Mental Health Exam 2

what is a serious mental illness?

mental disorder that significantly interferes with functioning

what are some barriers to health?

MANY;

* residual symptoms and relapse
* medication side effects
* unemployment and poverty
* stigma
* social isolation and loneliness
* SUD
* anosognosia

\

what is anosognosia?

the inability of a person to recognize that he/she has an illness b/c of the illness itself, also contributes to nonadherence

what is assertive community treatment?

(ACT) programs use a treatment -team approach

* shows improved symptom management and quality of life while reducing hospitalization.

what is cognitive-behavioral therapy?

helps patients change thoughts, feelings, and behaviors to decrease symptoms and improve quality of life.

* helps patients perceive situations more positively and accurately

what is dialectical behavior therapy?

includes aspects of CBT and mindfulness practices, focusing on accepting what cannot be changed and changing what is amendable to change.

* may reduce symptoms of mood disorders

what is the rehabilitation model?

focuses on the deficits, symptoms, and stability rather than on quality of life and cure.

what is the national alliance of mental illness (NAMI)?

a leading advocacy organization , along with other mental health organizations and treatment providers.

what is vocational rehab?

prevocational training (skills needed to obtain employment) and initial employment in a sheltered setting, building to competitive employment in the business world

what is impulse control disorder?

**the decreased ability to resist an impulse**

\-tension is built until particular action is taken

\-can be from benign to harmful (stealing to fire setting)

\-uncontrollable urge despite knowing it is wrong

what are some examples of impulse control disorders?

intermittent explosive disorder

kleptomania

pyromania

gambling disorder

trichotillomania

\

what is intermittent explosive disorder?

recurrent, unpremeditated episodes of verbal or behavioral aggression or rage

* often severe enough to hurt people or destroy significant property

what is kleptomania?

uncontrollable and recurrent urge to steal

what is pyromania?

reoccurring compulsion to set fires and experiencing sense of accomplishment or relief when setting fires

\
\-often accompanied by a sense of pleasure or release

what is trichotillomania?

repetitively pulling one’s hair in order to relive tension

\-worsen with stress

what are some possible causes for impulsive control disorders?

higher serotonin levels

frontotemporal dementia, parkinson’s, MS, TBI, and substance abuse

dopamine-receptor agonists

coping mechanism

\

what medications are used in treatment of kleptomania, trichotillomania, and pathologic gambling?

SSRIs, bupropion, and opioid antagonists

what are nonpharmacological interventions for ICD?

hypnotherapy

CBT: habit reversal and sensitization

biofeedback

behavioral conditioning

group therapy

trust and empathy

\

what is gender dysphoria?

a difference NOT a disorder

* identification as gender different than original gender

\

what are paraphilias?

sexual acts or fantasies that involve deviation from social norm; NOT a disorder

* on a continuum with normal sexual interest, unless the person experiences distress about sexual differences!

what are paraphilic disorders?

cause distress, risk of harm, or actual harm to oneself or others- defined by the DSM-5

* exhibitionistic disorder
* fetish
* frotteuristic disorder
* pedophilia
* sexual masochism and sexual sadism
* transvestic fetishism
* voyeuristic disorder

what is an exhibitionistic disorder?

achievement of sexual arousal or pleasure by exposing one’s genitals, usually to a stranger

what is frotteuristic disorder?

obtaining sexual arousal and gratification from rubbing one’s genitals against unsuspecting others in public places

what is transvestic disorder?

deriving sexual gratification by dressing as a person of the opposite gender.

what is voyeuristic disorder?

deriving sexual gratification from observing secretly unsuspecting persons in sexually arousing situations ( undressing or engaging in sexual activity)

\
**peeping tom**

what may be possible causes of paraphilic disorders?

neurodevelopmental

TBI

dementia

failure to develop appreciate attachments (erikson’s)

learned responses

what are some interventions for paraphilic disorders?

support

group therapy

stress reduction- to decrease impulsive behaviors and to reduce urges

decrease in sexual hormones to reduce sexual urgers

\

what mediations can help with paraphilic disorders?

antidepressants, naltrexone, antipsychotics, mood stabilizers, \n medications that interfere with sexual hormones.

what is naltrexone?

help narcotic dependents who have stopped taking narcotics to stay drug-free

what is adult ADHD?

exhibits a persistent pattern of inattention, impaired ability to focus and concentrate, and hyperactivity and impulsivity

\
\-inhibits academic and socioeconomic achievement

\-more impulsive and risky behaviors

what are possible causes of ADHD?

