Exam 2/Final Flashcards
1
Q
Anxiety
A
- a state arising from stress or change and frequently emanates from fear
- differs from fear in that it is diffuse, internal, and an anticipatory reaction to danger that may be ambiguous or non-specific
- the state of anxiety may be disproportionate to the degree of perceived danger
- the continuum of anxiety ranges fro a mild form to severe
- spectrum disorder
2
Q
Normal Anxiety
A
Normal: protective response that the body uses to mobilize coping resources to maintain homeostasis
- everyone experiences fear in response to the threat of injury, and the production of adrenaline accompanies the “fight or flight” response.
- expected to accompany developmental changes and life span issues
- increases in adolescence: don’t have built in resources, peer & parental pressure
3
Q
Abnormal Anxiety
A
- maladaptive responses or failure to mobilize homeostatic processes often culminate and contribute to formation of anxiety disorders
- overwhelming and enduring anxiety often produce maladaptive responses that globally affect a person’s level of functioning (avoidant behaviors & phobias)
- DSM: anxiety disorders one of the most common psychiatric conditions
- anxiety–>adrenaline. tissues absorb this and establish a higher baseline for anxiety.
4
Q
Epidemiology of Anxiety Disorders
A
- affects approximately 15% of the general population at sometime during lifespan
- one of the most common reasons for seeking medical and psychiatric tx
- one in four persons has met criteria for at least one anxiety disorder
- women higher prevalence
- most prevalent mental disorder in older adults (presenting symptom in depression)
- cultural variable: increased panic & OCD in Mexican immigrants, more phobias in AA population
5
Q
Causative perspectives and theories: Anxiety
A
- psychodynamic theories: early years. conflict, pleasure principle. Separation from primary caregiver: child doesn’t have coping to deal.
- Existential: world without a God. Pervasive uneasiness. Hopeless/pessimistic
- Cognitive-Behavioral: judgement & reasoning can be maladaptive. “overgeneralization”, “catastrophizing”. Learned from neg. reinforcement.
- Developmental: attachment. anxiety & separation from PCG. usually work through it by 3.
- Biological
6
Q
Biological Theories: Anxiety
A
- Neurotransmitter & Neuroendocrine Theories: GABA the most important. Helps control ongoing firing in limbic system. Serotonin. Norepi: mediates fight or flight.
- Neuroendocrine: ANS. HPA axis @ level of limbic system. Cortisol- excitation–> increased anxiety.
- Neuroanatomical Theories
- Genetic Factors: generalized anxiety disorders, phobias, PTSD. Twin studies indicate strong familial basis
7
Q
Autonomic/Biological global manifestations of anxiety responses
A
- increased respirations
- SOB
- tachycardia
- diaphoresis
- dizziness
- parasthesias (tingling, creeping feeling from increased cortisol levels. rule out med rx)
8
Q
Motor global manifestations of anxiety responses
A
- tension
- pacing
- tremors
- stuttering
- restlessness (akathesia)
9
Q
behavioral global manifestations of anxiety responses
A
- rituals: alleviate anxiety
- avoidance
- increased dependence
- clinging
- following (infant)
- crying (infant or school-aged child)
10
Q
Cognitive/Psychological/Spiritual global manifestations of anxiety responses
A
- sense of doom
- powerlessness
- intense fear
- vigilance (hyper- watching everything/everybody)
- rumination
- helplessness
- dissociation: like daydreaming. esp. in trauma
- distortions: watch when giving instructions. give hand written instructions.
- confusion
- overgeneralization: feeling disconnected from other people. don’t feel like we’re special or unique to other people.
11
Q
Common childhood and adolescent anxiety disorders
A
- separation: intense fear. normal- should be addressed by 3 y/o.
- Social Phobia: formal & interpersonal situations. modeling a parent, childhood losses, abuse, chronic illness
- OCD: 2-3%. Unwanted recurrent & intrusive thoughts and/or images. Compulsions relieve anxiety. Tx is family therapy. autoimmune beta strep= residual condition that manifests as OCD.
- PTSD: treat as early as possible. children do not have adequate coping mech. avoid closeness, clinging, regression, nightmares.
12
Q
Adulthood Anxiety Disorders
A
- GAD: onset in 20s. Chronic free-floating anxiety
- Panic Disorder w/or w/o Agoraphobia: sudden fear. ANS response. educate pt symtoms limited to 10 min.
- Agoraphobia: fear of outside environment. increased drinking. globally incapacitated.
- social phobia: can’t work. QOL. SSRIs.
- specific phobia
- OCD: Axis I. impaired social. rigidity/perfectionist. helplessness & powerlessness. lot of depression, alcoholism, eating disorders.
- Acute Stress Disorder: exposure to traumatic event- goes away in a couple days.
- PTSD: medication, cognitive. Pre-morbid, maladaptive coping. Recent- s/s can manifest after 6 mo. emotional numbing. EMDR- eye movement desensitization. disconnects flashback mechanism.
patients have increased CO2 from holding breath when anxious.
