Psych-Midterms Flashcards
1
Q
A response to external or internal stimuli that can have behavioral, emotional, cognitive, and physical symptoms
A
Anxiety
2
Q
most universal of all emotions
A
Anxiety
3
Q
- It cannot be observed directly but must be inferred from behavior
- Simultaneously an adaptation & a stressor
- As a stressor, it brings about maladaptive
behaviors - Unlike any other emotion; it is perceived as
negative - Its presence compounds the original stress
- Extremely communicable
- Cannot be distinguished from fear by the person experiencing it
- It occurs in degrees
- Mild anxiety serves the function of motivating the person and making him more physically and mentally alert
A
Anxiety
4
Q
As an adaptation, it serves as a signal that the
system is having difficulty maintaining homeostatic
A
homeokinesis
5
Q
A vague sense of impending doom, an
apprehension or a sense of dread, to the lay
person it is described as
A
nervousness
6
Q
- uses defense mechanisms to referee –
unconscious - coping mechanisms - conscious
A
Ego
7
Q
- Stress response from immediate danger.
- Physiologic and emotional response to a known or recognized danger.
- definite
A
Fear
8
Q
- Stress response just from your thoughts
- Tension that a person experiences in response to an unknown object or situation
- indefinite
A
Anxiety
9
Q
Types of Anxiety
A
- Anticipatory
- Signal
- Anxiety Trait
- Anxiety State
- Free-Floating
10
Q
“what will happen next” fears
A
Anticipatory
11
Q
Response to a perceived threat/danger
A
Signal
12
Q
Component of personality that has been present over a long period
A
Anxiety Trait
13
Q
Result of a stressful situation in which the
person loses control of his/her emotions
A
Anxiety State
14
Q
Always present and is accompanied by a feeling of dread.
A
Free-Floating
15
Q
Physiologic Responses
* Restlessness; fidgeting
* GI “butterflies”
* Difficulty sleeping
* Hypersensitivity to noise
Psychological Responses
* Wide perceptual field
* Sharpened senses
* Increased motivation
* Effective problem-solving
* Increased learning ability irritability
A
Mild (+1)
16
Q
Physiologic Responses
* Muscle tension
* Diaphoresis
* Pounding pulse
* Headache
* Dry mouth; high voice pitch; faster rate of
speech
GI upset and frequent urination
Psychological Responses
* Perceptual field narrowed to immediate task
* Selectively attentive
* Cannot connect thoughts or events
independently
* Increased use of automatisms
A
Moderate (+2)
17
Q
Physiologic Responses
* Severe headache
* Nausea, vomiting, and diarrhea
* Trembling Rigid stance
* Vertigo; pale; tachycardia; chest pain
Psychological Responses
* Perceptual field reduced to one detail or
scattered details
* Cannot complete task & solve problems or learn effectively
* Behavior geared toward anxiety relief and is
usually ineffective
* Doesn’t respond to redirection feels awe, dread, or horror, cries, ritualistic behavior
A
Severe (+3)
18
Q
Physiologic Responses
* May bolt and run or be totally immobile and
mute
* Dilated pupils
* Increased blood pressure and pulse
* Flight; fight, or freeze
Psychological Responses
* Perceptual filed reduced to focus on self
* Cannot process any environmental stimuli
* Distorted perceptions irrational thought
* Ineffective communication
* Hallucinations, delusions, suicidal tendencies
A
Panic (+4)
19
Q
Mental Health Continuum of Anxiety
A
- Mild
- Moderate
- Severe
- Panic
20
Q
Anxiety levels –aid in the work of living
A
Mild
21
Q
Psychological factors affecting medical condition
A
Moderate
22
Q
- Anxiety Disorders
- Somatoform Disorders
- Dissociative Disorders
- Personality Disorders
- Dysthymia- Major Depression
- Cyclothymia- Bipolar (maniac-depressive)
A
Severe
23
Q
- Psychosis
- Thought D/O
- Schizophrenia
- Cognitive Impairment Disorder
