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178 Cards in this Set
- Front
- Back
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How do people who experience high levels of anxiety which they cannot control and which interferes with their day to day functioning cope with their anxiety?
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use rigid behaviors to cope
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Why do the coping patterns of people that suffer from anxiety disorders not work?
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These behaviors are ineffective, and the anxiety returns.
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What are the most common psychiatric disorders?
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anxiety disorders
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______ seem to set a person’s vulnerability to anxiety as high, low, or intermediate
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Genes
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1st pathway for the brain to handle threatening situations
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Short cut path--> messages to the amygdala (fear center). Amygdala then activates body’s “fight or flight” response. At same time- amygdala stimulates nearby hippocampus (memory center). Hippocampus records the circumstances and feelings of threat to help person avoid dangerous situations in the future.
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2nd pathway for the brain to handle threatening situations
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prefrontal cortex- brain thinks about situation- decides on further courses of axn. (This part of the brain also decides when threat is gone). Now prefrontal cortex signals to amygdala that it is no longer needed (can turn itself off). This takes a while as its easier to turn on “fight or flight” stress response than it is to turn it off.
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Best treatment for anxiety disorders?
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behavioral cognitive therapy
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The symptoms of anxiety disorders are _________: the person views them as odd but is helpless to prevent them
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ego-dystonic
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Primary Gains experienced by people with anxiety disorders
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relief of anxiety symptoms
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Secondary Gains experienced by people with anxiety disorders
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benefit as a result of the disorder – increased attention, decreased work responsibilities. Preventing secondary gains is important during treatment, because they cause a person to be reluctant to change their behavior.
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Anxiety disorders often co-exist with _______
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depression
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Is there risk for suicide with anxiety disorders?
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Yes
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Panic disorder
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Panic is the key feature: Panic is recurring
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Panic disorder without agoraphobia
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sudden onset of extreme apprehension or fear associated with feelings of impending doom. May believe they are losing their mind or having a heart attack. Comes “out of the blue.”
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Panic disorder with agoraphobia
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recurrent panic attacks with agoraphobia (fear of open spaces, places from which escape may be difficult). Tend to avoid going places which produce anxiety. There is the fear that they will have an attack and not get help.
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Interventions for Panic disorders?
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slow deep breathing during attack, help client recognize signs of anxiety to dispel thoughts of dying,
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Phobias
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Persistent, irrational fear of object or situation that leads to avoiding object or situation. The person experiences overwhelming and crippling anxiety when faced with the object of the phobia.
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Specific phobias
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object or situation. Easy to avoid, so these don’t cause much disruption of life
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Acrophobia
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fear of heights
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Agoraphobia
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fear of open spaces
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Hydrophobia
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fear of water
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Mysophobia
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fear of germs
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Social phobia
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is the fear of social or performance situations. Fear of public speaking is the most common.
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Interventions for phobias
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relaxation techniques, model unafraid behavior
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Obsessive-Compulsive disorder
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disorder with obsessions and compulsions
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Obsessions
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persistent images/thoughts that cannot be dismissed.
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Compulsions
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ritualistic behavior done repetitively to reduce anxiety
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Excessive rituals take up lots of _____ preventing client from doing things he/she would like to do
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time
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General anxiety disorder
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Excessive anxiety and worry for greater than or equal to 6 months. worry out of proportion to actual issue, sleep disturbances common
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Do pts with GAD have trouble making decisions?
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Yes- Decision making difficulty = poor concentration & dread of making a mistake
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Posttraumatic stress disorder (PTSD)
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Repeatedly re-experiencing a highly traumatic event such as military combat.
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Symptoms of PTSD
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Flashbacks, feeling empty, exaggerated startle response, difficulty with all relationships, lack of trust
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Acute PTSD
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duration less than 3 months
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Chronic PTSD
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duration is 3 months or more
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Delayed PTSD
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onset of symptoms is at least 6 months after the stressful event.
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Acute stress response
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Similar to PTSD- Experience dissociative symptoms after trauma, symptoms develop within one month of event and lasts from 2 days to 4 weeks. re-experience trauma
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dissociative symptoms
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Sense of numbing
Decreased awareness of surroundings Derealization Depersonalization Amnesia for aspects of the trauma |
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Diagnoses for anxiety disorders
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Anxiety
Ineffective coping Disturbed thought processes Chronic low-self esteem Post-trauma syndrome |
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Client needs to be included in _____ _______ ____. This increases the likelihood of positive outcomes
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actively planning care
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Cognitive restructuring
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ID automatic negative anxiety arousing thoughts and negative self-talk
Discover source of these thoughts and look at situation more realistically Replace negative thoughts with positive self-talk |
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Relaxation training
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Decreases tension
Has positive effects on body Helps client realize that it is possible to feel better |
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Modeling
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client watches therapist/nurse model effective coping and then copies method
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Systematic desensitization
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Gradual introduction of phobic object/situation
Practice being relaxed during exposure to reduce anxiety response |
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Flooding
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exposed to large amount of stimulus – exhausts person’s anxiety response to stimulus. Causes an increase in anxiety at first.
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Response prevention
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only done with M.D. orders – gradually limit number of times client does ritual. Ordinarily allow client to practice rituals because there is such an increase in anxiety when they are prevented from doing so.
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Thought stopping
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earning to stop repetitive thoughts
“Stop” Rubber band Helps dismiss obsessive thoughts |
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Meds used for anxiety disorders?
