Exam 2 Flashcards
Alarm stage
Fight or flight response to the stressor
Initial, brief
Intense and can’t be tolerated for long periods of time
Resistance stage
Aka adaptation stage
Occurs if threat continues
Sustained and optimal resistance to stressor occurs
Exhaustion stage
Occurs when attempts to resist stressor fail
Resources depleted and stress becomes chronic
Leads to anxiety, depression, sleep disorders, heart disease and wt gain
Eustress
GOOD stress
Feelings of happiness, hopefulness, and purposeful movement
Ex. Vacation, birth of baby, marriage
Physiological stressors
Environmental conditions
Ex. Trauma, heat/cold, infection, hemorrhage, pain, hunger
Psychological stressor
Can be positive or negative
Ex. Marriage, divorce, unemployment, retirement, terrorist attack
Things that can affect a persons perspective
Age
Gender
History
Culture
Biofeedback
Visual or auditory feedback to gain control over involuntary bodily functions
Guided imagery
Focusing on pleasant images to replace negative or stressful feelings
Cognitive reframing
Changes an individuals perception of stress by reassessing a situation and replacing irrational beliefs
From “I’ll never” to “I should have”
Effects of stress on the body
HA
Anxiety
Depression
Backaches
Insomnia
ED
Decreased libido
Increased/decreased appetite
Increased BP, HR and BS
Crisis
Event that may lead to unstable and dangerous situation affecting an individual, group or society
Crisis intervention
A directive, time limited, and goal directed strategy designed to assist those experiencing a crisis
Perception of threat
Persons coping abilities
Perspective, culture and past experiences can affect this
Maladaptive coping mechanisms
Drinking, smoking, drugs
Maturational crisis
Each stage in eriksons stages represents an internal conflict or crisis
Ex. Marriage, birth of child, retirement
Situational crisis
Unanticipated external event/life event
Ex. Divorce, death, loss of job, financial status change, or pregnancy
Adventitious crisis
Not part of everyday life - caused by nature or human made/ disaster
Ex. Terrorist attack, hurricane, flood, school shooting, SIDS, rape, fire
Perception of precipitating event
Can they identify the event?
What brought them in for treatment?
How did it affect them?
Support system
Do they have friends, family or community resources for help?
Primary care
Prevents crisis
Identify potential problems
Teach coping skills
Problem solving strategies
Secondary care
Stabilize, lessen time frame of mental disability
Establish interventions
identify crisis and get help
Occurs in institution
Tertiary care
Provides long term support for experiencing a crisis
Promote optimal functioning levels and prevent further disruptions emotionally
Mild anxiety signs
Irritability
Slight discomfort
Restlessness
Nail biting
Finger or foot tapping
Fidgeting
Moderate anxiety signs
Ability to think is hindered - selective in attention
Increased HR, BP, respiration
GI upset
HA
Voice tremors and shaking
Severe anxiety signs
HA
Nausea
Insomnia
Dizziness
Trembling
Hyperventilation
Impending doom of dread
Panic signs
Lose touch with reality - inability to process what is happening
Hallucinations
Pacing
Shouting
Running or screaming
Withdrawal
Sublimation
Always healthy and is an unconscious process of transforming negative impulses into less damaging and even productive impulses
Altruism
Adaptive or maladaptive
Unconscious motivation to feel caring and concern for others and act for the well being of others
Compensation
Used to counterbalance perceived deficiencies by emphasizing strengths
Denial
Involves escaping unpleasant, anxiety causing thoughts, feelings, wishes, or needs by ignoring their existence
Identification
Consciously or unconsciously Attributing to oneself the characteristics of another person or group
Projection
Refers to the unconscious rejection of emotionally unacceptable features attributing them to others
Rationalization
Consists of justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations that satisfy the teller and the listener
Suppression
Conscious decision to delay addressing a disturbing situation or feeling
Separation anxiety
Concern with being away from significant other
Physical symptoms: GI upset, HA
Environmental stressors that can bring separation anxiety
Death
Separation
Immigration
Physical/ sexual abuse
Acrophobia
Fear of heights
Agoraphobia
Fear of open spaces
Claustrophobia
Fear of closed spaces
Social anxiety disorder
Anxiety or fear provoked by exposure to social or performance situation that could be evaluated negatively by others
Social anxiety in Japanese or Korean
Beliefs that individuals blushing, eye contact or body odor is offensive
Panic disorder
Sudden onset of extreme apprehension or fear with feelings of impending doom that can last for months
Feel they’re losing their minds
Never tell them to calm down
Panic attacks in Latin Americans and Northern Europeans
Sensations of choking, smothering, numbness or tingling and fear of dying
GAD
Worry excessively which leads to huge amounts of preparing
Putting things off
Sleep disturbance common
Never ask why