neurodevelopmental disorder

alterations in dopamine

genetic

fetal distress, prematurity, neurotoxins exposure, and maternal substance abuse

what are interventions for ADHD?

support groups

clear and concise communication

cognitive therapy

educate on dangers of sharing meds!

what medications can be used for ADHD?

same drugs for children

* stimulants are the most used- enhance dopamine and norepinephrine functioning such as
* methylphenidate(Ritalin) and amphetamine variants (Adderall)

what are sleep-related disorders?

alterations in sleep die to physical or psychological conditions or phenomena such as shift work

\
\-disruption in REM or non-REM sleep

\-increase risk of accidents

what is hypersomnolence?

excessive sleep

what is obstructive sleep apnea/hypopnea?

temporary cessation or decrease in breathing during sleep

what is narcolepsy?

sudden irresistible urge to sleep

what is a circadian rhythm disorder?

dysregulation of internal sleep-wake cycle

what is sleep arousal disorder?

abnormal experiences during sleep, often in response to a dream

what is restless leg syndrome?

urge to move one’s leg in response to irritating sensation that improves with movement

what are the possible causes of sleep-related disorders?

problem with hypothalamus

alteration in serotonin and norepinephrine that promote sleep

alteration in dopamine that affect wakefulness

genetic component

trauma

depression, mania, schizophrenia, anxiety

what are interventions for sleep-related disorders?

teach sleep hygiene

exercise

identify and treat underlying reason

CBT

\

what medications can be used for sleep-related disorders?

non-benzos: Ambien

melatonin

what mediations are used for narcolepsy?

Wake-promoting drugs such as methylphenidate and \n modafinil

* side effects: headache, irritability, and GI complaints

what are some side effects of benzos?

grogginess, impaired coordination and reflexes, dizziness, and increased fall risk in susceptible persons such as the elderly

* use short-term to avoid tolerance/addiction

what is stress defined as?

a process with physical, psychological, and behavioral ,a nd cognitive components in response too a perception of physical, environmental, and psychosocial demands placed.

what is eustress?

beneficial stress

what is distress?

stress that causes emotional and physical problems

what is the psychological response to stress?

\
“fight or flight”

amygdala sends signal to the hypothalamus→SNS signals the adrenal gland to release epinephrine→hypothalamus-pituitary-adrenal axis simulated by hypothalamus→if prolonged, CRH, ACTH, and cortisol are released→cortisol supplies cells with glucose and energy

what is another psychological response to stress?

option 2- FREEZE

what is PTSD?

usually occurs after a traumatic event outside the range of usual human experience

\-feelings of helplessness/powerlessness

\-symptoms can be present for >1 month

what are PTSD symptoms?

* traumatic event
* re-experiencing the trauma
* avoiding things associated with the trauma
* unable to function
* for 1 month or more
* increased arousal- such as irritability, angry outbursts, self-destructive behavior, sleep difficulties

what are the risk factors of PTSD?

female

family or personal history of psychiatric illness

lower education level

military service

TBI

cardiovascular disease or depressive disorders (also caused by PTSD)

\

what are patients with PTSD at risk for developing?

dementia, HTN, cancer, GI disorders, obesity, and dissociative symptoms

what are some interventions for PTSD?

CBBT

SSRIs

group therapy

family therapy

EMDR (eye movement desensitization and reprocessing)

what is the treatment for flashbacks, avoidance, and numbing?

SSRI antidepressants, second-generation antipsychotics

what is the treatment for “treatment-resistant PTSD”?

second-generation antipsychotics, anticonvulsants

what is the treatment for panic attacks?

antidepressants, MAOIs, and high potency benzos

what is the treatment for hyperarousal?

antidepressants, benzos, and anticonvulsants

what is the treatment for nightmares?

prazosin (Minipress)

when does acute stress disorder occur?

after experiencing a traumatic event or repeatedly witnessing a violet or traumatic event

\-symptoms can resolve within a month

what is compassion fatigue?

sometimes called secondary traumatic stress

* describes a phenomenon in which nurses and other health care workers become indirectly traumatized when trying to help a person who has experienced primary traumatic stress

what are the symptoms of compassion fatigue?

feeling overwhelmed, physically and mentally exhausted

interferes with ability to function

intrusive thoughts/images of another's critical experience

difficulty separating work from personal life

dread of working with certain individuals

depression

pessimistic and prone to anger

\

what are interventions for compassion fatigue?

practice self-care

* incorporate activities into your schedule that will bring you joy, pleasure, and diversion
* get medical care to relieve symptoms that infer with functioning
* find aspects of your life for which you are grateful and avoid negativity

what are some stress-reduction techniques?

eliciting the relaxation response

physical activity

social supports

reframing

sleep

reduce caffeine

\

how are dissociative disorders defined?

disturbance in the normally well integrated continuum of consciousness, memory, identity, and perception

* they do not display delusional thinking or hallucinations

what are examples of dissociative disorders?

depersonalization/derealization disorder

dissociative amnesia

dissociative identity disorder (DID)

what are some contributing factors to dissociative disorders?

