Mental Health Final

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Bupropion

(norepinephrine + dopamine re-uptake inhibitor)

acetylcholinesterase inhibitors

Donepezil (Aricept)

Galantamine (Razadyne)

Tacrine (Cognex)

Rivastigmine (Exalon)

used to treat dementia

benzodiazepams

(Librium)

Cloraze-pate (Tranxene)

Triazolam (Halcion)

anticonvulsants

Oxcarbazepine (Trileptil)

Lamotrigine (Lamictal)

Topirimate (Topamax)

Gabapentin (Neurontin)

atypical antipsychotics and mood stabilizers

Risperidone (Risperdal)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Aripiprazole (Abilify)

Zuclopenthixol Decanoate (Clopixol Depot)

how powerful?

Intermediate Potency

Fluphenazine Decanoate (Modecate)

how powerful?

High Potency

Flupenthixol Decanoate (Fluanxol)

how powerful?

High Potency

dystonia

-twisting and repetitive movements or abnormal postures

parkinsonism

drug induced; tremor either fine or course, drumming of fingers against the thumb; stiffness

Cogentin treat what EPS side effect? (2)

dysonia and parkinsonism

Artane treats what eps side effect?

parkinsonism

Kemadrin treats what eps side effect?

parkinsonism

panic disorder symptoms

paresthesia (is a sensation of tingling, burning, pricking, or numbness of a person's skin with no apparent long-term physical effect)

Milleu therapy

is an approach that uses the total environment (i.e. a hospital unit) to provide a therapeutic community. Personal responsibility for one's self and others is encouraged in a safe and caring community setting.

behavioral symptoms of anxiety

are inhibited, postural collapse,

cognitive symptoms of anxiety

are either sensory-perceptual, such as feeling dazed, objects blurred or seem in the distance, or the environment seems different or unreal,

physical symptoms of anxiety

increased reflexes, startle reaction, flushed or pale face, diarrhea

criteria of major depressive episode

a) Presence of ≥5 symptoms for at least 2 week period, and represent a change from previous functioning. One of the symptoms should be either 1- depressed mood or 2- loss of interest or pleasure (anhedonia). These symptoms are:

major depressive disorder

Major Depression Disorder diagnosis requires 2 or more of the previous episodes in 2 consecutive months. Some authors found that 5 out of 9 diagnostic criteria are required for diagnosis without the necessity of the depressed mood and anhedonia to be among them (Zimmerman et al., 2006).

MDD epidemiology and risk factors

Highest rate of onset occurs in young adult age group

manic depression epidemiology

Mean age of onset = 21-30yrs old

Main sign in children is intense rage

Older adults w/ mania have more abnormalities and cognitive impairments than younger patients

Increased incidence in mania in women (50+) and men (80-90+)

Bipolar II disorder 5% greater in women than men

suicide ideation epidemology

Most common in adolescents

dysthmia

Milder but more chronic form of MDD

symptons of dysthmia

Depressed mood for at least 2 years

serotonin and NERI

• Inhibit serotonin and NE reuptake

• Another first-line treatment for major depressive disorder

NE and Dopamine reuptake inhibitor

• Inhibit NE and dopamine reuptake

• Alternative use: smoking cessation

TCA function

In other words, the drug increases the amount of serotonin and norepinephrine available in the brain.

skills for care

information about the illness, treatments, symptom recognition and management, monitoring and rehabilitative strategies.

family cohesion

those suffering mental illness do better living at home.

A family that is taught to moderate their emotional responses to the illness can reduce relapse.

Family functioning may be strengthened by working together to problem solve and set coping strategies in plae.

respite care

the role of the caregiver can lead to extreme burn-out, and place higher levels of stress on family functioning. Retaining appropriate care for the mentally ill member can help relieve stress on the caregiver. If the family member is in the position where their care is priority, and lifelong, it is recommended to find a caregiver willing to take on that role if the present one is unable or dies.

problem focused coping

Problem focused coping is aimed at the actual stressor and its physical impact where the goal is to remove or reduce the physical impact. (i.e.) stressor= loud tv preventing studying and coping= asking neighbour to turn down the tv. The neighbour turns the tv down and the student resumes studying. The student will likely repeat this behaviour the next time as it successfully and physically removed the problem.

acute care vs community care mental health

Community care for a patient with a major depressive disorder offers a less intensive means of helping patients improve their health and wellbeing. Community care measures offer services to those who do not need inpatient services in order to manage their conditions. Examples of community care include mental health walk-in clinics, support groups, counsellor/psychiatrist visits, and community mental health centers.

