week 5 Flashcards
What is Somatization?
- Psychological distress is expressed as physical symptoms
- Symptoms are not intentional or under conscious control
ANXIETY BASED
What are the different types of somatic disorders?
- Somatic symptom disorder
- illness anxiety disorder
- functional neurological disorder
4.Factitious disorder
Why do individuals who have somatic symptoms disorder refuse psychiatric care?
because they believe they have a physical problem not an anxiety problem.
they believe its medical even with negative test findings
What is illness anxiety disorder also known as?
“Hypochondriasis”
What are the two types of hypochondriacs?
- They constantly go to the doctor, they have a headache but think they have brain cancer
- Other person just doesn’t go to the doctor they’re “fine”
What symptoms does someone experience with illness anxiety disorder?
- anxiety symptoms
- hyperventilate
- chest pain
What is the difference between illness anxiety symptoms and somatic symptoms disorder?
Somatic symptoms=PHYSICAL
illness anxiety=ANXIETY
What is functional neurological disorder knows as?
conversion disorder or hysteria
Describe what functional neurological disorder is?
sudden loss of function
all of the sudden their arm isn’t working or they become blind but there aren’t any medical findings that support that loss of function
Describe Munchausen syndrome.
The Act!!
mom intentionally fakes that the daughter is sick when the daughter isn’t actually sick
What is Munchausen syndrome motivated by?
attention
What are examples of factitious disorders?
munchausen syndrome
Malingering
Describe malingering
same as munchausen but it has a benefit
homeless pts need shelter in winter so they get food, shelter…theres an OBVIOUS benefit
What will we look for in an assessment in somatic symptoms disorders?
- full assessment
- if any dramatic terms are used
- ability to meet their own needs
- family and workplace dynamic
- childhood trauma
- ability to express feelings and needs
- dependence on medication
What are some expected outcomes in somatic symptom disorders?
- MAIN GOAL:live a normal life as possible
- pt will articulate feelings
- pt will resume performance of work-role behaviors
- pt will identify ineffective coping patterns
what are some nursing implementations in somatic symptom disorders?
- DO NOT IMPLY THAT THE SYMPTOMS ARE NOT REAL
- spend time with pt when they are not expressing a physical complaint
- show concern but avoid dependency
- reinforce their strengths
- teach stress reduction techniques
are there any pharmacological therapies for somatic symptom disorders?
No specific meds but they may have an SSRI
Define personality
the individual differences in characteristic patterns of thinking, feeling, and behaving.
Define personality disorders
enduring pattern of inner experience and behavior that deviates from the individuals culture
are traits inflexible and unpredictable in individuals with personality disorders?
yes
Explain the coping mechanisms for someone with personality disorder. How do they act?
coping mechanisms are primitive and immature
they act like a child
Explain the “patterns” of someone with personality disorders.
maladaptive patterns in behavior, lack of insight, and tendency to blame others.
Do those with a personality disorder tend to seek help?
Naur
What causes personality disorders?
- genetics
- neurobiological
- psychological influences
- cultural considerations
what kind of trauma is usually always experienced for those with personality disorder?
childhood trauma in which is rapid and severe
explain what projective identification is
ex: you hate your teacher but you believe its because they hate you
what in the “clinical picture” for someone with a personality disorder?
- Frequently use splitting or protective identification
- symptoms begin in early adulthood
- less intense symptoms in middle-age and older
what is cluster A described as?
odd and eccentric
What 3 disorders are part of cluster A?
- Schizotypal
- Paranoid
- Schizoid
What are some characteristics of someone who is schizotypal?
- odd speech, thinking, and beliefs
- Magical thinking
- Ideas of reference
- Inappropriate affect
- Suspicious of others
- Social anxiety
- Peculiar ideas
What are some characteristics of someone who is paranoid?
- distrust of others
- Reluctance to confide in others
- perceives attacks
- inability to forgive perceived insults
hostile to weak individuals
What are some characteristics of someone who is schizoid?
- unable to establish relationships
- restricted range of emotions
- take pleasure in few things
- emotional coldness
- solitary
- little desire to help others
no desire for humans but attached to animals
Do people with schizotypal have delusions or hallucinate?
no
What can category B be known as?
the all about me
what four disorders fall under cluster b?
- antisocial
- borderline
- narcissistic
- histrionic
Describe someone who has antisocial disorder.
- sense of entitlement (they tx people unfairly)
2.** lack of remorse** - disregard for safety for others
- impulsive
- fail to plan ahead
What may have happened to someone with antisocial disorder as a child?
- parents used substances
- disciplined harshly
- no supervision
What are some other characteristics of someone who has antisocial disorder?
