Midterm 14, 15, 16 Flashcards
DSM criteria for depression
5 or more of the following s/s in a 2-week period
- Depressed mood most of the day
- Diminished interest of pleasure
- Weight loss
- Increase or decrease in appetite
- Insomnia or hypersomnia
- Fatigue or loss of energy
- Feeling of worthlessness or excessive guilt
- Diminished ability to think or concentrate
- Recurrent thoughts of death or suicidal ideation
- Emptiness
- Irritability
- Somatic (body) concerns
- All impact a person’s ability to function
social skills training
EBP that focuses on teaching a wide variety of social and ADL skills.
i. Breakdown complex interpersonal skills (resolving conflicts) into more manageable subcomponents
ii. Teach them how to deal with problems step by step
iii. Use role playing and group interaction to practice skills
Anhedonia
A. loss of pleasure
B. inability to feel pleasure even with things that once made them happy
C. To assess someone’s mood ask “how do you feel”
Side effects of SSRI (11)
- Agitation
- anxiety
- sleep disturbances
- tremor
- sexual dysfunction
- tension HA
- dry mouth
- sweating
- weight change
- nausea
- loose bowel movement
Toxic side effects of SSRI (11)
Serotonin syndrome
- abdominal pain
- diarrhea
- sweating
- fever
- tachycardia
- increased BP
- altered LOC
- muscle spasms
- irritability
- hostility
- mood changes
How to prevent serotonin syndrome when using SSRI
- Do not give with MAOI or anything that increase serotonin
- discontinue all SSRI before starting MAOI 2-5 weeks and vice versa
ECT eight indications
- depression
- psychotic illness
- drug resistant patient with psychosis
- Severely malnourished. exhausted, and dehydrated patient (after rehydration)
- Pt with certain medical conditions that meds are not safe for
- Delusional depression
- Previous med trial have failed
- Schizophrenia with catatonia
ECT six risk factors
- Hypertension
- CHF
- Cardiac arrythmias
- Other cardiac conditions
- Brain tumors
- Subdural hematomas
ECT procedure
- General anesthetic to induce sleep and muscle relaxer
- EEG monitoring brain waves and ECG monitoring heart
- Brief seizure induced by electrical current through electrodes attached to both side of head
- 2-3 treatments/week for 6-12 weeks
ECT ADR
- Confused and disoriented for several hours
2. Retrograde amnesia: loss of memory of event leading up to and including the treatment
Body dysmorphic disorder
- Normal appearance but believe that they have a defective body part resulting in obsessive thinking and compulsive behavior such as mirror checking and camouflaging
- People can be aware that their thoughts are distorted or unaware
- Feelings of disgust, shame and depression
- Chronic and response to treatment is limited
- Often come from homes with abuse and neglect
- Suicide risk is high
- Form of OCD
What comorbidities are linked with body dysmorphic disorder
depression (most common), social anxiety, substance use and OCD
Treat mild-moderate anxiety
- Open-ended questions
- Explore and seek clarification
- Calm presence
- Recognizing the person’s anxious distress
- Willling to listen
- Help patient consider alternatives to problem situations and offer activities that may temporarily relieve feelings of inner tension
- DO NOT: being up irrelevant topics increase anxiety
Treat moderate to severe anxiety
- Safety of patient and others
- Meet physical needs
- Guiding person to quiet environment
- Use of medications and restraints/seclusion
- Reassure the patient that thry are safe
- Pointing out reality of environment to calm the patient’s distortions for severely anxious
- Deep breathing
- Firm, short, simple statements
Other ways to treat anxiety
- Counseling
- Teamwork and safety
- Promotion of self-care activities
- Medication
cognitive restructuring
Therapists help the patient:
- Identify automatic negative beliefs that cause anxiety
- Explore the basis of these thoughts
- Reevaluate the situation realistically
- Replace negative self-talk with supportive ideas
Anxiolytic drugs
Used to treat somatic and psychological symptoms of anxiety disorder
Anxiolytic: benzos
- most common because they have a quick onset
- Only use for short time because dependence, use as a bridge until other meds work
- ADR: sedation, ataxia, and decrease cognitive function, paradoxical reactions (opposite effect —> anxiety, agitation)
- Not recommended for people with substance abuse, elderly patient with delirium, falls ans fractures
- No recommended for pregnancy
Anxiolytic: Buspirone
- Alternative antianxiety medication because no dependence
- 2-4 weeks to reach full effect
- Long term and taken regularly
- ADR: dizzy, HA, nausea, nervousness, lightheadedness, and excitement
- Avoid in patients with liver and kidney dysfunction because can lead to toxicity
- Recommended during pregnancy and breastfeeding
Resilience
A. Positive adaptation or ability to maintain or regain mental health despite diversity
B. Factors that enhance resilience
i. Social support
ii. Positive emotions
iii. Self-efficacyDissociative Fugue
- Subtype of dissociative amnesia
- After week/months may remember their former identities and become amnesic to time spent in fugue state
- Usually follows a traumatic event
PTSD DSM-5 criteria
- Directly experiencing a traumatic event
- Witnessing in person an event occurring to others
- Learning about a traumatic event that occurred to a close family member or close friend
- Experiencing repeated exposure to details of a traumatic event (first responder)
What is PTSD characterized by?
Characterized by persistent reexperiencing a highly traumatic event that involves actual or threatened death or serious injury to self or others that resulted in intense fear, helplessness, or horror.
When do PTSD symptoms begin?
PTSD symptoms can begin after a month, but it is not uncommon for them to be delay for months or years
PTSD signs and symptoms
- Flashbacks
- Hypervigilance
- Sensation of terror in stomach
- Heart palpitations
- Muscle tensing
How do victims of PTSD feel long term?
Victims who suffer from PTSD often feel permanently damaged and hate themselves for feeling needy and helpless
What is dissociative fugue characterized by?
Characterized by sudden unexpected travel and inability to recall one’s identity and information about some or all the past
How do people with dissociative fugue function in fugue states?
In fugue states people function well in their new identity by choosing easy jobs and only having few intimate people in their life
Major depressive disorder
- Persistent for minimum 2 weeks to 6 months
- Chronic: Lasting more than 2 years
- Recurrent episodes common
- Symptoms cause distress or impaired function
- Episode not attributed to physiological effects
- Absence of a manic or hypomanic episode
SSRI
- always 1st line
- Minimal side effects
- teach pt. for s/s of suicide
- rare risk of serotonin syndrome
SSRI examples
paroxetine
fluoxetine
escitalopram
Benzo examples
alprazolam
lorazepam
diazepam
What is PTSD
- Re-experiencing of the trauma
- Avoidance of stimuli associated with trauma
- Persistent symptoms of increased arousal
- Alterations in mood
PTSD intervention stages
Stage 1: Provide safety and stabilization
Stage 2: Reduce arousal and regulate emotion through symptom reduction
Stage 3: Catch up on developmental and social skills; develop a value system
Interventions for PTSD in children
- Establish trust and safety
- Use developmentally appropriate language
- Teach relaxation techniques
- Use art and play to promote expression of feelings
- Involve caretakers in 1:1s, unless they are the cause of trauma
- Educate child and caretakers about grief process
- Assist caretakers in resolving personal distress
- Coordinate with social work for protections
Outcomes for PTSD
i. Manage anxiety.
ii. Increase self-esteem.
iii. Improve ability to cope.
Implementation for PTSD in adults
i. The same 3-stage model used for children
ii. Psychoeducation
iii. Psychopharmacology
