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#1 cause of worldwide disability: Unipolar Major Depression
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#10 cause of worldwide disability: BI-polar
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5 Different types of Somatoform Disorders: Somatization, pain disorder, conversion disorder, hypchondriasis, body dysmorphic disorder
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5 stages of sleep: 1-4 EEG wave is slow, 5th is REM when you have dreams and EEG waves increase) all phases take about 1-2 hours
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A.I.M.: Awareness, Intervention, Methodology: National Strategy for Suicide Prevention
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Acute Treatment for Depression: Eliminate symptoms
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Adaptive Responses to Emotions: appropriate emotional responsiveness, uncomplicated grief, suppression of emotions
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ADD & ADHD Psychopharmacology: psycho-stimulants (ritalin, methylphen) amphetamines (dexedrine, dextroamphetamine) Stratera (SNRI) atomoxetine
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ADD & ADHD Signs & Symptoms: inattentiveness & impulsivity, usually present in childhood, may not be diagnosed until adult,
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Age r/t sleep: decreases with age, elderly have more trouble falling asleep and wake more frequently, prone to drug toxicity, benadryl can help, newborns need 18 hours, school age 10-12 hours, adults 7-9 hours, elderly 6 hours with napping
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agoraphobia: unable to engage in any day-to-day activities, develops in 1/3 of people with panic disorders, 10 million people have panic disorder only 1/3 of people get proper treatment
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ANOREXIA-definition: eating disorder in which the person experiences hunger but refuses to eat because of distorted body image, intense fear of gaining weight & getting fat, 25% of body weight lost, 15% die and recovery takes 4-7 years, they see themselves as fat
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Anxiety Disorders in Children: 13% 9-17 year olds, OCD is easy to recognize, triggered by DNA +environment, OCD rarely occurs from strep infection in susceptible kids and goes away when strep goes away
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Anxiety medications: minor tranquilizers (Benzos), Ativan (lorazepam) anti-anxiety (BuSpar), SSRI's
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Anxiety Responses + Anxiety Disorders symptoms: increased pulse, increased RR, increased BP, vasoconstriction, cold sweat, dilated pupils, subjective can't concentrate, jittery, confused, nausea, pounding heart, irritability, unbearable, acting out
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Behavior Patterns to Cope w/anxiety: acting out: converting anxiety into anger; paralysis or retreating: immobilized; somatisizing: converts into physical symptoms; avoidance: alcohol, sleeping, keeping busy; constructive action: some use it to learn
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Behavioral Model of Depression: due to lack of positive reinforcing experiences
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behavioralists theory for hypochondriasis: learned behavior. Illness is rewarded so re-enforced
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Bi-Polar Disorder: recurrent mood disorder, one or mood episodes of mania & or depression & is distinct from major depression because history of manic or hypomanic. Earlier age of onset raises familial presence. Lithium effective for bi-polar but not for major depression or dysthymia
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Bi-Polar Incidence: .6%-.88% of adult population (2 mill)
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Bi-Polar medications: mood tranquilizers (Lithium, Tegretol, Neurtonin), Depression Tricyclics, SSRI's DON'T USE DILANTIN & PHENOBARBITAL
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Biologic theory of somatoform disorders: genetic predisposition, dependent emotionally, needy person, frustrated + chronically resentful person what is the underlying anxiety is determines what symptoms they develop
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Biological Model of Depression: endocrine: cortisol, neurotransmitters; biorhythms
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Biological theory for hypochondriasis: person is excessively sensitive to normal bodily sensations
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Body Dysmorphic Disorder: preoccupation with a body defect, exaggerated belief that body is deformed or defective, feeling of defect in face, can't see anything else, seen with depression and OCD
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Bruxism: teeth grinding
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Bulimia-definition: "insatiable appetite", an eating disorder characterized by uncontrollable binge eating alternating with vomiting or dieting, laxatives, vigorous exercise, persistent over-concerned with weight, patients often look normal in size and see themselves realistically sized
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Cognitive Model on Depression: its a result of disturbed thinking
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Complications of Eating disorders: electrolyte imbalance: low potassium, irregular heartbeat; edema & dehydration, GI problems
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compulsion: the doing of the thought
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Constructive Coping Mechanisms: emotional responsiveness, uncomplicated grief reactions
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Continuum Treatment for Depression: prevent relapse, promote recovery