In the mental health milieu acute inpatient care is generally reserved for acutely ill patients who due to a mental illness meet one or more of the following criteria: high risk for harming themselves, high risk for harming others, or possess an inability to meet one's own basic needs.

axis 2

Personality Disorders

Mental Retardation

axis 4

Psychosocial and Environmental Problems

General Medical Conditions that may Produce Psychosis (a break with reality)

Thyroid (thryoid regulates our metabolism but if someone is hyperthyroidism can lead to depression,

lupus causes psychosis

why 2nd generation antipsychotics over first gen antipsychotics

Treat negative symptoms

Improve cognition

Less prolactin elevation

atypical antipsychotic side effects

Weight gain (Olanzapine)

Insulin resistance and diabetes (Clozapine, Olanzapine)

Hyperprolactinemia (Risperidone)

Sialorrhea (Clozapine)

Sedation (Clozapine, Olanzapine, Quetiapine)

Rare parkinsonism and akathisia at higher doses (Risperidone, Ziprasidone)

Rare seizures (Clozapine)

Clozapine and olanzapine side effect

Weight gain (Clozapine, Olanzapine)

Insulin resistance and diabetes (Clozapine, Olanzapine

Risperidone side effect

Hyper-prolacti-nemia (abnormally high prolactin in blood)

clozapine side effect

Sialorrhea (excessive secretion of saliva)

Rare seizures (Clozapine)

Clozapine, Olanzapine and Quetia-pine side effect

Sedation

Risperidone and Ziprasidone side effects

Rare parkinsonism and akathisia at higher doses

con of using second gen over 1st gen antipsychotics?

Higher for second-generation antipsychotics but deemed worth the price due to reduced hospitalization time and improved client quality of life.

Types of acute treatment

1st or 2nd generation Antipsychotics

Benzodiazepines

PRN use of injectable, quick-acting agents
-Haloperidol + Lorazepam
-Zuclopenthixol Acetate (Acuphase)
-Chlorpromazine
-Methotrimeprazine
-Loxapine
-Olanzapine

types of maintenance treatment

2nd generation Antipsychotics

Depot Neuroleptics or Risperidone Consta

Mood Stabilizers

Antidepressants

tricyclics side effects

Drowsiness
Dizziness
Cardiac arrhythmias
Very toxic in overdose
Anticholinergic +++

MAOI side effects

Stimulation (anxiety, insomnia, etc)
Dizziness
Hypertensive crisis (tyramine foods)
Toxic in overdose

SSRI side effects

Gastrointestinal distress: hypermotility, loose BMs. Risk for NMS.
Sexual Dysfunction: delay or inhibition of orgasm, erectile dysfunciton, reduced libido.
Serotonin syndrome: fast onset, tremors, diarrhea, pyrexia, twitches, shivering.
Much safer in overdose.

mood stabilizers function

Used to treat Bipolar Affective Disorder
(Manic Depression)

lithium

Oldest psychiatric drug still in use

"Narrow therapeutic window"

60-80% response in "classic BPD"

lithium side effects

Stomach discomfort, g.i. hypermotility
Excessive thirst and urination
Weight gain, tremor
Weakness, dizziness, confusion

lithium interaction

how many? Nursing consideration?

