Psychiatric + Mental Health: Exam 2

bipolar disorder

• Mood swings (depression and euphoria) with periods of normalcy

• Impacts social & occupational functioning

• Psychotic symptoms may be present in acute phases

hypomania

a psychiatric condition characterized by a distinct period of abnormally elevated, high-energy, or irritable mood that is less severe than full mania

bipolar I disorder

• Characterized by one or more manic episodes, usually alternating with major depressive episodes

• For (1) week or longer with at least (3) symptoms of mania

bipolar II disorder

• One or more major depressive episodes

• Episodic occurrences of hypomania

cyclothymic disorder

• Chronic mood disturbance

• At least 2-year duration

• Numerous episodes of hypomania and depressed symptoms

MAJOR DEPRESSION

mnemonic for depressive symptoms of bipolar disorder

mood-depressed/memory problems

What does the M in MAJOR DEPRESSION stand for?

just no fun (anhedonia)

What does the J in MAJOR DEPRESSION stand for?

appetite changes, anxious, apathetic

What does the A in MAJOR DEPRESSION stand for?

occupational impairment; oppressive guilt

What does the O’s in MAJOR DEPRESSION stand for?

rheumative; reports vague symptoms

What does the R’s in MAJOR DEPRESSION stand for?

difficulty making decisions/doubts self

What does the D in MAJOR DEPRESSION stand for?

empty feelings, energy is gone

What does the E’s in MAJOR DEPRESSION stand for?

persistent sadness, psychomotor retardation

What does the P in MAJOR DEPRESSION stand for?

sleep disturbances, suicidal ideations

What does the S’s in MAJOR DEPRESSION stand for?

irritability

What does the I in MAJOR DEPRESSION stand for?

nothing can help

What does the N in MAJOR DEPRESSION stand for?

MANIC EPISODE

mnemonic for manic symptoms in bipolar disorder

mood swing

What does the M in MANIC EPISODE stand for?

active, aggressive

What does the A in MANIC EPISODE stand for?

nothing is wrong (in denial)

What does the N in MANIC EPISODE stand for?

impulsivity, irritability, intrusive, increased risk-taking behaviors (increased sexual activity, interests)

What do the I’s in MANIC EPISODE stand for?

cannot sit still

What does the C in MANIC EPISODE stand for?

panic disorder

• Characterized by recurrent panic attacks, not a response to a specific stimulus, accompanied by intense physical /cognitive symptoms and interferes with the person’s social, relational, & occupational functioning

• Onset is unpredictable

• Symptoms peak within 10 min of onset

palpitations, racing heart, diaphoresis, flushing, trembling, shaking

Name s/s of panic disorder.

phobia

an illogical, intense, persistent fear of a specific object or social situation that results in the person being compelled to avoid the object/situation, causes extreme distress and interferes with normal life functioning

agoraphobia

• Fear of being in situations where escape is perceived as difficult or not possible and help is not available

• Causes significant distress or impairment in occupational and/or social functioning

  • Onset: ages 20-30

  • Higher incidence in women

  • Varying degrees

social phobias

• Excessive fear of doing something embarrassing or the potential of being evaluated negatively by others.

• Causes significant distress or impairment in occupational and/or social functioning

  • Exposure yields symptoms of anxiety & panic

  • Excessive self-consciousness

to decrease the fear & increase ability to function in the presence of the stimulus

What is the goal of phobias?

systematic desensitization, cognitive restructuring, and relaxation techniques

What are the cognitive and behavioral therapies of phobias?

generalized anxiety disorder (GAD)

Characterized by pervasive, persistent anxiety of at least (6) months’ duration, more days than not, but without phobias, panic attacks or obsessions and compulsions.

restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbances

What are common symptoms of GAD?

obsessive compulsive disorder (OCD)

A combination of intrusive, irrational thoughts and behavioral rituals performed to dispel the unwanted thoughts that cause the person marked distress or significant impairment

hoarding disorder

The obsessive desire to hold on to objects regardless of their actual value or usefulness; excessive need to collect items

body dysmorphic disorder

The exaggerated belief that the body is deformed or defective in some specific way.

trichotillomania

Characterized by chronic, repetitive, pulling out of one’s body hair; noticeable hair loss anywhere on the body, an inability to stop the behavior, and causes distress or impairment

excoriation disorder (trichotillomania)

Characterized by recurrent skin picking resulting in skin lesions; often accompanied with anxiety or boredom, may occur with/ without full awareness, an inability to stop the behavior, and causes distress or impairment

developing more adaptive coping methods for anxiety without resorting to the use of ritualistic behaviors

What is the goal of OCD?

cognitive restructuring and relaxation techniques

What are the cognitive and behavioral therapies of OCD?

benzodiazepines

a class of central nervous system depressants that slow brain activity to relieve anxiety, relax muscles, prevent seizures, and aid sleep

bupropion

atypical antidepressant and norepinephrine-dopamine reuptake inhibitor (NDRI). It is available by prescription only.

