Test 2 psych Flashcards
Moderate Anxiety
- perceptual field narrows
- some details are excluded
- selective inattention
- ability to think clearly is hampered, but learning and problem solving can still tke place-not optimal
- phys symptoms:tension, pounding heart, increased pulse and RR, HA, gastric discomfort, urinary urgency
- voice tremors, shaking
- can be constructive
Severe Anxiety
- perceptual field greatly reduced
- may focus on one particular detail, or scattered details; difficulty noticing what’s going on even when pointed out.
- learning and problem solving-NOT possible
- may be dazed and confused
- behavior is automatic, aimed at reducing anxiety
- SOMATIC: trembling, pounding heart, hyperventilation, impending doom, HA, nausea, dizziness, insomnia
*Severe/Panic levels prevent problem solving/effective solutions. Unproductive relief behaviors=vicious cycle.
Panic
- most extreme level of anxiety
- markedly disturbed behavior
–unable to process what’s going on, lose touch with reality
- pacing, running, shouting, or withdrawal
- hallucinations/false sensory perceptions
- behavior may be erratic, uncoordinated, impulsive
- may lead to exhaustion
Mild Anxiety
- normal, everyday life
- allows person o see, hear, grasp more info
- problem solving = MORE effective
- physically: slight discomfort, restless, irritable
- mild tension relieving behaviors: nail biting, foot tapping)
*mild/moderate levels can alert the person that something is wrong and can stimulate appropriate action
Interventions:
Mild to Moderate Anxiety
–help client focus/solve problems
- provide calm presence
- recognize client’s distress
- willingness to listen
- communication: open ended questions, broad openings, clarification seeking.
Interventions:
Severe Anxiety
Panic
- physical needs (fluids, rest) must be met to prevent exhaustion
- quiet environment; reduce stimuli
- meds/restraints may be used after less restrictive interventions have failed
- communicate with firm, short, simple statements
- provide safe environment
- meet physical needs
Defenses against Anxiety
- automatic psychological processes that protect the person against anxiety
- Healthy, Intermediate, Immature
Healthy Defense Mechanisms
- Sublimation-unconscious process-substituting constructive, socially acceptable acivity for unacceptable activity/impulses: woman angry with boss writes short story about heroic woman.
- Humor-deal with stress/conflict by using amusing aspects of the conflict
- Suppression-conscious denial of disturbing situations or feelings (don’t worry about bills until after exams)
Intermediate Defense Mechanisms
- Repression-exclusion of unpleasant/unwanted experiences or emotions from conscious awareness-unconscious level-someone who has been sexually abused but can’t remember it. *cornerstone of defense mechanisms.
- Displacement-placing emotions associated with one person/thing/situation on to another person/thing/situation that is non-threatening-a pt criticizes a nurse after family fails to visit.
- Reaction formation-unaceptable feelings or behaviors ar controlled and kept out of awareness by develping the opposite behavior or emotion.
- Somatization-transfer of anxiety from the psychological to a physical symptom that has n organic cause. Aka conversion.
- Undoing-making up for an argument with a gift to undo
- Rationalization-justifying illogical ideas, actions, or feelings by developing acceptable explanaions that satisfy the teller as well as the listener-I didn’t get the raise bc my boss doesn’t like me.
Immature Defense Mechanisms
- Passive aggression-indirectly and unassertively expressing aggression toward others.
- Acting Out-dealing with conflicts/stressors by actions rather than reflections or feelings.
- Dissociation-feeling unattached to self, others or environment.
- Devaluation-giving negative value to self or others to try to appear good and reduce stress/anxiety.
- Idealization-emotional stressors are dealt with by idealizing or exaggerating another’s qualities.
- Splitting-inability to integrate positive and negative attributes at the same time (prevalent in people with borderline personality disorders)j.
- Projection-placing one’s own negative attributes onto another.
- Denial-excaping from unpleasant realities by ignoring their existence (hallmark of alcoholics/drug addicts).
Anxiety
Most common of all psychiatric disorders
Affects up to 13.3% of population
Women more than men
Tends to run in families
Evidence of specific genetic contributions.