Many drugs
Always monitor for toxicity

carba-zepine

Anticonvulsant

Rapid cyclers and lithium failure

"Narrow therapeutic window"

carba-zepine side effects and interactions

Stomach
Drowsiness, dizziness
Decreased white blood cells
Skin rash

Interactions- Many

valproic acid

Anticonvulsant
Classic BPD and rapid cyclers

valproic acid side effects

Stomach
Weight gain, menstrual changes, pancreatitis
Hair loss

anxiety/sleep meds

-antispasmotic
-anticonvulsant
-hypnotics
-antianxiety
-enhance the actions of GABA

Psychostimulants

increase synaptic dopamine and/or norepinephrine

Atomoxetine (Strattera)

non-stimulant; increases synaptic dopamine & norepinephrine

Memantine (Ebixa, Namenda)

blocks effects of glutamate

meds for dementia

Memantine (Ebixa, Namenda)

Medications for Attention Deficit (Hyperactivity) Disorder

psychostimulants

Atomoxetine (Strattera)- non-stimulant; increases synaptic dopamine & norepinephrine

Antidepressants (bupropion, imipramine, nortriptyline)

Anxiety/Sleep Medications

Trazodone (Desyrel)
Diphenhydramine (Nytol, etc)
Zaleplon (Starnoc)

Mood Stabilizers are..

some atypical antipsychotics are mood stabilizers

mood stabilizers and antipsychotics

Risperidone (Risperdal)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Aripiprazole (Abilify)

ways to behaviorally cope with mild anxiety

Sleeping
Eating
Drinking
Exercise
Smoking
Crying
Laughing
Consulting

ways to behaviorally cope with moderate anxiety

Compensation - when somebody got a perceived deficiency

Denial (most common)

Displacement - my boss yells at me at work, then I yell at my own kids

Identification - I buzz my face just like my dad

Projection - I walk in here in a bad mood then I yell at u

Rationalization - I have to get blind drunk cuz of the horrible class I have to endure

Regression -

Repression -when somebody can't remember something

Undoing -

Psycho-physiological responses to moderate anxiety

Headaches
Arthritis
Colitis
Ulcers
Asthma
Pain
Cancer
CHD (coronary heart disease)
Sexual dysfunction

...

Phobias
Obsessions
Compulsions
Hypochondriasis

Conversion disorder (a condition in which a person has blindness, paralysis, or other nervous system (neurologic) symptoms that cannot be explained by medical evaluation)

Dissociative ID (multiple personality disorder)

Amnesia

Fugue ( is a rare psychiatric disorder characterized by reversible amnesia for personal identity, including the memories, personality and other identifying characteristics of individuality

cerebrum

can be roughly divided into two halves or hemispheres. For most people, one hemisphere is dominant, whereas about 5 percent of individuals have mixed dominance. Each hemisphere controls functioning mainly on the opposite side of the body. The left hemisphere, dominant in about 95 percent of people, controls functions mainly on the right side of the body. The right hemisphere provides input into receptive nonverbal communication, spatial orientation and recognition; intonation of speech and aspects of music; facial recognition and facial expression of emotion; and nonverbal learning and memory in general, the left hemisphere is more involved with verbal language function, including areas for both receptive and expressive speech control. In addition, the left hemisphere provides strong contributions to temporal order and sequencing, numeric symbols and verbal learning and memory.

neurotransmission

o b/w nerve fibers are synapses. Between one fiber to the next ,communication occurs with the neurotransmitters. Neurotransmitters are metabolized by various enzmes

cerebral cortex

o abstracting thinking and decision making
o part of the brain we can see
o frontal lobes of the cortex - higher order thinking and good judgment
o impairment here; get them drunk and observe their social judgment.

limbic system

• Basic emotions (rage), needs, drives and instinct begin and are modulated in the limbic system
• Roles in memory and learning
• Seat of emotions.
• Composed of hippocampus, thalamus, hypothalamus, amygdala and limbic midbrain nuclei.

basal ganglia

• Involved with motor funcitons and association in both the learning and the programming of behavior or activities that are repetitive and, done over time, become automatic.
• Has to do with muscles and movts
• Damage to portions of these nuclei may procduce changes in posture or muscle tone. May also produce abnormal mvts, such as twitches or tremors.
• Subdivisions: putamen, globus pallidus, and caudate.

hypothalamus

• Basic human activities, such as sleep-rest patterns, body temp, and physical drives such as hunger and sex (basic sexual arousal and sexual behavior), are controlled by another part of the limbic system that rests deep within the brain and is called the hypothalamus.
• Dysfunction of this structure, whether from disorders or as a consequence of the adverse effect of drugs used to treat mental illness, produces common psychiatric symptoms, such as appetite and sleep problems.
• Dysfunction of this structure, produces common psychiatric symptoms, such as appetite and sleep problems.
• Secretes neuro hormones such as ADH

substantia nigra

manufacture dopamine which plays a major role in muscle mvt.

