Exam 2 Flashcards
recurrent intrusive idease, thoughts, and impulses
obsessions
ritualistic behaviors that people participate in to control thoughts
compulsions
what are two forms of OCD?
body dysmorphic disorder and hoarding
preoccupation with an imagined defective body part. these people obsessively think about it and have compulsive behaviors.
body dysmorphic disorder
why do people with body dysmorphic disorder develop emotions of disgust, shame, and depression?
because of their constant fear of rejection by others, perfectionism, and conviction of being disfigured
do people with body dysmorphic disorder respond well to reassurance?
no, they still believe they have the defect
excessive collection of items and the failure to discard these items. these people have severe distress and disruption of daily functioning and often do not believe they have a problem
hoarding disorder
what are all stress disorders related to?
exposure of several stressors which may include natural disasters, accidents or intentional harm
what are two types of stress disorders?
acute stress disorder and post-traumatic stress disorder
how quickly do acute stress disorders appear?
within one month of the traumatic experience
what are symptoms that occur with acute stress disorder?
numbess, detachment, derealization, depersonalization, and dissociative amnesia
when a person has symptoms of ASD past one month. this is accompanied by functional impairment and stress and the perosn may have flashbacks, nightmares, and sleep disturbances
post traumatic stress disorder
when is PTSD considered delayed?
if symptoms are delayed and do not occur until more than 6 months after the event
in addition to the symptoms of ASD, what are some symptoms of PTSD?
loss of trust, poor self esteem, feeling damaged, difficulty maintaining or building relationships, numb to emotions, increased arousal, may become more irritable, difficulty with concentration, try to avoid anything associated with the trauma they experienced
what biological factors play a role in anxiety and stress related disorders?
genetics, too much norepinephrine, too little serotonin, too little GABA
why do benzodiazapines work with anxiety and stress disorders?
they help to increase levels of GABA so that the patient calms down and feels good
what are psychological factors that increase a patients likelihood of developing an anxiety disorder?
shy and timid people, critical parents, learning anxiety through classical conditioning, social learning from parents and peers, cognitive distortions
what other disorders do anxiety disorders usually co-exist with?
depression, substance abuse, eating disorders, personality disorders, and schizophrenia
what are clues to look for with anxiety and stress disorders?
high alcohol/drug intake, history of barbiturate or benzodiazepine dependence, history of frequent use of healthcare for somatic complaints, negative outlook, distorted thinking, obsessions or compulsions, history of an eating disorder
why aren’t benzodiazepines used often in the outpatient setting?
because there is a high rate of addiction
what are the side effects of benzodiazepines?
drowsiness, sedation, ataxia, dizziness, feelings of detachment, irritability or hostility, anterograde amnesia, cognitive slowing with long-term use, tolerance, dependency, rebound insomnia/anxiety, rarely nausea, headache, confusion, depression
what are the withdrawal symptoms of benzodiazepines?
agitation, anorexia, hyperactivity, insomia, irritability, nausea, vomiting, sensitivity to light/sounds, tinnitus, tremulousness, anxiety, autonomic arousal, dizziness, generalized seizures, hallucinations, headaches
what drug do they use to treat benzodiazepine overdose?
Romazicon (flumazenil)
who often experience paradoxical effects of benzodiazepines?
children
what are some meds other than benzodiazepines that are used for the treatment of anxiety?
Buspiraone (BuSpar), antihistamines, blood pressure meds
will buspirone work PRN?
no, it generally takes several weeks for significant anti-anxiety effects
is buspirone (BuSpar) effective to manage drug or alcohol withdrawal or panic disorder?
no
why are antihistamines used as meds for anxiety?
they are used for their sedative effects, but they’re not usually as effective as other drugs, but they do not cause physical dependence
what blood pressure meds can be used for antianxiety?
propranolol (inderal) and clonidine (catapres). these are typically given lower doses than beta blockers
what biological aspects should you assess on a person with anxiety?
substance use, sleep patterns, eating patterns, sexual functions and menstrual cycles
what psychological factors should be assessed on a person with anxiety?
mood and affect, self esteem, and coping strategies
what anxiety disorders are blood pressure meds good to treat?
performance anxiety
what social factors should be assessed for a patient with anxiety?
interpersonal relationships, diversional activities, cultural expressions of anxiety
what are the signs and symptoms of anxiety disorders
heart rate increase, blood pressure increase, sweaty palms, shortness of air, lightheadedness, depression, irritability, difficulty focusing, more forgetful
what things do you want to look for when assessing family functions?
management, boundaries, communication, emotional support/availability, socialization
what do clear family values consist of?
very cohesive, good communications, general rules and expectations that are firm, yet flexible at the same time, family members are supported and nurtured, yet offered autonomy
what do diffuse or enmeshed family boundaries consist of?
families are overly involved with each other, not able to define the thoughts and feelings of each individual member, might lose some autonomy, can be emotionally involved and show warmth, but there might be a lot of hostility and meddling, child has more issues becoming an independent person
what do rigid or disengaged families consist of?
no flexibility, relationships may be cold and controlling or even withdrawn, individuals may be disengaged from each other, or as a family unit be disengaged from the rest of the society, not much negotiation and opportunities for individual development
what is healthy communication within a family unit?
clear and easy to comprehend, can help with adapting to stressors
what is unhealthy communication within a family unit?
unclear and indirect - more passive aggressive
what do healthy families have in emotional support/availability?
show affection and respect for one another, are allowed to express feelings and don’t repress someone else’s feelings
what do unhealthy families have in emotional support/availability?
will be more angry towards one another and have more conflict
occurs when a two system person starts to have tension and they bring in a third person to reduce the conflict between them
family triangles
how many generations should you look at when looking at multigenerational issues?
