Anxiety Disorders

Question 1

1. Stress:

Ex: exam, rent coming up

Answer 1

• Definition: Stress is a biological reaction to physical, mental, or emotional stimuli that tends to disturb the homeostasis of an organism.
  
  • Explanation: Stress can be triggered by various factors, and it manifests as the body’s response to a perceived threat or challenge. It involves physiological and psychological changes aimed at coping with the stressor.

Definition:
Stress is how your body reacts when you face things that bother you physically, mentally, or emotionally. These things can upset the balance or normal functioning of your body.

Explanation:
Imagine stress like an alarm system in your body. It can go off for different reasons, like when you’re facing a tough situation or feeling overwhelmed. When the alarm goes off, your body makes changes to help you deal with whatever is bothering you. These changes can happen in both your body and your mind, and they’re like your body’s way of trying to handle the stress.

Question 2

Anxiety:
Caused by that stress : Exam or rent coming up

Answer 2

• Definition: Anxiety is a feeling of apprehension (“قلق”), uneasiness, uncertainty, or dread resulting from a real or perceived threat. It is a reaction to stress, and symptoms can be physical or emotional.
• Explanation: Anxiety is a broader term encompassing a range of emotional responses to stressors. It can manifest in both psychological and physiological symptoms and is often characterized by a sense of worry or fear.

Definition:
Definition: Anxiety is when you feel uneasy, worried, or scared because you think there’s a threat, whether it’s real or just in your mind. It's a reaction to stress, and it can show up in how you feel physically or emotionally.

Explanation:
Think of anxiety as a big umbrella that covers different ways people react to stress. It’s not just one thing; it can be a mix of feeling nervous, having a sense of unease, or even physical symptoms like a faster heartbeat. Basically, it’s your body and mind responding to something that’s making you feel on edge or threatened.

Question 3

Fear:

Answer 3

Definition: Fear is a reaction to a specific danger, whereas anxiety is a vague sense of dread related to an unspecified danger. Fear is a cognitive process, while anxiety is an emotional one. Physiological manifestations of anxiety are similar to those of fear.
Explanation: Fear is a more specific response to a known threat, often eliciting a fight-or-flight response. Anxiety, on the other hand, may not have a clearly identified cause and can be more generalized in nature.

Definition:

Definition: Fear is how you react when you know there’s a specific danger. It’s a thinking process, a response to a clear threat.

Explanation:
When you’re afraid, it’s usually because there’s something definite to be scared of, like a growling dog or a loud noise. Fear triggers your brain to either fight the danger or run away from it. Now, compare this to anxiety.

Additional Definition:
Anxiety, on the other hand, is a feeling of worry or unease, but it’s not always about something specific. It’s more like a general sense of dread, and you might not know exactly what’s causing it.

Question 4

Normal Anxiety:

Answer 4

Definition: Normal anxiety is a healthy life force that is necessary for survival.
- Explanation: This term emphasizes that a certain level of anxiety is a normal and adaptive part of human experience. It serves a protective function, helping individuals respond appropriately to potential threats or challenges.

Question 5

Acute (State) Anxiety:
Caused by imminent event . Ex: job loss, exam tomorrow and you have not studied.

Answer 5

• Definition: Acute anxiety is precipitated by an** imminent **loss or change that threatens an individual’s sense of security.
• Explanation: This form of anxiety **is tied to specific events or situations that create a sense of urgency **or impending danger. It is a temporary and time-limited response to a particular stressor.

Example: Imagine a student who has a major exam the next day(por eso lo de imminent) but realizes they haven’t studied enough. The impending academic challenge creates a sense of urgency and threat, leading to acute anxiety. In this case, the anxiety is directly linked to the specific situation of facing an important exam without adequate preparation.

Question 6

Chronic (AKA as Trait anxity) Anxiety:

Answer 6

• Definition: Chronic anxiety is anxiety that the person has lived with for a long time.
• Explanation: Unlike acute anxiety, chronic anxiety is enduring and persists over an extended period. It can become a stable aspect of an individual's personality or mental health, influencing their overall well-being.

Ex: If someone has consistently experienced worry and anxiety related to financial concerns throughout their life. The persistent and enduring nature of the anxiety about money can become chronic and part of their personality even when they become rich later in life and will no longer have to worry about money

Question 7

Mild Anxiety:

Basically: You get stressed out because you have a test (the test here is the external stimuli that disturbs your homeostasis). This feeling causes you anxity because it’s your brian’s way to pushing you to find a solution. In this case this anxity pushes you to study.

Answer 7

• Characteristics:
  - Occurs in the normal experience of everyday living.
  - Helps one deal constructively with stress.
  - Heightened ability to take in sensory stimuli.
  - Learning is easier, and the person is more receptive to new learning.
  
  • Physical Signs:
    
    • Vital signs within normal limits (WNL) or mildly elevated.
    • Tense or excited feelings.
    • Behaviors such as nail-biting, foot or finger tapping, and fidgeting. (توتر)
  • Example: Studying the morning of a big test.

Question 8

Moderate Anxiety:

Answer 8

• Characteristics:
  - Ability to focus on only one thing at a time.
  - Perceptual field narrows. (No anxiety : when you are driving you can focus on the pedestrians in the car ahead. With moderate anxiety : you can only focus on the car ahead, nothing else.)
  - Selective inattention (only certain things in the environment are noticed).
  - Can refocus with direction but is less receptive to teaching.
  
