Week 10-14 Flashcards
What is an anxiety disorder?
An anxiety disorder differs from normal anxiety in the following ways:
- it is more severe
- long lasting
- interferes with a person’s work or relationships
Define: Anxiety
It is a biological mediated response to stress and change.
It helps us mobilise the protective resources necessary for adaption. When a person becomes excessive or maladaptive, that person is said to be experiencing an anxiety disorder
What are the types of anxiety disorders
- Generalised anxiety disorder (GAD)
- Panic disorder and agoraphobia
- Phobic disorders: Social phobia and specific phobias
- post-traumatic stress disorder (PTSD)
- Obsessive-compulsive disorder (OCD)
- Acute stress disorder (ASD)
What are the 5 theoretical explanations of anxiety disorders
- Behavioural theory: anxiety is learned
- Stress theory: anxiety is an endocrinology response to stress
- Existential theory: fact of life
- Biological theory: genetics, brain chemistry, physiological abnormality
- Psychoanalytic theory: anxiety occurs when individual represses negative thoughts/emotions and re-emerge in anxiety
Environmental Dimension
What factors precipitate or exacerbate the physiological experiences of anxiety
- caffeine
- opium and hallucinogenic drugs
- medications
- loss of sleep
- premenstrual oedema
- poor nutrition
- threats to body integrity
Define: Panic attack
A discrete period of intense fear or discomfort that is accompanied by somatic and cognitive symptoms
Obsessive Compulsive Disorder
Define: obsessions
Are thoughts or images that intrude into a persons mind despite efforts to exclude them
Obsessive Compulsive Disorder
Define: Complusions
Are actions: repetitive behaviours that are performed in a stereotyped fashion to neutralise or prevent some dreaded thing happening or to avoid danger
Explain: Post traumatic stress disorder
Occurs as the result of exposure to an extreme stressor
- even that involves actual and/or threatened death or injury
- witnessing an even that involved death or serious injury
What are the nursing interventions for anxiety/panic disorders
- stay calm
- speak in a reassuring manner
- speak clearly and slowly
- find somewhere quiet and comfortable
- ask if there is anything you can do to help
- reassure person they are safe
- reassure the episode will pass
- client education
- facilitate problem solving/ goal setting
Explain: Alcohol withdrawal symptoms
Onset: hours after last drink
Duration: 3-7 days
Features: agitation, sweating, tremor, nausea, vomiting, tachycardia, fever, disorientation, seizures, anxiety
What is the nursing intervention for managing Intoxication
Respectful , supportive care will most often prevent an intoxicated patient from becoming upset or frightened and/or disrupting other patients, staff and visitors.
- Avoid being patronising or authoritarian or combative
- Introduce yourself and your role.
- Provide orientation and establish rapport.
- Avoid information overload
- Clear, concrete instructions and explain all processes/ procedures
- Maintain safety and provide appropriate supervision
What is the nursing management of alcohol withdrawal using the Alcohol Withdrawal Scale
Using the AWS
- Monitor at least patient 4-hourly for at least 3 days.
- If the total score reaches 5, monitor hourly and notify the medical officer or drug and alcohol nurse practitioner.
- Encourage oral rehydration.
- Provide medications if severe withdrawal or experience nausea/headaches etc
Explain: AWS
Alcohol Withdrawal Scale
- a tool for monitoring the signs of withdrawal
Nursing Managment of withdrawal
the aim is early detection and treatment to prevent or reduce the severity of the withdrawal
- Monitoring
- Supportive care and prevent dehydration
- Medication
- Routine prevention of Wernicke’s encephalopathy
- Re-evaluate and treat all other conditions (sepsis, liver disease) ..is it withdrawal or something else.
