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PSYCH > TOPIC 2 - anxiety and somatic disorders > Flashcards

TOPIC 2 - anxiety and somatic disorders Flashcards

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1
Q

brainstem is composed of

A

medulla, pons, midbrain

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2
Q

cerebellum is responsible for

A

motor control and cognitive processing

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3
Q

the amygdala processes

A

fear and anxiety

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4
Q

hyperactive vs hypoactive amygdala

A

hyper - trauma, may underlie in schizophrenia
hypo - respons to antidepressants

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5
Q

what do antianxiety drugs do to the limbic system

A

slow

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6
Q

why do drugs that affect brain function stimulate resp depression

A

basal ganglia controls movement of the diaphragm that is essential for breathing and the basal ganglia is slowed with antipsychotic drugs

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7
Q

what part of the brain is associated with schizophrenia

A

thalamus and prefrontal cortex

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8
Q

what system is disrupted in depression, anxiety, insomnia, substance use disorder, and alzheimers

A

how CRH stimulates the cortex to secrete cortisol

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9
Q

first line drug for treating ADHD

A

sympathomimetics

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10
Q

common side effects of stimulants

A

decreased appetite and weight loss

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11
Q

CT scans

A

can detect lesions, abrasions, areas of infarct, aneurysm

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12
Q

MRI and fMRI

A

used to exclude neurological disorders in those presenting with mental illness

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13
Q

MRI and fMRI

A

used to exclude neurological disorders in those presenting with mental illness

can detect edema, ischemia, infection, neoplasm, trauma

detect blood flow to functionally active brain regions

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14
Q

PET scan

A

detect oxygen utilization, glucose metabolism, blood flow, and NE receptor interaction

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15
Q

dopamine

A

important neurotransmitter involved in cognition, motivation, and movement

stimulate hypothalamus to release hormones

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16
Q

ACH

A

plays a role in skeletal muscle movement, arousal, memory, and sleep-wake cycle

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17
Q

NE

A

mood, attention, arousal, stimulate fight or flight

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18
Q

serotonin

A

mood, sleep regulation, hunger, pain perception, aggression, libido, hormonal activity

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19
Q

histamine

A

alertness
inflammatory response
GI secretion

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20
Q

GABA

A

reduce anxiety, excitation, aggression

muscle relaxing

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21
Q

how do SSRIs work in the body

A

inhibit the re uptake, making it stay longer in the synapse

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22
Q

SSRIs are commonly used to treat …

A

panic disorder, GAD, OCD, PTSD, social phobia

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23
Q

what does buspirone do

A

reduce anxiety without causing immediate sedative and mildly euphoric effects of benzodiazepines

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24
Q

action of benzos

A

promote the activity of GABA

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25
Q

physiological response of anxiety

A

associated with muscle tension and vigilance in preparation for future danger with cautious or avoidant behaviors

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26
Q

difference between fear and anxiety

A

anxiety - no known cause
fear - known cause

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27
Q

why is normal anxiety beneficial

A

provides energy needed to carry out the tasks involved in striving toward goals

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28
Q

acute anxiety

A

imminent, real, or potential loss that threatens an individuals sense of security
triggered by an acute stressor

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29
Q

pathological anxiety

A
  1. intensity is our of proportion to the threat
  2. emotional response persists after the threat is resolved
  3. emotional response becomes generalized to benign situations
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30
Q

physical symptoms of mild anxiety

A

restless, irritable, tension relieving behaviors such as nail biting or finger tapping

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31
Q

physical symptoms of moderate anxiety

A

tension, pounding heart, increased pulse and resp, voice tremors

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32
Q

what do patients have a sense of with severe anxiety

A

impending doom

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33
Q

symptoms related to panic level anxiety

A

confusion, shouting, screaming, extreme withdrawal, hallucinations

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34
Q

what levels are affected with panic level anxiety

A

perceptual field
ability to concentrate and learn
physical manifestations

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35
Q

what should you do as a nurse when a patient is experiencing mild to moderate anxiety

A

remain calm, recognize patient distress, be willing to listen

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36
Q

what should you do as a nurse when a patient is experiencing severe to panic level anxiety

A

firm, short statements to be better understood
speak slower
wait longer for responses
repeat comments

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37
Q

what determines if a defense mechanism is adaptive or maladaptive

A

adaptive - healthy
maladaptive - unhealthy

frequency, intensity, and duration determines

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38
Q

healthy defenses

A

altruism, sublimation, humor, suppression

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39
Q

intermediate defenses

A

repression, displacement, reaction formation, somatization, undoing, rationalization

