Alyssa s note - psych 2 all psych content PDF

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ANXIETY AND ANXIETY DISORDERS -is distinguished as being afraid or threatened by clearly identifiable external stimulus. Anxiety disorders- group of conditions with excessive anxiety with ensuing behavioral, emotional, cognitive and physiologic response. RELATED DISORDERS: SELECTIVE MUTISM-diagnosed in children, fail to speak in social situations but freely speak at home with parent but fail to interact at school. ANXIETY DISORDER DUE TO ANOTHER MED CONDITIONresult directly form physiologic condition. Eg: Endocrine dysfunction, chronic obstructive pulmonary disease, CHF and neurologic condition. CAUSES: ¾ Genetic theories¾ STRESS- is the wear and tear that life causes on the body. THREE STAGES OF REACTION TO STRESS: 1. Alarm reaction stage-stress stimulates hypothalamus to the glands and organs prepare for potential defense needs. 2. Resistance stage-digestive system reduces function to shun blood to areas needed for defense. Fight and flight. 3. Exhaustion stage-person has responded negatively to anxiety and stress: body stores depleted. LEVELS OF ANXIETY: x Mild anxiety- helps person focus at attention to learn, solve problems, think, act, feel and protect himself or herself. E.g.: student on upcoming exam SS: 9 Restlessness & Fidgeting 9 GI “butterflies” 9 Difficulty sleeping 9 Hypersensitivity to noise TREATMENT: o Teaching is very effective. x Moderate anxiety-disturbing feeling something is definitely wrong. E.g.: client anxious about surgical procedure SS: 9 Muscle tension 9 Diaphoresis and dry mouth 9 Pounding pulse 9 Headache 9 High voice pitch and faster speech 9 GI upset and frequent urination TREATMENT: o Speaking in short, simple and easy to understand sentences. o Redirect client back to topic

Severe anxiety-primitive survival skills take over, defensive response ensue and cognitive skills decrease significantly. SS: 9 Severe headache 9 N/V and diarrhea 9 Trembling 9 Rigid stance 9 Vertigo and pale 9 Tachycardia and chest pain 9 Vital signs increase Person pace, restless, irritable and angry NI (SEVERE): o Remain with the person and reduce anxiety to moderate or mild level o Talking to client in a low, calm voice o If person cannot sit still, walk with him or her o Helping person to take deep even breaths x Panic anxiety-emotional-pyschomotor realm predominates with fight, flight or freeze response SS: 9 Adrenaline surge-increase V/S 9 Pupils enlarge 9 May bolt and run “fight of flight” 9 Totally immobile and mute “freeze” NI: o Person’s safety is primary concern o Nurse must keep talking in comforting manner o Going to a small quiet and non-stimulating environment TREATMENT:  Cognitive Behavioral Therapy (CBT)  Positive reframing-turning negative messages into positive messages. E.g.: ”My heart is pounding, I think im going to die”  Decatastrophizing-use of questions to more realistically appraise the situation. Use thought-stopping and distraction.  Assertiveness training-help the person negotiate interpersonal situations.  Short term anxiety treated with MEDS: BENZODIAZEPINES -prescribe for anxiety, high potential for abuse and dependence. Use should be no longer than 4- 6 weeks DIAZEPAM (Valium) AVOID ANTIHISTAMINE and ALPRAZOLAM (Xanax) ALCOHOL OR CNS DEPRESSANTS CHLORDIAZEPOXIDE Rise slowly, use sugar free drinks (Librium) and hard candy LORAZEPAM (Ativan) DO NOT STOP ABRUPTLY CLONAZEPAM (Klonopin) OXAZEPAM (Serax) x

BUSPIRONE (Buspar)

NONBENZODIAZIPENS Rise slowly, take with food, NO driving or hazardous activities

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PANIC DISORDER -discrete episodes of panic attacks that is 15 to 30 minutes of rapid, intense, escalating anxiety. SS: 9 Palpitations 9 Sweating 9 Tremors 9 SOB and sense of suffocation 9 Chest pain 9 Nausea 9 Abdominal distress 9 Dizziness 9 Paresthesia’s 9 Chills or hot flashes ONSET:  Late adolescence and the mid-30s TREATMENT:  CBT  Deep breathing and relaxation  Benzodiazepines, SSRI antidepressants, Tricyclic antidepressants and antihypertensive such as clonidine (Catapres) and Propranolol (Inderal) PHOBIAS -illogical, intense and persistent fear of a specific object or social situation that causes extreme distress and interferes with normal functioning. THREE CATEGORIES: 1. Agoraphobia- fear of being outside 2. Specific phobia-irrational fear of an object or situation 3. Social anxiety or phobia-provoked by certain social or performance situation SPECIFIC PHOBIA: x Natural environmental phobia: fear of storms, water, heights or natural phenomena x Blood injection phobia-seeing owns or ones blood, injection x Situational phobias-bridge or tunnel, elevator, small room hospital or airplane x Animal phobia-fear of animals or insects x Other types of specific phobias: fear of getting lost TREATMENT:  Behavioral therapy-helping identify anxiety responses, teaching relaxation, helping visualize phobic situations.  Systematic (Serial) Desentization-therapist progressively exposes the client to the threatening object  Flooding-rapid desentization

