Psych Unit Two (copy)

Adverse Childhood experiences

Sesitize people to stress later in life. These experiences include

* Any form of psychological physical or sexual abuse
* Violence against a parent, particularly the mother
* Living with people with substance use disorders, mentally ill, or incarcerated

Distress

Negative draining energy that results in anxiety, depression, confusion, helplessness, hopelessness, and fatigue

Eustress

Normla physiological positive energy that motivates individuals and results in positive feelings and purposeful movement

General adaptation syndrome

Syndrome that results from an attempt to adapt to anxiety situations. Has three stages

Three stages of GAS

1. Alarm or acute stress stage: activates the sympathetic nervous system, activates HPA axis to stay on alert “fight or flight” mode
2. Resistance or adaptation stage: sustained and optimal resistance to the stressor, recover, renewal, and repair may occur
3. Exhaustion stage: resources are depleted, the stress may become chronic. This can result in chronic health conditions

Mild Anxiety

Day to day tension. Keeps a person alert and motivated, problem solving and grasping information is increased. Can be considered Eustress

Moderate anxiety

Selective inattention, clear thinking is hampered, problem solving is less than optimal but still possible, SNS symptoms begin. Engaging a patient can bring them back from this.

Severe anxiety

Perceptual field greatly reduced. Difficulty concentrating on the environment, confused and automatic behavior. Somatic stress symptoms increase. Patient is unable to take in the “big picture” physical symptoms of stress develop

Panic

Markedly disturbed behavior such as running, shouting, screaming, pacing. Unable to process reality. Impusivity. Patient will be in danger of harming themselves or others, not able to judge their space

Crisis

Stressor in life that requires an individual to adjust to the unexpected and to adapt to an unpredicted situation or event.

Three types of crisis

* Maturational: Crisis that occurs due to transition into another stage of life
* Situational: events that are unusually distressing and unanticipated. Affects only the person experiencing the crisis
* Adventitious: Traumatic and external event that happens unexpectedly. Will typically affect many people. Ex: natural disaster

Phase 1 of the crisis response

Serious stressor results in increased anxiety. Stimulates the usual coping mechanisms to address the problem and decrease anxiety. Minor anxieties can be respolved here

Phase 2 of the crisis response

Defense mechanisms fail, threat persists, anxiety increases which results in feelings of discomfort, disorganized functioning, and trial and error attempts at problem solving. Person will be desperate and disorganized in attempt to resolve issues

Phase Three crisis response

Trial and error fails resulting in increased anxiety to severe or panic level. Automatic relief behaviors are mobilized(withdraw, flight, etc). Some form of resolution may be devised such as compromising or redefining the situation

Phase 4 Crisis response

Problem is unsolved and coping skills are ineffective. Overwhelming anxiety can lead to personality disorganization, confusion, violence, and self injury

Assessment of crisis situation

Assessing perception of the precipitating event. Assessing the situational support(who can help them through the crisis), assessing coping skills(how can they help themselves through the crisis)

Steps in crisis intervention

Planning

* devise a plan to restire client to previous level of functioning

Intervention

* Help pt gain understanding of the crisis, explore coping mechanisms

Resolution

* Restore to previous level of functioning. Anticipatory planning for next crisis

Levels of Crisis prevention

* Primary prevention: promotes mental health and reduces mental illness to decrease incidence of crisis
* Secondary prevention: intervention during an acute crisis to prevent prolonged anxiety
* Tertiary prevention: Provides long term support for those who have experienced crisis

Stress debriefing

Tertiary prevention tool. allows for a group to discuss a stressful event and express their emotions on it

Post-Traumatic stress disorders

Persistent re-experiencing of a highly traumatic event. This event will involve actual or threatened harm or death to self or others. Can begin a month after exposure, but symptoms may not arise for months to years

Major features of PTSD

Flashbacks: re-experiencing the trauma through intrusive recollections of the event

Avoidance: of stimuli associated with trauma

Hyper-vigilance: exaggerated startle response

Alterations in mood: chronic depression, lack of interest

Biological treatment for PTSD

SSRI’s, Sertraline(zoloft), Paroxetine(paxil), benzodiazepines

Psychological therapies for PTSD

Exposure therapy, cognitive reconstructing, EMDR therapy, CBT

Acute stress disorder

may develop after exposure to a highly traumatic event. Diagnosed 3 days to 1 month after exposure.