- increased chance of DUI
- Very charming and use that to manipulate
- they make poor financial decisions
- they don’t take responsibility
Describe someone who has borderline disorder.
think of Mario
- they have mood instability
- unstable self image
- unstable sense of relationships
- Frantic efforts to avoid abandonment-will do anything to avoid abandonment
- recurrent suicide
what is the key to know someone is borderline?
they have unstable and intense relationships
what disorder is borderline often confused with?
Bipolar disorder
What are other characteristics of someone with borderline?
- very clingy
- thoughts are intense and dramatic
Describe someone who has narcissistic disorder.
- Grandiose
- Arrogant
- Require excessive admiration
- lack empathy
Describe someone who has histrionic disorder.
- Self dramatization
- theatrical (main character, drama queen)
- use physical appearance
- labile
What is the difference between someone who is narcissistic or histrionic?
narcissistic want attention but also think they are better than everyone else while histrionic JUST wants attention
What disorders are in cluster C?
- Avoidant
- Obsessive compulsive personality disorder
- dependent
Describe avoidant disorder.
- Hypersensitive to criticism
- reluctant to take personal risks
- feelings of inadequacy
avoids relationships but DESIRES them/connections
Describe obsessive compulsive personality disorder.
- Preoccupied with rules and details
- rigid perfectionism
- Financially stingy
-high achievers
-cannot bend rules
-devote entire life to work
Describe dependent disorder
- clingy
- excessively submissive
- difficulty making everyday decisions
-they don’t like conflict
-they lack confidence
-tend to tolerate abusive tx
What should be included in an assessment for those with personality disorder?
- primitive defenses
- suicide/self harm
- aggressiveness
- substance use
- past abuse
For borderline and antisocial what would we implement?
limit settings
they’re very manipulative or abusive as far as language so set those limits a bitch
For dependent and histrionic what would we implement?
Modeling
when you do something and they copy you like a role model
for schizoid and schizotypal what should we implement?
Respect need for isolation
what is dialectal behavioral therapy?
addresses strategies for extreme mood swings
Which substance is the MOST used in substance use? Second most used?
- alcohol
- marijuana
What are some psychiatric comorbidities in someone with substance use and addictive disorders?
- anxiety disorder
- PTSD
- depressive disorders
- mania
- Schizophrenia
Are those with a substance use or addiction disorder at higher risk for suicide?
yuh
Describe cross tolerance.
If someone has a high tolerance of alcohol they will need a higher dose for benzos because they’re cross tolerable
describe synergistic effects
When you have two CNS depressants together the effect become more significant like death
describe cross dependance
when you substitute the dependance or addiction of a drug with another so if you want to get someone off opioids you replace it with methadone
describe antagonistic effects
when you give someone an antidote like narcan
describe flashbacks
when someone has a recurrence of a perceptual disturbance that was caused by an earlier hallucinogenic
someone has flashbacks from when they were high when they’re sober
Describe dual diagnosis
when someone has a mental health condition and substance use disorder
describe codependance
One person enables this compulsive behavior
Drug dealer enabling addict
Define substance use disorder
Cluster os cognitive, behavioral, and physiological symptoms
continues to use substance even if it causes problems
What disorders may be induced by substance use disorder?
- intoxication
- withdrawal
- psychosis or delirium
is addiction a brain disease
yes
define addiction
a chronic relapsing brain disease characterized by compulsive disorder
What is addiction disorder strongly motivated by?
cravings
What is the neurobiology of addiction?
- brainstem
- limbic system
- cerebral cortex
What does the brainstem control?
HR
RR
What does the limbic system control?
responsible for reward circuit
What is the cerebral cortex responsible for?
judgment, problem solving
What are some CNS depressants?
- alcohol
- Benzos
- barbiturates
*all cross tolerant of each other**
Define alcohol use disorder.
when someone has a problematic pattern of alcohol that leads to impairment or distress
taking larger amounts over a longer period that was intended
What does CAGE stand for?
C= Cut
A = annoyed
G= guilty
E= eye opener
What is the CAGE assessment tool?
to screen if there is a potential alcohol abuse
if you answer yes to at least two then you have a probability of having substance or alcohol use
What are the four questions in a
CAGE assessment tool?
- Have you ever felt you should CUT down on your drinking or drug use?
- Have people ANNOYED you by criticizing your drinking or drug use?
- Have you ever felt bad or GUILTY about your drinking or drug use?
- Have you ever had a drink or used a drug first thing in the morning to steady your nerves or to get rid of a hangover? EYE OPENER
What are some medical issues that can be caused by alcohol?
- Gastrointestinal medical problems
- Cardiovascular problems
- Wernicke-Korsakoff syndrome
- Nervous system and brain damage
What cardiovascular issues can be caused by alcohol?