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40
Q

immature defenses

A

passive aggression, acting out behaviors, dissociation, devaluation, idealization, splitting, projection, denial

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41
Q

altruism

A

emotional conflicts and stressorts are addressed by meeting the needs of others which in turn gives them gratification

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42
Q

sublimation

A

unconsciously substituting constructive and socially acceptable activity for strong impulses that are not usually considered acceptable
ex: man with strong hostile feeling participates in contact sports

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43
Q

humor

A

emphasizing amusing or ironic aspects of the conflict

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44
Q

suppression

A

conscious denial of a disturbing situation or feeling

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45
Q

repression

A

excluding unpleasant or unwanted experiences or ideas from conscious awareness

first line of psychological defense against anxiety

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46
Q

displacement

A

transfer of emotions associated with a specific person, object, or situation to another person that is not as threatening
ex: dad yells at mom, mom yells at kid

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47
Q

reaction formation

A

unacceptable feelings are kept out of awareness by developing the opposite behavior or emotion

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48
Q

somatization

A

repressed anxiety is demonstrated in the form of physical symptoms that have no organic cause

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49
Q

undoing

A

performing an action to make up for previous behavior

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50
Q

rationalization

A

justifying illogical or unreasonable ideas, actions, or feelings by developing explanations for the behavior

ex: everybody cheats, why wouldn’t I?

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51
Q

passive aggression

A

indirectly and unassertively expressing aggression toward others
masks covert resistance, resentment, and hostility

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52
Q

acting out behaviors

A

by lashing out at others, an individual can transfer the focus from personal doubts and insecurities to another person or object

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53
Q

dissociation

A

disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment

54
Q

devaluation

A

occurs when emotional conflicts or stressors are handled by attributing negative qualities to self or others

55
Q

idealization

A

emotional conflicts or stressors are addressed by attributing exaggerated positive qualities to others

56
Q

splitting

A

inability to integrate the positive and negative qualities of oneself or others into a cohesive image

57
Q

projection

A

unconsciously rejecting emotionally unacceptable personal features in one’s self and attributes those unacceptable traits to other people, objects, or situations

58
Q

denial

A

escaping unpleasant realities by ignoring their existence

59
Q

co-occurring conditions with anxiety

A

cancer, IBS, kidney and liver dysfunction, reduced immunity, cardiovascular morbidity and mortality

60
Q

prescription meds that onset acute anxiety

A

asthma meds, bp meds, hormones, amphetamines, steroids, thyroid meds, phenytoin, antidepressants

61
Q

nonprescription meds that may cause anxiety

A

caffeine, decongestants, illegal drugs

62
Q

parts of the brain involved in anxiety

A

frontal cortex: cognitive interpretations
hypothalamus: activate stress response
hippocampus: memory related to fear
amygdala: fear

63
Q

neurotransmitters involved in anxiety responses

A

serotonin, NE, GABA

64
Q

behavioral theory on anxiety

A

anxiety is a learned responses that can be unlearned

65
Q

cognitive theory on anxiety

A

belief that anxiety disorders are a results of cognitive distortions in an individuals thinking and understanding

66
Q

which cultural group is least likely to seek mental health services

A

african americans and asian americans

67
Q

what is an important criterion for the diagnosis of panic disorder

A

anticipatory anxiety (low level constant anxiousness of having another attack)

68
Q

treatments for panic disorders

A

benzos (short term)
antidepressants/SSRIs
CBT

69
Q

phobia

A

irrational fear that leads to a desire for avoidance or actual avoidance

70
Q

how does propranolol work on anxiety

A

reduce physiological symptoms of anxiety, but not the cognitive worry symptoms

71
Q

more pervasive social anxiety may respond better to what med

A

SSRIs

72
Q

agoraphobia

A

intense, excessive anxiety about fear of being in places where help may not be available and escape might be difficult or embarrassing

73
Q

symptoms of GAD

A

restless, fatigue, poor concentration, irritable, muscle tension, sleep disturbance

74
Q

drugs effective to GAD

A

buspirone and SSRIs

75
Q

conditions associated with anxiety

A

respiratory, cardiovascular, endocrine, neurological, metabolic

76
Q

selective mutism

A

complex childhood anxiety disorder characterized by a child’s inability to speak and communicate effectively in social settings