Adjustment disorder

Milder, less specific version of ASD and PTSD. Precipitated by a stressful event. Symptoms may include all forms of distress

PTSD in children and adolescents

Manifests in reduction in play, self blame, estrangement loss of interest in significant activities. Children are more resilient than adults and more able to return to previous levels of functioning after treatment

Interventions for children with PTSD

use interactive process, establish trust, developmentally appropriate language, regulate emotional response, art and play, coordinate with social work

Evaluation for children with PTSD

Treatment is effective when: safety is ensured, anxiety is reduced, eReamotions are appropriate

Reactive attachment disorder

Childhood condition: Consistent pattern of inhibited emotionally withdrawn behavior unresponsive to caregiver efforts to offer comfort

Disinhibited social engagement disorder

childhood disorder; no normal fear of strangers, seemingly unfazed by separation from caregiver

Dissociative disorders

Occur after significant adverse experiences/traumas. Individuals respond to stress with severe interruption in consciousness. Results in disturbance in memory, consciousness, self identity, perception

Dissociative amnesia

inability to recall important personal information. Often of a traumatic event

Dissociative Fugue

Subtype characterized by sudden, unexpeted travel and inability to recall ones identity/information about the past

Depersonalization

Focus on self-extremly uncomfortable feeling of being an observer of ones own body or mental process

Derealization

Focus on outside-recurring feeling that ones surroundings are unreal or ditant. Person feels as if walking in a fog

Dissociative Identity Disorder

Presance of two or more distinct personality states. Each alternate personality has its own pattern of perceiving, relating to and thinking about self and environment.

Manifestations of DID

History of multiple physical and psychiatric diagnoses, violent trauma. Inconsistencies in behavior, pattern of psychophysiological complaints, experiences of voice inside the head talking to one another(NOT psychosis)

Biological treatment DID

No specific medications, some may be used to hyperarousal and intrusive symptoms

Psychological therapies DID

CBT, psychotherapy, exposure therapy, EMDR, neurofeedback, somatic therapy,

Adaptive defense mechanisms

Lowers anxiety for acceptable achievement of goals

Maladaptive defense mechanisms

Immature defenses that can eventually make anxiety worse

Altruism

Motivation to feel caring and concern for other and act for the well being of others. Can be adaptive(Running an AA meeting) or maladaptive(hoarding dogs to “give them a better life”)

Compensation

Used to counterbalance perceived deficiencies by emphasizing strengths. Can be adaptive or maladaptive

Conversion

Unconscious transformation of anxiety into a physical symptom with no organic cause. Always maladaptive(CONVERSION DISORDER)

Denial

escaping unpleasant anxiety causing thoughts, feelings, wishes, or needs by ignoring their existence. Can be adaptive or maladaptive

Displacement

Transference of emotions associated with particular person, object, or situation to another nonthreatening situation or person. Can be adaptive or maladaptive

Dissociation

Disruption in consciousness, memory, identity, or perception of the environment that results in compartmentalizing uncomfortable or unpleasant aspects of oneself. Adaptive or maladaptive

Identification

attributing oneself to the characteristics of another person or group. Adaptive or maladaptive

Intellectualization

a process in which events are analyzed based on remote, cold facts and without passion, rather than incorporating feeling and emotion into the processing. Adaptive or maladaptive

Projection

refers to the unconscious rejection of emotionally unacceptable features and attributing them to others. Always maladaptive

Rationalization

justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations that satisfy the teller and the listener. Adaptive or maladaptive

Reaction formation

unacceptable feelings or behaviors are controlled and kept out of awareness by developing the opposite emotion or behavior. Adaptive or maladaptive

Regression

reverting to an earlier, more primitive and childlike pattern of behavior that may or may not have been exhibited previously. Adaptive or maladaptive

Repression

unconscious exclusion of unpleasant or unwanted experiences, emotions, or ideas from conscious awareness. Adaptive or maladaptive

Splitting

inability to integrate the positive and negative qualities of oneself or others into a cohesive image. Always maladaptive

Sublimation

unconscious process of transforming negative impulses into less damaging and even productive impulses. Adaptive or maladaptive

Suppression

conscious decision to delay addressing a disturbing situation or feeling. Adaptive or maladaptive

Undoing

a person makes up for a regrettable act or communication. Adaptive or maladaptive.

Primary gain

Action that contributes to a first initial decrease of anxiety

Secondary gain

Reinforces actions and behaviors as well as detachment from anxiety

Ego-dystonic

A person recognizes what they are doing is maladaptive

Ego-syntonic

person feels as if their disorder and maladaptive behaviors is part of who they are

Separation Anxiety

Developmentally inappropriate levels of concern over being away from a significant other or support person(parent, etc).

Symptoms of separation anxiety

Excessive distress when away from support person leading to constant reassurance seeking. Clingy even when home, persistent worry about losing attachment figure. Worry about something bad happening to attachment figure

Generalized anxiety disorder

Excessive anxiety and worry most days for more than 6 months. Difficulty controlling the worry.

