147 terms

Pysch Test #2

DSM-IV Classification of Mood Disorders:
Depressive disorders, dysthythmic disorder, bi-polar disorders, cyclothymic disorder, mood disorder not otherwise specified
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
Prevalance of mood disorders
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,
Top 7 Chronic Diseases
hypertension; diabetes, hypercholestremia, arthritis, kidney disease, COPD, asthma
Rate of suicides have increased or decreased since the 70's?
True or False: rate of teen young adults has almost tripled since 1952
Is the suicide rate higher or lower than the homicide rate?
50% higher
Awareness, Intervention, Methodology: National Strategy for Suicide Prevention
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
Protective Factors:
Affective & Protective care for underlying disorders, easy access to care, support from family, community & mental health staff
Primary Affective Disorders
either no previous symptoms or only mania or depression in the past
Secondary affective Disorders
feelings of sadness, inadequacy or hopelessness, occur with another pre-existing psychiatric or medical disorder
Depression vs. Sadness
Depression is quantitative & qualitatively different, has anhedonia, helplessness, loss of mood and reactivity
Literal Definition of Melancholy
Black BIle
Contiuum of Normal Emotional Responses
fear, joy, anxiety, love, anger, sadness, surprise
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
Adaptive Responses to Emotions
appropriate emotional responsiveness, uncomplicated grief, suppression of emotions
Maladaptive Responses to Emotions
delayed grief, depression/mania, prevents reaction from running usual course, pathological delayed or distorted
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.
Mood Disorders r/t Other Disease
Frequently co-morbid (co-exists) with other disorders, ETOH abuse, drug abuse, panic disorder, OCD
#1 cause of worldwide disability
Unipolar Major Depression
#10 cause of worldwide disability
Diagnosing Mood Disorders
other medical illnesses & treatments can mimic mood disorders (dominate hemisphere stroke, hyperthyroid, cushings, pancreatic cancer) and can cause mood disorders
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
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
Episodes may vary in intensity, in young kids it can include irritability
Mania is not as severe
Bi-Polar Incidence
.6%-.88% of adult population (2 mill)
Risk Factors for Bi-polar
women, family member has it, usually first incidence is prior to age 50
Seasonal Affective Disorder, depressed onset with shortened daylight, goes away in the spring. Treated with meds and light therapy
Symptoms of SAD
hypersomnia, lethargy, fatigue, increased anxiety, ambivalence, irritability, increased appetite (weight gain) may be due to abnormal melatonin metabolism
PostPartum Blues
brief, 1-4 days, teary, labile, 50-80%, nurse gives them reassurance and time to resolve
Postpartum depression
2 weeks-12 months after, resolves within 6 months, 10-15% of women
Postpartum Psychosis:
depressed quickly after delivery, increases with subsequent deliveries but usually responds to treatment, mom may go on to develop Bi-polar
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?
Prediliction for Depression
genetics & environment (6% general population, in family 20%)
Freud's theory of Depression
Aggression Turned inward theory, not a lot of support for this theory
Object loss theory
theory of depression, traumatic separation from significant objects of attachment
Personality Organization Theory
self concept on adaptation, how they think about themselves
Cognitive Model on Depression
its a result of disturbed thinking
Learned helplessness/hopelessness model
one has no control of their life similar to cognitive model
Behavioral Model of Depression
due to lack of positive reinforcing experiences
Biological Model of Depression
endocrine: cortisol, neurotransmitters; biorhythms
sensitizing phenomenon, sensitized by a stressor and reactivated without stressor being present
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
Constructive Coping Mechanisms
emotional responsiveness, uncomplicated grief reactions
Destructive Coping Mechanisms
suppression, delayed grief, depression/mania
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
Acute Treatment for Depression
Eliminate symptoms
Continuum Treatment for Depression
prevent relapse, promote recovery
Maintenance for Depression
prevent recurrence, teach better coping strategies
Interventions for Depression
highest priority: potential for suicide, always assess risk for self harm, safety!
Highest Risk period for Suicide
when the patient appears to be coming out of depression, they feel better but not good
Physical Treatment for Depression (in-patient)
give them finger food, help them to shower, don't make them make decisions
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
Tricyclic Antidepressant Examples
amitriptyline (Elavel) -amines
SSRI Examples
paxil, prozac (long 1/2 life), zyprexa
Nardil, Erisam, marplan
Coping resources for suicide
conscious choice for people with chronic or life threatening illnesses (support groups), hospice
Coping Mechanisms for Suicide
Denial, rationalization, regression, magical thinking
Nursing Diagnoses for Suicide
risk for suicide, self-mutilation, non-compliance, non-adherance, risk for self-adherence, risk for self-directed violence
Hyperactivity Disorders
ADD & ADHD Signs & Symptoms
inattentiveness & impulsivity, usually present in childhood, may not be diagnosed until adult,
ADD & ADHD Psychopharmacology
psycho-stimulants (ritalin, methylphen) amphetamines (dexedrine, dextroamphetamine) Stratera (SNRI) atomoxetine
Anxiety medications
minor tranquilizers (Benzos), Ativan (lorazepam) anti-anxiety (BuSpar), SSRI's
Bi-Polar medications
mood tranquilizers (Lithium, Tegretol, Neurtonin), Depression Tricyclics, SSRI's DON'T USE DILANTIN & PHENOBARBITAL
Other Mood Disorders
Panic disorders, OCD, PMS (PMDD)
Sleep disorders
patients go to a sleep clinic; sleep study includes EEG & heart monitor
disorder in amount, quality or timing of sleep
abnormal events during sleep
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
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
True or False: lack of sleep affects mental & physical health
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
irresistible need for short periods of sleep, short paralysis (cataploxy), 1-1000 people have it, genetic predisposition
insomnia vs. hypersomnia
excessive daytime sleepiness (hypersomnia) no REM sleep
nightmares, sleep terrors, night-waking
no recall, common between 7-12 y.o.