Psychoneuroimmunology

looks at how psychosocial factors affect our immune system. There are great connects not well understand between SN endocrine sytem, etc

norepinephrine

• proposed role in learning and memory, attributing value in reward systems; fluctuates in sleep and wakefulness

• has effects on our moods and our bp. Antidepressant effects

• very widespread throughout the cortex, thalamus, cerebellum, brain stem and spinal cord.

• Basal forebrain, thalamus, hypothalamus, brain stem and spinal cord.

dopamine

• Striatum, limbic system and cerebral cortex. Pituitary
• Involved in involuntary motor mvts. Some role in mood states, pleasure components in reward systems, and complex behavior such as judgment, reasoning and insight.

serotonin

• Very widespread through the cortex, thalamus, cerebellum, brain stem, and spinal cord

• Proposed role in the control of appetite, sleep, mood states, hallucinations, pain perception, and vomiting, activity levels. Antidepressant effects

AcH

• Diffuse throughout the cortex, hippocampus. Peripheral NS.
• Important role in learning and memory.
• Some role in wakefulness and basic attention.
• Peripherally activates` muscles and is the major neurochemical in the autonomic system.

GABA

• Found in cells and projections throughout the CNS, especially in intrinsic feedback loops and interneurons of the cerebrum

• Also in the extrapyramidal motor system and cerebellum

• Fast inhibitory response postsynaptic ally (calms NS), inhibits the excitability of the neurons and therefore contributes to seizure, agitation and anxiety control. Antianxiety muscle relaxant, hypnotic effects, anticonvulsant. Affected by antianxiety meds.

endorphins

• Suppresses pain, modulates mood and stress. Relaxant and analgesic.
• Likely involvement in reward systems and addiction

anxiety disorders

• The most common of the psychiatric illnesses treated by health care providers.

ECT

• A brief electrical current is passed through the brain to produce generalized seizures lasting 25 to 2 min and 30 sec

• A short acting anaesthetic and a muscle relaxant are given before induction of current

• A brief pulse stimulus, administered unilaterally on the non-dominant side of the head is associated with less confusion after ECT.

• Some individuals require bilateral treatment for the effective resolution of depressive symptoms

• Induction of a seizure is necessary to produce positive treatment outcomes.

• the lowest possible electrical stimulus necessary to produce seizure activity is used

• Blood pressure and ECG are monitored during the procedure. The procedure is repeated two or three times per week.

• ECT is most effective in treating severe depression, mania and schizophrenia when other treatments have failed. Also used for severe forms of depression, delusions and paranoia.

• After symptoms improve antidepressants are given to prevent relapse

• ECT causes rapid improvement in depressive symptoms, the exact mechanism remains unclear

ECT function

• ECT produces an up-regulation in serotonin, especially 5-HT, also an increased influx of calcium and effects on second messenger systems

ECT side effects

• Adverse Effects are: hypotension, hypertension, bradycardia, tachycardia, minor arrhythmias

• After Effects are: headache, nausea, muscle pain

• Cognitive side effects are: after seizure disorientation, short term retrograde amnesia, retrograde memory loss

• ECT is contraindicated for patients with increased intracranial pressure, recent MI, recent CVA

Risk factors associate with self-harm, and attempted and successful suicide

age: The incidence of suicide increases with age. However, recently the incidence in young adult men up to 45 years of age has been increasing

gender: Suicide is approximately three times higher in men across all ages
Self-harm has a higher incidence among females, especially those aged 25 years and under.

race: Suicide and self-harm have a higher incidence among Caucasians

marital status: Suicide has a higher incidence among divorced, single or widowed individuals

living circumstances: Suicide and self-harm have a higher incidence among those living alone or homeless

unemployed status: Suicide and self-harm have a higher incidence among the unemployed

