Week 2- anxiety/mood/affect/ de-escelation techniques Flashcards
types of
adverse childhood experiences
ACEs
- abuse
- neglect
- household dysfunction
impact of ACE’s on health through lifespan
order at which it occurs-7 steps
adverse event –> disrupted neurodevelopment –> cognitive impairment –> health risk behavior –> social problems/disease –> early death
trauma informed approach
emphasis on
- heavy emphasis on safety and choice/collaboration
- not problem focused but strength focused
core principles
trauma informed care
- safety
- transparency
- peer support
- collaboration
- empowerment
- humility
trauma informed care
what to do vs not do
avoid medicalized jargon, be careful with labels, education about trauma and management is NOT the first priority
recovery oriented care
definition
the process through which people find ways of living meaningful lives with or without symptoms of their condition
recovery model
- what is needed for well being
- individual focused
- promote personal recovery
- share control
recovery orient care
components
expect periods or relapse or difficulty and know that mental health problems can be lifelong
relapse
if it occurs you should
learn (triggers), review (careplan), renew (action plan)
anxiety
most common mental illness defined as the fight, flight, or freeze response or reaction that occurs in response to perceived threat
- often begins in childhood
GAD
generalized anxiety disorder
general feeling of dread linked to perception of unpredictability of situations
- will seek constant reassurance
- difficulty focusing
- difficulty sleeping
- irritability
panic disorder
fear of panic attacks or consequences
- will avoid activities linked to strong sensations
- avoids places where prior attacks have occured
OCD
obsessive compulsive disorder
fear of unwanted thoughts, image, or urges
- constant worries about germs
- worry about harming others
- ritualized activities
compulsions
any behavior performed to help make the anxiety go away
PTSD
post traumatic stress disorder
- symptoms will begin in first 3 months after trauma but can be delayed
- can affect anyone experiencing trauma
- associated with SI
- intrusive memories
- substance use may be common for coping
not an anxiety disorder
mild anxiety
peplaus levels of anxiety
enhanced learning and optimal function
- some anxiety can be good
moderate anxiety
peplaus levels of anxiety
decreased concentration and decreased problem solving
severe anxiety
peplaus levels of anxiety
serious impairment in cognition, physical and emotional symptoms
panic anxiety
peplaus levels of anxiety
complete loss of focus, marked functional impairment
typical presentation of anxiety in children
will focus more on somatic such as headache, body pain, sore tummy
typical preentation of anxiety in adults
may go unrecognized such as disturbed sleep and any physical symptoms will be seen as other illnesses
euthymia
definition
the “normal” or tranquil mental state/mood
euthymia
mood/energy/cognition
healthy fluctuations in energy, mood, and cognition
mild to severe melancholy
mood/energy/cognition
low to no feelings of energy or mood, no information processing
mild to severe mania
mood/energy/cognition
little to no information processing and mood and energy will be very high or none at all
major depressive disorder
depressed mood most of the day nearly every day
- vegetative shift
- will cause significant disruption in life
depressive state
symptoms associated
decreased: appetite, energy, libido
increased: sleep
manic state
symptoms associated
decreased: sleep
increased: appetite, energy, libido
risk factors for mood disorders
- stress
- trauma
- neglect
- abuse
- genetics
- medical issues
- social issues
bipolar disorder I
usually presents as major fluctuations between major depression and severe mania
cyclothymia
fluctuations in mood but not to the extent of bipolar
bipolar disorder II
fluctuates from mild mania to major depression
impacts/consequences of bipolar disorder
- financial
- impulsivity
- sexual
- physical harm
- substance use
- violence
primary prevention
anxiety and mood disorders
reduce poverty, racism, violence, stress, social inequity and exclusion
secondary prevention
anxiety and mood disorders
screening aimed at early detection but that is not a diagnosis
- PHQ-2
- GAD-7
- BDI
- GDS
- Ham-D
physical signs to assess for anxiety and mood disorders
- thyroid palpation
- cranial nerves
- lab tests (TSH, CBC, electrolytes)
- GI or sleep disturbances
highest risk for suicide
signs
low mood, high energy, elevated cognitive capacity
- sometimes people with severe mania
escelating risk of suicide
signs
low mood, energy and cognition cycling up
- moderate depression
decreasing risk of suicide
signs
low or “suicidal” mood, energy and cognition cycling down
- mild state of mania to mild state of depression
common nursing priorities
ineffective coping/role performane, insomnia, imapired communication, social isolation, risk of trauma or harm
interventions
anxiety
calm and simple instructions, clear statements, disrupt negative thibking and distortions
interventions
for panic
direct to breathing and different types
- pursed lip or alternate nostril breathing is best
basic care
- establish routine
- high calorie meal replacements (finger foods for manic patients)
- establish healthy sleep
- break down tasks into smaller steps
goal setting
- start small and then expand to higher level
- should be obtainable
- provide positive reinforcement
intervening for safety
mania
- use activities to expand energy
- observation levels
- distraction techniques
- positive reframe
SSRI’s
first choice for anxiety and depression
novel antidepressants
bupropion, mitrazapine, trazadone
MAOIs
not 1st choice but can also be helpful for OCD
benzodiazepines
used for panic or mania
- high risk for addiction
mood stabilizers
used for bipolar disorder
- anticonvulsants, abilify
(3rd gen antipsychotic)
- need blood monitoring
atypical antipsychotics
used for severe OCD, PTSD, or psychotic symptoms
lithium
therapeutic range
very narrow therapeutic range; 0.6-1.2
lithium toxicity
symptoms
blurred vision, tinnitus, thirst, polyuria
behavioral incident
interviewing strategy
helps obtain concrete data to get around those who hide SI
- questions should recreate behavior in running narrative
symptom amplification
interviewing strategy
assumes behavior occured and uses overestimation so the patient will provide true estimate
gentle assumption
interviewing strategy
the behavior is assumed
- go back to broad if gentle assumption questions dont work
normalization
interviewing strategy
gives permission for patient to feel or act a certain way
aggression
emotion that results in verbal or physical attack
violence
includes the intent to harm
impulsive aggression
is externally provoked
psychotic aggression
is related to symptoms of illness
organized aggression
is driven by a motive or goal
trigger
stage of crisis development
early signs of escelating behavior
escelation
stage of crisis development
begining to lose ability to behave rationally
outburst
stage of crisis development
behavior poses a risk to self or others
- loss of control
recovery
stage of crisis development
decrease is physical and emotional energy
steps for de-escelation
- identify issue
- validate
- provide opportunity to talk
- offer choices (no more than 2)
- give time to make choice
- reinforce positive outcomes
- prepare for restraints
- control environment