teeth grinding
Prevalence of eating disorders
10-20% women, increasing male population, (dieting is rising in men and lower age populations too)
Risk Factors for Eating disorders
runs in families, older + younger, need control, media, increased desire to look good
Psychoanalytic Theory of Causation for eating disorders
is a negative response of parents, unworthy of love, "afraid of being a woman"
Freud's Theory of Causation for eating disorders
Regression; ineffective emotional development, disturbance in hypothalamus-dopamine
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
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
"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
Signs & Symptoms of Bulimia
15-24 y.o., not successful dieter so they get into the cycle of bingeing and purging
Complications of Eating disorders
electrolyte imbalance: low potassium, irregular heartbeat; edema & dehydration, GI problems
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
Non-nursing Eating Disorder treatment
anti-depressants, anxiolytics, cognitive therapy, family and individual behavioral therapy
First step in Eating Disorder Treatment
Physiological stability, nutritional rehab, psycho-therapy, stress management + maintenance strategies
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)
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
Stress is:
stimulus one perceives as harmful or challenging
Stress theories
Hans "father of stress theory", general adaptation syndrome 3 phases: alarm, resistance, exhaustion, body goes thru biological changes in each phase
Psychosocial responses to stress
fight/flight (biologic; energized); conservative: withdrawal state
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
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
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
Stages of Anxiety: Mild
day to day tension, helps with motivation
Stages of Anxiety: Moderate
narrow perception
Stages of Anxiety: Severe
detail, reduced perception
Stages of Anxiety: Panic
dread terror, loss of control, personality disintegrates they become disorganzied
Major Anxiety Disorders
GAD, Panic Disorder, Agoraphobia (other phobias), OCD, PTSD
Generalized Anxiety Disorder
excessive anxiety with common daily life experiences, restless, tired, can't concentrate, muscle tension, irritable, sleep problems
GAD Treatment
cognitive behavioral therapy, meds: SSRI's, BENZO's (short term)
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
Treatment for Panic Disorder
Cognitive therapy, SSRI's, Benzos, teach them s+s that lead to attacks, reduce environmental stimuli
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
Treatment for agoraphobia + other phobias
cognitive therapy, same meds for panic disorder, desensitization therapy, virtual reality therapy, Anxiolytics, SSRI's, antidepressants, betablockers,
fear of particular object or situation, panic attacks can lead to phobias,
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)
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
Treatment for PTSD
group therapy, SSRI's, cognitive therapy,
Somatoform Disorders
conditions in which there are physical symptoms with no known organic cause. Not under the person's control and from unconscious mechanisms
Psychoanalytic theory to Somatoform Disorders
rooted in defense mechanisms of denial, repression and displacement
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
5 Different types of Somatoform Disorders
Somatization, pain disorder, conversion disorder, hypchondriasis, body dysmorphic disorder
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
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
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)
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
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
secondary gain with conversion disorder
more powerful than primary, attention and care
psychoanalysts theory for hypochondriasis
repressed anger and hostility
behavioralists theory for hypochondriasis
learned behavior. Illness is rewarded so re-enforced
Biological theory for hypochondriasis
person is excessively sensitive to normal bodily sensations
Treatment for hypochondriasis
physical exam, medical re-inforcement, medical reassurance, repeat of exam and reassurance. Education to decrease anxiety
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
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
Factitious Disorder or Munchausen's syndrome
intentionally makes up symptoms (consciously controlled)
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
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
Theories of Dissociative Disorder
believed to have psychogenic severe anxiety or psychological treatment
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)
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
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
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
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
MEDS for DID/Multiple Personality
anxiolytics, antidepressants
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
Separation Anxiety
normal in infants and toddlers, kid refuses to go to school because mom will die when they're there
Social Anxiety (kids)
worry intensely about being judged worry excesssively about everything, GAD has to interfere with lifestyle for 6 months
Treatment for anxiety disorders in kids
cog. behavior therapy, coping, parents in therapy, meds SSRI's
the thought
the doing of the thought