  • Physical Signs:
    
    • Tension, (VS↑) increased pulse (↑P), increased respiratory rate (↑R), perspiration.
    • Mild somatic symptoms like gastric discomfort, headache, urinary urgency, and tense muscles.
  • Example: A nursing student doing an oral presentation on a sensitive topic (e.g., suicidal ideation paper).

Question 9

Severe Anxiety:

Answer 9

• Characteristics:
  - Feeling threatened and disorganized.
  - “Fight or Flight” response is prominent.
  - Sensory perception is greatly reduced (difficulty hearing, tunnel vision).
  - Difficulty problem-solving.
  - Autonomic nervous system activation with various physiological symptoms.
  
  • Physical Signs:
    
    • Headache, nausea, dizziness, diarrhea, tachypnea, rigid muscles, dilated pupils, dry mouth, elevated blood pressure, and heart rate.
    • Need to decrease stimuli; may need assistance with basic needs.
  • Example: A patient in the emergency room crying and feeling like she can’t breathe well after finding out her mom died.
  • Intervention: Deep breathing exercises to help manage the physiological response.

Question 10

Panic:

Last stage of anxity

Answer 10

• Characteristics:
  - Terrified and helpless.
  - Logical thinking is impossible.
  - May exhibit extreme behaviors like becoming angry and combative, running, crying, or total withdrawal.
  - Sense of losing control and touch with reality; dissociation (observing the something from outside her own body.) may occur.
  - May act impulsively; anticipation and protection are crucial.
  
  • Interventions:
    
    • Reduce stimuli and create a calm environment.
    • Meet basic needs to ensure safety.
  • Physical Signs:
    
    • Confusion, shouting, screaming, or withdrawal.
    • Distorted sensory perceptions.

Question 11

Helping Patients Focus:
Mild to Moderate Anxiety:

Answer 11

• Interventions:
  - Open-ended questions to encourage expression.
  - Providing broad openings to allow patients to share their thoughts and feelings.
  - Exploring and seeking clarification on the issues causing anxiety.
  - Incorporating relaxation techniques such as deep breathing and guided imagery.

Question 12

Helping Patients Focus:
Severe Anxiety to Panic:

Answer 12

• Interventions:
  - Prioritize safety concerns for both the patient and others.
  - Address physical needs such as providing fluids and rest.
  - Consider the use of medications, which may include anxiolytics or other psychotropic drugs.
  - Use firm, short, and simple statements to communicate effectively.
  - Continue to emphasize deep breathing techniques for immediate symptom relief.

Question 13

Etiology of Anxiety:

Answer 13

1. Biologic, Psychosocial, and Genetic Factors:
   
   • Anxiety has multifactorial origins, with contributions from biological, psychosocial, and genetic factors.
   • Neurotransmitters play a crucial role:
     
     • GABA (gamma-aminobutyric acid) (calms you down) activity is decreased in anxiety. Benzodiazepines (BZDs) can increase GABA activity.
     • Serotonin shows decreased activity.
     • Norepinephrine exhibits increased activity.
2. Medical Conditions Associated with Anxiety Symptoms:
   
   • Various medical conditions can present with symptoms of anxiety, including:
     
     • Excessive caffeine intake.
     • Substance abuse.
     • Vitamin B12 deficiency.
     • Hyperthyroidism. (Too much cortisone for example)
     • Hypoglycemia. (coz brain uses sugar and the lack of it can cause problems)

Question 14

DSM-5 Classifications and Prevalence of Anxiety Disorders: 1. Panic Disorder (3-5%):

Answer 14

1. Panic Disorder (3-5%):
   
   • Definition:
     
     • Involves panic attacks characterized by the sudden onset of extreme apprehension or fear, often associated with feelings of impending doom or terror.
   • Symptoms:
     
     • Palpitations, chest pain, breathing difficulties, nausea, feelings of choking, chills, hot flashes.
   • Treatment:
     
     • Manage expectations and keep instructions minimal and simple.
     • Teach deep, slow, abdominal breathing.
     • Medication teaching, including the use of benzodiazepines (e.g., Xanax for acute treatment) and SSRIs for maintenance.``
     • Psychological interventions such as systematic desensitization (Plane crsh video) and cognitive therapy.

Question 15

DSM-5 Classifications and Prevalence of Anxiety Disorders: 2. Phobias (15-25%):

Answer 15

2. Phobias (15-25%):
   
   • Definition:
     
     • Characterized by an intense, irrational fear of a specific object or situation.
   • Prevalence:
     
     • 15-25% of the population.

Question 16

**DSM-5 Classifications and Prevalence of Anxiety Disorders: ** 3. Social Anxiety Disorder (7-13%):

Answer 16

3. Social Anxiety Disorder (7-13%):
   
   • Definition:
     
     • Involves an intense fear of social situations or performance situations where embarrassment may occur.
   • Prevalence:
     
     • 7-13% of the population.

Question 17

DSM-5 Classifications and Prevalence of Anxiety Disorders: 4. Obsessive-Compulsive Disorder (OCD) (1-3%):

Answer 17

4. Obsessive-Compulsive Disorder (OCD) (1-3%):
   
   • Definition:
     
     • Involves recurrent, intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) performed to reduce anxiety.
   • Prevalence:
     
     • 1-3% of the population.