Define: Dual Diagnosis
one or more diagnosed mental health problems occurring at the same time as problematic drug and alcohol use
Comorbidity of Substance-Related Disorders and other Mental Disorders
What are the explanations of comobidity
Direct causal relationship
- Mental health problems cause substance use problems
- Substance use problems cause mental health problems
Indirect causal relationship
Common factors
- Biological factors
- Social and environmental factors
What is the DSM V criteria for substance use disorders
Substance use disorder in DSM-5 combines the DSM-IV categories of substance abuse and substance
dependence into a single disorder measured on a continuum from mild to severe. Each specific substance
(other than caffeine, which cannot be diagnosed as a substance use disorder) is addressed as a
separate use disorder (e.g., alcohol use disorder, stimulant use disorder, etc.), but nearly all substances
are diagnosed based on the same overarching criteria
Define: SMHSOP
Specialist Mental Health Services for Older People
- provideS specialist mental health services for people aged 65 or older
Explain: Dementia
Dementias are organic brain disorders. That is, they are due to actual, observable, physical changes in brain structure and functioning (unlike other mental illnesses where there are no observable changes in brain structure)
- not a mental illness
Explain: Delirium
Delirium usually results from severe, untreated infections such as urinary tract infections or from poisoning by, or withdrawal from, substances such as alcohol or other drugs
- not a mental illness
Explain: Depression in older people
- Estimates of the prevalence of depression in older people vary widely, ranging from 2% to 45%. This variation may be due to the inclusion of people with mild depression in the estimates
- Depression in older people may be difficult to recocgnise or diagnose as people may focus more on physical problems such as tiredness or feel that unhappiness is an unavoidable aspect of ageing
Explain: Schizophrenia
Schizophrenia is usually evident early in life and it is extraordinarily rare for a person to develop schizophrenia for the first time in older age
Schizophrenia like symptoms may be evident in older people but this is usually related to conditions such as dementia or delirium
In some people with lifelong, mild psychotic symptoms, such as paranoia, these symptoms may become more evident due to processes such as the early stages of dementia
Explain: Suicide in older people
Suicide rates increase in older people
Men aged over 85 have the highest suicide rate of any age group
Older people often have access to a wide range of potentially dangerous medications
Euthanasia (assisted dying) is an ongoing issue of discussion and is particularly relevant for older people
Define: Anhedonia
Inability to feel pleasure in normally pleasurable activities
Which medications are commonly used for depression
TBA
Selective Serotonin Reuptake Inhibitors (SSRI)
Jean Piaget theory focuses on what type of development
cognitive development
- Developed parameters for normal milestones in cognitive development
John Bowlby’s theory focuses on what type of development
Attachment theory
- The early relationship between an infant and its primary caregiver (usually the mother) is crucial for cognitive, social and emotional developmen
Freud’s theory focused on what type of development
Developed a theory of psychosexual development
- This theory has been largely discredited because of its focus on sexuality
What are the Defence Mechanisms
Denial: unable to accept the truth or reality for daily behaviours or events
Repression: ‘forgetting’ something bad ie. past unpleasant situations. However memory may return later
Regression: Revert back to childhood state when you had some nature of unconscious fear
Rationalization: Explain behaviours or painful emotion – try to rationalise the situation to help you make sense or conceptualise the situation
Define: Perinatal mental health
work with pregnant women and mothers of children up to 4 years of age
Define: Infant
a child in the first year of life
Deifne: Toddler or pre-schooler
a child aged between 2 and 4 years of age
Define: Child
a child aged between 5 and 11 years of age
Define: Adolescent
a young person aged between 12 and 17 years
Define: Youth
a young person aged between 14 and 25 years of age
What are the general principles for Infant, Child, Adolescent and Youth mental health services
- generally work with the young person and their family or carers
- It is considered counter-productive to work with the young person in isolation because most young people are reliant on others to meet their needs for food, shelter, emotional support and other needs
- Some problems that young people experience are precipitated and perpetuated by difficulties in family relationships and these can only be addressed within the family system
- Diagnoses are avoided if possible due to the stigmatising effect of labelling and because problems may be transitory
- Medications are not always helpful and are not recommended as first line treatment in many situations
Explain: the effects of abuse on a young person
- usually has a detrimental effect on development. The earlier the abuse occurs the more pervasive are the effects
- young people are reluctant to talk about abuse and they should not be pushed to talk about it
- Where sexual abuse is disclosed, a specialist sexual assault service is the best option
Explain: Infant mental health
- Foetuses and babies have specific needs in order to foster their development at an optimal level
- Foetuses require a mother with good physical health, an absence of toxins such as drugs or alcohol and reasonable emotional health
- Anxiety and depression in a pregnant woman are known to have a detrimental effect on the growing foetus due to increased levels of maternal cortisol
- The quality of the mother (primary caregiver)/baby relationship in the first 2 or 3 years of a child’s life is crucial to the child’s physical and emotional development
List Infant mental health interventions
Interventions include: - Circle of security - Parent child - interaction training Individual therapies for the mother/caregiver such as mindfulness, anxiety and depression management such as cognitive behavioural therapy and medication
Which period in a young persons life do they do through a period of rapid development physically, neuro-developmentally and emotionally?