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Contiuum of Normal Emotional Responses: fear, joy, anxiety, love, anger, sadness, surprise
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Conversion Disorder: loss of function with no physical finding; conversion of an anxiety into a physical symptom; early adolescent and childhood, severe physical symptoms, paralysis, blindness, symptom is tied into a negative experience involving a body part. Patients aren't faking symptoms, they are real & unconscious, patient may be nonchanlant (la belle indifference)
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Coping Mechanisms for Suicide: Denial, rationalization, regression, magical thinking
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Coping resources for suicide: conscious choice for people with chronic or life threatening illnesses (support groups), hospice
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Depersonalization disorder: dissociative disorder: oriented x3 but perception of reality has changed. <40 yo. out of body experience, detached, outside themselves, in a dream, suicide risk, coincides with personality disorders, schizo or seizure disorders
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Depression or Mania Clusters: Outside the normal fluctuations from sadness to elation potentially severe consequences for morbidity & mortality, co-morbidity of anxiety & depression are so pronounced it can lead to substance abuse or worsens it,
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Depression vs. Sadness: Depression is quantitative & qualitatively different, has anhedonia, helplessness, loss of mood and reactivity
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Destructive Coping Mechanisms: suppression, delayed grief, depression/mania
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Diagnosing Mood Disorders: other medical illnesses & treatments can mimic mood disorders (dominate hemisphere stroke, hyperthyroid, cushings, pancreatic cancer) and can cause mood disorders
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Dissociative Disorders: a person's mental processes (thought, memory + id), breaks off from the main stream of personality. Occurs along a spectrum of severity, mild: driving feeling that you can't remember last miles you drove; severe: means of mentally escaping from an unbearable situation
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DSM-IV Classification of Mood Disorders:: Depressive disorders, dysthythmic disorder, bi-polar disorders, cyclothymic disorder, mood disorder not otherwise specified
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Dysomia: disorder in amount, quality or timing of sleep
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Dysthythmia: Chronic form of depression, early onset, unrelenting & smoldering course, becomes so intertwined with personality that they may be misidentified as neurotic, in childhood and adolescents it effects personality & development & coping skills, prompting passive, avoidant and depressive states
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Eating Disorder Nursing interventions: monitor caloric intake, weigh daily, observe for purging (signs are throat ulcers, enamel erosion), involving the family, make sure they don't staff-split, monitor electrolytes, limit setting one-on-one care, promote positive self concept, positive coping skills, bathroom restrictions, discourage patient from focusing on food
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Factitious Disorder or Munchausen's syndrome: intentionally makes up symptoms (consciously controlled)
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First step in Eating Disorder Treatment: Physiological stability, nutritional rehab, psycho-therapy, stress management + maintenance strategies
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Freud's Theory of Causation for eating disorders: Regression; ineffective emotional development, disturbance in hypothalamus-dopamine
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Freud's theory of Depression: Aggression Turned inward theory, not a lot of support for this theory
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GAD Treatment: cognitive behavioral therapy, meds: SSRI's, BENZO's (short term)
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Generalized Anxiety Disorder: excessive anxiety with common daily life experiences, restless, tired, can't concentrate, muscle tension, irritable, sleep problems
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Grief Reactions: grief follows loss, powerful emotion, universal, uncomplicated grief, process runs predictable response depending on value placed on the loss is how someone reacts.
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Highest Risk period for Suicide: when the patient appears to be coming out of depression, they feel better but not good
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Hyperactivity Disorders: ADD ADHD
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Hypochondriasis: preoccupation or fear that one has a serious illness and cannot be helped, care they're getting isn't good enough, afraid they'll get an illness when they hear about one
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Hypomania: Mania is not as severe
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Incidence of Depression: males 7-12%, females 20-30%, medical illness, seen frequently in primary care setting, failed to be diagnosed 50% of the time, loss of control, cause of illness, MS, Cancer, CVA, epilepsy, Parksinson's, Endocrine disorders, diabetes, Addison's, Cushings
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insomnia vs. hypersomnia: excessive daytime sleepiness (hypersomnia) no REM sleep
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Interventions for Depression: highest priority: potential for suicide, always assess risk for self harm, safety!
