methal health exam 3

32 questions, 2 will be thrown out

Being able to recognize symptoms and what they are experiencing, no meds on this, a lot of this is application, how would you know what would you see

Stress

Types of stress: maturational stress, adventitious stress
- Stress Definition: Perceptions, emotions, anxieties, or social/economic events considered threatening to physical health, personal safety, or well-being.
- Types of Crisis:
  - Situational: Triggered by unexpected events.
  - Maturational: Developmental life events.
  - Existential: Related to purpose and meaning (e.g., "Why am I here?").
  - Adventitious: Social crises or natural disasters.
- Key Terms
  - Eustress: Positive stress that protects health.
  - Distress: Damaging stress.
  - Stressor: A trigger, which can be real or perceived
SATA: resolution of a crisis, how we resolve a crisis, what we need
- Phases of Crisis Development:
  - Phase 1: Specific stressful event occurs; feelings of discomfort/bewilderment.
  - Phase 2: Event perceived as threat; anxiety increases; usual coping (denial, talking) is attempted.
  - Phase 3: Disorganization and cognitive/physical/social symptoms occur.
  - Phase 4: Mobilization of resources; new problem-solving methods or redefinition of the threat.
- Goal of Crisis Intervention: Return the person to the pre-crisis level of functioning or raise the level of functioning via improved coping strategies.
- Phases of Crisis Development:
4 questions on the differences between the different anxieties
- Definition of Anxiety:
  - Normal Response: A natural reaction to threatening situations.
  - Pathological Anxiety: Occurs when the response interferes with adaptive behavior, causes physical symptoms, or exceeds a tolerable level for the individual.
- DSM Classifications of Anxiety and Related Disorders:
  - Generalized Anxiety Disorder (GAD)
  - Panic Disorders
  - Phobias (Social and Specific)
  - Obsessive-compulsive disorder (OCD)
  - Body Dysmorphic Disorder
  - Acute stress disorder
  - Posttraumatic stress disorder (PTSD)
  - Secondary Anxiety: Anxiety Disorder due to a Medical Condition, Substance-Induced, or Medication-Induced.
- Somatic Symptom Disorders:
  - Somatic Symptom Disorder
  - Illness Anxiety (formerly Hypochondriasis)
  - Conversion Disorder (Functional Neurobiological Symptom Disorder)
Agoraphobia
- Three Main Types:
  - Agoraphobia: Fear of being in public/open spaces or situations where escape is difficult or help is unavailable (e.g., fear of fainting).
  - Social Phobia: Fear of being humiliated, scrutinized, or embarrassed in public (e.g., choking while eating in front of others).
  - Specific Phobia: Fear of a specific object or situation not covered by the above (e.g., flying, animals).
- Alprazolam (Xanax) for Agoraphobia.
- Agoraphobia Comorbidity: Panic disorder can be accompanied by agoraphobia, defined as the fear of being in a place or situation where escape may be difficult or embarrassing.
Stages: mild to severe
PTSD signs and symptoms
- Posttraumatic Stress Disorder (PTSD):
  - Can be unrecognized for years due to numbing responsiveness.
  - Persistent attempt to avoid situations, activities, or persons that evoke memories of the trauma.
Compassion fatigue s/s
- Burnout vs. Compassion Fatigue:
  - Burnout: Exhaustion from work demands and organizational factors; develops gradually; symptoms include cynicism and reduced efficacy.
  - Compassion Fatigue: Exhaustion from empathetic engagement with others' suffering; can occur suddenly; symptoms include intrusive thoughts and reduced empathy.
- Stages of Compassion Fatigue:
  - 1. Empathetic Ability: Wanting to alleviate pain.
  - 2. Empathetic Response: Helping to alleviate pain.
  - 3. Compassion Stress: Anxiety from overextending care.
  - 4. Compassion Fatigue: Unmanaged stress requiring coping mechanisms.
OCD: what is behind OCD, what interventions
- Obsessions: Recurrent and persistent thoughts, ideas, impulses, or images experienced as intrusive and senseless. The client knows they are trivial but cannot control them (e.g., counting sidewalk lines).
- Compulsions: Repetitive behaviors performed in a particular manner in response to an obsession to neutralize anxiety (e.g., hand washing, checking locks, counting).
- DSM Criteria:
  - Recognition that obsessions/compulsions are unreasonable or produced by own thoughts.
  - Excessive behaviors to reduce distress.
- Collaborative Treatment:
  - CBT and Psychopharmacology.
  - TCA: Clomipramine hydrochloride (Anafranil).
  - SSRIs: Luvox (First-line treatment).
identifying triggers for people with anxiety
- Induced Panic Triggers: Panic can be induced by external substances including:
  - Caffeine.
  - Carbon dioxide
  - Sodium lactate
interventions for anxiety
- Nursing Interventions:
  - Safety & Comfort: Provide a calm, quiet environment. Ask about suicidal plans.
  - Active Listening: Reflect back patient concerns to show understanding.
  - Triggers: Help patients identify physical/emotional triggers and connect behavior to feelings.
  - Patient Education: Postpone teaching until anxiety subsides; provide clear info on treatment plans.
  - Problem Solving: Discuss previous coping mechanisms; assist in exploring alternative behaviors.
  - Promotion of Activities: Encourage hobbies, walks, role-playing, and recreational games.
- Preventive Care/Self-Help:
  - Breathing exercises and meditation.
  - Guided imagery and progressive muscle relaxation ( $PMR$ ).
  - Assertiveness and stress management training.
- Milieu Management:
  - Structured environment with protection from self-harm.
  - Participation in decision-making and daily activities.
  - Recreational and relaxation activities to reduce body tension.
What do you do when someone has a panic attack
- Preventative Care:
  - Avoidance of substances that increase levels of caffeine, $CO_2$ , and sodium lactate.
  - Recognition of triggers that may initiate an attack.
  - Teaching stress management and relaxation exercises.
- Assessment Factors: Assess for lightheadedness, shortness of breath (SOB), palpitations, trembling, nausea, fear of losing control, and paresthesias.
- Interventions during a Panic Attack:
  - Stay with the patient and acknowledge their discomfort.
  - Maintain a calm style and demeanor.
  - Speak in short, simple sentences.
  - Give one direction at a time in a calm tone of voice.
  - Provide a brown bag for hyperventilation.
  - Allow patients to pace or cry.
  - Communicate that you are in control and will not let anything happen to them.
  - Move the patient to a quieter, less stimulating environment.
  - Crucial Rule: Do not touch these patients during an attack.