-highly SS: 9 9 9 9 9 9 9

GENERALIZED ANXIETY DISORDER (GAD) anxious at least 50% of the time for 6 months or more

Uneasiness Irritability Muscle tension Fatigue Difficulty thinking Sleep alterations Quality of life is greatly diminished in older adults with GAD TREATMENT:  Buspirone (BuSpar) and SSRI or SNRI antidepressants most effective treatments

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TRAUMA AND STRESSOR-RELATED DISORDERS POST TRAUMATIC STRESS DISORDER (PTSD) -disturbing pattern of behavior by someone who has experienced, witnessed or been confronted with traumatic event such as combat, natural disaster or assault characterized by inattentiveness, overactivity and impulsiveness. DX: ¾ Symptoms occur in 3 months or more after trauma which distinguishes from acute stress disorder ¾ Can occur at age ¾ Chronic in nature but symptoms fluctuate in intensity and severity RISK FACTORS: ¾ ¼ of physical assault victims develop PTSD ¾ 70% rape victims THREE MAJOR ELEMENTS OF PTSD: 9 Re-experiencing trauma through dreams or recurrent/intrusive thoughts 9 Showing emotional numbing-feeling detached 9 Being on guard, irritable or experiencing hyperarousal SS: 9 Appears hyperalert and reacts to evens small environmental stimuli, startle response 9 Anxious or agitated-pacing or moving around 9 Frightened or scared, hostile 9 May experience flash backs 9 Dissociating-speaking in different tone or voice or having a vacant stare RELATED DISORDERS: ADJUSTMENT DISORDER-stressful event causes problems for the individuals. CAUSE: ¾ Financial, relationship, work stressors and etc. DX: ¾ Develop within a month lasting to more than 6 months. TREATMENT: ¾ Outpatient counseling or therapy is the most common and successful treatment. ACUTE STRESS DISORDER-occurs after a traumatic event and characterized by re-experiencing, avoidance and hyperarousal DX: ¾ 3 days to 4 weeks TREATMENT: ¾ Cognitive Behavioral Thera py CBT REACTIVE ATTACHMENT DISORDER (RAD) AND occur DISINHIBITED SOCIAL ENGAGEMENT DISORDER (DSED) – occur before age 5 from child abuse or neglect or grossly pathogenic care. SS: 9 Disturbed, inappropriate social relatedness 9 Child with RAD exhibits minimal social and emotional responses

9 Lacks positive affect 9 Sad, irritable or afraid for no reason 9 Child with DSED unselective socialization, lack hesitation of approaching strangers TREATMENT:  Counseling or therapy-outpatient basis only inpatient when patient is suicidal  CBT and specialized therapy programs  Exposure therapy-treatment approach designed to combat the avoidance behavior that occurs with PTSD, help client face troubling thoughts and feelings by confronting the event in reality for example returning the place where one was assaulted..  Adaptive disclosure-specialized CBT, intense specific short term therapy for active duty military personnel with PTSD. Eg. Empty chair technique client says whatever he or she needs to say to anyone dead or alive.  Cognitive processing therapy- involves structures that focus on examining beliefs that are erroneous or interfere with daily life such as guilt or slef blame.  Medications-symptoms that deal with insomnia, anxiety, hyperarousal. Eg, SNRI, SSRI, SGA NI: o Promote client safety o Help client cope with stress and emotions Eg.: Grounding techniques-remind client that he or she is in the present, is an adult and is safe o Help promote clients self-esteem DISSOCIATIVE DISORDERS DISSOCIATION-subconscious defense mechanism helps a person protect his or her emotional self from recognizing the full effects of some horrific or traumatic event by allowing mind to forget or remove itself. DISSOCIATIVE DISORDERS-essential feature of a disruption integrated functions of consciousness, memory, identity or environmental perception SS: 9 Dissociative amnesia-cannot remember important personal information. 9 Dissociative identity disorder-two or more distinct identities or personally. 9 Depersonalization/derealization disorder-persistent feeling of being detached from his/her mental processes or body NI: o Group or individual therapy o Clients who dissociate focuses on reassociation or putting consciousness back together o Improve quality of life, improved functional abilities and reduced symptoms o Medications for anxiety or depression or both o Short hospital treatment for PTSD and dissociative disorders require stabilization when acute symptoms have become dangerous to client or others