Co-morbidities=major depression, substance abuse
Panic Disorders
panic attack
terror
feels like heart attack-palpitations, chest pain, breathing difficulties
occurs out of the blue
intense, recurrent, unexpected
impending doom
Agoraphobia
Fear of being in an environment or situation from which excape may be difficult
Anxiety Disorders
- Panic Disorder
- Phobias-agoraphobia, social phobia, specific phobia
- OCD
- Generalized Anxiety Disorder (more days than not for 6 months)
- Stress Related: PTSD/Acute Stress Disorder-stress response of the hypothalamus-pituitary-adrenal system is abnormal.
SSRI’s are first line of treatment.
OCD
Obsessions: thoughts, impulses, or images that persist
Compulsions: ritualistic behaviors that help reduce anxiety
Drugs: SSRI’s, Luvox
Effective: thought stopping and response prevention
SSRI’s
- First line of tx for anxiety
- rapid onset, few SE’s
- SE’s-GI, weight gain/loss, sexual, sweating, RLS
- BBW in 2004 (since then suicid rate has increased 18%)
Meds for Anxiety
- SSRI’s=first line
- Anxiolytics/benzodiazepines (addictive)
- Xanax, librium, klonopin, valium, ativan
- don’t stop abruptly (withdrawl, DTs, seizures)
- additive effect with alcohol
- tolerance
- short term only
-Buspar=non-addictive (2-4 wks for full effect)
Somatoform Disorders
- Physical symptoms, but no physical disorder.
- Sx are linked to psychobiological factors.
- Expression of stress through phys sx
- faulty perceptions and incorrect assessments of bodily sensations associatedwith attention deficits and cognitive impairments.
- abnormalities in brain chemical balance or structural abnormalities.
- serotonin and endorphin deficiency may affect incoming pain signals
- serotonin deficiency may be a factor in body dysmorphic disorder
Dissociative Disorders
- altered mind-body connection
- distubances in consciousness, memory, identity and perception.
- unconsciousdefense mechanism-rare
ThreeTypes:
- Depersonalization (persistant alteration in self perception; feeling surreal; robot like.
- Dissociative Amnesia and Fugue (sudden travel away from usual location) precipitated by traumatic event.
- Dissociative Identity Disorder-long term therapy needed, rare, 2+ personality states; dissociationg is coping mechanism.
Conversion Disorder
Deficits in voluntary motor or sensory function.
Lack of emotional concern about the symptoms (la belle indiffernce)
(temporary, rare)
Major Depressive Disorder (MDD)
- represents a change in previous functions
- symptoms cause clinically significant distress or impoiar social, occupational or other important areas of functioning.
- Five or more of the following nearly every day for 2 wks:
depressed mood
anhedonia
signifcant weight loss/gain
insomnia/hypersomnia
increased/decrased motor activity
anergia (fatigue/loss of energy)
feeling of worthlessness
decreased concentration
recurrent thoughts of death/suicide
Diathesis-Stress Model
Depression results from a dynamic interplay of biology and environment. Some people may be born with a pre-disposition toward depression which is triggered by experiencing a stressful life event.
Norepinephrine, serotonin, and acetylcholine play a role in stress regulation. When these neurotransmitters become overtaxed through stressful events, neurotransmitter depletion may occur.
Neurotransmitters related to altered mood states
serotonin
norepinephrine
Serotonin
regulator of mood, sleep, apetite, libido
Shortage of serotonin can cause depression
exercise increases serotonin
low serotonin is implicated in suicide
Norepinephrine
Modulates attention and behavior
Stimulated by stressful situations
Deficiency: apathy, reduced responsiveness, slowed psychomotor activity.
Dopamine
Involved in fine muscle movement, integration of emotions and thoughts, decision making.
schizophrenia, Parkinson’s, RLS, rewards
Acetylcholine
Plays role in learning, memory
(Alzheimers)
GABA
Reduces aggression, excitation, and anxiety.
