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Trauma, OCD, Anxiety, Personality Disorders Flashcards

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1
Q

Trauma

A

may result in anxiety, insomnia, grief, and variety of responses

some people return to baseline level of coping and equilibrium after trauma

some people may develop adjustment disorder, ASD, PTSD, or dissociative disorder

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2
Q

PTSD

A

duration of disturbance: more than 1 month

person exposed to event that posed actual or threatened death, serious injury, or sexual violence:

  • direct experience
  • witnessing in person as event occurred to others
  • learning about the event (close family or friend/violent or accidental)
  • repeated exposure to traumatic event (police officers, EMT)
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3
Q

PTSD: Clinical Course

A
  • intrusive thoughts (dreams, distressing memories)
  • avoidance of stimuli associated w/ the event (avoid thoughts or feelings of event, avoid situations that trigger memories)
  • negative thoughts/alterations in cognition associated w/ the event (inability to recall aspects of event)
  • hyperarousal (startle response)
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4
Q

PTSD: Dissociative Symptoms

A
  • depersonalization: person feels disconnected from their body
  • derealization: person feels as if world around them isn’t real (experiencing world in a dreamlike state)
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5
Q

PTSD: Co-occuring Disorders

A

depression
anxiety
substance use

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6
Q

PTSD: Risk Factors

A
  • lack of social support
  • previous mental health hx or personality factors
  • adolescent and PTSD: at increased risk for suicide, substance use, academic problems, poor physical health
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7
Q

Acute Stress Disorder

A

occurs in the aftermath of a traumatic event

symptoms similar to PTSD

time fram = 3days but less than 1 month

precursor to PTSD

therapy (CBT) to help anxiety management

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8
Q

Adjustment Disorder

A
  • emotional/behavioral reaction to a stressful event - causes problems for the person
  • seen often in children
  • symptoms develop w/in 3 months of the event
  • syndrome resolves w/in 6 months
  • therapy
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9
Q

Reactive Attachment Disorder (RAD)

A
  • onset before 5YO in response to trauma of child abuse or neglect
  • inhibited or emotionally withdrawn behavior toward caregiver
  • diminished response to seek comfort when distressed
  • minimally responsive to comfort
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10
Q

Dissociative Disorders

A
  • dissociation: a defense to protect an individual from the full effects of a traumatic event
  • disruption in consciousness, memory, identity, and environmental perception
  • dissociation can be seen w/ PTSD
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11
Q

Anxiety

A
  • common in all ages
  • associated w/ fear and worry
  • fear: immediate response to a threat (identifiable stimulus)
  • anxiety: worry about future threats
  • problem when it interferes w/ daily living
  • w/o tx may become chronic (vs episodic)
  • avoidance
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12
Q

Anxiety Disorders: Etiology

A

incidence: highest prevalence in all mental health condition in the US

most prevalent in: women, people over 45YO, divorced or separated people, people of lower socio economic status

onset: variable

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13
Q

Anxiety Disorders: Neurophysiology

A

amygdala: involved in detecting threats and response to threats

autonomic nervous system: release of epinephrine (HR/BP), norepinephrine

GABA: decrease in GABA is related to increase in anxiety

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14
Q

GAD

A

highly anxious at least 50% of the time for 6 months

cause is unknown (may be imbalance of serotonin/GABA)

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15
Q

GAD: Sx

A

MISERA-ble

muscle tension
irritability
sleep disturbance (decreased)
energy (decreased)
restlessness
attention (decreased)
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16
Q

Phobias

A

intense illogical fear about an object or situation

a person may have no hx of a negative experience w/ the object or situation that they fear

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17
Q

Phobias

A

social phobia
specific phobia
agoraphobia

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18
Q

Phobia: Tx

A

CBT w/ exposure:

  • systematic densensitization: gradual exposure in safe space to phobia
  • flooding

relaxation techniques

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19
Q

Panic Disorder

A

Dx: recurrent, unexpected attacks followed by at least 1 month of concern/worry about future panic

no stimulus for the panic

half of people w/ panic have agoraphobia

increased risk of suicidality

onset: late adolescence to mid 30s

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20
Q

Panic Symptoms

A 
sense of dying
startle reactions
palpitations, chest pressure
nausea or diarrhea
SOB
sweating
inability to think
chills
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21
Q

