Stress and Distress Part 2 Flashcards
When your pt is projecting all their anger and you remind them of your uncle joe what is this called?
transferance
What lets patients their out of here
anti psychotics. This did not solve the problem. This is deinstitutionalization
If pt goes through marital separation what axis is this?
Axis 4
If pt has history of diabetes or stroke what axis is this?
Axis 3
If they have personality disorder how would you code it and where would you code it
deferred axis 2
what treats depression or ocd
decrease activity at sub thalamic nucleus; deep brain stimulation
What treats treatment resistant depression.
Vagal nerve stimulation
Are anxiety and stress the same thing?
no; anxiety deals with dysfunctional psychological thoughts. Repetitive constant state of alert. Ongoing state of apprehension
What does stress include
Includes physical, mental and emotional responses
What part of the brain tricks the rest of the brain to think were in danger
anterior cingulate gyrus; via axons
what is the psychiatric definition of stress
Life events, or stressors that have the force to alter the expected course of an individuals goals, employment, relationships, and health.
What are two assumptions of psychosomatic medicine
- unity of mind and body
2. psychological factors must be taken into account when considering all disease states
What did Dr. Walter Cannon’s systematic study of relation of stress to disease determine
If you activate sympathetic NS, body gets ready for stress by increasing BP, HR, and CO
What did Sigmund Freud say?
Deep psychic conflict is at the root of the problem. You get a pt with conversion disorder. The hysterical forces is directly connected to the uterus. Women want penis envy.
What is clinical ex of what Freud said
Clinical ex is that you have itching in anal area if male has fear of homosexuality
What does Dr. Franz Alexander say
Psychosomatic symptoms are due to prolonged autonomic system arousal linked to repressed psychic conflict. He linked it to hypertension and peptic ulcer disease, but research doesn’t agree
What did Hans Selye say and what are the 3 stages
He described the human stress response in relation to adrenocortical hormones and said there were three stages:
- Alarm
- Resistance to place where stress levels come back down to equlibrium, if not you go to overload.
- Exhaustion; Overload; adrenal fatigue
What does the Rahe Social Rating scale tell us
Relationships are very important to us and are major stressors.
If you have _____ on the scale you are at risk of illness in the following year. If you have _____ your risk of illness is moderate. If you have less than _____ then you have a slight risk of illness.
300+; 150-299; 150
What did the Rahe findings conclude
80% of individuals that scored 300 or more devoloped physical illness during the following year. 20% did not
Acute stress deals with anti allergic and anti inflammatory and is designed to help us and deals with immunosuppressive effects on lymphoreticular system and marked antiallergic and anti inflammatory effects. Catecholamines and opiates, growth hormone and prolactin are initially ____ enhancing.
immuno
Chronic stress deals with ______. there is an inhibition of growth hormone and prolactin. You get a dysregulation of the immune system.
cytokines; play a role in diabetes, rheumatoid arthritis and deals with depression.
Primordial dwarfism is genetic. But with children who develop dwarfism is the psychosocial stressors which deals with being in orphanage. It has potential to shut down the entire body _____
system
_____ and wholeness is extremely important in regards to stress and your spirit.
Wellness
What are some symptoms of major depression
- pain
- fatigue
- backache
what are some symptoms of generalized anxiety disorder
- chest pain
2. shortness of breath
What are 3 key variables that modulate the stress response
- outlets for frustration
- social support is highly protective
- predictability - coping strategies
What are the 3 C’s
- commitment to self AVOID isolation
- Sense of control over one’s life
- Ability to see change as a challenge.
What is the 4th C?
Coherence; a belief that ones internal and external environments are predictable and that things will work out as well as can be expected.
How do you reduce stress
- Exercise/play - Improve time management
- Improve sense of humor
- Perspective: meaning and purpose of life
- Cultivate spiritual activities
- Increase emotional self disclosure
- Short term psychotherapy
- Social support network
- Increase assertiveness
- reduce exposure to unnecessary stressors
- Monitor sensory input (introvert vs extrovert)
What does the GI system involve
Stress, anxiety and phsyiological symptoms. Some examples include esophageal spasm, globus dysphagia, ulcer vulnerability, ulcerative colitis, Crohns disease.
What is esophageal spasm like
Inc tone of esophageal sphincter. Might think or confuse it with chocking, nausea and vomiting, and heart attack
How does cardiovascular system deal with stress
near double risk for MI, revascularization procedures for unstable angina related to depression. Emotional stress can stimulate arrhythmias
How does musculoskeletal system involved with stress.
you can get rheumatoid arthritis due to stress and depression. Low back pain, may be associated with anxiety, fear and panic.
What are risk factors for specific organ systems associated with psych consults?
- anxiety
- hostility
- anger
- acute mental stress
What is metabolic syndrome
Associated with atypical antipsychotics.
In cases of moderate depression mortality is at 26.5%. This is in connection with ____ disease
cardiac
Depression is an _____ risk factor for ischemic heart disease.
independent; Higher morbidity/mortality after MI
What are possible mechanisms of people who have depression and cardiac disease
- Medication non adherence
- shared risk factors: smoking, diabetes, obesity
- lowered HR variability
- chronic inflammation
- platelet activation
- sympathoadrenal
Describe how puts are when they have stress and cardiac disease
Patients with stress and cardiac disease are hyper vigilant. They have high stress and are competitive. These are negative factors. T
What is the toxic core of someone who has a Type A personality
Hostility; anger, cynicism, and suspiciousness
what are other characteristics of hostility and cardiac disease
- lipid accumulation
- Inc BP and HR- smokers, drinkers, and higher BMIs
- Platelet physiology
People who have higher hostility are associated with coronary risk factors?
increased:
- plasma homocysteine levels
- triglycerides
- BMI
- waist to hip ratios
- glucose levels
- alcohol consumption
- smoking.
With depression ask about history, does it run in family, and has it gone so painful that you want to ___ yourself
kill
Dialysis is a _____ treatment
metabolic
What is over looked with dialysis
Depression; they are completely dependent on this machine and feel like a burden to everyone. They spend a lot of time here.
With pt who develops MI and loses her husband 4 weeks ago describe what is happening
- base line health issues
- death of loved one
- Moving from acute to chronic and moving toward exhaustion if untreated.
- If she is hesitant to talk to anyone it would be another significant factor