Occupation: Suicide has a higher incidence among certain professions, for example farmers, dentists, and doctors, possibly associated with accessibility of methods.

episodes of loss or bereavement: Suicide has a higher incidence among those experiencing recent losses, for example loss of job, partner, health due to illness, especially diagnosis of chronic or terminal illness such as HIV, hepatitis C virus or cancer

Season Variation: Suicide has a higher incidence during spring (except for prison populations where the incidence increases in autumn)

regional variation: Suicide has a higher incidence in rural regions

deliberate self-harm: Suicide and self-harm risk is greater if there is a previous or current history of such behavior

Mental Illness: Suicide has a higher incidence in patient with current episodes, receiving treatment or an inpatient with previous 12 months (that is, recent discharge)

social support history: Suicide and self-harm have a higher incidence among those with poor social support networks

substance abuse: Suicide and self-harm have a higher incidence among patients with a history of substance misuse

forensic history: Suicide and self-harm have a higher incidence where there is a history of violent crime

biological factors: Suicide risk is greater where there is a family history of suicide

giving broad statements

Purpose?

Giving broad openings
• Introducing an idea and letting the client respond
• Nurse: trust means....CT: that someone will keep you safe.
• Purpose: used when helping client explore feelings or gain insight.

reflecting feelings

purpose?

Reflecting feelings
• Redirection the idea back to the client.
• CT: Should I go home for the weekend? Nurse: should you go home for the weekend?
• Purpose: used when client is asking for the nurse's approval or judgment. Use of reflection helps nurse maintain a nonjudgmental approach.

advice

why is it prohibited during therapeutic communication?

• Problem: nurse solves the client's problem, which may not be the appropriate solution and encourages dependency on the nurse.
• If advice doesn't work out, trust in relationship is broken and nurse is blamed.

agreement

why is it prohibited during therapeutic communication?

Agreement
• Agreeing with a particular viewpoint of a client
• CT: Abortions are sinful. Nurse: I agree.
• Problem: Client is denied opportunity to change one's view now that the nurse agrees

reassurances

why is it prohibited during therapeutic communication?

Reassurances
• Tell a client that everything will be ok.
• CT: everyone thinks I'm bad. Nurse: you are a good person.
• Problem: nurse makes a statement that may not be true. Client is blocked form exploring feelings.

self-disclosure

is it good or bad?

Self-disclosure can be used in very specific situations, but self-disclosure is not the first intervention to consider. In prioritizing interventions, active listening is one of the first to use.

boundary violations

Role
• Be professional
• Don't have sex with client.
• Don't be friends with client.
• Time
• Place and space
• Money
• Gifts and services
• Clothing
• Language
• Self-disclosure
• Post-discharge
• Physical contact

principles of therapeutic communication

1) The client should be the main focus of the interaction.
2) A professional attitude sets the tone of the therapeutic relationship
3) Use self-disclosure cautiously and only when the disclosure has a therapeutic purpose.
4) Avoid social relationships with clients.
5) Maintain client confidentiality.
6) Assess client's intellectual competence to determine the level of understanding.
7) Implement interventions from a theoretic base.
8) Maintain a nonjudgmental attitude. Avoid making judgments about the client's behavior and giving advice. By the time the client sees the nurse, he or she has had plenty of advice.
9) Guide the client to reinterpret his or her experiences rationally/
10) Track the client's verbal interaction through the use of clarifying statements. Avoid changing the subject unless the content change is in the client's best interest.

therapeutic relationships are characterized by

Therapeutic relationships are characterized by:
• • Trust
• • Professionalism
• • Mutual respect
• • Caring
• • Empathy
• • Genuineness
• • Unconditional positive regard

This relationships is:
• One-way
• Focused on improving the health of the patient.
• Whereas with a social relationship, it's a mutual benefit.
• Nurse is in power position and at the same time, the nurse is trying to give power to patient by giving that patient more autonomy
• Patient is vulnerable.
• Therapeutic relationships are intentional
• Relationship is short-term

orientation phase

• Definition: when you make the connection with the person, about their life situation, about why they come for help

• Goal: 1) to build trust and rapport and 2) to get some initial info

• Tuning in- focus on what the patient is saying; maintain eye contact. Start a conversation. Do not ask questions right away

• Active listening - listening to what the person is saying

• Respond with empathy - to communicate with them that you understand what they said.