buspirone

an oral prescription medication primarily used to treat generalized anxiety disorder (GAD) and provide short-term relief of anxiety symptoms. It belongs to the azapirone class of compounds and is not chemically or pharmacologically related to benzodiazepines or barbiturates

personality

enduring and consistent attitudes, beliefs, desires, values and patterns of behavior

personality disorders

an enduring pattern of inner experience and behavior that deviates markedly from the expectations of an individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to significant distress or impairment

cognition, affectivity, interpersonal behavior, impulse control

Where can symptoms of personality disorders be manifested?

substance, general medical condition, inflexible, rigid, and maladaptive responses, social, occupational, objectively

Common Characteristics of all Personality Disorders

1. Patterns of behavior are not a result of another mental illness or due to the direct effects of a ____________ or ________________

2. _______________ and _________ to stressors and life events

3. Distress and impairment in ______, ________, and/or other areas of functioning

4. Inability to see themselves _______, tend to merge personal boundaries with others

psychodynamic/developmental, cognitive/behavioral, biological/neurochemical

Name the etiology theories related to personality disorders.

paranoid PD, schizotypal PD, and schizoid PD

What is cluster A of personality disorders?

antisocial PD, borderline PD, histrionic PD, narcissistic PD

What is cluster B of personality disorders?

avoidant PD, dependent PD, obsessive-compulsive PD

What is cluster C of personality disorders?

psychodynamic/developmental theories of personality disorders

• Unconscious Conflicts & Early Trauma: Rooted in Sigmund Freud's and later object-relations theories, this perspective views personality disorders as the result of unresolved childhood conflicts, repressed trauma, and poor early attachment styles (anxious, ambivalent, or disorganized).

• Defective Sense of Self: Childhood neglect, abuse, or domestic violence impairs the development of a stable ego and an integrated sense of self-identity.

• Maladaptive Defense Mechanisms: Individuals rely heavily on primitive defense mechanisms—such as splitting, projection, and projective identification—to manage overwhelming internal anxiety and unstable relationships.

• Clinical Application: Long-term exploration of transference and defense mechanisms is available through resources like the American Psychiatric Association

cognitive/behavioral theories of personality disorders

• Maladaptive Schemas & Distortions: The cognitive view argues that personality disorders stem from rigid, dysfunctional core beliefs and cognitive distortions (such as dichotomous "all-or-nothing" thinking or discounting the positive) that misguide how a person perceives themselves and others.

• Learned Behaviors & Modeling: The behavioral view sees personality traits and disorder patterns as learned through environmental conditioning, family modeling of dysfunctional behaviors, and the reinforcement of maladaptive habits.

• Social Skill Deficits: A lack of adaptive problem-solving skills and poor interpersonal strategies keep the individual stuck in destructive relational cycles.

biological/neurochemical theories of personality disorders

• Genetics & Heritability: Twin and family studies show a strong genetic component predisposing individuals to specific temperament traits, such as high emotional reactivity, impulsivity, or aggression.

• Brain Structure & Circuitry: Imaging studies reveal physical and functional differences in key brain regions, including prefrontal cortex deficits (impacting impulse control and executive function), an overactive amygdala (heightening threat detection and emotional volatility), and enlarged ventricles in certain disorders.

• Neurotransmitter Imbalances: Dysregulation in core brain chemicals—specifically serotonin (affecting mood and impulse control), dopamine (affecting reward and cognition), and norepinephrine—plays a major role in emotional instability.

cluster A personality disorders

• Core traits: Social detachment, unusual thought processes, and general distrust or suspicion of others.

• Paranoid Personality Disorder: Pervasive distrust and suspiciousness of people, assuming others intend to harm or deceive.

• Schizoid Personality Disorder: Pervasive pattern of detachment from social relationships and a restricted range of emotional expression.

• Schotypal Personality Disorder: Acute discomfort in close relationships, cognitive or perceptual distortions, and eccentric behaviors. [1, 2, 3, 4]

cluster B personality disorders

• Core traits: Impulsivity, intense or unstable emotions, and dramatic relationship patterns.

• Antisocial Personality Disorder: Disregard for and violation of the rights of others, often lacking guilt or remorse.

• Borderline Personality Disorder: Marked instability in self-image, interpersonal relationships, and mood, coupled with intense fear of abandonment.

• Histrionic Personality Disorder: Pervasive and excessive emotionality and attention-seeking behavior.

• Narcissistic Personality Disorder: Grandiosity, a constant need for admiration, and a lack of empathy for others.

cluster C personality disorders

• Core traits: Chronic anxiety, fear of rejection, and a strong need for control or reliance on others.

• Avoidant Personality Disorder: Social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation or rejection.

• Dependent Personality Disorder: Submissive and clinging behavior driven by an excessive need to be taken care of.