Obsession, Ex: John has a fear of germs and contamination, avoids shaking hands

Compulsions: Checking and Rechecking, Example: Lisa has a fear of her house catching fire

Question 18

DSM-5 Classifications and Prevalence of Anxiety Disorders: 5. Generalized Anxiety Disorder (GAD) (3-5%):

Answer 18

5. Generalized Anxiety Disorder (GAD) (3-5%):
   
   • Definition:
     
     • Characterized by excessive anxiety or worrying that persists for at least 6 months. The anxiety is not limited to a specific person or situation and is disproportionate to the actual impact of the concern.
   • Symptoms:
     
     • Restlessness, fatigue, poor concentration, irritability, tension, sleep disturbance.

Question 19

Treatment Approaches for Anxiety Disorders:

Answer 19

1. General Strategies:
   
   • Medications:
     
     • SSRIs (Selective Serotonin Reuptake Inhibitors).
     • SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors).
     • BZDs (Benzodiazepines).
     • Buspar (Buspirone).(non-benzodiazepine anxiolytic.)
     • Effexor (Venlafaxine). (serotonin-norepinephrine reuptake inhibitor (SNRI).)
     • Doxepin. (tricyclic antidepressant (TCA).
     • Beta blockers.
   • Therapies:
     
     • Cognitive and behavior therapy.
     • Identify effective coping mechanisms used in the past and teach new ones.
     • Have the patient write an assessment of strengths.
     • Reframe situations in positive ways through “cognitive reframing.”
2. SSRIs (Selective Serotonin Reuptake Inhibitors):
   
   • Examples: Fluoxetine (Prozac), Sertraline (Zoloft), Escitalopram (Lexapro).
   • Mechanism of Action: SSRIs increase the levels of serotonin in the brain by blocking its reuptake, enhancing the communication between nerve cells.
   • Treatment for Anxiety Disorders: SSRIs are commonly used to treat generalized anxiety disorder (GAD), panic disorder, and social anxiety disorder. They are considered a first-line treatment due to their efficacy and generally favorable side effect profile.
3. SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors):
   
   • Examples: Venlafaxine (Effexor), Duloxetine (Cymbalta).
   • Mechanism of Action: SNRIs increase the levels of both serotonin and norepinephrine by blocking their reuptake.
   • Treatment for Anxiety Disorders: SNRIs are often prescribed for various anxiety disorders, including GAD and social anxiety disorder. They may be especially helpful when individuals do not respond well to SSRIs alone.
4. BZDs (Benzodiazepines):
   
   • Examples: Alprazolam (Xanax), Diazepam (Valium), Lorazepam (Ativan).
   • Mechanism of Action: BZDs enhance the effect of the neurotransmitter GABA, which has inhibitory effects in the brain, leading to a calming effect.
   • Treatment for Anxiety Disorders: Benzodiazepines are typically used for short-term relief of severe anxiety symptoms or during acute episodes. However, they are associated with the risk of dependence and are generally prescribed cautiously due to potential side effects.
5. Buspar (Buspirone):
   
   • Mechanism of Action: Buspirone is believed to act on serotonin and dopamine receptors.
   • Treatment for Anxiety Disorders: Buspirone is used for the treatment of generalized anxiety disorder. It is not associated with the same risk of dependence as benzodiazepines, making it a preferred option for long-term treatment.
6. Effexor (Venlafaxine):
   
   • Mechanism of Action: Effexor is an SNRI, and like other SNRIs, it increases the levels of serotonin and norepinephrine.
   • Treatment for Anxiety Disorders: Effexor is prescribed for various anxiety disorders, including GAD and panic disorder. It may be used when other medications have not provided sufficient relief.
7. Doxepin:
   
   • Mechanism of Action: Doxepin is a tricyclic antidepressant that affects the levels of serotonin and norepinephrine.
   • Treatment for Anxiety Disorders: Doxepin may be used in the treatment of anxiety disorders, particularly when other medications have not been effective. It is also sometimes prescribed for insomnia.
8. Beta Blockers:
   
   • Examples: Propranolol, Atenolol.
   • Mechanism of Action: Beta blockers block the effects of adrenaline, reducing heart rate and blood pressure.
   • Treatment for Anxiety Disorders: Beta blockers are often used to manage physical symptoms of anxiety, such as rapid heartbeat and tremors. They are commonly used in performance anxiety situations, such as public speaking.

Certainly! Here’s an overview of the mentioned therapeutic approaches and techniques:

1. Cognitive and Behavior Therapy:
   
   • Overview: Cognitive-Behavioral Therapy (CBT) is a widely used therapeutic approach that focuses on identifying and changing negative thought patterns and behaviors. It is based on the premise that our thoughts, feelings, and behaviors are interconnected.
   • Key Components:
     
     • Cognitive Restructuring: Identifying and challenging negative thought patterns to develop more balanced and realistic thinking.
     • Behavioral Techniques: Implementing strategies and activities to modify and replace maladaptive behaviors.
2. Identify Effective Coping Mechanisms:
   
   • Overview: This involves exploring and recognizing coping mechanisms that have been effective for the individual in managing stress and anxiety.
   • Therapeutic Process:
     
     • Exploration: Identifying coping mechanisms that have worked well in the past.
     • Adaptation: Adapting or building upon these strategies to address current challenges.
     • Skill Building: Introducing new coping skills to broaden the individual’s toolkit for managing stress.
3. Assessment of Strengths:
   
   • Overview: This involves having the patient reflect on and document their personal strengths and positive qualities.
   • Therapeutic Benefits:
     
     • Empowerment: Recognizing strengths can empower individuals and enhance self-esteem.
     • Resource Utilization: Leveraging existing strengths as resources in coping with challenges.
     • Positive Focus: Shifting the focus from weaknesses to strengths promotes a positive mindset.
4. Cognitive Reframing:
   
   • Overview: Cognitive reframing involves changing the way an individual perceives and interprets situations by altering the meaning or context of their thoughts.
   • Techniques:
     
     • Positive Reinterpretation: Finding alternative, more positive explanations for situations.
     • Perspective Shifts: Encouraging the individual to consider alternative viewpoints.
     • Challenge Negative Assumptions: Actively challenging and questioning negative beliefs.

