Mental Health Exam 2

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what is a serious mental illness?

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1

what is a serious mental illness?

mental disorder that significantly interferes with functioning

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2

what are some barriers to health?

MANY;

  • residual symptoms and relapse

  • medication side effects

  • unemployment and poverty

  • stigma

  • social isolation and loneliness

  • SUD

  • anosognosia

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3

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

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4

what is assertive community treatment?

(ACT) programs use a treatment -team approach

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

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5

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

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6

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

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7

what is the rehabilitation model?

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

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8

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

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

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9

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

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10

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

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11

what are some examples of impulse control disorders?

intermittent explosive disorder

kleptomania

pyromania

gambling disorder

trichotillomania

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12

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

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13

what is kleptomania?

uncontrollable and recurrent urge to steal

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14

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

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15

what is trichotillomania?

repetitively pulling one’s hair in order to relive tension

-worsen with stress

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16

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

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17

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

SSRIs, bupropion, and opioid antagonists

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18

what are nonpharmacological interventions for ICD?

hypnotherapy

CBT: habit reversal and sensitization

biofeedback

behavioral conditioning

group therapy

trust and empathy

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19

what is gender dysphoria?

a difference NOT a disorder

  • identification as gender different than original gender

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20

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!

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21

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

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22

what is an exhibitionistic disorder?

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

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23

what is frotteuristic disorder?

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

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24

what is transvestic disorder?

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

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25

what is voyeuristic disorder?

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

peeping tom

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26

what may be possible causes of paraphilic disorders?

neurodevelopmental

TBI

dementia

failure to develop appreciate attachments (erikson’s)

learned responses

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27

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

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28

what mediations can help with paraphilic disorders?

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

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29

what is naltrexone?

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

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30

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

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31

what are possible causes of ADHD?

neurodevelopmental disorder

alterations in dopamine

genetic

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

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32

what are interventions for ADHD?

support groups

clear and concise communication

cognitive therapy

educate on dangers of sharing meds!

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33

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)

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34

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

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35

what is hypersomnolence?

excessive sleep

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36

what is obstructive sleep apnea/hypopnea?

temporary cessation or decrease in breathing during sleep

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37

what is narcolepsy?

sudden irresistible urge to sleep

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38

what is a circadian rhythm disorder?

dysregulation of internal sleep-wake cycle

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39

what is sleep arousal disorder?

abnormal experiences during sleep, often in response to a dream

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40

what is restless leg syndrome?

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

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41

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

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42

what are interventions for sleep-related disorders?

teach sleep hygiene

exercise

identify and treat underlying reason

CBT

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43

what medications can be used for sleep-related disorders?

non-benzos: Ambien

melatonin

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44

what mediations are used for narcolepsy?

Wake-promoting drugs such as methylphenidate and \n modafinil

  • side effects: headache, irritability, and GI complaints

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45

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

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46

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.

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47

what is eustress?

beneficial stress

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48

what is distress?

stress that causes emotional and physical problems

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49

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

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50

what is another psychological response to stress?

option 2- FREEZE

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51

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

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52

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

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53

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)

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54

what are patients with PTSD at risk for developing?

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

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55

what are some interventions for PTSD?

CBBT

SSRIs

group therapy

family therapy

EMDR (eye movement desensitization and reprocessing)

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56

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

SSRI antidepressants, second-generation antipsychotics

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57

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

second-generation antipsychotics, anticonvulsants

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58

what is the treatment for panic attacks?

antidepressants, MAOIs, and high potency benzos

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59

what is the treatment for hyperarousal?

antidepressants, benzos, and anticonvulsants

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60

what is the treatment for nightmares?

prazosin (Minipress)

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61

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

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62

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

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63

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

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64

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

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65

what are some stress-reduction techniques?

eliciting the relaxation response

physical activity

social supports

reframing

sleep

reduce caffeine

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66

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

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67

what are examples of dissociative disorders?

depersonalization/derealization disorder

dissociative amnesia

dissociative identity disorder (DID)

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68

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

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69

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

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70

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

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71

fear is defined as:

a reaction to a specific danger

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72

who is anxiety more prevalent in?

women

  • begins at any age

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73

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

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74

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

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75

what is normal anxiety?

healthy life force necessary for survival

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76

what is acute anxiety?

precipitated by imminent loss or threat

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77

what is pathological anxiety?

intense emotional response not in proportion

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78

what are the levels of anxiety?

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79

moderate anxiety

perceptual field narrows; physical symptoms involve more vital organs

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80

severe anxiety

perceptual filed is greatly reduced; physical symptoms intensify

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

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81

panic anxiety

nearly complete loss of perception; physical symptoms are severe

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

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82

GAD-7

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

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83

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

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84

what are interventions for severe to panic anxiety?

safety

attend to physical needs

communicate with short, firm, and simple statements

quiet environment

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85

what are healthy defense mechanisms?

altruism

sublimation

humor

suppression

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86

what are intermediate defense mechanisms?

repression

displacement

reaction formation

somatization

undoing

rationalization

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87

what are detrimental defense mechanisms?

passive aggression

acting-out behaviors

dissociation

devaluation

idealization

splitting

projection

denial

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88

what is a panic attack?

sudden onset of extreme apprehension or fear

-misinterpretation of reality

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89

what do panic attacks increase rates of?

suicide attempts and suicides

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90

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

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91

what are the interventions of panic attacks?

benzos- short term only

SSRI

CBT

SNRI- venlafaxine, duloxetine

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92

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

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93

what are interventions for phobias?

propranolol-social

SSRI

CBT

social skill training

acceptance and commitment therapy

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94

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.

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95

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

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96

what are interventions for GAD?

buspirone

SSRI

CBT

SNRI-venlafaxine, duloxetine

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97

what is obsessive compulsive disorder?

combination of obsessions and compulsions

they exist on a continuum

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98

obsessions:

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

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99

compulsions:

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

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100

when does OCD occur?

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

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