Toddlers
Explain: Children’s mental health
A number of mental health concerns can develop during childhood.
- It is sometimes difficult to distinguish between issues such as shyness and more serious concerns such as social anxiety
- Anxiety and behavioural problems are the most common issues in childhood
List children’s anxiety interventions
- group programs such as Cool Kids
- individual therapies based on Cognitive Behavioural Therapy (CBT).
- Families are usually involved in any intervention so that they can learn skills to help their child
- Medication may be used for anxiety and behavioural problems but is rarely used for depression
- Medication is not recommended as a first line treatment in children
What are adolescent developmental tasks
Establishing a separate identity
Moving towards independent living
Intimate relationships and sexuality
Preparing for adult life
Explain: Adolescent mental health
- Disorders in adolescence may be a continuation of previous issues such as behavioural difficulties or anxiety
- Disorders such as bipolar disorder and schizophrenia/psychosis may emerge during adolescence
- Drug and/or alcohol use also increases during this time and may become concerning
List Adolescent interventions
adolescents usually incorporate individual therapy such as cognitive behavioural therapy plus family therapy in many cases.
- Medication is used more frequently
- Medication and psychosocial interventions are used with young people with psychosis or bipolar disorder
- There are a growing number of non-government services such as headspace and a number of internet resources such as Reachout and Kids Helpline
Explain: Suicide in Young people
- Suicidal thinking and behaviour is very rare in children aged 10 years or less
- Suicidal thinking and behaviour becomes more common through adolescence but death by suicide is still quite rare in people aged less than 17 years
Explain: Assessing young people for suicide risk
- Suicidal thinking and behaviour in adolescents can be quite transitory
- Risk assessment is difficult in adolescents due to the transitory nature of risk
- A good risk management plan is also helpful – what to do when stressed, what is helpful, what is not helpful, who can help, where to get help, emergency responses
Explain: Psychosis in young people
Psychosis (schizophrenia) can develop at any age but is extraordinarily rare before late adolescence and most commonly appears in early adulthood
- It is a low prevalence disorder and effects about 1% of the population
Define: Fear
Is a response to a perceived threat that is consciously recognised as a danger
Real danger- requires a response
Define: Anxiety
Is a biological, psychological, emotional and cognitive and behavioural response to a perceived threat or fear experienced by the individual.
Perceived- Potential
What are the biological and psychological effects of being frightened or anxious
Biological Responses: Increased cardiac output, pupil dilation, muscle tension, nausea, decreased external temperature, incontinence
Psychological Responses: unable to concentrate, unable to take in new information, no higher order cognition will work, unreal, overwhelming thoughts, usually negative
Explain: flight or fight response
The reaction of the body to stress, a person’s reaction to stress by either fleeing or remaining to deal with the situation
Define: Stress-vulnerability model
provides a conceptual framework for understanding the relationship between stress and vulnerability as an explanation for an individual vulnerability of developing a mental illness.
Define: Stress
a variable that influences the manifestation of symptoms)
Define: Ambient stress
day-to-day stress
Define: Life event stress
specific, high levels of stress
Define: Vulnerability
Is a disposition of the person to manifesting symptoms of serious mental illness
What are the 2 types of vulnerability
Innate- genetically determined
Acquired- specific disease, perinatal complications, previous life events
Define: Protective factors
can act as a buffer against stress
Eg. family support, stable housing, employment, strong supportive social network, education, ability to cognitively reframe your circumstances
What are the 3 pillars of harm minimisation
Demand reduction
Supply reduction
Harm reduction
3 pillars of harm minimisation
Explain: Demand reduction
prevent uptake and/or delaying the onset of alcohol, tobacco and other drugs.