• Obsessive-Compulsive Personality Disorder: Preoccupation with orderliness, perfectionism, and mental or interpersonal control (distinct from obsessive-compulsive disorder or OCD).

paranoid personality disorder

• Distrusting, suspicious

• Argumentative, Short tempered,

• Difficulty adjusting to change

• Unwarranted jealously of a significant other regarding fidelity, attention, etc

• Unforgiving, insensitive, vengeful

schizoid personality disorder

• Prefers solitude, low stress, routines and repetition

• Indifferent to feedback from others

• Anhedonia, flattened affect, restricted range of emotions

• Difficulty expressing anger

• Brief psychotic episodes in response to stressful events

• Higher incidence in families with schizophrenia

schizotypal personality disorder

• Belief that all events refer to self

• Odd beliefs that influence behaviors (superstitious, telepathy, etc)

• Odd speech and appearance (metaphorical, over elaborate, etc)

• Inappropriate or constricted affect

• Excessive anxiety in social situations related to paranoid fears

• Higher incidence in families with schizophrenia

antisocial personality disorder

• Failure to conform to social norms

• Involvement in illegal activities

• High incidence of substance abuse

• Lack of guilt and empathy

• Lack of impulse control

• Irresponsibility

• Dishonest, Manipulative

• Aggressive

borderline personality disorder

• History of abuse, neglect, and/or early parental loss or separation

• Frantic efforts to avoid real or imagined abandonment, intense, stormy relationships

• Recurrent suicidal ideations and self mutilation

• Markedly and persistently unstable self image

• Impulsive (bingeing, spending, unsafe sex, etc)

• Negative or angry affect

histrionic personality disorder

• Attention seeking, self-centered attitude

• Sexually seductive or provocative behavior

• Rapidly shifting, shallow emotions, easily influenced

• Use of suicidal gestures and threats for attention

• Attentiveness to physical appearance

• Considers relationships to be more intimate than they actually are

• Complaints of physical illness,

narcissistic personality disorder

• Grandiose view of self, requiring excessive admiration

• Lack of empathy towards others

• Interpersonally exploitative, envious

• Preoccupied with fantasies of self importance, beauty, brilliance, etc

• Arrogant behaviors and attitude

• Sense of entitlement

avoidant personality disorder

• Avoidance of social situations due to fear of criticism or rejection

• Tendency to withhold thoughts/feelings

• Negative sense of self, low self esteem

• Very critical of themselves

• Reluctant to take risks or engage in new activities

• Shy and anxious

dependent personality disorder

• Needs others to assume major responsibility for them

• Unable to make decisions independently

• Clingy and submissive

• Preoccupied with fears of being left to take care of self

• Goes to excessive lengths to obtain support and nurturing from others

obsessive-compulsive personality disorder

• Very rigid, perfectionist

• Preoccupied with rules, details, lists, etc

• Difficulty in relaxing, self-criticism

• Insistent on others’ conforming to their methods, reluctant to delegate tasks

• Discarding or hoarding issues

• Fear of losing control over situations, objects or people

losses, major affective disorder, anxiety disorder, interpersonal conflicts, somatic issues, referred, alcoholism/chemical dependency

What are things that might bring a client with PD into treatment?

acute coexisting disorder

Hospitalization for personality disorders is inappropriate unless there is an _______________________ or the client exhibits a suicide risk, self-mutilating behaviors, etc.

anxiolytics and SSRIs

may be used to reduce anxiety and depression

lithium/anticonvulsants

helps regulate moods and control aggression and impulsivity, and predatory behaviors

short-term, low-dose antipsychotics

may be used for transient psychotic states caused by overwhelming stress

risk control, adherence behavior, symptom control/decreased use of maladaptive coping behaviors

What are the goals of treatment for personality disorders?

family support of personality disorders

• Assist family members in defining and maintaining boundaries

• Encourage the family to set clear definitions of acceptable behavior for the client within the family

• Assist family members with coping skills in dealing with the client

• Teach family members to use stress management techniques

self-care for the nurse

• Self-awareness is crucial, analyze your own feelings and reactions to a client with personality disorder

• Seek assistance from a peer to prevent feelings from interfering with therapeutic performance

• Maintain ongoing team communication regarding expectations for these clients

empathize, for, against, maladaptive, new patterns

Outpatient Care of Personality Disorder

• _____________ with client, facilitate the development of a therapeutic relationship

• Address the presenting problems

• Assist client in realizing that their behaviors are not working ___ them, but rather ______ them

• Find appropriate behaviors to replace their current _____________ behaviors

• Encourage the client to try out ____ _______ of thinking and behaving, therapist acts as a coach

history, physical exam, family assessment, mental status exam/psychological tests, legal history

What are the assessments of a personality disorder?

suicidal ideation and/or violence towards others

During a mental status exam, what specifically should you look for in a personality disorder?

promote safety, administer medications, present reality, enhane socialization

Name nursing interventions for bipolar disorder.