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OBSESSIVE COMPULSIVE DISORDER Obsession-recurrent, persistent, intrusive and unwanted thoughts, images, impulses cause anxiety and interfere with social, interpersonal or occupational functioning. Compulsion-ritualistic or repetitive behaviors or mental acts in attempt to neutralize anxiety. COMMON COMPULSIONS: 9 Checking rituals (repeatedly making sure door is lock or coffe pot is turned off) 9 Counting rituals (counting each step) 9 Washing and scrubbing until skin is raw 9 Prating or chanting 9 Touching, rubbing or tapping 9 Ordering (arranging furniture or items) 9 Exhibiting rigid performance 9 Having aggressive urges (throwing child against wall) ONSET: ¾ Childhood especially in males hwile females beings in 20s TREATMENT:  Combination of medication and behavior therapy  Behavior therapy-includes exposure and response prevention. x Exposure assist patient to deliberately confront situations and stimuli that he/she avoids. x Response prevention-focuses on delaying or avoiding performance of rituals.  MEDS: SSRI ANTIDEPRESSANTS FLUVOXAMINE (Luvox) SETRALINE (Zoloft) 2ND GENERATION ANTIPYSCHOTICS -treatment for resistant OCD RESPIRIDONE (Respirdal) QUITIAPINE (Seroquel) OLANZAPINE (Zyprexa) NI: o Offer encouragement, support and compassion o Be clear with the client that you believe he/she can change o Encourage to talk to client about feelings, obsession and rituals in detail o Gradually decrease time for client to carry out ritualistic behavior o Assist client to use exposure and response prevention o Encourage client to manage anxiety o Assist client to complete daily routine with agreed on time limits o Encourage client to develop and follow written schedule

RELATED DISORDERS: EXCORIATION- also called DERMATILLOMANIA, skin picking as a self-soothing behavior TRICHOTILLOMANIA-chronic repetitive hair pulling as selfsoothing behavior BODY DYSMORPHIC BEHAVIOR (BDD)-preoccupation with imagine or slight defect in physical appearance. HOARDING DISORDER-progressive, debilitating compulsive behavior, excessive acquisition of animals or useless items, cluttered ling spaces becomes uninhabitable ONYCHOPHAGIA-chronic nail biting as self-soothing behavior KLEPOMANIA-compulsive stealing reward seeking behavior ONIOMANIA-compulsive buying reward seeking behavior. BODY IDENTITY INTEGRITY DISORDER (BIID)- client who feel “oversample” or alienated from a part of their body and desire amputation.

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EATING DISORDERS CATEGORIES: ¾ Anorexia Nervosa-life threatening eating disorder by clients restriction of nutritional intakes, necessary to maintain a minimally normal body weight, intense fear of gaining weight or becoming fat. Two Types: 1. Restricting subtype-lose weight primarily through dieting, fasting, or excessive exercising 2. Bing eating and purging subtype-engage regularly in binge eating followed by purging. ¾ Binge Eating-consuming large amount of food far greater than most people eat at one time in usually 2 hour or less period. ¾ Purging-compensatory behaviors designed to eliminate food by means of self-induced vomiting or misuse of laxatives, enemas and diuretics. ¾ Bulimia Nervosa-recurrent episodes of binge eating followed by inappropriate compensatory behaviors to avoid weight gain. Weight of clients with bulimia usually in normal range. RELATED DISORDERS: BINGE EATING DISORDER-recurrent episodes of binge eating, no inappropriate compensatory behaviors. More likely overweight or obese as children and is teased about their weight NIGHT EATING SYNDROME-morning anorexia, evening hyperphagia (consuming 50% of daily calories after the last evening meal), and nighttime awakenings (at least once a night) to consume snacks. EATING OR FEEDING CHILDHOOD DISODERS- include pica (persistent ingestion of nonfood substances) and rumination or repeated regurgitation of food that is rechewed, reswallowed or spit out. CAUSES:  Biological factors: x Family history of mood or anxiety disorder x Disruptions in the hypothalamus x Increased neurotransmitter serotonin increased satiety in anorexia while low levels found with bulimia or binge & purge subtype  Developmental factors x Family that are overprotective or enmeshment(lack clear boundaries) exist x Body image disturbance-extreme dissatisfaction with one’s body image  Family influences  Sociocultural factors x Ideal woman is thin in united states or western countries

