disorders occur when a person:

•takes more of the substance or takes it longer than intended (abuse)

•  has persistent desire to or unsuccessful effort to cut down or control use

•  experience cravings for the substance

•  is unable to fulfill major role obligations at work, home, or school

•  needs more of the substance to achieve a “high”

•  spends significant time obtaining the substance

•  gives up important functions to use the substance

•  tired to quit but obsesses about the substance

•  difficulty with job/family/or social activities d/t use or withdrawal

•  experiences withdrawal

•  uses the substance to avoid withdrawal

Codependence

people lose their own identity and exist solely for the abuser