77
Q

obsession vs compulsion

A

obsession : thoughts, impulses or images that persist and recur so that they are not dismissed from the mind

compulsions : ritualistic behaviors that individuals feels driven to perform in an attempt to reduce anxiety

78
Q

pharmacological agents for treating people with BDD

A

SSRI antidepressants and clomipramine, a TCA

79
Q

hoarding

A

excessively collecting of items that may or may not have value and the persistent difficulty in discarding or parting with these obsessions

80
Q

screening tools to monitor symptoms changes in anxiety

A

clinically useful anxiety outcome scale
GAD-7
hamilton rating scale for anxiety

81
Q

how to assess for anxiety

A
  1. ensure a complete neurological and physical exam
  2. assess potential for self harm
  3. perform a psychosocial assessment
  4. assess cultural beliefs and background
82
Q

goals of health teaching, health promotion, and psychoeducation

A

-provide info
-support treatment adherence through med teaching
-teach ways to promote sleep
-access to info and continue learning the tools to help reduce symptoms

83
Q

mileu therapy techniques

A

structure daily routine, provide info about daily routine, provide daily activities to promote sharing and cooperation, provide therapeutic interactions such as one on one care, include patient in decisions

84
Q

cognitive restructuring

A

identify the distortion, challenge the distortion, replace the distortion with a more realistic interpretation

85
Q

meditation vs mindfulness

A

meditation: relaxed or restful alertness
mindfulness: become more aware of present moment

86
Q

aversion therapy

A

undesirable behavior associated with unpleasant stimulus

87
Q

flooding

A

uses prolonged exposure to a feared object

88
Q

systematic desensitization

A

gradually exposing a person to a feared object or situation until the person is free of incapacitating anxiety

89
Q

exposure and response prevention

A

systematically desensitize people to their fears by repeatedly facing fears

90
Q

modeling

A

imitate another person

91
Q

thought stopping

A

get rid of unwanted thoughts

identify thought, focus exclusively on thought, actively interrupt the thought by performing a behavior such as saying “stop”

92
Q

types of relaxation techniques

A

deep breathing, guided imagery, progressive relaxation, autogenic training, self hypnosis, biofeedback assisted relaxation

93
Q

most effective treatment strategy

A

combination of psychopharmacology with other therapies such as CBT

94
Q

antidepressants

A

most widely prescribed for long term anxiety and OCD

taper off !!

SSRI - first line treatment, rapid onset
SNRI - venlafaxine = PD, GAD, social anxiety, OCD / duloxetine = GAD, PD, OCD

95
Q

benzos

A

anxiolytics for short term use

tolerance requires higher dosages to achieve the same calming effect

increases risk of falls, development of dementia, and increased mortality

96
Q

antihistamines

A

provide quick, periodic anxiety relief

most effective for short term uses and are useful for those with substance use problems because they are not addicting

97
Q

buspirone

A

nonaddictive med used in the management of long term relief

most effective for GAD

98
Q

anticonvulsants

A

valproic acid, gabapentin, pregabalin

treat GAD, social anxiety, panic attacks

99
Q

antipsychotics

A

may be used as calming agents for acute anxiety in certain situations

100
Q

CAMS

A

kava kava, valerian, lavender oil, st johns wort

101
Q

symptoms of somatic disorders diagnosis

A

presence of physical symptoms but also how to patient interprets them

symptoms are not intentional or under conscious control

relate to body more than the mind

102
Q

cognitive theorists beliefs on somatization

A

somatic disorders are the result or negative, distorted, catastrophic thoughts and reinforcement of these thoughts

focus on body sensations, misinterpret their meaning and respond with excessive alarm

103
Q

effect of adverse childhood experiences

A

shown to contribute more negative health outcomes in adulthood, including somatic symptoms

104
Q

somatic symptoms disorder

A

medical findings are lacking or less than expected to magnitude of complaint

patient may have histories of multiple treatments, substance abuse, marital difficulties, suicidal ideation, chronic pain, and impaired work and life function

105
Q

functional neurological disorder

A

chronic or brief symptoms of altered voluntary motor or sensory function that cause substantial distress or psychosocial impairment

106
Q

freuds beliefs on FND

A

unbearable effect of stressors is converted into physical symptoms that provide an escape from an unpleasant conflict

107
Q

Type A vs D personalities

A

A- increased survival, more goal oriented
D- extreme difficulty approaching other people and have an avoiding coping style