Panic Disorder: Tx

A 
CBT
Antidepressants (SSRI, SNRI)
buspirone 
Benzos (for acute treatment only)
Clonidine/propranolol
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22
Q

CBT

A

positive reframing

decatastrophizing: explores the reality of a feared stimulus

assertiveness training: “I statements”

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23
Q

Mental Health Promotion

A

exercise
well-balanced meals
rest/sleep
stress management techniques

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24
Q

OCD

A

hallmark signs:

  • repeated thoughts (obsessions)
  • repetitive behaviors (compulsion)
  • need to achieve perfection
  • preoccupation w/ behaviors and thoughts that interfere w/ ADLs

Dx: when compulsion or obsessions interfere w/ personal, social, and/or occupational functioning

person has insight that the thoughts/behaviors are unreasonable but cannot stop them

onset: may be in childhood, in women more common onset in the 20s

periods of waxing and waning sx over lifetime

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25
Q

OCD: Obsessions

A

recurrent, persistent, intrusive, and unwanted thoughts, images or impulses

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26
Q

OCD: Compulsions

A

ritualistic/repetitive behaviors or mental acts that a person carries out continuously to decrease anxiety

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27
Q

OCD: Tx

A

medications:
- SSRI’s (fluvoxamine)
- clomipramine (Antidepressant - TCA)

exposure therapy: confronting situation and stimuli that client usually tries to avoid

response prevention

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28
Q

OCD: Related Disorders

A

excoriation: skin picking
trichotillomania: chronic hair pulling

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29
Q

Nursing Interventions Anxiety

A
  • teach avoidance of caffeine
  • decrease stimulation
  • remain w/ the pt when anxious
  • assessment of client anxiety level
  • speak w/ calm, low voice
  • for panic, maintain safety
30
Q

Grounding

A
  • helpful w/ dissociation or flashback
  • remind the person that they are safe
  • increase contact w/ reality
  • decrease the dissociative experience by focusing on the present
31
Q

Personality

A

ingrained pattern of behaving and relating to the self, others, and the environment

  • includes: perceptions, attitudes, emotions
  • person is not aware of their personality
  • influenced by: genetics, environment
32
Q

Personality Disorders

A

maladaptive or dysfunctional personality traits

may include:

  • negative behavior toward others
  • anger/hostility
  • lack of remorse
  • impulsivity, poor judgement

Dx: people will complain of anxiety, depression, problems at work (rarely go to PCP and say their is something wrong w/ their personality)

33
Q

Personality Disorders: Prognosis

A
  • chronic
  • show signs in teenage years
  • w/o tx, personality disorders remain
  • cluster B: see leveling off (decreased symptoms) over time as people age
  • not diagnosed until 18 YO when personality is fully formed
  • longstanding: personality does not change easily
  • most people have co-occurring mental illness
34
Q

Personality Disorders: DSM Diagnosis

A

organized by clusters

clusters around the predominant behavioral pattern:

  • Cluster A: odd or erratic
  • Cluster B: erratic or dramatic
  • Cluster C: anxious or fearful
35
Q

Most common Personality Disorders

A

antisocial

borderline

36
Q

Cluster A

A

Psychosis

  • paranoid personality disorder
  • schizoid personality disorder
  • schizotypal personality disorder
37
Q

Paranoid Personality Disorder

A

fear, mistrust, suspiciousness

  • suspects that others are exploiting, harming, or deceiving
  • preoccupation w/ unjustified doubts about the loyalty or trustworthiness of people
  • reluctant to confide in others: fear of malicious use of information
  • bear grudges
  • perception of attacks on one’s own character that are not apparent to others, quick to get angry
  • recurrent suspiciousness regarding fidelity of partner w/o justification
38
Q

Paranoid Personality Disorder: Defense

A

Projection

  • blaming other people for their own difficulties
  • blame the government for personal problem (parking ticket = plot by police to get them out of the neighborhood)
39
Q