Somatoform disorders:

3 on what type of disorder are you seeing (vignettes)
SATA Munchausens
- Factitious Disorder
  - Physical or psychological symptoms are intentionally produced or feigned to assume the "sick role."
  - Identified by Dr. Richard Asher (Munchausen's syndrome).
  - Motivations: Primary gain (internal), such as receiving medical attention or sympathy.
  - Characteristics: Symptoms presented with "dramatic flair," vague responses when questioned, pathological lying, extensive medical knowledge (often among nurses or healthcare workers).
  - Confrontation: Patients often discharge themselves and deny allegations to avoid treatment.
- Subtypes of Factitious Disorder
  - Factitious Disorder Imposed on Self: Deliberate symptom fabrication with no reward beyond attention.
  - Factitious Disorder Imposed on Another (Munchausen by Proxy/MSP): Perpetrator intentionally injures a victim (usually a child) to garner sympathy and attention

Personality disorders:

Overall, what do they have in common
- Definition of Personality:
  The combination of thoughts, emotions, and behaviors that make an individual unique, encompassing how one views, understands, and relates to the world, and self-perception.
- Shared Traits: Symptoms range from mild to severe. Patients believe they are normal and others have the problem.
interventions for someone with BPD SATA
- Borderline Personality Disorder (BPD):
  - Characteristics: Unstable relationships, emotional lability, poor impulse control.
  - Defenses: Splitting and projective identification.
  - Assessment: Appears high-functioning, but may be argumentative and manipulative.
- Manipulation Defined: Influencing another person to meet one's own needs regardless of the other's needs.
- Verbatim Phrases indicating Manipulation:
  - ‘I never told this to anyone before!’
  - ‘You’re the ONLY one I can talk to!’
- Interventions for Manipulation:
  - Consistency and limits; don’t take insults personally; take suicide threats seriously.
picking out disorders: what does a histrionic pt look like, dependent, narcissistic and how would you know

Cluster B: Dramatic, Emotional, or Erratic Behaviors

General Characteristics: Emotional reactivity, poor impulse control, manipulation, vague identity. Diagnosed under $18$ if symptoms persist for over a year.
Antisocial Personality Disorder:
- Note: Cannot be diagnosed before age $18$ .
- Symptomology: Socially irresponsible; aggressive disregard for others' rights.
- Life Patterns: Employment issues; prone to criminal behavior.
Narcissistic Personality Disorder:
- Symptomology: Grandiose self-importance; needs constant admiration.
- Behavior: Exploits others; arrogant, lacks empathy.
Histrionic Personality Disorder:
- Symptomology: Attention-seeking; self-centered and flamboyant.
- Behavior: Craves immediate satisfaction, somatization, uses suicidal gestures for attention.
Borderline Personality Disorder (BPD):
- Characteristics: Unstable relationships, emotional lability, poor impulse control.
- Defenses: Splitting and projective identification.
- Assessment: Appears high-functioning, but may be argumentative and manipulative.