Obsessive compulsive disorder
Obsessive: intrusive and recurrent thoughts
Compulsive: ritualistic behavior that reduces anxiety r/t obsession
Can occur independently but mostly together
Trichotillomania
Pulling hair
Trichophagia
Secretly swallowing hair
Excoriation
Skin picking
Relieves/decreases anxiety
SSRIs
Anxiety- 1st line
Paroxetine, fluoxetine, escitalopram, fluvoxamine, sertraline
SNRI
Depression and anxiety
Venlafaxine: Tx of severe anxiety
Duloxetine: Tx of GAD
MAOIs
Quick onset, good for panic attacks
Risk for dependence
Paradoxical reactions(opposite reaction)
Side effects: sedation, ataxia, cognitive impairment
Buspirone
No dependency risk
Weeks to see effect
No for renal/hepatic dysfunction
SE: HA, dizziness, nausea, nervousness, excitement
Modeling
ARNP ONLY
acts as role model to demonstrate appropriate behavior in feared situations and client imitates
Systemic desensitization
ARNP only
Gradually introduced to a feared object or experience through a series of steps from the least frightening to the most frightening
Flooding
ARNP ONLY
exposes pt to large amounts of undesirable stimulus in effort to extinguish anxiety response
Thought stopping
Negative thought or obsession is interrupted
Universality
Members realize they’re not alone
Altruism
Members gain or profit from giving support to others leading to improving self esteem
Ex. I’ll never get over my husband…. I felt that way too
Imitative behavior
Members may copy the behavior of the leader or peers thus adopting healthier habits
Group cohesiveness
Arises in a mature group when members feel connected to one another as a whole
Ex. Group develops norms that are non judgemental and accepted
Catharsis
Genuine expression of feelings that can be interpreted by patient and group
Over expression can be detrimental to group processes
Planning phase
Group name
Schedule
Objectives of group
Members
Group size
Description of leader and member responsibilities
Orientation phase
Group forming
Leader structures an environment of respect, true and confidentiality
Provides intro and purpose of group
Members encouraged to provide intros
Working phase
Working on achieving goals
Conflicts can be expressed
(Storming, norming, and performing)
Storming
Disagreements
Personality clashes
Norming
Disagreements and clashes reach a resolution
Cooperation emerges
Performing
Group established normal roles and focuses on achieving goals
Termination phase
Each member summarizes personal accomplishments
Share new insights
Identifies future goals
Task role
Keeps group focused on its main purpose and getting work done
Maintenance roles
Keep the group together, helps each person feel valuable and included
Individual roles
Have nothing to do with the group related to personal agenda and personal desires
Autocratic
Exert control
Do not encourage interaction amongst members
Democratic
Supports group interaction
Laissez-faire
Members can act how they choose
No direction in the group
Monopolizing group members
Speaks at every moment
Lengthy response
Doesn’t allow others to participate
Ask them to limit their responses & time
Disruptive group members (demoralizing)
Challenges the leader, angry, rude, self centered and lack of empathy or concern for others
Silent group members
Little to no response
Give them time to respond and process what is going on
Delusional disorder
False thoughts or beliefs that have lasted 1 month or longer
Doesn’t impair functioning
Brief psychotic disorder
Sudden onset of at least one of the following: delusions, hallucinations, disorganized speech and behavior
Sx last longer than 1 day but no longer than 1 month
Schizophreniform disorder
Sx similar to schizophrenia but lasted less than 6 months
Schizoaffective disorder
Involves major depressive, manic, or mixed episode concurrent with symptoms of schizophrenia
Schizophrenia onset occurs when
Men: 15-25 yrs
Women: 25-35 yrs
Risk factors for schizophrenia
GENETICS
increased dopamine
Prenatal, environmental, and psychological stressors
Prenatal stressors for schizophrenia
Father older than 35
Winter or spring pregnancy
Psychological stressor for schizophrenia
Moving away from
College
Trauma
Abuse
Environmental stressor for schizophrenia
Toxins
Prodromal phase of schizophrenia
“Something strange” or “not right”
Begin to have problems in school/work
May be odd or eccentric
Sx occur 1-12 months before 1st full episode
Acute phase of schizophrenia
Functional impairment present
May require hospitalization
Can last months even w/ Tx
May experience hallucinations, delusions and be socially withdrawn
Stabilization phase of schizophrenia
Sx stabilize or diminish
Can last several months
Care in an outpatient mental unit or partial hospitalization
Maintenance or residual phase of schizophrenia
Condition has stabilized and a new baseline may be established
Interventions for psychosis
Establish trust and rapport
Safety main concern
Anosognosia
Pt can’t see disease or that they are sick
What to do with pt that is having hallucinations
Present reality- what’s real and what’s not
Ask “are they telling you to do something, are they telling you to hurt yourself?”