A
Panic
24
Q
- Diagnosed when anxiety no longer functions as a signal of danger or motivation but becomes chronic
- Uses rigid, repetitive, and ineffective behaviors to try to control their anxiety
A
Anxiety Disorders
25
* Phobias
* Panic Disorders with or without Agora Phobia
* Generalized Anxiety Disorders
* Obsessive Compulsive Disorders
* Post-Traumatic Stress Disorder (PTSD)
* Acute Stress Disorder
* Substance-Induced Anxiety Disorder
Anxiety Disorders
26
* Body Dysmorphic Disorder
* Somatization Disorder
* Conversion Disorder
* Pain/Psychogenic Pain Disorder
* Hypochondriasis
* Undifferentiated Somatoform Disorder
Somatoform Disorders
27
* Dissociative Amnesia
* Dissociative/Psychogenic Fugue
* Dissociative Identity Disorder/Multiple
Personality Disorder
* Depersonalization Disorder
Dissociative Disorders
28
Levels of Anxiety
1. Euphoria Level (0)
2. Mild/Alertness Level (+1)
3. Moderate Level (+2)
4. Severe or Free Floating (+3)
5. Panic Level (+4)
29
Other types of Level of Anxiety
1. Normal
2. Acute
3. Chronic
4. Panic
30
exaggerated feeling of well-being, not directly
proportional to a specific circumstance
Euphoria Level
31
anxiety related to normal tension of everyday life
Mid/Alertness Level
32
focus is directed to immediate concerns
Moderate Level
33
creates a feeling of impending doom
Severe or Flee Floating
34
feelings of helplessness and terror
Panic Level
35
Unresolved, unconscious conflicts resulting from repressed wishes and drives cause guilt and shame which leads to anxiety. Anxiety threatens the ego and defense mechanism is used to respond to this threat.
Psychoanalytic Theory
36
Anxiety is learned or conditioned response to a stress event or perceived danger
Cognitive Theory
37
alterations in the brain especially in the limbic system has been implicated in stress and anxiety related disorders. Deficiency of GABA,
Deficits or Imbalance of Serotonin in the
Amygdala, Norepinephrine is either
overactivated or underactivated
Biologic Theory
38
* 5-HTTP gene
* 15-20% OCD- immediate family
* 40% agoraphobia- relative
Genetic Theory
39
Difficulty adapting to everyday social and
cultural demands because of low self-esteem
and inadequate coping. Decrease tolerance to
stress.
Sociocultural Theory
40
* Discrete period of intense fear or discomfort in the absence of real danger
* Sudden onset of symptoms, peaking within 10 minutes
* **Onset**: Late Adolescence (20’s) and the mid 30’s
Panic Disorder
41
Symptoms of Panic Disorder
* A- Abdominal distress, Accelerated HR
* B- Breathlessness (smothering)
* C- Choking feeling, Chills, Chest pain
* D- Dizziness, Derealization, Depersonalization
* F- Fear of losing control, Flushes (hot)
* S- Shaking, Sweating
* T- Tingling sensation (paresthesias)
42
Triggers for Panic Attacks/Etiology
**I**- Injury (accidents, surgery), Illness, Interpersonal conflict or loss, Ingestion of stimulants (caffeine, sympthomimetics)
43
Nursing Interventions
* M- Emergency
* E- Non-threatening, supportive environment
* T- Cognitive Behavioral Therapy
* H- Health education focus
* O- Out-patient follow-up
* D- Caffeine reduction
* S- Emphatetic, non-argumentaive
44
* Anxiety about being in places or situations for fear of having a panic attack or panicky feelings
* Overwhelming fear that occurs out of the blue w/o warning and for no reason
Panic Disorder with or without Agrophoria
45
Side Effects of Panic Attacks
* Avoidance
* Agoraphobia
* Anticipatory Anxiety
46
avoids activities, places, people, situations
that he thinks triggers the attack
Avoidance
47
person fears and avoids public places where he thinks he has no escape when panic occurs
Agoraphobia
48
worrying when and where the next attack will strike. Becomes fearful just by thinking of having the possibility of having the attack
