Exam 2 Flashcards
client experiences excessive fear or anxiety when seperated from an individual to which the client is emotional attached
seperation anxiety
client experiences irrational fear of certain situation or object
specific phobia
extreme fear of certain places(outdoors, bridge) where client feels vulnerable or unsafe
agoraphobia
client experiences excessive fear of social performance siutations
social anxiety
client experiences recurring panic attacks
panic disorder
client exhibits uncontrolled, excessive worry for at least 6 months
generalized anxiety disorder
Is OCD an actual anxiety disorder?
NO! but has similar effects
client has intrusive thoughts or unrealistic obsessions and tries to control these thoughts through compulsive behaviors
obsessive compulsive disorder
client has difficult parting with possessions, resulting in extreme stress and functional impairments
hoarding disorder
client has preoccupation with perceived flaws or defects in physical appearance
body dysmorphic disorder
3 types of OCDS
- OCD
- Hoarding disorder
- Body dysmorphic disorder
anxiety and OCD’s have a _______ and _____link
genetic and neurobiological
need what to qualify as panic disorder?
4 or more of :
- palpitations
- shortness of breath
- choking/smothering feeling
- chest pain
- nausea
- depersonalization
- fear of dying or insanity
- chills/hot flashes
manifestations of GAD
(majority of days for 6 months)
- restlessness
- muscle tension
- avoidance of stressful activities
- increased time to prepare for stressful events
- procrastination in decision making
- sleep disturbance
first line meds for anxiety/OCD?
SSRI
other meds for anxiety
SNRI, benzo, buspirone, beta blocker, antihistamine, anticonvulsant
anxiety patient centered care interventions
- assess for comorbid condition of substance abuse
- panic needs calm quiet enviro
- remain with client during worst of anxiety
- relaxation techniques
- hope for positive outcomes
- enhance client self esteem
- postpone health teaching until after acute anxiety subsides
use flooding for which kind of anxiety?
phobias
-large amount of undesireable stimulus in attempt to turn off anxiety response
exposure to traumatic events causes anxiety, detachment, and other manfiestations about the event for at least 3 days but not more than 1 month following the event
acute stress disorder
exposure to traumatic events causes anxiety, detachment, and other manifestations about the event for longer than 1 mo following the event
post-traumatic stress disorder
a stressor triggers a reaction causing changes in mood/dysfunction in performing usual activities. The stressor and effects are less severe than with ASD or PTSD
Adjustment Disorder
-pattern of LIFE LONG difficulty accepting change
4 types of dissociative disorders
- depersonalization/derealiziation disorder
- dissociative amnesia
- dissociative fugue
- dissociative identity disorder
disorder characterized by temporary change in awareness displaying depersonalization, derealization, or both in response to stress.
-depersonalization/derealiziation disorder
feeling that a person is observing one’s own personality or body from a distance
depersonalization
feeling that an outside event is unreal or part of a dream or that objects apprear larger or smaller than they should
derealization
inability to recall personal information related to traumatic or stressful events. amnesia can be events of certain period of time or just certain details
dissociative amnesia
tyoe of dissociative amnesia in which client travels to a new area and is unable to remembers ones own identity and at least some of ones past. Can last weeks to months, usually follows traumatic event
dissociative fugue
client displays more than one distinct personality, with a stressful event precipitating the change from one personality to another
dissociative identity disorder
when should military and first responders receive treatment related to trauma?
before severe trauma reactions occur (ie preventative)
PTSD prevention after a traumatic incident
- need for breaks, rest, water, nutrition
- emotional support
- staff supporting each other
- debrief following incident
- expression of feelings
- offer counseling resources
PTSD puts client at risk for what other mental health disorders?
anxiety, depression, substance abuse, dissociative
ASD and PTSD expected findings
- intrusive memories or flashbacks
- dissociative flashbacks where client feels event is occuring again in present
- avoidance ofthings associated with event
- avoiding thinking about event
- anxiety, depression
- anger, irritability
- decreased interest and inability to feel happiness
- guilt
- hypervigiliance
- inability to focus
- suicidal or homicidal thoughts
adjustment disorder expected findings
depression
anxiety
changes in behavior( erratic, arguing)
signs of dissociative identity disorder
client displays 2 or more seperate personalities
nursing intervention for dissociative disorders
- grounding techniques
- facilitate decisions that lower stress
- when ready, encourage client to make deicision independntly
- avoid giving too much info about past events to prevent increased stress
meds for ASD and PTSD?
antidepressants
prazosin (decrease hypervigilance and insomnia)
propranolol
meds for adjustment and dissociaitve disorders?
online if shoing signs of anxiety and depression
EMDR for PTSD is contraindicated in which patient populations?