Question 20

Treatment Approaches for Anxiety Disorders:

Answer 20

2. Specific Disorders:
   • Phobias:
     
     • Definition: Persistent, irrational fear of a specific object, activity, or situation leading to avoidance or actual avoidance.
     • Types:
       
       • Specific phobia: High anxiety or fear provoked by a specific object or situation (e.g., arachnophobia, xenophobia).
       • Social Anxiety Disorder (Social Phobia): Severe anxiety or fear in social or performance situations (e.g., fear of public speaking).
       • Agoraphobia: Intense fear of situations from which escape might be difficult, embarrassing, or help might not be available.
         
         • Examples include being alone outside, at home, traveling, on a bridge, riding in an elevator.
     • Treatment:
       
       • Teach relaxation techniques (deep breathing, progressive muscle relaxation, guided imagery).
       • Model unafraid behavior in phobic situations and discuss with the patient.
       • Therapies like systematic desensitization, flooding, hypnosis, and psychotherapy.
       • Short-term use of BZDs and beta-blockers to control autonomic symptoms.
       • Antidepressants, especially SSRIs.
   • Obsessive-Compulsive Disorder (OCD):
     
     • Characteristics:
       
       • Obsessions: Persistent and recurring thoughts, impulses, or images.
       • Compulsions: Ritualistic behaviors performed to reduce anxiety.
     • Common Compulsions:
       
       • Hand-washing, checking, counting, putting things in order.
     • Treatment:
       
       • Behavioral therapy, including systematic desensitization and flooding.
       • Medications like SSRIs and clomipramine. (tricyclic antidepressant (TCA) )

Question 21

Other Anxiety and Related Disorders:
1. Body Dysmorphic Disorder:

Answer 21

1. Body Dysmorphic Disorder:
   
   • Definition:
     
     • Involves the exaggerated belief that the body is deformed or defective in some way.

Question 22

Other Anxiety and Related Disorders: 2. Hoarding Disorder:

Answer 22

2. Hoarding Disorder:
   
   • Definition:
     
     • Characterized by persistent difficulties parting with or discarding possessions, regardless of their actual value.
     • Three times more common in older people.

Question 23

Other Anxiety and Related Disorders: 3. Hair-Pulling Disorder (Trichotillomania) and Skin-Picking Disorder (Dermotillomania):

Answer 23

3. Hair-Pulling Disorder (Trichotillomania=trenza) and Skin-Picking Disorder (Dermotillomania):
   
   • Characteristics:
     
     • Similar to OCD but feels involuntary to the person.

Question 24

Other Anxiety and Related Disorders: 4. Posttraumatic Stress Disorder (PTSD):

Answer 24

4. Posttraumatic Stress Disorder (PTSD):
   
   • Definition:
     
     • Characterized by repeated re-experiencing of a highly traumatic event that involved actual or threatened death or serious injury, leading to intense fear, hopelessness, or horror.
   • Common Traumatic Events:
     
     • Military combat.
     • Being a prisoner of war or a victim of a terrorist attack.
     • Natural disasters such as floods, tornadoes, and earthquakes.
     • Rape or assault.
   • Symptoms:
     
     • Recurrent intrusive recollections of the event.
     • Nightmares.
     • Flashbacks.
     • Social withdrawal.
     • Guilt over being a survivor (e.g., sole survivor of a car crash).
     • Persistent numbing (reduced ability to experience emotions) of general responsiveness:
       
       • Feeling detached or estranged from others.
       • Feeling empty inside.
       • Feeling turned off to others.
     • Persistent increased arousal:
       
       • Irritability.
       • Difficulty sleeping.
       • Difficulty concentrating.
       • Hypervigilance.
         - Exaggerated startle responses. YO CON LOS TERREMOTOS
   • Duration:
     
     • Symptoms last more than one month.

Question 25

Treatment Approaches for Anxiety Disorders: 1. Medications:

Answer 25

1. Medications:
   
   • SSRIs, SNRIs, and Beta-blockers:
     
     • Sometimes used to manage anxiety symptoms.
   • Anticonvulsants (e.g., Depakote):
     
     • Used for addressing specific symptoms like flashbacks and nightmares.

Question 26

Treatment Approaches for Anxiety Disorders: 2. Psychotherapy:

Answer 26

2. Psychotherapy:
   
   • Eye Movement Desensitization and Reprocessing (EMDR) (used for PTSD):
     
     • A specific form of psychotherapy that has shown effectiveness, particularly in treating PTSD.

Psychotherapy is a form of talk therapy that involves verbal communication between a trained mental health professional and an individual or group, aiming to improve mental health by exploring thoughts, feelings, behaviors, and relationships.