Anticipatory Anxiety
49
Nursing Interventions
1. Medication- Benzodiazepines; Buspirone, SSRI, Beta Blockers, TCA’s
2. Behavior Cognitive Theory- client education and awareness, breathing and relaxation techniques
50
* uncontrollable, persistent irrational fear of an object or situation that impairs normal functioning of a person
* An attempt to cope with specific internal or external dangers by avoidance
* Defense against threatening impulses
* Displacement of Anxiety
Phobia
51
Categories of Phobia
1. AGORAPHOBIA
2. SPECIFIC PHOBIA
3. SOCIAL PHOBIA
52
some may become housebound where they think is the safest place, they avoid normal activities such as grocery, shopping or driving
Agoraphobia
53
* excessive fear of an object or situation
* Common in females- because strong fears have traditionally been compatible with female roles in the society
Specific Phobia
54
Etiology of Phobia
1. Genetic factors
2. Biological theory
3. Psychological theories
4. Environmental Factors
55
Nursing Intervention
1. Psychotherapy
2. Pharmacologic
3. Patient Education
56
* Psychotherapy
* Behavioral therapy
* Cognitive-behavioral
* Psychodynamic (insight-oriented)
Psychotherapy
57
* Panic D/O - Benzodiazepines (Lorazepam)
* GAD - Clonazepam, Alprazolam, Buspirone
* Social Phobia - Clonazepam
Pharmacologic
58
F- Fear (marked/persistent, excessive) and cued by presence or anticipation of a specific object or situation
E- Exposure to phobic stimulus--anxiety response -situationally-bound or predisposed panic attack
A- Avoidance of feared situations
R- Recognized fear as excessive and unreasonable
S- Significant interference with Normal routine, occupational or academic functioning, Social activities/relationships
Patient Education
59
Fear of storms, water, heights, or other natural phenomena
Natural Environment
60
Fear of seeing one’s own or others’ blood, traumatic injury, or an invasive medical procedure such as an injection
Blood injection
61
Fear of being in a specific situation such as on a bridge or in a tunnel, elevator, small room, hospital, or airplane
Situational
62
Typically Displays
* Anticipatory anxiety
* Avoidance behavior
63
Fear of animals or insects
Animals
64
Fear of getting lost while driving if not able to make turns to get to one’s destination
Others
65
heights
Acrophobia
66
cats
Ailurophobia
67
pain
Algophobia
68
flowers
Anthophobia
69
people
Anthrophobia
70
water
Aquaphobia
71
spiders
Arachnophobia
72
lightning
Astraphobia
73
needles
Belonophobia
74
thunder
Brontophobia
75
closed places
Claustrophobia
76
dogs
Cynophobia
77
insanity
Dementophobia
78
horses
Equinophobia
79
lizards, reptiles
Herpetophobia
80
germs
Mikrophobia
81
mice
Murophobia
82
dirt, germs, contamination
Mysophobia
83
numbers
Numerophobia
84
darkness
Nyctophobia
85
snakes
Ophidiophobia
86
fire
Pyrophobia
87
railways
Siderordomophobia
88
being buried alive
Taphaphobia
89
death
Thanatophobia
90
hair
Trichophobia
91
13 persons at a table
Triskaidekaphobia
92
strangers
Xenophobia
93
animals
Zoophobia
94
* fear of being watched, scorned or humiliated in social situation, while doing something in front of an audience or interacting with others
* They experience excessive self-consciousness in everyday social situation
* They often worry for days or weeks in advance of a dreaded situation, they may miss work, school or appointments for fear of meeting new people
* Physical symptoms: blushing, profuse sweating, trembling, nausea, DOB
Social Phobia
95
Causes of Social Phobia
* Overprotective and anxious parents
* Exposure to traumatic events
96
Nursing Intervention of Social Phobia
1. Monitor medication for effectiveness
2. Teach patient increasing signs of anxiety &
select anxiety reducing measures.