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Is the suicide rate higher or lower than the homicide rate?: 50% higher
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Kindling: sensitizing phenomenon, sensitized by a stressor and reactivated without stressor being present
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Learned helplessness/hopelessness model: one has no control of their life similar to cognitive model
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Literal Definition of Melancholy: Black BIle
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Maintenance for Depression: prevent recurrence, teach better coping strategies
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Major Anxiety Disorders: GAD, Panic Disorder, Agoraphobia (other phobias), OCD, PTSD
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Maladaptive Responses to Emotions: delayed grief, depression/mania, prevents reaction from running usual course, pathological delayed or distorted
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Mania: Episodes may vary in intensity, in young kids it can include irritability
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MAOI's: Nardil, Erisam, marplan
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MEDS for DID/Multiple Personality: anxiolytics, antidepressants
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Mood Disorders r/t Other Disease: Frequently co-morbid (co-exists) with other disorders, ETOH abuse, drug abuse, panic disorder, OCD
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Multiple Personality Disorder/Dissociative ID Disorder: 2 or more separate alternate personalities. dominate one that is usually unaware of others but alternate personalities are aware of each other including dominate personality. different sexes, characteristics, personalities, result of severe trauma in life, physical or sexual abuse or trauma, develops split to escape pain and/or guilt of what's happened. more common in women. Presents in 20's-early 30's. typical patient spends 7 years in mental institution before diagnosed. Very hard to diagnose. therapist has to see person changing personalities, blinking, rolling of eyes, looking up, different hair, clothes, voice, vocab., handwriting, age, race, gender, amnesia, fragmented memories, may not recall major events or parts of things. Find themselves wondering how they got there. regressing. most times family doesn't know, person is unpredictable and alarmed at mood swings
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Munchausen's by proxy: child abuse, trying to get attention by bringing child + falsely reporting that the child has a medical condition, un-necessary medical treatment MUST REPORT, men more than women, often goes along with other mental illnesses, may be grudge against medical profession, severe personality disorder, difficult to diagnose and treat
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Narcolepsy: irresistible need for short periods of sleep, short paralysis (cataploxy), 1-1000 people have it, genetic predisposition
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Non-nursing Eating Disorder treatment: anti-depressants, anxiolytics, cognitive therapy, family and individual behavioral therapy
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Nursing Care for Somatoform Disorders: good communication; accept that pain is real to them, build up stress, honest, ask clear questions, focused in therapy, involve them in goal setting + intervention, keep focus OFF dysfunction, OT, RT, social activities, don't re-enforce dysfunction or symptoms
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Nursing Diagnoses for Depression: anxiety, communication: impaired, coping: ineffective, grieving: anticipatory; grieving; dysfunctional; hopelessness, powerlessness, self-esteem: low (chronic or situational), sexual dysfunction, disturbed sleep pattern, social isolation, spiritual distress, suicide: risk for, violence: risk for self-directed
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Nursing Diagnoses for Suicide: risk for suicide, self-mutilation, non-compliance, non-adherance, risk for self-adherence, risk for self-directed violence
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Nursing Interventions for Crisis: RE-Establish equilibrium, setting mutual goals, active listening, sincerity, unconditional acceptance, understanding the subjective experience, assisting patient to recognize themes and meaning of crisis event, be specific and direct when anxiety is increased, assessing safety level
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Object loss theory: theory of depression, traumatic separation from significant objects of attachment
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Obsession: the thought
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OCD: anxiety persists throughout life; repetitive thoughts and behavior, 2.3% of population (20-25% DNA), twins 63%, equal with males and females, preoccupied with order, lists, rules, goals, perfectionism, can function pretty well in society. women starts 20-30 years old men 6-15 years old, can occur as young as 2 years old, obsession and impulses constant + persistent unreasonable belief, excessive need to do something. Response to obsessions are compulsions, relieves the anxiety, thought stopping (rubber band on wrist helps)
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Other Mood Disorders: Panic disorders, OCD, PMS (PMDD)
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Pain Disorder: persistent complaints of pain with no physical findings, adolescents to early adulthood women, think there might be hormonal component, level of pain is inconsistent with physical ailment, pain is not along expected neural pathways, pain doesn't change location like in somatization disorder
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Panic Disorder: recurrent panic attacks, a lot of worrying of when the next one will occur, can lead to suicide, acute attacks, violent & short lived, pounding heart chest pain, flushes, chills, shortness of breath, feel smothered, like a heart attack
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Parasomnias: nightmares, sleep terrors, night-waking