Eye Movement Desensitization and Reprocessing (EMDR) is a specific psychotherapy developed by Francine Shapiro in the late 1980s. It is particularly effective in treating post-traumatic stress disorder (PTSD). EMDR involves phases such as history-taking, preparation, assessment, desensitization and reprocessing, installation of positive beliefs, body scan, closure, and reevaluation. The therapy utilizes bilateral stimulation, often involving eye movements, to process traumatic memories and reduce their emotional impact. EMDR has shown effectiveness in treating various psychological conditions, especially PTSD, but it should be conducted by trained and certified therapists for optimal results.

Question 27

Treatment Approaches for Anxiety Disorders: 3. Support Groups:

Answer 27

3. Support Groups:
   
   • Can provide individuals with a sense of community, understanding, and shared experiences.

Question 28

Treatment Approaches for Anxiety Disorders: 1. Assessment:

Answer 28

1. Assessment:
   
   • Level of Anxiety:
     
     • Evaluate the intensity of anxiety symptoms.
   • Coping Style:
     
     • Explore the patient’s usual coping mechanisms and past effective problem-solving strategies.
   • Stressors:
     
     • Identify current stressors affecting the individual.
   • Type of Anxiety:
     
     • Distinguish between trait and state anxiety.Meaning: Acute vs chronic
   • Self-Esteem:
     
     • Assess the patient’s self-esteem.
   • DTS/DTO (Danger to Self/Danger to Others):
     
     • Evaluate the risk of self-destructive and suicidal behavior.

Question 29

**Using the Nursing Process: **2. Nursing Diagnoses:

Answer 29

1. Anxiety:
   
   • Related to: Academic performance pressure and upcoming final exams.
2. Ineffective Coping:
   
   • Related to: Recent loss of a loved one and difficulty managing grief.
3. Defensive Coping:
   
   • Related to: Ongoing family conflicts and difficulties in communication.
4. Fear:
   
   • Related to: Recent diagnosis of a life-threatening illness.
5. Powerlessness:
   
   • Related to: Limited mobility due to a recent injury and dependency on others for basic activities.
6. Chronic Low Self-Esteem:
   
   • Related to: History of persistent negative feedback and bullying in the workplace.
7. Post-Trauma Syndrome:
   
   • Related to: Witnessing a traumatic event, such as a serious accident or natural disaster.
8. Disturbed Personal Identity:
   
   • Related to: Major life changes, such as a divorce or significant career transition, leading to an identity crisis.

Question 30

**Using the Nursing Process: 3. Planning:

Answer 30

3. Planning:
   
   • Establish goals that are measurable and achievable:
     
     • Identify Healthy Coping Mechanisms:
       
       • Pt will identify a designated number of healthy coping mechanisms, drawing on past effective strategies.
     • Report Decreased Level of Anxiety:
       
       • Pt will report a decreased level of anxiety on a 1-10 scale.
     • Increase Time Between Anxiety Episodes:
       
       • Pt will report an increased time between anxiety episodes.
     • Utilize Healthy Coping Strategies:
       
       • Pt will use a designated number of healthy coping strategies.
     • Identify Triggers to Anxiety:
       
       • Pt will identify triggers to anxiety (“Describe what you were doing right before you started to feel anxious”).

Question 31

Interventions for Anxiety Disorders:

Answer 31

1. Teaching Coping Skills and Referrals:
   
   • Provide education on coping skills.
   • Make referrals to community resources for skill development.
2. Identifying Stressors:
   
   • Assist the patient in identifying stressors (Exam) contributing to anxiety.
3. Developing a Trigger Plan:
   
   • Help the patient develop a plan for managing triggers, emphasizing goal-setting and daily planning.
4. Encouraging Expression of Feelings:
   
   • Encourage the expression of feelings, especially in cases of mild to moderate anxiety.
5. Cognitive Therapy: (Cambiar el pensamiento)
   
   • Focus on the here and now.
   • Implement cognitive restructuring techniques.
6. Behavioral Therapy: (Cambiar el comportamiento)
   
   • Use modeling, systematic desensitization (mirar algo progresivamente "avion crash" hasta que ya no nos afecte ), flooding ( mirar algo con intensidad "avion crash" hasta que ya no nos afecte)" response prevention, and thought-stopping techniques.
7. Relaxation Training:
   
   • Teach and encourage the practice of relaxation techniques, including breathing exercises, guided imagery, and head-to-toe relaxations.
8. Physical Activities:
   
   • Promote exercise as a way to manage anxiety.
   • Recommend activities such as yoga and meditation.
9. Teaching About Sleep Habits:
   
   • Provide education on good sleep habits to improve overall well-being.
10. Support Systems:
    
    • Encourage the use of support systems, including friends, family, or support groups.
11. Medications:
    
    • When appropriate, medications such as SSRIs, SNRIs, and others may be prescribed.