3. Videotaping and feedback and role playing
F
E
A
R
S
* For under 18 years old- duration of phobia is at least 6 months
* If a GMC or another mental disorder is present, the fear in criterion A is unrelated to it, i.e. The Fear is not of stuttering or trembling in Parkinson’s Disease, or exhibiting abnormal eating behavior in AN or BN
* REMEMBER: Generalized: if the fears include
most social situations, also consider additional
diagnosis of AVOIDANT PERSONALITY D/O
97
(marked/persistent) of one or more social or
performance situations; not due to direct physiological effects of a substance, GMC, another mental disorder
Fear
98
anxiety symptoms that are humiliating/embarrassing; situationally-bound or predisposed panic attack
Exposure to unfamiliar people or possible scrutiny
99
Nursing Intervention/Treatment
1. Psychotherapy
2. Medications
3. Patient Education
100
* Behavioral Therapy
- Systematic desensitization
- Flooding
* Psychodynamic (insight-oriented)
Psychotherapy
101
* Panic disorder – Benzodiazepines (Lorazepam)
* Social Phobia – Clonazepam
Medications
102
* Teach what anxiety is and helping client identify anxiety responses
* Teach relaxation techniques, goal setting
* Discuss methods to achieve goals, and help the client to visualize phobic situation
Patient Education
103
W- worries excessively
O- out-of-control, out-of- proportion worry
R- restlessness
R- rigidity/inflexibility
I- irritability
E- easy fatigability
R- rule out of substance abuse or other medical conditions as the cause
S- sleep disturbance
General Anxiety Disorder (GAD)
104
Etiology
1. GENETIC - predisposition
2. BEHAVIORAL - learned behavior from parents
3. ENVIRONMENTAL - parental emotional problems, disrupted attachment, stressful life events, traumatic experiences --risks
105
Clinical Picture of Phobia
* characterized by unrealistic or excessive anxiety & worry about two or more life circumstances that are usually developmentally determined
106
Causes of Phobia
1. Faulty Development (Modelling)
2. Inability to handle dangerous impulses
3. Anxiety arousing decisions
4. Reactivation of prior trauma
107
Nursing Intervention of Phobia
1. Pharamacologic Intervention
2. Non-pharmacologic Intervention
108
cocktails: SSRI-first line, Anxiolytics (Benzodiazepines)
Pharmacolgic Intervention of Phobia
109
* Environment – Calm, non-stimulating
* Relationship - consistent, supportive, trusting, non-demanding
* Education
1. **Illness** - how to recognize anxiety, coping
mechanism; factors contributing to anxiety;
treatment goals
2. **Diet**-no caffeine, no alcohol
* Other treatment
1. Cognitive
- Modifying self-talk/challenging irrational
beliefs
- Relaxation, modeling, imagining,
visualizing
Non-Pharmacologic Intervention
110
M cocktails: SSRI-first line, Anxiolytics
(Benzodiazepines)
E calm, non-stimulating environment
T Cognitive Behavioral therapies
* Modifying self-talk/challenging irrational beliefs
* Relaxation, modeling, imagining, visualizing
H Educate: how to recognize anxiety, coping
mechanism; factors contributing to anxiety;
treatment goals
O follow-up treatment
D cut down on caffeine
S consistent, stable, supportive home environment
METHODS
111
* Characterized by recurrent or persistent intrusion of unwanted desires, thoughts and actions.
* They are conscience driven, sensitive, shy, meticulous
* **Ego Dystonic**- symptoms are not acceptable to the person
* **Onset**: 20 years old but it can occur as early as 2 years old
Obsessive-Compulsive Disorder
112
Etiology
* Unknown
* Genetics
* Infections group A streptococcal infections
* Stress (OCD symptoms can worsen with stress)
* Interpersonal relationships
113
* Recurrent and persistent thoughts, ideas, images or impulses that are intrusive and senseless.
* Intrinsic to the person rather than the effect of insertion
* Inappropriate and irrational
* Ignoring attempts to obliterate thoughts but failing to dismiss them completely
* Intrusive
Obsessions
114
Common Obsessive Thoughts
* Religion
* Blasphemous thoughts (sexual thoughts)
* Violence and aggression
* The need for symmetry and exactness
* Contamination, dirt, germs
115
* Ritualistic, repetitive behaviors that an individual does to decrease anxiety
* repetitive or routinely done
* reduction of obsession is the goal
* ritualistic performances
Compulsions
116
* Grooming
* Repeating movements
* Checking door knobs
* Hoarding
* Set limits on the rituals that may interfere with client’s well-being
* Encourage verbalization of concerns
* Establish a written contract that will gradually lessen compulsion
Common Compulsive Complications
117
* Substitutive thoughts and activities
* Guilt and fear of punishment
* Assurance of order and predictability
Causal Factors
118
Nursing Intervention of OCD
1. Behavior Therapy
2. Cognitive Therapy
3. Group Therapy
4. Family Therapy
5. Yoga meditation
119
METHODS
* M- cocktails: SSRI-first line, Clomipramine
* E calm, non-stimulating environment
* T Behavior therapy
- Cognitive and relaxation techniques
- Neurosurgery
- Hospitalization – severe impairment, suicide
risk
* H Nature and treatment of OCD
- Correct misconceptions about illness and
management
- Contact information of support groups
- Impact of illness to personal experiences/relationships
* O follow-up treatment
* D cut down on caffeine
* S consistent, stable, supportive home environment
120
Nursing Care of OCD
* Do not interrupt compulsive behaviors & allow time for the client to perform compulsive rituals
* Provide safety
121
The OCD Cycle
1. Obsession
2. Anxiety
3. Compulsions
4. Relief
122
Unwanted distressing thoughts, urges, mental images. May include “what if..” and doubts.