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Parasomnias: abnormal events during sleep
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Personality Organization Theory: self concept on adaptation, how they think about themselves
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Phobias: fear of particular object or situation, panic attacks can lead to phobias,
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Physical Treatment for Depression (in-patient): give them finger food, help them to shower, don't make them make decisions
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PostPartum Blues: brief, 1-4 days, teary, labile, 50-80%, nurse gives them reassurance and time to resolve
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Postpartum depression: 2 weeks-12 months after, resolves within 6 months, 10-15% of women
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Postpartum Psychosis:: depressed quickly after delivery, increases with subsequent deliveries but usually responds to treatment, mom may go on to develop Bi-polar
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Prediliction for Depression: genetics & environment (6% general population, in family 20%)
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Prevalance of mood disorders: 7%
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Prevalence of eating disorders: 10-20% women, increasing male population, (dieting is rising in men and lower age populations too)
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Primary Affective Disorders: either no previous symptoms or only mania or depression in the past
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Protective Factors:: Affective & Protective care for underlying disorders, easy access to care, support from family, community & mental health staff
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psychoanalysts theory for hypochondriasis: repressed anger and hostility
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Psychoanalytic Theory of Causation for eating disorders: is a negative response of parents, unworthy of love, "afraid of being a woman"
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Psychoanalytic theory to Somatoform Disorders: rooted in defense mechanisms of denial, repression and displacement
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Psychogenic Amnesia: dissociative disorder: inability to recall info as a result of physical or psychological trauma. Not just forgetting. can't recall memories, more women. temporary and terminates abruptly (war or natural disaster)
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Psychogenic fugue: dissociative disorder: person takes on the id of new person, travels/trips, appears alert + oriented, temporary, can be triggered by ETOH use + severe stress, wandering, forgetting, don't know they've forgotten + are wandering, psychotherapy helps and can be quickly reversed + rarely recurs
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Psychopharmacology for Depression: mood stabilizers, antidepressants (take 2-4 weeks to kick in, 6+months for max workload; tricyclics, SSRI's, MAOI's), somatic therapy, ECT, light therapy, sleep deprivation treatment
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Psychosocial responses to stress: fight/flight (biologic; energized); conservative: withdrawal state
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PTSD: exposure to trauma or terrifying events, any age, can be chronic (60% of people exposed to danger get it). flashbacks nightmares, insomnia, avoidance, hyperarousal, irritable
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Rate of suicides have increased or decreased since the 70's?: decreased
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Risk Factors for Bi-polar: women, family member has it, usually first incidence is prior to age 50
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Risk Factors for Eating disorders: runs in families, older + younger, need control, media, increased desire to look good
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Risk Factors for Suicide:: male, other mental disorders (esp. depression & substance abuse), prior suicide attempts, unwilling to seek help, barriers to accessing treatment, recent or series of stressful life events or losses, easy access to lethal methods
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Risk of Depression: Lifetime Risk 1:8, higher of a first degree relative has it, history of major depression, untreated lasts 6-24 months, recurrence is 50% one episode, 25% chronic recurrent depression
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SAD: Seasonal Affective Disorder, depressed onset with shortened daylight, goes away in the spring. Treated with meds and light therapy
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Secondary affective Disorders: feelings of sadness, inadequacy or hopelessness, occur with another pre-existing psychiatric or medical disorder
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secondary gain with conversion disorder: more powerful than primary, attention and care
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Separation Anxiety: normal in infants and toddlers, kid refuses to go to school because mom will die when they're there
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Signs & Symptoms of Anorexia: onset is insidious, amenorrhea, eat only 200-400 calories a day, excessive exercise, perfectionism, lack of trust in own emotions, fine downy hair, decreased potassium
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Signs & Symptoms of Bulimia: 15-24 y.o., not successful dieter so they get into the cycle of bingeing and purging
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Sleep disorders: patients go to a sleep clinic; sleep study includes EEG & heart monitor
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Sleep Hygiene: regular sleep schedule, avoid caffeine, nicotine, ETOH, not eating too close to bed time, not exercising too close to bedtime; establish a sense of security with environment, dim lights, medication, have a routine, reading, back rub, comfortable temperature
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sleepwalking: no recall, common between 7-12 y.o.