Dysrythmias and stroke
Describe Wernicke-korsakoffs syndrome
Deficiency of Vitamin B
-confused and can’t learn new things
-irreversible
How do you measure alcohol intoxication?
measure the blood alcohol level
not by how they feel
What is the legal Blood alcohol level?
0.08%
What can alcohol intoxication effect?
- decreased reflexes
- impaired judgement
What can alcohol withdrawal syndrome syndrome effect?
- Autonomic
- motor
- awareness
- psychiatric
What autonomic symptoms will be experienced in alcohol withdrawal syndrome?
- Elevated BP
- Diaphoresis
- n/v/d
elevated vitals in general
What motor symptoms will be experienced in alcohol withdrawal syndrome?
- Tremors
- Dysarthria-slurred speech
- Seizures- BIG CONCERN
What awareness symptoms will be experienced in alcohol withdrawal syndrome?
- agitation
- Irritability
- Insomnia
- Disorientation
What psychiatric symptoms will be experienced in alcohol withdrawal syndrome?
- Anxiety
- hallucinations
- paranoia
When does alcohol withdrawal delirium peak?
peaks 48-72 hours after cessation/reduction
how long does alcohol withdrawal delirium last?
2-5 days
Is alcohol withdrawal delirium a medical emergency?
yes
What is important to ask/look for when someone is experiencing alcohol withdrawal delirium?
- when was their last drink
- seizures are crucial watch for this
What is the CIWA scale?
scale used to assess and diagnose the severity of alcohol withdrawal.
What are the medications for alcohol withdrawal?
- Benzos
- Barbituates
- Anticonvulsants
- Vitamins
Why would you give someone with alcohol withdrawal a barbiturate?
only give barbs if not responding to benzos
What are the medications for alcohol sobriety?
- Disilfiram (Antabuse)
- Naltrexone
- Acamprosate
Which medication focuses on cravings and should NOT be taken if they’re taking opioids?
Naltrexone
Which medication is used as an eversion therapy/used everyday for alcohol sobriety?
Disulfiram
What is important to avoid when taking Disulfiram?
avoid things with alcohol in them like hand sanitizer, wine cooked in food etc. if they ingest they can have terrible symptoms
What are some examples of opiates?
- heroin
- Oxycodone
- Fentanyl
When does someone peak with opioid withdrawal?
3-5 days but withdrawal can last up to 4 weeks
When does opioid withdrawal occur?
12 hr after last use
What are symptoms of opioid withdrawal?
- low energy
- irritability
- flu-like symptoms
- hot and cold sweats
- severe muscle aches and pains
- abdominal cramping
What is a key symptom of someone who has an opioid overdose?
PINPOINT pupils
what are symptoms of opioid overdose?
- pinpoint pupils
- respiratory depression
- decreased LOC
What are medications for opioid overdose?
- Nalaxone
- Nalmefene
How often should naloxone be administered?
every few hours and works almost instantly
Why don’t we normally give nalmefene?
because withdrawal symptoms could last longer
What are the medications for opioid withdrawal?
- methadone
- Clonididne
- Buprenorphine
What medication for opioid withdrawal is given to a pt with unstable vitals?
Clonidine
What medication for opioid withdrawal is given to a pt that needs help with cravings?
Methadone
which medication is a long acting opioid and doesn’t give them the high?
Methadone
Which medication for opioid withdrawal is given as a detox AND to help cravings?
Buprenorphine
What are some CNS stimulants?
- Cocaine
- Methamphetamine
What can CNS stimulants cause?
- increase alertness
- heighten sexual arousal
- increase energy
If someone is using CNS stimulants what is key to know?
they have nose bleeds and dilated pupils
due to OD they can suffer from stroke or heart attack
What withdrawal symptoms can someone experience with cocaine and crack?
- Depression
- Paranoia
- Lethargy
- Anxiety
- N/V
- Sweating
Euphoria but then sends them into deep depression
What can meth cause?
- a more permanent psychosis
- cracked teeth
- skin infections
Why are those that use meth more prone to skin infections?
because their always picking at their skin because they think there’s bugs
aka meth induced psychosis
Why is meth used for survival for the homeless?
- keeps them awake
- keeps them warm
- Decreases appetite
Explain abstinence syndrome.
- strong cravings
- impaired concentration
- restlessness
- Increased appetite
like withdrawal
What are some nicotine based pharmacological aids?
- Patches
- Gums
- Lozenges
- Nasal sprays
- inhalers
What are some nicotine free pharmacological aids?
- Varenicline (Chantix)
- Buproprion (Zybran)
Why should someone using bupropion as a nicotine free pharmacological aid be cautious?
its an antidepressant and can cause SJS and suicidal ideation