Obsession
123
May be distress, fear, worry, or disgust. It’s a
false alarm. Feel the need to do something
Anxiety
124
any behavior performed to help make the
anxiety go away, including checking.
Compulsions
125
It is only temporary. Obsession come back sooner
Relief
126
Occurs after experiencing a severe physical or
psychological trauma. Rape, fire, disasters, violent attacks, such as mugging, torture, being kidnapped, child abuse, serious accidents
Post-traumatic Stress Disorder
127
Onset of PTSD
* Acute- < 3 months after the event
* Chronic- beyond 3 months
* Delayed- 6 months or more
128
Duration of PTSD
* Acute- 1 to 3 months
* Chronic- 3 months or more
129
TRAUMAS
* T- Tragic exposure
* R- Re-experiencing the episode
* A- Avoidance of recall
* U- Unable to function or the symptoms interfere with daily function
* M- Month-long duration (approximate) of the symptoms
* A- Arousal experiences
* S- Sleep pattern disturbance
130
Clinical Symptoms of PTSD
1. BEHAVIORAL
- hyperalertness, tend to abuse drugs, isolation, triggering events create a cycle of reminders
2. AFFECTIVE
- irritable, tense and restless, labile, guilt feelings numbing of emotions, feel detached from others
3. COGNITIVE
- memory of traumatic events may be relieved by amnesia, flashbacks, nightmares, dreams, illusions.
131
DREAMS: A Mnemonic Tool for Screening Clients for PTSD
* D Detachment: Does the individual detach from the traumatic event or personal relationship?
* R Reexperiencing: Is the client re-experiencing nightmares, recollections, or flashbacks of the traumatic event?
* E Event: As a result of the traumatic event, does the client exhibit significant distress accompanied by fear or helplessness?
* A Avoidance: Does the client avoid close friends or places associated with the traumatic event?
* M Month: Has the client experienced the identified clinical symptoms for at least 1 month?
* S Sympathetic: Is the client experiencing
sympathetic hypervigilance or hyperarousal
symptoms?
132
Nursing Intervention for PTSD
* Combination of pharmacologic and non-pharmacologic therapies
* Consist of two or more of the following:
1. Individual
2. Family
3. Group
4. CBT
5. Behavioral (desensitization, relaxation)
6. Play therapy, Art therapy
7. Anxiety management
133
METHODS of PTSD
* M- SSRI (sertraline), beta-blockers (propanolol)
* E non-stimulating, calm
* T hospitalization-Suicidal, homicidal
* H coping strategies, relaxation, stress/anger
management
* O counseling/treatment follow-up
* D caffeine reduction
* S empathetic, supportive, non-threatening
134
* Short term response to extreme trauma.
* Onset: during or immediately after the trauma
* Duration: 2 days (resolved by 4 weeks)
* Assessment: Hx of exposure to trauma
Acute Stress Disorder
135
Symptoms of ASD
* Avoidance of stimuli related to trauma
* Sleep disturbances, hypervigilance, startle response, irritability, decreased concentration.