Question 32

Somatic Symptom Disorders:

No tiene nada que ver con la ansiedad . Otro tema "vale"

Answer 32

1. Characteristics:
   
   • Definition:
     
     • Characterized by physical symptoms without a sufficient organic cause.
   • Note:
     
     • The patient is not faking or delusional but genuinely believes in the presence of a physical problem.
   • Comorbidity:
     
     • High comorbidity with depression and anxiety disorders.
2. Differential Diagnoses:
   (Differential diagnosis is a process in which a healthcare professional distinguishes between two or more conditions that share similar symptoms)- Somatic Symptom Disorder:
   
   • History of multiple somatic complaints over many years, most of which cannot be explained medically.
   • Conversion Disorder: (type of somatic symptom disorder)
     
     • Abrupt, dramatic loss of motor or sensory function, often with an obvious or symbolic significance. The patient may appear unconcerned (“la belle indifference”). Despite facing a significant and unexpected loss of motor or sensory function, the individual with Conversion Disorder might not show the emotional reaction that one would normally expect. (Conversion: Because of converting psychological stress or emotional conflicts into physical symptoms. ) The symptoms often involve the loss of motor or sensory functions, such as paralysis, blindness, or difficulty speaking. These symptoms are not consciously feigned; instead, they are considered to be a way in which the mind expresses emotional distress.
   • Illness Anxiety Disorder:
     
     • Exaggerated concern with health and illness for more than six months despite medical evaluation and reassurance by a physician.
       Hypochondriac, now known as illness anxiety disorder (IAD)

Question 33

Interventions for Somatic Symptom Disorders:

Answer 33

1. Identifying Stressors:
   
   • Assist the patient in identifying stressors, as symptoms are often stress-related.
2. Decreasing Secondary Gain:
   
   • Address and decrease secondary gain associated with symptoms, such as attention-seeking or avoiding responsibilities.
3. Evaluating Support System:
   
   • Evaluate the patient’s support system for potential improvements.
4. Therapeutic Approaches:
   
   • Utilize individual and group therapy.
   • Consider hypnosis, behavioral therapy, and relaxation therapy.

Question 34

Factitious (صنعي) Disorder (Munchausen Syndrome):

Answer 34

• Characteristics:
  
  • In contrast to patients with somatoform disorders, individuals with factitious disorder know that they are pretending to have a mental or physical illness to obtain medical attention.
  • In factitious disorder (attention) by proxy, an adult (usually a parent) feigns (feins,feinin, Fingir algo) or induces illness in a child to obtain medical attention.

Malingering: تمارض (mlngrin) Financial

• Definition:
  
  • The conscious simulation or exaggeration of physical or mental illness for financial or obvious gains (e.g., avoiding work or incarceration).

Dissociative (rape forget) Disorders:

• Characteristics:
  
  • Characterized by sudden but temporary loss of memory or identity, or by feelings of detachment due to emotional (traumatic) factors.

Dissociative Disorders are marked by abrupt and transient memory loss, identity disruption, or a sense of detachment, often stemming from emotional trauma. This dissociation, a defense mechanism, enables individuals to cope with distressing experiences, such as avoiding memories of traumatic events like rape.

Question 35

Dissociative Disorders:

Answer 35

Dissociative Amnesia (TYPE of Dissociative Disorder)
Dissociative amnesia involves the inability to recall significant personal information, often triggered by trauma or stress. This amnesia is not due to a medical condition and is beyond ordinary forgetfulness.

Example:
Imagine someone witnessing a traumatic event, like a car accident. Following the incident, they might struggle to remember key details about themselves, such as their identity, personal history, or even the accident itself.

Dissociative Fugue
Dissociative fugue goes beyond amnesia. It involves sudden memory loss, coupled with the individual unexpectedly leaving their home, moving to a new location, and sometimes adopting a new identity. The person may be unaware of this behavior and may seem bewildered (perplexed) when confronted.

Example:
A person experiencing a dissociative fugue might wake up one day in a different city with no recollection of how they got there, unable to remember their previous life. They may take on a new name, job, and social identity without realizing the abrupt change.

Dissociative Identity ``Disorder (DID):
DID is characterized by the coexistence of two or more distinct identities or personality states within one individual. These different identities are often referred to as “alters” and may have unique memories, behaviors, and characteristics. Victims of rape often

Example:
An individual with DID might have one personality that is outgoing and extroverted while another is introverted and anxious. Each personality can take control at different times, and there might be limited awareness of the other personalities.

Depersonalization:
Depersonalization involves recurrent and persistent feelings of detachment from oneself. Individuals may feel like they are observing their own life from the outside, leading to a sense of unreality.

Example:
Imagine someone going through a stressful period who suddenly feels like their body and mind are separate entities. They may describe feeling like a robot or watching their own actions without a sense of personal connection.

Derealization:
Derealization involves recurrent and persistent feelings of detachment from the social situation or environment. The external world may seem distorted, dreamlike, or unfamiliar.

Example:
A person experiencing derealization might find themselves in a familiar place, like their workplace or home, but everything around them seems surreal and distant, as if they are in a dream.

Question 36

How stress/stressor causes anxity in order for you to find a solution

Answer 36

Exactly! Your example illustrates a common scenario where stress and anxiety can serve as motivators:

1. External Stimulus (Test):
   
   • The external stimulus, in this case, is the upcoming test. It disrupts your usual state of calm or equilibrium (homeostasis).
2. Stress Response:
   
   • Your brain perceives the test as a challenge or threat, triggering a stress response. This response is a natural and adaptive mechanism designed to help you deal with challenges.
3. Anxiety as a Motivator:
   
   • The feeling of anxiety is your brain’s way of signaling that there’s something important that requires attention. It’s like an internal alarm pushing you to take action.
4. Finding a Solution (Studying):
   
   • The anxiety motivates you to find a solution to the perceived challenge, which, in this case, is studying for the test. By studying, you’re actively addressing the source of stress, and ideally, it helps you feel more prepared and confident.