3-4 generations because dysfunctional systems are passed down from generation to generation
what are the objective factors of the family burden?
practical problems family members face while caring for ill relative, symptomatic behaviors like deficit behaviors when they don’t do things that they should and intrusive or acting out behaviors, care-giving, and stigma
what are the subjective factors of family burden?
negative emotions that family members experience in response to a loved ones mental illness - grief, fear, guilt, anger
how do traditional family therapies work?
working with the family as a whole. might focus on here and now or the past that lead up to where they are now.
how do psychoeducational family therapies work?
they focus on helping the family understand that mental illness and includes teaching them about side effects, medications, etc
how does case management work?
someone goes into the home and helps the family and patient handle day-to-day problems. this is a good way to keep an eye on patients in between appointments
what are iatrogenic family burdens caused by?
a dysfunctional mental health system and by the attitudes and behaviors of some mental health professionals who have outmoded theories about families
harsh physical or verbal action reflecting rage, hostility, and potential for destructiveness that can be directed at self or others
aggression
term uniquely associated with human beings that refers to physical aggression and is usually out of context of what the stimulus was
violence
how much more likely are patients with psychiatric disorders to be violent than those who don’t have them?
they are 5x more likely than those who don’t
which psychiatric disorders have an increased risk of violence?
ADHD, ODD, PTSD, dementia, paranoid delusions and personality disorders
which medical/neurological disorders have an increased risk of violence?
TBI, temporal lobe epilepsy, brain tumor, infections, intoxicated or withdrawing from drugs/alcohol
what neurobiological factors are related to anger and aggression?
limbic system, amygdala, and temporal lobe dysfunction can cause behavioral problems and violence and aggression; serotonin and GABA help regulate emotions and keep us calmer and not having enough of these can lead to aggressive or violent behaviors
in which communities do violent deaths occur most often in?
lower to lower middle class communities. it could be related to the stress of those environments
are men or women more likely to be aggressive?
men
what are childhood red flags to anger and aggressive behaviors?
animal cruelty and setting fires
what questions should you ask when assessing for violent behavior and aggression?
have you ever thought of harming someone else? have you ever seriously injured another person? what is the most violent thing you have ever done?
which factors should you identify when assessing for violent outcomes?
angry, irritable effect, hyperactivity, increasing anxiety, verbal abuse, loud voice, history of recent acts of violence, suspicious or paranoid patients, substance abuse, possessions of a weapon, milieu characteristics conductive to violence
what milieu characteristics are conductive to violence?
loud, overcrowding, staffing unconsistent, understaffing
what is the most important priority when assessing for a person with anger and aggression?
safety of the patient and others: risk for self-directed violence and risk for others-directed violence
what is the most important aspect in decreasing the risk of anger and violence?
consistency of staff response - the use of well-trained staff skilled in the use of de-escalation techniques. must include comprehensive patient, situation, enviromental, and staff assessment
what things can you do to ensure safety when anger and aggression are risks?
position self where you can get to the door, don’t be directly in front of the patient, search valuables and get anything that can be used for a weapon, work with other staff - let them know where you are going to be
what do you want to do in the preassaultive stage of violence?
de-esculation approaches, remain calm with a soft, nonjudgemental tone; try to find out what is going on and how you can help the patient, try to talk the patient through their anger
what should you do during the assaultive stage of the violence cycle?
medicaiton, seclusion, restraint; patient is being violent; have other patients go to their rooms and shut their doors
what should you do during the post-assaultive stage of the violence cycle?
seclusion and restraint, delicate reentry of the patient back onto the unit
what things do you want to document about violence?
what was going on - early behaviors and what you did about them, narrative, if there are injuries - in which case you will have to fill out an incident report
how can you distract a patient with a neurocognitive deficit?
validate things about them and then distract them - if you cannot orient them
what interventions can you use to keep catastrophic reactions of neurocognitively impaired patients from happening?
adopt a calm, unhurried manner when responding to patients agitation/aggression, might put pictures up around the room to help orient them, approach patients from the front- don’t come up behind them; tell people who you are and smile
what does cognitive-behavioral approaches do for anger/aggression?
attempt to teach anger management skills. behavioral interventions are based on social learning theory.
what is dialectical behavioral therapy based on? where is it commonly used?
based on a principle of mindfulness - thinking before you act; it is used in patients with anger issues, personality disorders and in prisons
what drugs are used to treat acute aggression?
atypical antipsychotics or high potency typical antipsychotics (haloperidol) that are used to calm and sedate the patients; benzodiazepines (adivan and lorazepam)
what drugs are used to treat chronic aggression?
anticonvulsants (carbamazepine); beta blockers (propranolol); lithium carbonate
what are good interventions to do when a patient is experiencing anger/aggression?
calm approach, stay on patient’s non-dominant side, make sure you are between the patient and the door, tell client that you expect him/her to stay in control, ask what you can do to help, suggest ways that the patient can get their needs met, clarify with a lot of reflection, don’t ask why
what is the definition of suicide?
the act of intentionally ending one’s life and opting for nonexistance