* Flashbacks though dreams, nightmares, illusion
* Defense mechanism: Denial, suppression, repression
136
Duration of ASD
* Acute onset- within 6 months after the events
* Delayed Onset – 6 months after the events
* Duration:
- Acute duration:1-3 months
- Chronic duration:3 months or more
137
* Type A Personality trait
* Medical Conditions caused by Psychological
Factors:
- Allergy, asthma, ulcers, sexual dysfunctions, backaches, acne, dermatitis, eczema, high BP
Anxiety Disorder Due to Medical Condition
138
Anxiety Symptoms are the physiological consequence of another medical condition:
* *** Endocrine disease***: hyperthyroidism, hypoglycemia, hyperadrenalcorticolism
* ***Cardiovascular disorders***: congestive heart failure, arrhythmia, pulmonary embolism
* ***Respiratory illness***: asthma,
pneumonia
* ***Metabolic disturbances***: B12
deficiency, porphyria
* ***Neurological illnesses:*** neoplasms,
encephalitis, seizure disorder
139
* Coping Assistance- support group, facilitate
self-esteem enhancement, spiritual group
* Behavior Therapy- Art, Music, Play (for children)
* Psychological Support- simple relaxation, for
muscle pain, tension and anxiety
* Techniques to reduce anxiety
- Visual Imagery, Change of pace or scenery, Exercise or massage, Transcendental Meditation, Biofeedback, Systematic desensitization, Relaxation Exercises, Psychotherapy
* Medications- Benzodiazepines, Beta blockers
* Encourage verbalization of feelings especially anger, shock, depression
* By non-judgmental and honest
* Encourage writing a journal- safe way to express anger & negative feelings
* Expressive Therapy- to externalize emotions:
psychodrama, art, music, poetry
* Sleep disturbance therapy
- Physical exercise at daytime, relaxing music, prayer or meditation, eliminate stimulants: coffee, etc., use of bed only for sleeping and at regular time
General Intervention for Anxiety Disorder
140
* Behavior Therapy
* Psychotherapy
* Cognitive-behavioral Therapy (CBT)- last 12
weeks, must be directed at the person’s specific anxieties
* Supportive Family
* Stress Management Techniques
General Treatment for Anxiety
141
Transference of mental experiences and states into bodily symptoms
Somatization
142
* Presence of physical symptoms that suggest a medical condition without a demonstrable organic basis
* Features:
- Physical complaints
- Psychologic factors
- Symptoms uncontrolled
* Characterized by:
- Complaints of physical symptoms
- Gains : primary (anxiety relief), secondary
(attention, relief from responsibilities)
- Ego-syntonic (self-congruent)
- Significant impairment: social/occupational
functioning
- Multiple visits/treatments (Doctor
shopping)
Somatoform Disorder
143
“Fight or flight” response
Selye’s General Adaptation Syndrome (GAS)
144
* Chemical imbalances (serotonin and endorphins)
* 10-20% of female first-degree relatives of people with this disorder
Genetic and Biologic Theory
145
Person responds to stress primarily with physical manifestations in one specific organ or system
Organ Specificity Theory
146
Characteristics of dynamic family relationships, such as parental teaching, parental example, and ethnic mores
Familial/Psychosocial Theory
147
Person learns to produce a physiologic response to achieve a reward, attention, or some other reinforcement
Learning Theory
148
* High levels of physiologic arousal
* Alexithemia (deficiency in the communication between brain hemispheres-difficulty expressing emotions
Psychobiologic theory
149
Impaired thinking and learned behavior
Cognitive-behavioral theories
150
Denial of psychological source of conflict—displacement
Psychoanalytic Theory
151
* Incidence higher among LES
* Cultures view direct expression of emotions:unacceptable
Socio-cultural theory
152
* preoccupied with an imagined defect in
appearance that are usually facial flaws
- Camouflaging
- Comparing
- Scrutinizing
- Mirror gazing
- Skin picking
- Depressive syndrome
* Onset: adolescence through the third decade of life
Body Dysmorphic Disorder
153
* Chronic, severe anxiety disorder in which a client expresses emotional turmoil or conflict through significant physical complaints
- Pain
- GI
- Sexual
- Neurologic
* Onset: by 30 years of age
* Often familial
* Occurs most often among clients who have little education and low income
* Very dramatic when they describe the symptoms
* Physical complaints are thought to be an
unconscious cry for help
* May help person avoid responsibilities
Somatization Disorder (Briquet's Syndrome)
154
* Involves motor or sensory problems suggesting a neurologic condition
* Psychological condition in which an anxiety-provoking impulse is converted, unconsciously into functional symptoms
Conversion Disorder
155
Subtypes of Conversion Disorder
* Motor symptoms
* Sensory symptoms
* Seizures or convulsion with voluntary motor and sensory components
* Mixed presentation
156
patient appears to be unconcerned about the symptoms
‘La belle Indifference’
157
Clients with Conversion Disorder benefit by:
* Primary gain – relief from anxiety
* Secondary gain - allow gratification of
dependency
158
Defense mechanism used:
* Respression
* Conversion
159
* Individual experiences significant pain without a physical basis for pain
* Occurs more frequently in the fourth or fifth decade of life, usually in women.