Paranoid Personality Disorder: Presentation

A

social isolation (thinking that people are out to get them)

multiple paranoid ideas

40
Q

Paranoid Personality Disorder: Nursing Interventions

A
  • maintain professionalism
  • avoid humor
  • be on time, keep commitments
41
Q

Schizoid Personality Disorder

A

schizoid personality - avoids social relationships

lack of interest in social relationships:

  • does not desire or enjoy close relationships
  • choice of solitary activities
  • little, if any, interest in sexual experiences with others
  • little pleasure inactivities
  • lack of close friends or relationships
  • indifferent to praise or criticism of others
  • emotional, flattened affect
42
Q

Schizoid Personality Disorder: Presentation

A
  • lead solitary lives
  • lack of social contact does not appear to bother them
  • may develop interest in fiction or fantasy worlds through games/books (ability to distinguish reality from fantasy remains intact)
43
Q

Schizotypal Personality Disorder

A

Odd beliefs, difficulty relating to others:

  • ideas of reference
  • odd beliefs or magical thinking-consistent w/ subcultural norms (superstitiousness, telepathy, sixth sense)
  • unusual perceptual experiences
  • odd thinking and speech
  • suspicious or paranoid ideation
  • inappropriate or constricted affect
  • behavior/appearance odd, eccentric
  • lack of close relationships
  • social anxiety (does not change with familiarity)
44
Q

Schizotypal Personality Disorder: Presentation

A
  • strongly resembles schizophrenia (not as significant impairment)
  • isolation, loneliness (fear that others will find them odd)
  • difficulty with employment
45
Q

Schizotypal Personality Disorder: Nursing Interventions

A
  • self care
  • social skills
  • social skills training
46
Q

Cluster B

A

mood states

  • antisocial personality disorder
  • borderline personality disorder
  • histrionic personality disorder
  • narcissistic personality disorder
47
Q

Antisocial Personality Disorder

A

Infringes on the rights of other - deceit and manipulation:

  • failure to comply to social norms
  • deceitfulness (lying, use alias, conning others)
  • impulsivity (failure to plan ahead)
  • irritability/aggression (physical fights)
  • disregard for the safety of others
  • irresponsibility (repeated failure to maintain work or financial obligations)
  • lack of remorse (feeling indifferent to having hurt, mistreated, stolen)
48
Q

Antisocial Personality Disorder: Nursing Interventions

A
  • therapeutic relationship
  • promotion of responsible behavior (limit setting)
  • problem solving (promoting control of emotions - rest or time out)
  • behavioral contract
  • avoid argument or confrontation
49
Q

Antisocial Personality Disorder: Prognosis

A
  • difficult to treat: no medication or therapy has been shown to be effective
  • more common in men
  • little motivation for treatment (do not identify behavior is problematic)
50
Q

Borderline Personality Disorder

A

Chronic instability in multiple areas of life:

  • efforts to avoid real or imagined abandonment
  • unstable interpersonal relationships
  • identity disturbance
  • impulsivity in two areas that are self-damning (spending, substance, sex)
  • recurrent suicidal behavior, gestures, threats
  • affective instability (reactivity of mood)
  • feelings of emptiness
  • inappropriate intense anger
  • transient stress related paranoia or dissociative symptoms (micro psychotic episodes)
51
Q

Borderline Personality Disorder: Defense

A

Splitting - inability to hold opposing thoughts

52
Q

Borderline Personality Disorder: Nursing Interventions

A
  • safety: no self harm contract
  • strict boundary setting: set limits
  • helping client cope with emotions
  • maintain consistency in your approach with the client
53
Q

DBT

A

Dialectal Behavioral Therapy:

  • teaching cognitive and behavior skills to target
  • regulation of emotions
  • distress tolerance
  • splitting
  • reduction of impulsivity or self-destructive behaviors
54
Q

Histrionic Personality Disorder

A

Excessive emotionality and attention seeking:

  • uncomfortable when not the center of attention
  • sexually seductive, provocative behavior towards others
  • rapidly shifting and shallow expression of emotion
  • use physical appearance to draw attention to self
  • style of speech that is impressionistic
  • self-dramatization, exaggerated expression of emotion
  • easily influenced
  • considers relationships more intimate than reality
55
Q

Histrionic Personality Disorder: Nursing Interventions

A
  • feedback about relationships

- social skills training via role play

56
Q

Narcissistic Personality Disorder

A

Grandiosity, need for admiration, lack of empathy:

  • sense of self importance (grandiose) - exaggerates achievements, talents expects to be recognized
  • fantasies of unlimited success, power, brilliance
  • belief that they are special can only be understood or should only associate with high status people or institutions
  • required excessive admiration
  • sense of entitlement
  • takes advantage of others for own good
  • lacks empathy (unwilling to recognize needs of others)
  • is envious or belief that others are envious of them
  • arrogant attitudes
57
Q

Narcissistic Personality Disorder: Presentation

A
  • primarily seen in men
  • individual psychotherapy is most helpful tx
  • may experience success at work because of confidence/ambition
  • may have trouble working with others
  • may believe that they are underpaid or should have a higher position when not qualified
58
Q

Narcissistic Personality Disorder: Nursing Interventions

A
  • self awareness

- setting limits on behavior

59
Q

Narcissistic Personality Disorder: Differential Diagnosis

A
  • often misdiagnosed as mood disorders (emotional extremes)
  • mood disorders are episodic rather than chronic
  • personality disorders are reactive to external events
60
Q

Cluster C

A

Anxiety

  • avoidance personality disorder
  • dependent personality disorder
  • obsessive compulsive personality disorder
61
Q

Avoidant Personality Disorder

A

Chronic avoidance:

  • avoids occupational activities with interpersonal interaction for fear of criticism, rejection
  • unwilling to get involved with others unless certain of being liked
  • restraint in intimate relationships for fear of shame
  • preoccupied with criticism in social situations
  • inhibited in new interpersonal situations, feeling of inadequacy
  • view of self as socially inept, unappealing, inferior
  • reluctance to take personal risk - may prove embarassing
62
Q

Avoidant Personality Disorder: Nursing Interventions

A
  • support and reassurance
  • self affirmations
  • positive self talk
  • enhance self-esteem
63
Q

Dependent Personality Disorder

A

Overreliance upon other people:

  • difficulty making decisions w/o advice from others
  • need others to assume responsibility for life
  • difficulty expressing disagreement
  • difficulty initiating projects (lack of confidence)
  • excessive lengths to obtain nurturance
  • uncomfortable and helpless when alone
  • urgently seeks another relationship when close relationship ends
  • fear of being left to take care of oneself
64
Q

Dependent Personality Disorder: Nursing Interventions

A
  • fostering autonomy and self-reliance
  • promotion of independence
  • help the client identify strengths
  • assistance in daily functioning in areas where they have relied on others
  • refrain from giving advice
65
Q

Obsessive-Compulsive Personality Disorder

A

Emotional and behavioral rigidity:

  • preoccupied w/ details, rules, lists
  • perfectionism - interferes w/ completing a task
  • excessive devotion to work and productivity
  • over consciousness, inflexible on matters of morality and ethics
  • unable to discard worthless objects
  • reluctance to delegate tasks
  • money viewed as something to hoard for future catastrophes
  • rigidity and stubbornness
66
Q

Obsessive-Compulsive Personality Disorder: Presentation

A
  • low openness to new experiences
  • does not involve obsession or compulsions
  • feeling that the way they do things is correct (in OCD - tend to cause distress rather than satisfaction)
  • high overlap w/ anorexia nervosa
  • “perfectionist personality disorder”
67
Q

Trauma and Personality Disorders

A

hx of trauma should be explored w/ all personality disorders as it is often associated

68
Q

Personality Disorders: Tx

A

“treatment resistant”

“difficult to treat”

therapy is more effective than medication:

  • medications are symptomatic not curative treatments
  • no specific medication targets personality
69
Q

Personality Disorders: Therapy

A

CBT

DBT

70
Q

Personality Disorders and Stigma

A

personality disorders carry stigma

Psych (18 decks)

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