In this context, anxiety is serving a functional purpose as a motivator to prompt a beneficial response (studying). It’s a natural part of the human experience, and when managed appropriately, it can contribute to improved performance and problem-solving.

Question 37

Cognitive (Thought/Pensamiento "manera de pensar ") Therapy:
- Focus: Targets changing negative thought patterns and beliefs.
- Goals: Modify dysfunctional thinking to improve emotional well-being and behavior.
- Techniques: Thought challenging, cognitive restructuring, examining evidence.
- Application: Widely applicable to various mental health issues.
- Time Emphasis: Present-focused, examines how current thoughts impact feelings and behaviors.

Behavioral Therapy: (comportamiento/reaccion a una situacion)
- Focus: Targets changing observable behaviors.
- Goals: Modify specific behaviors associated with difficulties or challenges.
- Techniques: Behavioral modification, reinforcement, exposure therapy.
- Application: Effective for behavioral issues, phobias, anxiety disorders.
- Time Emphasis: Present-focused, uses strategies for immediate and observable behavior change.

Commonalities:
- Present-focused, structured, and goal-oriented.
- Can be used independently or integrated into approaches like CBT.

Differences:
- Primary focus on thoughts (cognitive) vs. behaviors (behavioral).

Integration: Hybrid, mix
- Cognitive-Behavioral Therapy (CBT) integrates elements of both approaches for a comprehensive treatment strategy.

Question 38

Somatic Symptom Disorders (SSD) are when a person experiences physical symptoms like pain or fatigue that are real to them, but doctors can’t find a clear medical reason for them. It’s important to know that the person is not pretending or making it up; they genuinely believe something is physically wrong. Often, there’s a lot of worry about health, and it can be linked to feelings of sadness or nervousness. It’s like having real physical discomfort, but it’s not explained by a known medical condition. Treatment usually involves talking with a mental health professional to help manage both the physical symptoms and the worries connected to them.

Question 39

Behavioral therapy

Answer 39

Behavioral therapy is a psychological approach that focuses on changing observable behaviors through various techniques. Here are explanations and examples for each of the mentioned behavioral therapy techniques:

1. Modeling:
   
   • Explanation: Modeling involves learning by observing others and imitating their behavior.
   • Example: A person with a fear of public speaking might watch videos of confident speakers or attend public speaking events to observe and model effective communication techniques. By emulating these behaviors, they can learn to overcome their fear.
2. Systematic Desensitization:
   
   • Explanation: This technique involves gradually exposing an individual to anxiety-provoking stimuli in a systematic and controlled manner, allowing them to build tolerance and reduce anxiety.
   • Example: Someone with a fear of flying (aviophobia) might start by looking at pictures of airplanes, then progress to watching videos of takeoffs and landings, and eventually, they may work up to taking short flights. The gradual exposure helps desensitize the fear.
3. Flooding:
   
   • Explanation: Flooding is an intense and prolonged exposure to the fear-inducing stimulus with the aim of extinguishing the associated anxiety.
   • Example: A person with a phobia of spiders might be exposed to a room filled with spiders for an extended period until the anxiety diminishes. The overwhelming exposure helps the individual realize that the feared outcome (e.g., getting bitten) is unlikely, reducing anxiety over time.
4. Response Prevention:
   
   • Explanation: This technique involves preventing the individual from engaging in a maladaptive behavior, thereby breaking the cycle of reinforcement and reducing the frequency of the behavior.
   • Example: For someone with obsessive-compulsive disorder (OCD) who engages in compulsive hand-washing, response prevention would involve preventing them from washing their hands immediately after exposure to perceived contaminants. Over time, this helps to weaken the compulsive behavior.
5. Thought-Stopping:
   
   • Explanation: Thought-stopping is a cognitive-behavioral technique designed to interrupt and replace negative or intrusive thoughts with more positive ones.
   • Example: An individual struggling with self-critical thoughts may use thought-stopping by mentally shouting “stop!” when a negative thought arises. After stopping the negative thought, they can then replace it with a more positive and constructive one, promoting a healthier mental outlook.

These behavioral therapy techniques aim to modify maladaptive behaviors and responses, providing individuals with effective tools to manage and overcome various psychological challenges. It’s important to note that these techniques are often used in conjunction with other therapeutic approaches for comprehensive treatment.

Question 40

Psychotropic drugs (Todas las medicinas que afectan la mente ) are medications that affect the mind, emotions, and behavior. They primarily target the central nervous system to alter neurotransmitter levels in the brain. These drugs are commonly used in the treatment of various mental health conditions, including anxiety disorders, depression, bipolar disorder, schizophrenia, and other mood disorders. Here are some common types of psychotropic drugs:

1. Antidepressants:
   
   • Selective Serotonin Reuptake Inhibitors (SSRIs): Examples include fluoxetine, sertraline, and escitalopram.
   • Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): Examples include venlafaxine and duloxetine.
   • Tricyclic Antidepressants (TCAs): Examples include amitriptyline and nortriptyline.
   • Monoamine Oxidase Inhibitors (MAOIs): Examples include phenelzine and tranylcypromine.
2. Anxiolytics:
   
   • Benzodiazepines: Examples include alprazolam, lorazepam, and diazepam. They are often used for short-term relief of severe anxiety or panic attacks.
   • Buspirone: An anxiolytic that works differently from benzodiazepines and has less potential for dependence.
3. Antipsychotics:
   
   • Typical Antipsychotics: Examples include haloperidol and chlorpromazine.
   • Atypical Antipsychotics: Examples include risperidone, olanzapine, and quetiapine. They are often used to treat schizophrenia and bipolar disorder.
4. Mood Stabilizers:
   
   • Lithium: Primarily used to stabilize mood in bipolar disorder.
   • Anticonvulsants: Medications like valproic acid, carbamazepine, and lamotrigine may also be used as mood stabilizers.
5. Stimulants:
   
   • Methylphenidate and amphetamine-based medications are commonly used to treat attention deficit hyperactivity disorder (ADHD).
6. Hypnotics and Sedatives:
   
   • Medications like zolpidem and eszopiclone are used to treat insomnia.