108
Q

factitious disorder imposed on self

A

faking symptoms in order to assume sick role with no obvious external benefits

109
Q

malingering

A

intentionally faking or exaggerating symptoms for an obvious benefit

is a behavior, not a psychiatric disorder

110
Q

factitious disorder imposed on another

A

deliberate fabrication of symptoms or injury is imposed upon another person

111
Q

assessment of somatic disorders

A

collect data about the nature, location, onset, character, and duration of symptoms

assess patients ability to meet their own needs

nutrition, fluid balance, and elimination

altered sexual desires

history of childhood trauma

altered respiratory and heart rate

altered safety, security, rest, hygiene, ADLs

112
Q

if patients cannot identify their anxiety and emotionally coach themselves…

A

the stage is set to believe only a medical problem could be the cause

113
Q

dependence on medication

A

somatic complaints are likely to have dependence on meds and experience “rebound anxiety” when the dosage wears off, exacerbating the anxiety problem over time

114
Q

goal of somatic symptoms care

A

meet needs without resorting to somatization,
increase quality of life and independence

115
Q

assertive training

A

teach a direct means of meeting needs and thereby decreases the need for somatic symptoms

teaches people to stand up for themselves

use “I” statements

116
Q

feeding and eating disorders in adolescence

A

pica - eating nonfood substances

rumination disorder - eating regurgitated food

avoidant food intake - persistent failure to meet nutritional needs

117
Q

elimination disorders in adolescence

A

enuresis - repeated voiding of urine
encopresis - repeated passage of feces

118
Q

disruptive, impulse control, and conduct disorders in adolescence

A

oppositional defiant disorder - beyond normal limit testing, displays symptoms with at least one person who is not a sibling (at least four of: temper, annoyed, angry, argues with authority, defies rules, deliberately annoy others, blames others for mistakes)

conduct disorder - more severe than ODD, at least 3 of the following: bullies, initiates fights, used a weapon, physically cruel, stolen, raped, sets fires, destruction of property, broken into places, lies, stay out at night against rules, have run away at least twice

119
Q

trichotillomania

A

recurrent twisting or pulling off of ones hair

120
Q

anxiety and trauma/stressor related disorders

A

reactive attachment disorder - consistent pattern of inhibited, emotionally withdrawn behaviors

separation anxiety - developmentally inappropriate fear of separation from a person they are attached to

selective mutism - failure to speak when speaking is an expectation

121
Q

when is anxiety normal vs not normal

A

anxiety is a universal human experience and is normal until is lasts well beyond a specific stressful event or when it interferes with a persons day to day ability

122
Q

acute anxiety

A

This level of anxiety is precipitated by an imminent loss or change that threatens one’s sense of security. For example, the sudden death of a loved one precipitates an acute state of anxiety.

123
Q

chronic anxiety

A

This level of anxiety is one that usually develops over time, often starting in childhood. The adult who experiences chronic anxiety may display that anxiety in physical symptoms, such as fatigue and frequent headaches.

124
Q

pathological anxiety

A

differs from normal anxiety in duration, intensity, and impact on functioning

125
Q

stress vs anxiety vs fear

A

stress : a state produced by a change in the environment that is perceived as challenging, threatening, or damaging to ones well being

anxiety : a subjective emotional state, often with feelings of apprehension, uneasiness, uncertainty, dread - results from a real or perceived threat or stressor whose actual source is unknown

fear : a reaction to a specific danger or stressor

126
Q

what symptoms are people likely to seek help for when they experience anxiety

A

physical symptoms

127
Q

contributing factors to anxiety

A

family history

NE, GABA, serotonin imbalance

co occurring medical or mental health diagnoses (Substance use disorders, Disordered sleep, Mood disorders, Eating disorders, Heart disease, Irritable bowel syndromes, Reduced immune response)

cultural approach

128
Q

where is the criteria for diagnosis found

A

DSM-5

129
Q

how to assess and analyze anxiety

A

consider cognitive ability, literacy level, and primary language
consider that fear or shame may prevent a client from disclosing anxiety
assess : physical signs, affective symptoms, cognitive symptoms, social symptoms, and spiritual symptoms

130
Q

non benzos and benzos

A

NON BENZOS
beta block - propranolol
antihistamine - hydroxyzine, diphenhydramine
alternative anxiolytic - busprione
SSRIs
anticonvulsant - pregabalin, gabapentin

BENZOS
lorazepam, alprazolam, donazepam

PSYCH (15 decks)

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