-active suicidal ideation, psychosis, severe dissociaitiv, disorders, eyes disorders, unstable substance abuse
eye movement desensitization and reprocessing
a single or recurrent episode of unipolar depression (not associated with mood swings from major depression to mania) resulting in a significant change in a pts ability to function normally.
major depressive disorder mdd
In order to have MDD, 5 or more of the following symptoms must be present for at least 2 weeks
depressed mood
difficulty sleeping, increased sleepiness
indecisiveness, decreased ability to concentrate
suicidal ideation
psychomotor agitation, or psychomotor retardation increase/decrease in weight
Psychotic Features of MDD vs postpartum features of MDD
visual or auditory hallucinations or the presence of delusions
a depressive episode that begins within 4 weeks of childbirth
PMDD (prementstrual dysphoric disorder) is associated with whih phase of the menstrual cycle?
luteal
phases of MDD threatment
- acute: severe clinical findings , 6-12 week treatment : safety, reduction of major symptoms
- continuation: improved function, 4-9 mo duration: medication, relapse prevention
- maintenance: remission - goal = prevent future depressive episodes
risk factors for MDD
- family history
- females
- > 65 yrs
- neurotransmitter deficiences (decrease serotonin)
*depression can be a primary disorder or a response to another physical or mental health disorder
top 3 SSRI for depression, pateint education
citalopram fluoxetine sertraline -no st john wort -sexual dysfunction common -HA/N, insomnia, anxiety, agitation
Tricyclic antidepressant for depression + education
amitriptyline
-orthostatic hypotension
anticholingergic remediation:
- chew sugarless gum
- high fiber
- increase fluid
MAOI for depression + education
phenelzine
- no tyramine
- high drug drug interaction- talk to provider before new meds
a typical antidepressant + patient education
buproprion
- HA, dry mouth, constipation, Nausea insomnia, increase HR
- appetite suppression- monitor weiht
- not cool with seizure disorders
SNRI for depression + education
venlafaxine
duloxetine
- nausea, insomina, weifght gain, sweating, sexual dysfunction
- caution with HTN
SSRI + St John wort =
serotonin syndrome
milder depression that lasts at least 2 years for adults, 1 year for children and 3 clinical findings of depression
persistent depressive disorder
distrust/suscipision based on unfound beliefs others want to harm/exploit deceive that person
paranoid personality disorder
emotional detachment from relationships , indifference to praise/criticism, uncooperative
schizoid personality disorder
odd beliefs leading to interpersonal difficulties, magical thinking, perceptual distortions that are not clear delusions or hallucinations
schizotypal personality disorder
instability of affect/identity/relationships, manipulation, fear of abandonment, self injurious, nonadherence to traditional morals/values, verbally charming and engaging, extreme mood lability, SAFETY PLANS, stigma towards this diagnosis, may have element of attention seeking behavior
borderline personality disorder
lack of empathy, disregarding of people around them, bring people in to get what they need and then discard them, grandiose/arrogance, sensitive to criticism, risk for suicide and depression when not getting praise from people
narcissistic personality disorder
need for secondary gain, report inability to function when they can, want family to take care of them, physical complaints frequent, level of validation that allows them to move beyond
◦ fictitious/Munchausen
characterized by emotional attention-seeking behavior, in which the person needs to be the center of attention; often seductive and flirtatious
Histrionic personality disorder
characterized by disregard for others w/ exploitation, lack of empathy, repeated unlawful actions, deceit, and failure to accept personal responsibility; sense of entitlement, manipulative, impulsive, and seductive; nonadherence to traditional morals and values; verbally charming and engaging
antisocial personality disorder
characterized by social inhibition and avoidance of all situations that require interpersonal contact, despite wanting to close relationships, due to extreme fear of rejection; often very anxious in social situations
avoidant personality disorder
characterized by extreme dependency in a close relationship w/ an urgent search to find a replacement when one relationship ends
Dependent personality disorder
characterized by perfectionism w/ focus on orderliness and control to the extent that the individual might not be able to accomplish a given task
Obsessive-compulsive personality disorder