ANOREXIA NERVOSA SS: 9 Begins between 14 and 18 years of age 9 Profound sense of emptiness 9 Unable to identify to explain emotions about life events 9 Social isolation 9 Clients believe their peers are jealous of their weight loss and trying to make them fat or ugly 9 Clients who use laxatives at greater risk for medical complications TREATMENT:  Inpatient specialty eating disorder units, partial hospitalization or day treatment programs and outpatient therapy  Cognitive behavior therapy  Psychotherapy of family and individual  Enhanced cognitive behavioral therapy (CBT-E)  Medical management: weight restoration, nutritional rehabilitation, rehydration and correction of electrolyte imbalances.  PYSCHOPHARMACOLOGY/MEDS: AMITRIPTYLINE (Elavil) ANTICHOLINERGIC EFFECTS -antidepressants CYPROHEPTADINE (Periactin) -antihistamine which can promote weight gain OLANZAPINE (Zyprexa) -Antipsychotic effect on bizarre body image distortions FLOUXETINE (Prozac) MONITOR SINCE WEIGHT -Preventing relapse LOSS IS SIDE EFFECT BULIMIA SS: 9 Begins between 18 years of age, late adolescents 9 Between binging and purging episodes 9 Client may eat restrictively choosing salads and other low calorie foods and this sets them up for next binging and purging episodes 9 Eating behavior is pathologic and go to eat great lengths to hide it 9 Clients have near normal weight TREATMENT:  Cognitive behavior therapy – most effective treatment for bulimia, outpatient approach.  Web-based CBT including face time with therapist NI FOR EATING DISORDERS: o Establishing nutritional eating patterns Sit with client during meals and snacks and observe 1-2 hours after Weight the client daily o Help client identify emotions and develop non-food related strategies o Helping client deal with body image issues o Providing client and family education

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GRIEF AND LOSS Grief-subjective emotion and affect that are normal response to the experience of loss. Grieving-also called bereavement, the process by a person experiences the grief. Anticipatory grieving-facing an imminent loss Mourning-outward expression of grief. TYPES OF LOSSES: Base on Abraham Maslow’s hierarchy of human needs: 1. Physiologic needs-food, air, water, sleep 2. Safety needs-safe place to live 3. Security and belonging needs-satisfying relationships 4. Self-esteem needs-feeling of adequacy and confidence 5. Self-actualization-realize ones actual potential ¾ Physiologic loss e.g: amputation of limb ¾ Safety loss eg.: loss of safe environment like child abuse or public violence ¾ Loss of security and sense of belonging e.g: changes in relationship like divorce, illness, death ¾ Loss of self-esteem eg.: loss valued in relationship or work ¾ Loss related to self-actualization e.g: person who wants to go to college or write a book reaches a point in life where those plans will never materialized. THEORIES: x Kubler-Ross (1969)  stage 1:denial  stage 2:anger  stage 3: bargaining  stage 4: depression  stage 5: acceptance x Bowlby (1980)  Numbness and denial  Emotional yearning for love one and protesting permanence of loss  Cognitive disorganization, emotional despair, difficulty functioning  Cognitive reorganization; reintegrating sense of self x Engel (1964)  shock and disbelief  developing awareness, crying, frustrated and angry  restitution-rituals, resolution-preoccupied with loss  recovery x Horowitz (2001)  outcry or suppressed feelings  denial and intrusion  working through-managing life and the loss  completion-life feels normal again

GRIEVING PROCESS Grieving tasks-or mourning, sometimes called grief work. Bereaved person faces involve active rather than passive participation. Rando (1984)“six Rs”: 1. Recognize-understanding the loss is real and has happened 2. React-emotional response 3. Recollect and re-experience-memories relieved 4. Relinquish-accepting the world has changed and that there is no turning back 5. Readjust-beginning to return to daily life 6. Reinvest-accepting changes, forming new relationships and commitment Worden (2008): 1. Accepting the reality of loss 2. Working through the pain of grief 3. Adjusting to an environment that has changed because of the loss 4. Emotionally relocating that which has been lost and moving on with life DIMENSIONS OF GRIEVING Cognitive responses: 9 Questioning and trying to make sense of the loss 9 Attempting to keep the lost one present 9 Believing in after life to keep lost one present Emotional responses: 9 Anger, sadness and anxiety 9 resentment 9 Guilt over things not done or said in the lost relationship 9 Stunned/feeling numb-common first response then suddenly become overwhelmed and panic 9 Profound sorrow, loneliness 9 Apathy, despair and depression 9 Sense of independence & confidence evolves Spiritual responses: 9 Grieving person may become disillusioned and angry with God or other religious figures Behavioral response: 9 Tearfully sobbing, crying uncontrollably, showing great restlessness and searching 9 Seeking out as well as avoiding places 9 Keeping valuables of lost one 9 Possibly abusing alcohol or drugs 9 Possible Suicidal and homicidal gestures 9 Reorganization or recovery by participating in activities and reflection Physiological response: 9 Insomnia and Headaches 9 Impaired appetite and weight loss 9 Lack of energy 9 Palpitations and Indigestion 9 Changes in immune and endocrine system

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NI: DISENFRANCHISED GRIEF -is grief over a loss that is not or cannot be acknowledged openly, mourned public...