• Checking understanding - use interpretation or summarize what you heard back
o It's ok to ask both close-ended and open-ended questions

• Probing - probe for more details

• Summarizing - summarize back the message and then patient says "yes, you got it" then you understand what they're saying

• Challenging
• negotiating

transference

o is an unconscious response in which the patient experiences feelings and attitudes (of inappropriate intensity) toward the nurse that were originally associated with other significant figures in his or her life. Transference reduces self-awareness by allowing the patient to maintain an inaccurate view of the world.
o Client uses transference to examine problems.
o During the phase, client is psychologically vulnerable and emotionally dependent on the nurse.

countertransference

o is a therapeutic impasse created by the nurse's specific emotional response to the qualities of the patient. This response is inappropriate to the content and context of the therapeutic relationship and inappropriate in the degree of intensity of emotion.

o The nurse needs to recognize countertransference and prevent it from eroding professional boundaries.

factors that facilitate effective interviewing

o If you intend to make notes, inform others of this at the beginning of the interview. Keep your notes brief; most of the attentional resources should be focused on interaction
o Maintain an open body posture and actively attend to the encounter.
• Avoid jargon
o Repeatedly check with participants to ensure that they understand what you are saying.
• Being with a less sensitive topic and move toward sensitive issues as rapport develops.
• Leave some time at the end of the encounter for closure and future planning.
o Monitor the available time

"SAD CHILDREN" - Framework for Suicide Assessment

S - Support System. Does indiv have support system?

A - Alcohol and Drug Use. Substance use may intensify the individual¡¦s mood and increase the risk of suicide

D - depression. The single best predictor of suicidal thinking is the presence of a mood disorder, including mania.

C - communication.  Is the individual able to verbalize feelings? With whom?

H - hostility. Is the individual angry? How is anger expressed? (i.e. internalized or expressed outwardly)

I - impulsivity. Impulsivity when combined with method of high lethality indicates significant risk

L - lethality. What means has the individual chosen? Especially lethal methods include weapons, jumping, hanging, toxic medication. Is there a plan to avoid being discovered or rescued?

D - demography.

R - reaction of evaluator. Are you worried about the client? Do you feel depressed listening to the client?

E - Events. Severe life events often precede a suicide attempt such as: losses (significant others; marriage; job; past lifestyles) or conflicts (in relationships; making decisions)

N - No hope. Expressions of hopelessness

Asking a patient "Do you feel like killing yourself?" will
put ideas into his or her head and lead to suicide attempt.

T/F

F

Children and adolescents with anxiety disorders

have higher rates of suicidal behavior, early parenthood, drug and alcohol dependence, and educational underachievement later in life.

psychodynamic theory about anxiety disorder

. The kid may begin with a neurophysiologic vulnerability that predisposes one to fearfulness.

This fearfulness is enhanced by parental behavior in some way, which results in disturbed parent-child relationships and causes the child to feel conflict about dependence and independence (separating from parent), self-doubt and confusion regarding self-identity, and personal control.

interpersonal theory of anxiety disorder

Loss or disapproval of relationships leads to anxiety disorder

biochemistry evidence about OCD

• Pharmacologic evidence that serotonin plays a role in OCD

• Dysfunction in GABA and other neurotransmitters.

panic attacks

discrete period of intense fear with 4 or more of the following symptoms that develop abruptly and reach a peak within 10 minutes.

panic attack symptoms (some of them)

o Chest pain
o Depersonalization (feeling detached from oneself)
o Numbness or tingling sensations

agoraphobia

can lead to avoidance behaviors

frequently occurs with panic disorder/

generalized anxiety disorder

defn

characterized by long-standing excessive worry and anxiety (apprehensive expectation) often over uncontrollable events. Ex: what if? Indiv with this disorder experience excessive worry and anxiety almost daily for extended periods.