13
Q
Treatment considerations: Anxiety
A
- Cognitive behavioral: new & adaptive ways of coping. reasoning power. intellect intervenes- effective for diffusing anxiety.
- systematic desensitization: gradually expose to things they’re anxious about. Wolpy: 3 steps. 1: relaxation. 2: gradual exposure. 3: desensitization.
- progressive relaxation: visualize, sequentially relax muscle groups
14
Q
medications used as anxiolytic agents
A
- benzodiazepines: GABA. insomnia, anxiety, withdrawal. do NOT mix with alcohol. Klonapin: long acting. Ativan: short.
- nonbenzos: Busbar. non-addictive. serotinergic/ anxiety component. has to be used on a regular basis.
- SSRIs: inhibit 5-HT.
- TCA’s: norepi. mediate fight or flight. drowsiness a concern.
- MAOIs: not used much due to food contraindications. HTN crisis.
- beta blockers: Inderal, Atenolol. block phys. manifestation of anxiety. use caution for blocking @ b2 receptors.
15
Q
alternative/complementary therapies for A.D.
A
- biofeedback: promote healthy restoration
- visualization/imagery: focusing
- stress mgmt: residential care
- meditation: calm trance
- yoga/t’ai chi: decreases anxiety by focusing.
- hypnosis: self. deep form of relaxation.
- exercise: endorphins. burn off anxiety.
- acupuncture: 12 meridians linked to organs. rebalances energy flow.
- massage: improves circulation.
16
Q
Definition of personality disorders
A
Kernberg: defined personality disorders as a spectrum of maladaptive traits that produce or influence considerable psychological and emotional disturbance and impaired relationships
- DSM: delinieates clinical features of PD as an enduring pattern of feeling (emotions), thinking (cognitive distortions), and behaving (maladaptive in nature) that become rigid and stable over time.
17
Q
behavioral features of personality disorders
A
- rigid & inflexible
- distress or maladaptive coping skills
- personal problems that induce extreme anxiety, distress & depression–>ability to perform at optimum level compromised.
- lifelong difficulty adapting to change, tolerating frustration and crises, forming healthy relationships.
- deny existing problems, lack insight (ego-syntonic: rest of the world has trouble with their behavior, not the other way around)
- extremely sensitive to outside opinions & feedback
- differ from other patients b/c they experience ego-dystonic state (uncomfortable and unacceptable)
18
Q
recognition of special needs in patients with PDs
A
- understand factors associated with personality development
- recognize the impact of early traumas on coping styles
- deal with intense reactions that occur when working with these patients
- work with other MH professionals to develop consistency and prevent splitting of staff
- recognize the need to maintain boundaries that are extremely clear.
19
Q
splitting
A
- behavior that involves setting up conflict b/t others
- not uncommon to create between staff
- such behaviors arouse intense feelings and negative reactions (countertransference)
- clear boundaries essential
20
Q
boundary
A
- rule defining and how members participate in a subsystem or a relationship
- important to stay in role/in charge.
21
Q
understanding the origins of PD
A
- understanding the origins of these behaviors can play a key role in minimizing negative reactions
- must be perceived as a challenge rather than a burden
- nurses are challenged to sharpen skills in patience, self-awareness, creativity and a nonjudgemental approach
- staff needs to develop treatment plans that do not allow for splitting staff. must confer frequently
22
Q
foundations of PD
A
- most theories emphasize the significance of primary caregivers in growth & development. if PCG hasn’t helped child to feel safe and flourish, they will think people can’t be trusted.
- child must master the initial demands for the socialization within family, where the foundation is laid for the future emergence of interpersonal relationships with all others
- early interactions mediate the infant’s perception of the world–>maladaptive.
- nurses must understand key concepts in personality formation such as ego development and organization, and must assess the meaning of their own.
23
Q
Psychodynamic Theories: PD
A
Object Relations Concept: internalized relationships recollected from early primary caregivers. considered the core of the person’s existence, “all other human behavior and experiences…are relational derivatives.”
Mahler: internalization of the PCG allows child to maintain an image of the caregiver when absent (object constancy)
Kernberg: the basis of severe PD was r/t inadequate or impaired object relations that are ingrained in the personality (sees & functions in the world).
24
Q
Neurobiological Theories: PD
A
- NT such as Serotonin and Dopamine have been implicated in impulsivity, aggression and suicidal gestures manifested in disordered personalities, especially Borderline & Antisocial types
- cutting- way to feel. person numbed by trauma.