Pain Disorder (Psychalgia)
160
* preoccupied with bodily functions and unrealistic beliefs of having serious physical illness based in misinterpretation of physical symptoms
* Preoccupation with the fear that one has a serious disease ***(disease conviction***) or will get a serious disease (***disease phobia***)
* Generally occurs in early adulthood, equally in men and women
Hypochondriasis
161
Causes of Hypochondriasis
* Parents continually worrying about the child’s sneeze, cough, GI upset and the chills attaches undue significance to such manifestations
- Maintenance of the pattern by
reinforcement
162
* “Aggressive and hostile wishes toward others are transferred (through ***repression and displacement***) into physical complaints”
* “Also viewed as a defense against guilt, a sense of innate badness, an expression of low self-esteem, and a sign of expressive self-concern”
Psychodynamic School of Thought
163
Nursing Intervention for PST
* Establish trust and empathy
* Reassure client and family that there is no
illness
* Insight Therapy
* Work with client to identify events that
precipitated the symptoms
* Set limits
* Diversional Activity
* Medications
164
Characterized by one or more unexplained
physical symptoms of at least 6 months duration, which are below the threshold for diagnosis of somatization disorder
Undifferentiated Somatoform Disorder
165
Nursing Intervention for USD
* Focus on Anxiety reduction
* Diversional activity, anti-anxiety medications
* Do not reinforce the sick role by not being overly attentive
* Explore possible links between the symptoms and the emotions, past experiences or evoking thoughts
* Establish a written contract that will redirect
client’s thoughts and feelings
* Allow the person to discuss physical complaints
* Matter of fact attitude
* Psychotherapy
* Relaxation Training
* Hypnotherapy
166
* Pre-morbid personality: immature, egocentric, episodes of emotional disturbance
* Ego protecting himself against overwhelming anxiety from a painful memory
Dissociative Disorders
167
* “Psychogenic Amnesia”
* Inability to recall an extensive amount of important personal information because of physical or psychological trauma
Dissociative Amnesia
168
Predisposing factors of DA
* Intolerable life situation
* Unacceptability of certain impulses or acts
* Threat of physical injury or death
169
Can be describes as:
* Circumscribed
* Selective
* Generalized
* Systematized
* Continuous
170
* “Psychogenic Fugue”
* Episodes of suddenly leaving the home or place of work without any explanation, travelling to another city, and being unable to remember his or her part or identity
* characterized by sudden unexpected travel to a new place and is unaware of how he travels there
* Rare disorder
* Occurs in Adulthood
* Days to month
* Extreme stress:
- War
- Severe conflict
- Natural disasters
Dissociative Fugue
171
* “Multiple personality disorder”
* Displays two or more distinct identities or
personality states that recurrently take control of his or her behavior
“host” – dominant personality
“alter” – any personality that is displayed in the
clinical setting
* May occur in early childhood or later, but rarely is diagnosed until adolescence
* More common in women
* Goal: to merge all personality into one
* Multiple trauma in childhood
Dissociative Identity Disorder
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Causes of DID
Deep seated conflict between contradictory impulses and beliefs that a resolution is achieved through separating the conflicting parts from each other
173
* Persistent or recurrent feeling of being detached from his or her mental processes or body
* Feelings of being in a dreamlike state, out of the body, mechanical, or bizarre in appearance
* Feels self-estranged or detached from self
* Adolescents and young adults (rarely occurs after age 40 years)
**Predisposing Factors:**
* Fatigue
* Meditation
* Hypnosis
* Anxiety
* Physical pain
* Severe stress
* Depression
Depersonalization Disorder
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Nursing Intervention of Depersonalization Disorder
* Assure patient that he is not to blame for behaviors that occur during dissociative states
* Assure that staff will remain with him during overwhelming anxiety
* Listen actively and help patient identify effective coping methods
* Assist patient to utilize alternative coping
methods
* Provide opportunities for patients to vent anger, fear, shame, doubt.