GAD symptoms

• Patients with GAD often have mood symptoms, from mild depressive symptoms, such as dysphoria (restlessness, unwell), to comorbid, major depressive disorder.

• They are also highly somatic, with complaints of multiple clusters of physical symptoms, including muscle aches, soreness, and GI ailments. In addition to physical complaints, patients with GAD often experience poor sleep habits, irritability, trembling, twitching, poor concentration, and an exaggerated startle response.

social phobia

what neurotransmitter is it linked to?

• Linked to a number of key neurotransmitter systems. Recent evidence links low dopamine receptor binding to social anxiety disorder

xeno-phobia

fear of strangers

nycto-phobia

fear of night or dark places

re-experiencing

re-experience the event through distressing images, thoughts or perceptions and may have reoccurring nightmares. In addition, the patient may experience flashbacks and exhibit extreme stress upon exposure to an event or image that resembles the traumatic event (e.g. fireworks may bring back memories of war). Generally outside the norm of human experience.

avoidance (PTSD)

• Avoidance: patients will avoid discussing the event altogether or avoid ppl and places that remind them of the traumatic event

heightened arousal (PTSD)

Increased arousal: evidenced by difficulty sleeping, irritability, poor concentration, exaggerated startle response, or hypervigilance.

risk factors of PTSD

o Prior diagnosis of depression
o Prior diagnosis of acute stress disorder
o Duration and intensity of trauma involved
o Environmental issues
o Coping style
o Low self-esteem

biofeedback (anxiety)

to monitor and display your physiological activity to expand your awareness and increase control of your body.

Person hooked up to a screen that will let them know when certain brain waves are occurring.

systematic desensitization (anxiety)

• Exposes the patient to a hierarchy of feared situations that the patient has rated from least to most feared.
• The patient is taught to use muscle relaxation as levels of anxiety increase through multisituaaqtional exposure
• Planning and implementing exposure therapy needs special training, because of the multitude of outpatients in treatment for agoraphobia, exposure therapy would be a useful tool for home health psychiatric nurses.

flooding (anxiety)

• Desensitizing is done by presenting feared objects or situations repeatedly, without session breaks, until the anxiety dissipates.

cognitive restructuring function

Its goal is to alter the patient's immediate, dysfunctional appraisal of a situation and perception of long0ternm consequences.

cognitive restructuring steps

-monitor thoughts & feelings:
o Taught to monitor automatic thoughts
o Then to recognize the connection between thoughts, emotional response and behaviors.

-question the evidence: am I drawing the right conclusion
o The distorted thoughts are examined and tested by for-or-against evidence presented by the therapist, which helps the patient to realistically assess the likelihood that the feared event will happen if the compulsive behavior is not performed.

-examine alternatives and perspectives
'
-de-catastrophizing: is the plain going to crash? Slim chance

-re-framing: How the event can be looked at positvley

-thought-stopping:
o Taught to interrupt obsessional thoughts by saying "Stop!" either aloud or subvocally. This activity interrupts and delays the uncontrollable spiral of obsessional thoughts.

learning new behavior (anxiety disorder)

modellling

shaping:learning new behavior one step at a time.

token economy: Clients are rewarded with tokens for selected desired behaviors. They can use these tokens to purchase meals, leave the unit, watch tv, or wear street clothes.

role playing: i'll play you and you play my mother-inlaw

social skills training: Involves instruction, feedback, support and practice with learning behaviors that help children to interact more effectively with peers and adults. ex: toastmasters

aversion therapy

contingency contracting

aversion therapy

a form of psychological treatment in which the patient is exposed to a stimulus while simultaneously being subjected to some form of discomfort. This conditioning is intended to cause the patient to associate the stimulus with unpleasant sensations in order to stop the specific behavior.
o for example: placing unpleasant-tasting substances on the fingernails to discourage nail-chewing

contingency contracting

o A contract is a written document that the nurse and client develop. The document clearly states acceptable and unacceptable behaviors, consequences and rewards, and the role of both the client and nurse in preventing and managing anxiety
o Having a what if plan.

mood

• A pervasive and sustained emotion that colors one's perception of the world and how one function in it; emotional state that influences personality and life functioning.