- Done through education, increase price/cost, health promotion campaigns, TV ads, reduce advertising, anti-ice campaign, Healthy Harold
3 pillars of harm minimisation
Explain: Supply reduction
Preventing, stopping or disrupting or otherwise reducing the production and supply of illegal drugs.
- Done through increasing border security, lock-out laws, age restrictions, police action (drug busts), prescribing laws
3 pillars of harm minimisation
Explain: Harm reduction
reducing the adverse health, social and economic consequences of the use of drugs.
- Done through passive smoking laws, smoking area restrictions, methadone, medically supervised injecting room, needle and syringe program, RBT and RDT, NO smoking laws
Define: Tolerance
Tolerance- the capacity to endure continued subjection to something such as a drug or environmental conditions without adverse reaction.
Define: Withdrawal
Withdrawal- action of withdrawing something; the action of ceasing to participate in an activity.
- A series of symptoms that occur when a person stops or substantially reduces substance use, if they have been used for a long period of time over/ high doses
Define: Dependence
Dependence- addiction to drink or drugs. the state of relying on or being controlled by someone or something else.
- A preoccupation with obtaining and using a drug for its psychic effects and the need to keep taking a drug to feel ok
What happens when we experience something pleasurable such as taking an ‘addictive drug’?
The reward system is activated. This reinforces the affect of taking the drug. brain responses by increasing the release of dopamine
What pathway is responsible for the reward system
Mesolithic pathway
List depressant drugs
- heroin
- cannabis
- alcohol
- ketamine
- low dose marijuana
List stimulant drugs
- methamphetamine
- cocaine
- ecstasy
- nicotine
- ritalin
List hallucinogenic drugs
- cannabis
- LSD
- ecstasy
- ketamine
- high dose marijuana
Define: Intoxication
the condition resulting from the use of psychoactive substance that produces behavioural and/or physical changes
Define: Overdose
the use of any drug in such an amount that acute adverse physical and mental effects are produced. A dose that exceeds the individuals tolerance
What drugs cause the most morbidity/ mortality?
Tobacco, alcohol, heroin, meth/Amphetamine
Name the key elements of assessment in relation to drugs and alcohol use.
Type of drug, route, frequency of use, dose, how long they have been using
Substance abuse
What are the main issues of risk being assessed?
Risk to physical health, mental health, risk of suicide, risk of intoxication, risk of masking another illness, other illnesses mimicking other illnesses, risk of withdrawal, risk of neglect for those within a persons care, risk of blood-borne viruses, risk of DV
What are the components of Index of Suspicion
Regular intake
Small amounts with CNS depressants
Previous episodes of withdrawal
Current admission for an alcohol related reasons
Physical appearance indicates chronic use
Pathology
Anxiety, agitation, tremor, sweatiness, early morning retching
What are the 3 D’s in older peoples mental health
Dementia
Delirium
Depression
What are the characteristics of Dementia
Onset: Chronic
Course: slow progressive cognitive failure
Duration: months to years
What are the characteristics of Delirium
Onset: rapid, usually hours or days
Course: Short, daily fluctuations in symptoms
Duration: Hours to days
What are the characteristics of Depression
Onset: Abrupt
Course: diurnal fluctuations, worse in morning
Duration: 6 weeks to years
Assessment of suicide risks in adolescents can be difficult because….
adolescents are impulsive and risk can be transitory, making it difficult to quantify risk
The most common mental health concern for children are…
Anxiety and behavioural changes
What considerations are there for assessing children and adolescent’s
- Physical, biological and gender issues
- Developmental
- Knowledge
- Social/relationships
- Family system factors
- Legal and ethical
- Environmental
- Behaviour
- Communication style used
- Working individually or with family as well as the individual
- Presence of parents for interview duration
List common signs/symptoms associated with anxiety
Mind racing Dizzy/ disorientated Lightheaded Difficulty swallowing Trembling/shaking Nausea Upset stomach/loss of appetite Breathlessness/fast or shallow breathing Sleep disturbances Heart racing/ palpatations
What medications are used for anxiety
Antidepressants- SSRIs
Betablockers- propranolol