SSRI’s
SE’s: agitation, anxiety, sleep disturbance, tremor, sexual dysfunction, headache, dry mouth, sweating, wt change
TOXIC: serotonin syndrome=abd pain, diarrhea, sweating, fever, tachy, High BP, delerium, muscle spasm, irritiablility
incompatible with St Johns Wort (serotonin malignant syndrome)
Celexa, Lexapro, Prozac, Luvox, Paxil, Zoloft
TCA’s
(tricyclic antidepressants)
inhibit re-uptake of norepinephrine and serotonin
SE’s-orthohypo, anticholinergic (dry mouth, blurred vision, urinary retention), dysrhythmias, tachy, MI, heart block
Caution: elderly, those with MI, narrow angle glaucoma, hx of seizures, PG women
Takes 10-14 d to work
OD is an issue
MAOI’s
antidepressants
only used if nothing else works
monitor tyramine inkake (causes HTN)-avoid: avacados, figs, smoked meats, cheeses, yeast extract, beer, chianti, soy sauce, OTC meds (pseudoephedrine), TCAs, narcotics, antihypertensives, sedative stimulants.
SE’s-ortho hypo, weight gain/edema, constipation, urinary hesitancy, sexual dysfunction, vertigo, muscle twitching, insomnia, fatigue
HTN crisis may begin with HA, stiff neck, chest pain, vomiting
hypertensive crisis-severe HA, tachy, palpitations, HTN, n/v
Bipolar Disorder
Distinct period of abnormality and persistently elevated mood for at least 4 days for hypomania, 1 week for mania. Ages 18-30. Substance abuse is common comorbidity.
During period of mood disturbance, 3+ of the following have persisted (4 if mood is only irritable) and present to significant degree:
inflated self esteem/grandiosity
decreased need for sleep
more talkative than usual
flight of ideas, racing thoughts (can include jokes, puns, teasing)
distractability
increase in goal directed activity, psychomotor agitation
excessive involvement in pleasurable activities that have a high potential for painful consequences (shopping, sex, business investments)
excess/imbalance of norepinephrine, dopamine, and serotonin
Bipolar I
Bipolar II
I.at least 1 episode of mania alternating with major depression (males)
II. hypomanic episode alternating with major depression (females
Drugs for agitated/combative
Haldol
Ativan
Lithium carbonate
for bipolar since 1800s
takes at least 2 wks
monitor blood levels
therapeutic = 0.4-1.0 (>1.5 is toxic), monitor 5 days after beginning
draw blood weekly until therapeutic levels reached, then monthly, after 6 months-year of stabiliy, measure every 3 months
SE’s: fine hand tremor, polyuria, mild thirst, mild nausea, general discomfort, weight gain
Early signs of toxicity: n/v/d, thirst, polyuria, lethargy, slurred speech, muscle weakness, fine hand tremor
Advanced Toxicity: (1.5-2.0) coarse hand tremor, persistent GI upset, mental confusion, muscle hyperirritability, eeg changes, incoordination, sedation
Severe toxicity: (2.0-2.5) ataxia, confusion, large output of dilute urine, serious eeg changes, blurred vision, seizures, stupor, severe hypotension, coma, death
>2.5 convulsions, oliguria, death
Contraindicated for pts with impaired renal or thyroid function.
Depakote
(Valproic Acid)
anticonvulsant
useful for bipolar non-respondant to lithium
monitor liver function, platelet count
Tegretol
(carbamazepine)
anticonvulsant
used in bipolar-pts with rapid cycling (4+ in one year)
Lamictal
anticonvulsant
first line treatment for bipolar depression
may cause potentially life-threatening rash-Steven Johnson syndrome
Antianxiety drugs for Bipolar Disorder
Klonopin
Ativan
for treatment of acute mania in some pts resistant to other meds
Atypical Antipsychotics used in Bipolar Disorder due to mood-stabilizing properties
FDA approved for mania:
Zyprexa
Risperdal
Abilify
Seroquel (wt gain/diabetes)
Geodon
(used for their sedating and mood-stabilizing properties-esp. during initial treatment)
Eating Disorders
Highest death rate compared to all other psychiatric disorders.
Comorbidities:
- 50-75% MDD
- 13% bipolar
- OCD is common with bullemia
Also:
-anxiety, substance abuse, personality disorder, sexualy abuse
Anorexia Nervosa
- control issues
- SSRIs improv rate of weight gain and reduce relapse
- Zyprexa (atypical antipsychotic) to decrease agitation and resistance to treatment.
- admit for systolic BP < 70
- weight < 75%
- treatment goal is 90% of ideal body weight (menstruation can occur)
Bulimia Nervosa
- poor impulse control
- SSRIs may be helpful
- dental erosion
- enlarged parotid glands (chipmunk cheeks)