- imbalance: might use SSRIs, atypicals, typicals under rare circumstances to get it under control
25
Q
Cluster A Personality Disorders
A
- those in which patients are considered withdrawn, odd, or eccentric. Include: - paranoid - schizoid - schizoptypal
26
Q
paranoid personality disorder
A
- not an axis I
- there are delusions
- on guard, hypervigilant
- doesn’t affect global functioning
- think people want to harm them
- bear grudges
27
Q
schizoid personality disorder
A
- pervasive pattern of detachment; lots of isolation
- unlikely to seek treatment
- could be hospitalized
- no social connectedness
- non-nurturing/empathetic parents
- mostly men
28
Q
schizotypal personality disorder
A
- odd & eccentric
- limited capacity for interpersonal r/s
- lots of social anxiety
- hyper-sensitive
- genetic markers for schizophrenia- likely grew up with someone w/it
- odd ways of seeing the world
29
Q
nursing interventions for paranoid personality disorder
A
- establish rapport
- minimize potential for aggressive behaviors
- support adaptive behaviors: talk about how pt. can communicate with people
- do not need the increased level of precision in speech like in a schizophrenic patient
30
Q
nursing interventions for schizoid & schizotypal PD
A
- approach pt in calm manner
- maintain a comfortable distance based on the patient’s verbal and nonverbal communication (assess everything)
- administer psychotropics and observe the patient’s responses- both desired and adverse effects
- provide structured social interactions
31
Q
Cluster B PD
A
- patients seek attention and engage in erratic behavior Include: - antisocial - borderline - histrionic - narcissistic
32
Q
Antisocial PD
A
- the “conman”
- regularly engage in risky behavior
- lack sense of fidelity
- repetitive legal problems
- dysfunctional family
- watch out for being manipulated
- ADHD hx
33
Q
Borderline PD
A
- deep, painful base
- tremendous fear of abandonment
- regulating affect
- chronic feelings of emptiness
- love/hate manifests in splitting
- “affect dysregulation disorder”
34
Q
Histrionic PD
A
- exaggerated, labile emotion
- flamboyant/dramatic
- think r/s more intimate than they are
- theatrical
- sexualization of relationships
35
Q
Narcissistic PD
A
- grandiose sense of self
- require a lot of admiration
- arrogant
- etiology: child from cold/rejecting parents
- lack of positive self worth
- aloof, detached, hauty
- depression common later in life
- illness: “narcissistic injury”
36
Q
Nursing Interventions: antisocial PD
A
- respond to patient’s maladaptive behavior with firm and consistent limit setting
- approach patient in a sensitive and nonjudgemental manner to facilitate trust and rapport; they fear and mistrust intimacy and closeness
37
Q
Nursing interventions: borderline PD
A
- form a nurse-patient relationship based on clearly stated, realistic expectations
- assist in reduction of self-destructive behavior and intent
- encourage verbalization of feelings about self
- tend to be out of themselves- don’t want to talk about their pain
- goal: affect regulation
- dialectical behavior therapy: 5 part series. meditation, cognitive, behavioral
- meds: antipsychotics, mood stabilizers, antidepressants
38
Q
Nursing interventions: histrionic PD
A
- treatment is similar to that of other PD and e.g. BPD
- consistency
- understanding
- managing countertransference issues
- providing an environment that minimizes maladaptive coping patterns
- psychopharmacologic approaches center on depression, anxiety, and psychosis (fixed delusions)
39
Q
Nursing interventions: narcissistic PD
A
- hospitalization is usually precipitated by depression, suicidal behaviors, and mood swings that often follow failure and rejection
- group therapy may be avoided by the pt because it would require them to balance the desire for a special patient-therapist r/s and because they may fear confrontation by group members
- may be alcohol connected with this
- older–> symptoms get worse
- medical illness- lot of distress
40
Q
Cluster C PDs
A
- conditions in which the symptoms are anxiety and fear Include: - avoidant - dependent - obsessive-compulsive
41
Q
avoidant PD
A
- any kind of activity that can cause criticism
- avoid intimate r/s
- preoccupied with rejection
- don’t engage in intimate r/s
- produces a lot of anxiety
- etiology: parental rejection/criticism
- self doubt
42
Q
dependent PD
A
- very submissive
- child-like
- fearful of making own decisions
- like having someone tell them what to do
- mostly females
- etiology: fear of making decisions- controlling environment
43
Q
obsessive-compulsive PD
A
- not Axis I
- pervasive rigidity and pre-occupation with control
- exaggerated feeling of losing control
- inflexible
- interferes with ability to establish r/s, get along with others
- etiology: overly controlling parents
- organized, efficient
44
Q
Nursing interventions: avoidant, dependent, OCD
A
- establish trust to minimize anxiety
- once anxiety is minimized, the nurse-patient relationship focuses on exploration of old behaviors with consideration for individual change, improved insight, improved sense of self, and overall improved quality of life relationships
45
Q
Bipolar according to the DSM
A
a recurrent mood disorder featuring one or more episodes of mania or mixed episodes of mania and depression.
Differs from major depression in that there is a history of manic or hypomanic (milder and not psychotic) episodes.
46
Q
Bipolar I: types
A
- mania
- hypomania
- depression
- mixed episodes (mania & depression)
spectrum disorder: mild, moderate, severe.
severe- psychotic s/s