Physical symptoms of anxiety

Restlessness, Fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance

Panic Disorder

Recurrent or unexpected panic attacks, attacks are followed by one or more months of worry about additional attacks. Includes functional changes, occasionally agoraphobia

Symptoms of panic disorder

Rapid heart rate, sweating, trembling, shortness or breath, fear of losing control or death

Specific phobias

Fear or anxiety with a specific object or situation. Fear is irrational to the situation and the person may recognize it as unreasonable

Symptoms of phobias

Object or situation ALWAYS provokes anxiety, active avoidance of object, disproportionate feat, avoidance of object for over 6 months

Social anxiety disorder

AKA social phobia, fear or anxiety about one or more social situations in which the person is exposed to possible judgment or negative appraisal by others. Fear of humiliation of embarrassment

Characteristics of social anxiety

Social situations almost always cause distress, avoidance of social situations, fearing public speaking

Agoraphobia

Fear of the public, including open spaces, crowds, and being outside of home

Obsessive Compulsive disorder

recurrent thoughts or behaviors that are extremely distressing and/or interfear with functioning

Obsessions

Unwanted, intrusive images or thoughts that are intensly distressing. Includes contamination, religious concerns, perfectionism, and commiting violence

Compulsions

Compensatory behaviors that are used to relive the anxiety caused by the obsession or decrease distress

Body dysmorphic disorder

Preoccupation with one or more perceived personal deficits. False assumptions about appearance, repetitive behaviors, significant distress about appearance. Not otherwise explained by eating disorder

Hoarding

Persistent difficulty discarding items regardless or value, has a perceived need of these items. Accumulation of items clutters space and causes distress in daily functioning

Trichotillomania

recurrent pulling on ones hair resulting in hair loss. Repeated attempt to stop with no success results in distress and functional impairment

Excoriation disorder

recurrent skin picking that results in lesions, often on hands and face. Repeated attempts to stop with no success results in distress and functional impairment. No medical cause

Risk factors for OCD

Child abuse and trauma. Post infectious autoimmune syndrome. Genetics(first degree relative), comorbidity with GAD, eating disorders, and tic disorders

Somatization

Expression of stress through physical symptoms that are often manifestations of psychological and emotional distress. Symptoms expressed in place of anxiety, depression, irritability

Somatic symptom disorder

One or more distressing somatic symptoms, excessive thoughts, anxiety and behaviors around symptoms or health concerns. Without significant physical findings and medical diagnosis. Suffering is authentic and there is a high level of functional impairment

Illness anxiety disorder

Fear and preoccupation with having of aquiring serious illness for at least 6 months.

Symptoms of illness anxiety disorder

Somatic symptoms absent or mild, frequent self scanning for illness, excessive health related behaviors and avoidance, care seeking or care avoidant

Conversion disorder

Neurological symptoms in the absence of a neurobiological diagnosis. presence of deficits in voluntary motor or sensory functions.

Symptoms conversion disorder

Paralysis, blindness, movement and gait disorders, numbness, paresthesias, loss of vision or hearing, epileptic episodes, **la belle indifference** not distress

Selective Serotonin Reuptake Inhibitors

Blocks the synaptic reuptake of serotonin. First line treatment for depression, anxiety, and OCD,

Names of SSRIs

Citalopram, escitalopram, fluoxetine, paroxetine, Sertraline

Side effects SSRIs

Agitation, Insomnia, headache, N/V, sexual dysfunction, hyponatremia

SSRI Withdrawl

occurs when SSRIs are stopped suddenly, causes dizziness, insomnia, headache, irritability and agitation

Serotonin Norepinephrine Reuptake Inhibitor

Blocks the synaptic reuptake of serotonin and norepinephrine

Types of SNRIs

Desvenlafaxine, Duloxetine(cymbalta), Levomilacipran, Venlafaxine(effexor)

Side effects SNRIs

Nausea, hypertension, GI upset(diarrhea or constipation), dizziness, dry mouth, sweating, decreased appetite, insomnia

Serotonin Antagonists and Reuptake inhibitors

Blocks reuptake of serotonin due to being an antagonist in the receptor.

Types of SARI

Nefazodone, Trazodone, Vilazodone, Vortioxetine

Norepinephrine Dopamine Reuptake Inhibior

Bupropion(Wellbutrin), Blocks reuptake of norepinephrine and dopamine.

Side effects of NDRIs

Reduction in appetite, agitation, insomnia, headache, N/V, high dose is a seizure risk

Tricyclic Antidepressants

Inhibit the synaptic reuptake of serotonin and norepinephrine, antagonize adrenergic, histaminergic, muscanaric receptor. More side effects than SSRIs

Types of tricyclic antidepressants

Amitriptyline, amoxapine, desipramine, doxepine, imipramine,