• Normal mood variations, such as sadness, euphoria and anxiety, are time limited and are not associated with significant functional impairment. The normal range of mood or affect varies considerably both within and between cultures.

inappropriate affect

discordant affective expression accompany the content of speech or ideation. Ex: smile at a sad event

reactive affect

varies normally to any situation. Ex: When I talk of something of concern, I would frown.

labile affect

varied, rapid and abrupt shifts in affective expression. Up and down expressions Ex: laughing to angry in seconds. You see it in mania.

restricted or constricted affect

mildly reduced in the range and intensity of emotional expression. Ex: when everyone is laughing loudly, and you hardly respond....just chuckle.

where does the suppression of emotions fit in the continuum of emotional responses

middle

where does delayed grief reaction fit in the continuum of emotional responses

right to the middle.

-Most maladaptive mood states are characterized by their:

1) intensity: how depressed is somebody?
2) pervasiveness
3) persistance: how long does it last?
4) interference with normal functioning

pathological grief

occurs when grief does not run its normal course. Gotta go through the grief, not around it. You can't schedule it. Ex: can schedule childbirth.

endocrine predisposing factors to mood disorders

-disinhibition of hypothalamic-pituitary-adrenal (HPA) and h-p-thyroid (HPT) axes:
• sometimes there's a problem b/w the target and the pituitary gland.

-cortisol hypersecretion.
• Result in chronic stress, which might lead to neurotoxin in brain thus leading to dementia.

DST: dex-metha-soad Suppression Test.
• Last indicator of depression. Cortisol secretion may not be reduced by the hypothalamus, or there may be no change at all after receiving the synthetic cortisol. In healthy individuals cortisol levels drop at first, but then return to normal as the hypothalamus compensates for the dexamethasone in the blood.

kindling

if you have subsequent reoccurrences (episodes) of depression, each one can be worse than the last. That means it can be brought on by weaker forces (causes), will have more severe symptoms, and be harder to treat (need more meds and time). In fact, at some point, it will come on without any push

psychodynamic theory of depression

• Ascribes the cause of depression to an early lack of love, care, warmth, and protection and resultant anger, guilt helplessness, and fear regarding the loss of love.
• This ensuing conflict b/w wanting to be loved and fear of rejection produces pathologic self-punitiveness (aggression and anger turned inward), self-rejection, low self-esteem and depressive symptoms.

depression range of severity

-range of severity: anywhere from a mild sadness to a complete incapacitation with psychotic features (ex: I caused the death of thousands of African ppl, and it's my fault).

depression female/male ratio

70:30

self-limiting aspect for untreated depression

4-6 months duration; sometimes a person have a single episode or have chronic depression.

an estimated of cases will seek help, be diagnosed, and obtain appropriate treatment

1/3

dysthmic disorder

depressed mood for most days for at least 2 years and two or more of the following symptoms:

Cyclothymic Disorder

• Periods of hypomanic episodes and depressive episodes that don't meet full criteria for a major depressive epidsode.

behaviors associated with depression

-change from previous functioning: " He's just not himself"
o Anhedonia: inability to experience pleasure
-expression of mood:
o Come across as sadness; or negative passivity (pessimism)
o Irritability: "aww I have to do it again?"
o Withdrawal: less involved with people than before
o Pessissm: nothing's going to turn out well.
o Sometimes crying.
o Looks overstressed
o Easily overwhelmed. Ex: give them a task, and they'll say "can't u do that."

Anxiety
-free floating anxiety


-diurnal variation:
o Depressions gets worse in te morning and gets a bit better by evening.
o Ruminating: thinking the same thing over and over again.

somatic or vegetative (biological) s&s:
o Constipation
o Loss of appetite
o Various aches and pains
o Lack of lipido is a big one
o Feelings of weakness in the body which are quite real for them. Ex: do I have to walk in hallway again. We just did that yesterday.
o Catatonia: immobile state. Inability to make a small decision. Ex: ok, lets side down but no I gotta stand up.

mania

-may occur alone or also in people with hx of depressive episodes

hypomania

milder form of mania

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