* Engage patient in physical activities that require energy and concentration
* Encourage patient to write thoughts, feelings, fears in a diary
* Praise the patient for the use of effective coping
* Refrain from passing judgment on the patient, instead let the patient know he/she is
worthwhile.
175
“Affective Disorders”
Mood Disorders
176
* Pervasive alterations in emotions that are manifested by depression, mania, or both
* “**The common cold of psychiatric disorders**”-are characterized by persistent feelings that cause a wide range of emotional and behavioral problems that interfere with the patient’s social and psychological functioning.
Mood Disorders
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* sustained emotional state
* What the person describes
- Dysphoric
- Irritable
- Elevated
Mood
178
* Outward expression of emotion, emotional display, emotional responsiveness.
* What others observed
- Appropriate
- Flat
- Blunted
- Restricted/Constricted
- Inappropriate
- Labile Affect
Affect
179
Congruent
Appropriate
180
Complete or almost complete absence of outward emotional expression
Flat
181
Severe reduction in the intensity of outward emotional expression
Blunted
182
Severe reduction in the intensity of outward emotional expression
Blunted
183
Reduction in the intensity of outward emotional expression
Restricted/Constricted
184
Affect that doesn’t match the situation, inability to show appropriate emotional response
Inappropriate
185
Exhibiting unstable, rapidly shifting emotions
Labile Affect
186
5 Types of Mood Disorders
1. Bipolar Disorder
2. Cyclothymic Disorder
3. Dysthymic Disorder
4. Major Depressive Disorder
5. Depressive Disorder
187
Higher correlations of mood disorders -
* IDENTICAL TWIN 40- 70%,
* PARENTS/SIBLINGS 15%,
* GRANDPARENTS/AUNTS/UNCLES 7% (5-10%)
Genetic Theories
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* Deficiencies or abnormalities in the brain’s
chemical messengers/ neurotransmitters
1. Serotonin & Norepinephrine
- Regulate mood, control drives (hunger, sex, thirst)
2. Acetylcholine
- Sleep, wake
3. Dopamine
- Regulate emotional response
4. Biogenic Amine Hypothesis
- Deficiencies in norepinephrine & serotonin
Neurochemical Theories
189
* Hypersecretion of cortisol (depression)
* ↓ level of thyroid hormone (d)
* postpartum hormone alterations
* premenstrual syndrome (PMS)
Neuroendocrine/Hormonal Theory
190
Circadian rhythm disturbances (early morning
awakening), decreased total sleep time
Biological Rhythms
191
* Depressed- process information in negative way
* Experience cognitive distortions and thinking
errors
* MAGNIFICATION/MINIMIZATION
- (- ) OVEREMPHASIZED
- (+) UNDEREMPHASIZED
Cognitive Theory (A. Beck)
192
1. Negative perception of self
* (worthless, bad, defective, inadequate, undesirable) ,
2. Negative interpretation of experiences/ world
* demanding, defeating ,
3. Negative view of future
* expectation of ongoing hardship, suffering,
deprivation, failure
Cognitive Triad
193
* Learned helplessness theory (seligman)
- little positive reinforcement → withdrawn, passive , giving up hope→ helplessness and hopelessness
Behavioral Theory
194
* Faulty family dynamics
* Real or perceived loss = **anger turned inward**
* Tyrannical Superego →** guilt, self-criticism**
* Defense reaction against underlying depression = **mania**
* Depression results from a harsh superego
(“conscience” of the unconscious mind),self
criticism, guilt
* **RESPONSE TO LOSS**- Actual, perceived,
threatened
* **TRAUMA IN ORAL PHASE**- Need for warmth, affection, appreciation
*** RESULT**: Anger is turned inward on self
(depression)
* **DEFENSE REACTION**→ Pleasurable impulses, aggression (mania)
* **UNDER LYING HOSTILITY**- both shared
Psychoanalytic/Psychodynamic Theory (Freud, Abraham)
195
* Stressful life events
- loss of parent or spouse
- financial hardship
- illness, midlife crisis
- perceived/ real failure
- relocation
- loss/change employmen
- retirement
- trauma
- abuse
- parental neglect
Life Event and Environmental Theory