Cluster A: Odd or Eccentric Behaviors

General Characteristics: Unusual beliefs, indifference to interpersonal relationships, and avoidance of social contact.
Paranoid Personality Disorder (PPD):
- Theories: Excessively critical parents or projected anger.
- Symptomology: Pervasive, persistent suspiciousness; hostile and jealous behavior.
- Behavior: Finds malice in benign comments; holds grudges and counterattacks if reputable image is threatened.
Schizoid Personality Disorder:
- Theories: Emotional isolation from indifferent or detached parents.
- Symptomology: Flat affect, indifference to social relationships; strong preference for solitude.
- Interests: Heavily invests in non-human interests (e.g., astronomy, mathematics).
- Clinical Example: Mr. G, a $30$ -year-old math student, lives alone and has a low-paying job.
Schizotypal Personality Disorder:
- Symptomology: Resembles schizophrenia without psychosis; odd, eccentric behaviors and speech.
- Traits: Magical thinking, odd perceptual experiences, social anxiety related to paranoia.

Eating Disorders:

s/s of anorexia SATA
- Anorexia Nervosa
  - Weight Loss: Significant weight loss leading to being underweight or emaciated, typically (<85 weight / expected)
  - Distorted Body Image: A persistent perception of being overweight despite being underweight.
  - Reduction in Food Intake: Drastic decrease in food consumption and possible extensive exercising.
  - Metabolic Abnormalities: Presence of various metabolic issues, including electrolyte imbalances.
  - Bingeing and Purging: May include episodes of binging and purging, though typically with smaller caloric amounts compared to bulimia nervosa (BN)
  - Physical Symptoms: Potential physical health issues such as fatigue, dizziness, hyperactivity, or gastrointestinal problems due to starvation.
  - Psychological Symptoms: Includes depression, anxiety, or signs of obsessive-compulsive disorder related to food and weight.
- Bulimia Nervosa ( $BN$ ):
  - Characterized by compulsive eating.
  - Cycles of binging (eating large amounts) and purging (compensatory behaviors).
- Binge-Eating Disorder ( $BED$ ):
  - Variant of compulsive overeating resembling obesity.
  - Recurrent episodes of eating large amounts of food in short periods.
  - No regular use of compensatory behaviors (purging).
- Orthorexia (Over-Eating Disorder/OCD related):
  - Term coined in $1998$ .
  - Obsession with "proper" or "healthful" eating.
  - So fixed on nutritional quality that it damages the individual's well-being.
What would you say to someone with an eating disorder
- Express Concern: "I care about you, and I've noticed some changes that worry me. How are you feeling?"
- Listen Actively: Allow the person to share their feelings and thoughts without judgment. Show that you are there to support them.
- Avoid Judgment: Steer clear of comments about weight, body image, or eating habits. Focus on their feelings and experiences instead.
- Encourage Professional Help: "Have you considered talking to a professional? They can provide support and help you through this."
- Offer Support: Let them know that you are willing to help them find resources, attend appointments, or just be there to talk.
- Be Patient: Recovery from an eating disorder can be a long journey. Let them know you will be there to support them every step of the way

What is your priority diagnosis, and what would you do first
refeeding syndrome
- Refeeding syndrome is a potentially serious condition that can occur when feeding resumes to individuals who are malnourished or have been in a state of starvation. Key points include:

Definition: A metabolic disturbance that occurs when nutrients are reintroduced to malnourished individuals, leading to rapid changes in serum electrolytes.
Risk Factors: Those with a history of prolonged fasting, malnutrition, alcoholism, or significant weight loss due to eating disorders like anorexia nervosa or severe bulimia nervosa
Pathophysiology: When refeeding starts, insulin secretion increases resulting in shifts of electrolytes such as phosphate, potassium, and magnesium into the cells, potentially leading to deficiencies in the bloodstream.
Symptoms: Can include weakness, confusion, seizures, edema, respiratory failure, and cardiac complications.
Prevention: Gradually introduce feeding, monitor electrolytes closely, and provide appropriate supplementation when initiating nutrition in at-risk individuals.

how would you structure the milieu of someone with an eating disorder
- Creating a Supportive Environment
  - Establish clear structure and routines to promote stability.
  - Encourage positive interactions between patients, minimizing negative peer influences.
  - Provide a safe space for open discussions about feelings and experiences related to food and body image.
- Therapeutic Activities
  - Incorporate group therapy sessions focused on coping strategies and self-esteem building.
  - Offer art or music therapy to express emotions in non-verbal ways.
- Nutritional Support
  - Collaborate with nutritionists to design meal plans that meet the specific needs of patients.
  - Provide education on healthy eating habits without vilifying food or promoting harmful dieting practices.
- Behavioral Interventions
  - Monitor eating patterns and behaviors to identify triggers.
  - Implement cognitive-behavioral strategies to address distorted thoughts about food and self-image.
- Recovery Focus
  - Emphasize progress, no matter how small, to foster a sense of achievement.
  - Provide resources for ongoing support after discharge to prevent relapse.