Say “I don’t hear the voices but it must be scary”
What to do with a delusional pt
Don’t debate- can’t force them into reality
Validate the parts that are true and help identify triggers
Persecutory delusions
One is being singled out for harm
Ex. Believing that your food has been poisoned
Referential delusions
Events/circumstances that have happened are connected to you even when they’re not
Ex. Believing that birds sing to cheer you up
Grandiose delusions
Believing one is powerful or important person
Ex. Believing you are a superhero
Erotomanic delusions
Believing that another person desires you romantically
Nihilistic delusions
Conviction that a major cotastrophe will occur
Ex. Giving things away that won’t be useful because a hurricane is coming
Somatic delusions
Believing the body is changing in unusual ways
Ex. Your heart is dead and rotting away
Control delusions
Some outside force controls you
Ex. Aliens control you
1st gen antipsychotics
For schizophrenia - treats positive Sx only
Haldol
Fluphenazine
Side effects of 1st gen antipsychotics
Sedation
Orthostatic hypertension
Photosensitivity
Cataracts
Sexual dysfunction
Wt gain
Positive symptoms
Things that shouldn’t be there
Hallucinations
Delusions
Associative looseness
Bizarre behaviors
Dangerous adverse effects of 1st gen antipsychotics
Tardive dyskinesia
EPS
Anticholinergic toxicity
Agranulocytosis
NMS
Liver impairment
QT prolongation
Acute dystonia
Sudden sustained contraction of one or more muscle groups
Akathisia
Motor restlessness, pacing or inability to sit still
2nd gen antipsychotics
Treats positive and negative Sx
Clozapine
Risperidone
Olanzapine
Side effects of 2nd gen antipsychotics
Sedation
Sexual dysfunction
Seizures
DECREASED CHANCES of EPS and tardive dyskinesia
Can cause metabolic syndrome, high BS and insulin resistance
Bipolar I
Move severe due to mania
Experience at least one manic episode
Keep pt safe and determine last time they ate or slept
Bipolar I how they appear
Initially- happy, excited, energized, euphoric, don’t sleep or eat
As mania intensifies- psychotic (hallucinations) and have dramatic thoughts
Then become agitated, irritable and exhausted
Bipolar II
Experience at least one hypo mania and depressive episode
Hypomania leads to euphoria and increased functioning
Mania
Increased energy/less need for sleep
Euphoric
No aspirations
Spend money
Engage in hazardous activities -pushes limits
May be psychotic
Eventually collapses into depression-suicide risk
Hypomania
Excessive energy and activity
Psychosis never present
Not severe enough to cause impairment
Big appetite for social interaction
May pursue elaborate get rich quick schemes
Doesn’t usually require hospitalization
Cyclotbymic disorder
Hypomania with alternating mild to moderate depression
Speech patterns in bipolar pts
Pressured speech- fast, rapid, inappropriate speech
Circumstantial speech- adding unecessary detail
Tangential speech- speaker wanders and loses focus on subject
Thought process in bipolar pts
Loose associations
Flight of ideas
Clang association
Grandiose delusions
Persecutory delusions
Somatic symptoms
Expression of stress through physical symptoms like pain, paralysis and skin rashes
Positive symptoms of schizophrenia
Appear early and are dramatic
Delusions
Reality testing
Associative looseness
Echolalia (repeating words)
Hallucinations
Catatonia
Echopraxia (mimicking movements of another)
Negative symptoms of schizophrenia
No essential human qualities
Poor hygiene
Anhedonia - unable to feel pressure
Flat, blunted, inappropriate behavior
Concrete thinking
Interprets things literally
Anosogosia
Inability to realize they’re ill
Lithium level
0.6-1.2
Signs of lithium toxicity
GI upset
Coarse hand tremor
Confusion
Ataxia
Blurred vision
Clonic movements
Convulsions
Oliguria
Neologism
Made up word
Alogia
Poverty of speech
Reduced volume or lack of spontaneous comments and overly brief responses
Clang association
Repetition of words or phrases that are similar in sound but in no other way
Echolalia
Repetition of words or phrases from another person
Pressured speech
Speaking as if the words are being forced out quickly
Religiosity
Excessive preoccupation with religous ideas
Tangentiality
Digression from one topic to another without ever completing the thought or reaching a conclusion
Verbigeration
Purposeless repetition of words or phrases
Echopraxia
Repeating the movements of another person
Waxy flexibility
Having one’s arms or legs placed in a certain position and holding that same position for hours
Circumstantiality
Before getting to the point, the client gets caught up with countless details and explanations
Confabulation
Filling memory gap with detailed fantasy believed by the teller
Purpose is to maintain self-esteem
Thought blocking
Sudden stop of thought in the middle of a sentence - unable to continue training of thought
Monopolizing member
Lengthy responses
Speaks anytime they can
Addresses entire group
Doesn’t allow others to participate
Demoralizing member
Challenges the leader
Angry, rude
Self-centered
Lack empathy or concern for others
Refuse to take personal responsibility
ECT
Usual course is 6-12 tx every 2-5 days then monthly for maintenance
Contraindications of ECT
MI
Stroke
Intracranial mass lesions
ECT teaching
NPO 4 hrs before tx
Hairpins, contact lenses and dentures removed
Seizure lasts 15-70 sec
Wakes up 15 min after procedure