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Social Anxiety (kids): worry intensely about being judged worry excesssively about everything, GAD has to interfere with lifestyle for 6 months
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Somatization disorder: persistent multiple complaints with no physical findings, group of symptoms related to anxiety, acc'd to DSM-IV: must have 13 symptoms, 4 pain symptoms in 4 different parts of the body, 2 GI symptoms other than pain; 1 reproductive or sexual other than pain, 1 pseudoneurological symptom or deficit that suggests a neurodisorder (blindness or deafness) symptoms not under voluntary control <35 years old
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Somatoform Disorders: conditions in which there are physical symptoms with no known organic cause. Not under the person's control and from unconscious mechanisms
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SSRI Examples: paxil, prozac (long 1/2 life), zyprexa
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Stages of Anxiety: Mild: day to day tension, helps with motivation
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Stages of Anxiety: Moderate: narrow perception
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Stages of Anxiety: Panic: dread terror, loss of control, personality disintegrates they become disorganzied
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Stages of Anxiety: Severe: detail, reduced perception
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Stages of Crisis: 1: Threat/Situation, 2: increased anxiety, decreased coping, 3: escalating anxiety (use whatever they can to manage, counseling) 4: Panic (depression, psychosis)
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Stress is:: stimulus one perceives as harmful or challenging
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Stress theories: Hans "father of stress theory", general adaptation syndrome 3 phases: alarm, resistance, exhaustion, body goes thru biological changes in each phase
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Stressors that may trigger symptoms of Depression:: loss of attachment (real or imagined), life events, role strain, physiological changes (hormonal, illness, meds, hyperthyroidism, beta blockers, hypertension
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Suicide risk assessment: assess risk in all clients with mood disorders, ask questions, most tell the truth, are you gonna act on it? Do you have a plan? Do you have the means?
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Symptoms of SAD: hypersomnia, lethargy, fatigue, increased anxiety, ambivalence, irritability, increased appetite (weight gain) may be due to abnormal melatonin metabolism
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Symptoms of Stress:: emotional lability, physical illness, inability to concentrate, pet scans show cerebral cortex + limbic system (feeling of terror), even though we don't think how we're gonna respond to stress we do so automatically
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Theories of Dissociative Disorder: believed to have psychogenic severe anxiety or psychological treatment
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Top 7 Chronic Diseases: hypertension; diabetes, hypercholestremia, arthritis, kidney disease, COPD, asthma
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Treatment for agoraphobia + other phobias: cognitive therapy, same meds for panic disorder, desensitization therapy, virtual reality therapy, Anxiolytics, SSRI's, antidepressants, betablockers,
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Treatment for all Somatoform: treating the symptoms, hypnosis, relaxation techniques, finding the underlying cause of the anxiety, they can be uneasy that if it has a psych basis rather than physio basis, behavioral modification, meds: antidepressants + antianxiety meds
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Treatment for anxiety disorders in kids: cog. behavior therapy, coping, parents in therapy, meds SSRI's
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Treatment for DID/Multiple Personality: diagnosis is hard, person fails to mention voices or halluc. b/c they're scared of being labeled psychotic, treated with psycho therapy, hypnosis, id-ing, understanding + integrating the personalities, takes a long time. process can be painful, wanna keep alters hidden cuz they're helping suppress
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Treatment for hypochondriasis: physical exam, medical re-inforcement, medical reassurance, repeat of exam and reassurance. Education to decrease anxiety
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Treatment for Panic Disorder: Cognitive therapy, SSRI's, Benzos, teach them s+s that lead to attacks, reduce environmental stimuli
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Treatment for PTSD: group therapy, SSRI's, cognitive therapy,
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Tricyclic Antidepressant Examples: amitriptyline (Elavel) -amines
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True or False: lack of sleep affects mental & physical health: true
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True or False: rate of teen young adults has almost tripled since 1952: True