Question 41

Hypnosis for anxiety involves using a relaxed and focused state of mind to address and alleviate anxious thoughts and feelings. Here’s a simple example to illustrate how hypnosis might be used for anxiety:

Example Scenario:
Sarah is dealing with social anxiety, making it challenging for her to participate in social events. She often feels nervous, self-conscious, and experiences physical symptoms like a racing heart and sweaty palms in social situations. Sarah decides to try hypnosis to manage her anxiety.

Hypnosis Session:
1. Introduction: Sarah’s therapist explains the hypnosis process and ensures she feels comfortable. Hypnosis is not a loss of control but rather a heightened state of focused attention.

2. Relaxation: Sarah is guided to relax through deep-breathing exercises and calming imagery. The therapist may suggest a peaceful place or scenario for Sarah to visualize.
3. Focused Attention: As Sarah becomes more relaxed, the therapist directs her attention inward. The therapist might use calming and reassuring language to create a sense of safety.
4. Addressing Anxiety Triggers: While in this relaxed state, the therapist works with Sarah to explore the root causes of her social anxiety. They discuss specific triggers and associated thoughts or memories.
5. Reframing Thoughts: The therapist helps Sarah reframe negative thoughts and beliefs related to social situations. For instance, they might encourage her to visualize a successful, positive social interaction.
6. Suggestion: Positive suggestions are introduced to promote a more relaxed and confident mindset in social settings. These suggestions aim to counteract the anxious thoughts that contribute to Sarah’s social anxiety.
7. Exiting Hypnosis: The therapist gradually brings Sarah out of the hypnotic state. She leaves the session feeling calm, with a new perspective on social situations.

Post-Hypnosis: Over subsequent sessions, Sarah may continue to reinforce the positive suggestions and coping mechanisms learned during hypnosis. The goal is to help her approach social situations with greater ease and reduced anxiety.

It’s important to note that while some individuals find hypnosis beneficial for anxiety, it may not be suitable for everyone. Additionally, hypnosis should be conducted by a trained and qualified therapist. Always consult with a mental health professional to explore the most appropriate therapeutic approaches for your specific needs.

Question 42

Dissociative Disorders

Here’s a breakdown:

1. Dissociative Fugue: A subtype of Dissociative Amnesia, characterized by sudden travel, identity change, and amnesia.
2. Dissociative Amnesia: Involves sudden memory loss, often related to traumatic (rape) or stressful events.
3. Dissociative Identity Disorder (DID): Involves the presence of 2 or more distinct personalities within an individual, accompanied by memory gaps.
4. Depersonalization/Derealization: While not specified as a distinct disorder within the Dissociative Disorders category, depersonalization and derealization are considered dissociative experiences. Depersonalization involves feelings of detachment from oneself, and derealization involves a sense of unreality or detachment from the external world.

Answer 42

Let’s differentiate between Dissociative Fugue, Dissociative Amnesia, Dissociative Identity Disorder (DID), and Depersonalization/Derealization:

1. Dissociative Fugue:
   
   • Characteristics: In Dissociative Fugue, individuals experience sudden, unexpected travel away from home, accompanied by amnesia for their past and a lack of awareness regarding their identity. They may assume a new identity during the fugue state.
   • Example: Someone suddenly leaves their home, travels to a different city, adopts a new identity, and is unable to recall their previous life.
2. Dissociative Amnesia:
   
   • Characteristics: Dissociative Amnesia involves the sudden inability to recall important personal information, often related to traumatic or stressful events. The memory loss is beyond ordinary forgetfulness.
   • Example: Someone experiences memory loss regarding a traumatic event, such as sexual assault, and cannot remember details of the incident.
3. Dissociative Identity Disorder (DID):
   
   • Characteristics: DID involves the presence of two or more distinct identities or personality states within an individual. Each identity may have its own unique memories, behaviors, and characteristics. The transition between identities is often accompanied by memory gaps.
   • Example: A person may switch between different identities, each with its own name, memories, and behaviors, often as a result of severe trauma in childhood.
4. Depersonalization/Derealization:
   
   • Depersonalization: Involves feelings of detachment or disconnection from oneself, as if observing one’s own life from a distance. The person may feel like an outside observer of their thoughts and actions.
   • Derealization: Involves a sense of unreality or detachment from the external world. The surroundings may appear distorted or dreamlike.
   • Example: Feeling like you are watching your own actions from outside your body (depersonalization) or perceiving the external world as unreal or distorted (derealization).

Key Points:
- Dissociative Fugue: Sudden travel with identity change and amnesia.
- Dissociative Amnesia: Sudden memory loss, often related to trauma.
- DID: Presence of multiple distinct identities or personality states.
- Depersonalization/Derealization: Feelings of detachment from oneself or the external world.