* protective response to trauma
* comorbid disorders such as SUD, depression and anxiety disorders, PTSD, and personality disorders
* underactive prefrontal and anterior cingulate cortex
* overactive amygdala

what are some interventions for dissociative disorders?

* maintain safety and trust
* milieu therapy ( good environment)
* CBT
* dialectical behavior therapy
* eye movement desensitization and reprocessing
* group therapy

anxiety can be defined as:

a feeling of apprehension, uneasiness, uncertainty, or dread resulting from a real or perceived threat whose actual source is unknown or unrecognized

\
can be maladaptive or adaptive

levels: mild, moderate, severe and panic

fear is defined as:

a reaction to a **specific** danger

who is anxiety more prevalent in?

women

* begins at any age

what are the comorbidities of anxiety?

co-occur with depressive disorders, SUD, eating disorders, BPD, cancer, IBS, kidney and liver dysfunction, reduced immunity, and cardiovascular disorders

what are the causes of anxiety?

* medications or medical conditions
* possible combination of biological, psychological, and environmental factors, trauma, and/or social influences
* originates in the limbic system
* low serotonin, elevated norepinephrine, and and/or low GABA
* learned response
* cognitive distortion

what is normal anxiety?

healthy life force necessary for survival

what is acute anxiety?

precipitated by imminent loss or threat

what is pathological anxiety?

intense emotional response not in proportion

what are the levels of anxiety?

\

moderate anxiety

perceptual field narrows; physical symptoms involve more vital organs

severe anxiety

perceptual filed is greatly reduced; physical symptoms intensify

\-S/S: hyperventilation and sense of dread or impending doom

panic anxiety

nearly complete loss of perception; physical symptoms are severe

\-confusion, shouting, screaming, or extreme withdrawal may be present

GAD-7

generalized anxiety disorder tool used to get objective data- evidence based assessment

what are interventions for mild to moderate anxiety?

active listening

escalation prevention

developing self-awareness of verbal and non-verbal relief behaviors

assist in generating solutions

support groups

what are interventions for severe to panic anxiety?

safety

attend to physical needs

communicate with short, firm, and simple statements

quiet environment

what are healthy defense mechanisms?

altruism

sublimation

humor

suppression

what are intermediate defense mechanisms?

repression

displacement

reaction formation

somatization

undoing

rationalization

what are detrimental defense mechanisms?

passive aggression

acting-out behaviors

dissociation

devaluation

idealization

splitting

projection

denial

what is a panic attack?

sudden onset of extreme apprehension or fear

\-misinterpretation of reality

what do panic attacks increase rates of?

suicide attempts and suicides

what are symptoms of a panic attack?

palpitations, chest pain, diaphoresis, muscle tension, urinary frequency, hyperventilation, breathing difficulties, nausea, feelings of choking, hot flashes, and GI distress

what are the interventions of panic attacks?

benzos- short term only

SSRI

CBT

SNRI- venlafaxine, duloxetine

phobias:

are persistent, intense irrational fear of an object, activity, or situation that leads to a desire or actual avoidance

\-specific or social

\-associated with panic level anxiety

what are interventions for phobias?

propranolol-social

SSRI

CBT

social skill training

acceptance and commitment therapy

what is agoraphobia?

an intense and excessive level of anxiety and a fear of being in places and situations from which escape is impossible, avoidance behavior is debilitating.

what is generalized anxiety disorder?

excessive worry about several events and activities present most days out of 6 months

\-have at least 3 of the following

* restlessness
* fatigue
* poor concentration
* irritability
* muscle tension
* sleep disturbances

what are interventions for GAD?

buspirone

SSRI

CBT

SNRI-venlafaxine, duloxetine

what is obsessive compulsive disorder?

combination of obsessions and compulsions

they exist on a continuum

obsessions:

\n unwanted, intrusive, persistent ideas, thoughts, impulses, or \n images that cause significant anxiety or distress

compulsions:

\n Unwanted, ritualistic behavior the individual feels driven to perform to reduce anxiety

when does OCD occur?

neurobiological disorder that presents in late teens to early 20’s