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SSRIs (first choice), benzos, buspar, inderal, anti-histamines
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SSRI’s
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(first choice) and serotonin/norepinephrine blockers (Effexor) work well
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Benzodiazepines
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short term relief from symptoms while anti-depressant or Buspar starts to work. Unfortunately they are very addicting because they reduce anxiety so rapidly, and it can be difficult for anxious patients to discontinue their use.
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Buspar
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nonaddicting and not sedating but takes several months to take effect.
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Inderal
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blocks physical responses. By preventing the usual bodily sensations associated with anxiety, the person feels less anxious. This is often used for people with social phobias.
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Anti-histamines
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may be used to relieve anxiety because they are non-addictive, vistaryl, benadryl
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Anxiety disorders, health teaching
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Avoid caffeine, alcohol, nicotine, get enough rest, healthy diet, exercise, job change is needed, encourage checks with MD
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Over react and sense of impending doom- Can have with or without agoraphobia (Afraid of wide open spaces)
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Panic disorder
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Irrational fear of something
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Phobias
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Persistent thoughts they cannot get rid of
Sometimes (not always) have rituals |
OCD
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Worries all the time about everything
Six months or more |
Generalized anxiety disorder (GAD)
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feeling of apprehension, uneasiness, uncertainty, or dread; results from real or perceived threat
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Anxiety
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instruction in communication skills that help people ask directly in appropriate ways for what they want
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Assertiveness training
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unconscious movements that resemble tics
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Automatisms
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conscious or unconscious defensive mechanisms by which a person tries to escape from unpleasant situations or feelings
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Avoidance behavior
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therapeutic cognitive behavioral therapy technique used to identify and replace irrational automatic thoughts that cause anxiety
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Cognitive restructuring
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repetitive, seemingly purposeless behaviors performed according to certain rules known only to the patient that relieve anxiety
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Compulsion
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treatment where patient is helped to realize fears are exaggerated
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Decatastrophizing
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unconscious processes used to lower anxiety
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Defense mechanisms
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reaction to a specific danger
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Fear
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occasional reoccurrences of perceptual disturbances caused by trauma or drug use
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Flashback
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defense mechanism by exposing a person to the situation until the anxiety subsides
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Flooding
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fear of water
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Hydrophobia
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fear of germs
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Mysophobia
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idea, impulse, or emotion that cannot be put out of consciousness
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Obsessions
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strong irrational fear
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Phobia
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therapy where we look at the same situation in a new way
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Positive reframing
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defense mechanisms in order to relieve anxiety
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Primary gain
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exposing someone with OCD to thing that causes anxiety and then not allowing the ritual to happen
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Response prevention
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advantages from symptoms of relief behaviors employed. Ex: increased attention
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Secondary gain
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defense mechanisms in order to relieve anxiety
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Primary gain
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slowly exposing someone to phobia to desensitize the fear
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Systematic desensitization
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exposing someone with OCD to thing that causes anxiety and then not allowing the ritual to happen
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Response prevention
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What is the "brain problem" with pts suffering from anxiety disorders?
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problem with the amygdala- it is ultra-sensitive, always turned on. Something had gone wrong ;)
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advantages from symptoms of relief behaviors employed. Ex: increased attention
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Secondary gain
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Somatization Disorder
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Hx of many physical complaints beginning before age 30, resulting in treatment being sought.
Impaired social and occupational functioning Symptoms cannot be explained medically |
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slowly exposing someone to phobia to desensitize the fear
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Systematic desensitization
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Hypochondriasis
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Preoccupation w/ having serious disease or fear of having a serious disease.
Often misinterprets bodily symptoms, will often go to multiple doctors because they are not being diagnosed |
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What is the "brain problem" with pts suffering from anxiety disorders?
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problem with the amygdala- it is ultra-sensitive, always turned on. Something had gone wrong ;)
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Pain Disorder
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Pain in one or more body sites- causes significant distress, impairs social and occupational functioning.
Psychological factors thought to cause onset and severity. |
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Body dysmorphic disorder
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Preoccupation w/ imagined defect in appearance.
Causes significant social and occupational impairment- often will go to plastic surgeon over and over again |
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Somatization Disorder
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Hx of many physical complaints beginning before age 30, resulting in treatment being sought.
Impaired social and occupational functioning Symptoms cannot be explained medically |
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Conversion disorder
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One or more symptoms that suggest the presence of a neurological disorder (blind, paralyzed, mute) that cannot be explained medically
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Hypochondriasis
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Preoccupation w/ having serious disease or fear of having a serious disease.
Often misinterprets bodily symptoms, will often go to multiple doctors because they are not being diagnosed |
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Pain Disorder
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Pain in one or more body sites- causes significant distress, impairs social and occupational functioning.
Psychological factors thought to cause onset and severity. |
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Body dysmorphic disorder
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Preoccupation w/ imagined defect in appearance.
Causes significant social and occupational impairment- often will go to plastic surgeon over and over again |
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Conversion disorder
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One or more symptoms that suggest the presence of a neurological disorder (blind, paralyzed, mute) that cannot be explained medically
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“La Belle Indifference:”
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(the beautiful indifference) calmly indifferent to symptoms (like person that woke up paralysed now no longer has stress- happy because stress converted to physical symptom- easier to deal with i guess)
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Dissociative Disorders
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Disruption of mental functions which are usually coordinated:
Consciousness, Memory, Identity, Perception of the environment- One part of these points of connection are off... separated. |
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Depersonalization disorder
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Recurrent experience of feeling detached from and outside one’s body or mental processes
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Dissociative amnesia
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One or more episodes of an inability to recall important information.
Associated with trauma or stress |
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Dissociative fugue
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Sudden unexpected travel away from home with an inability to remember the past.
Person assumes a new identity |
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Dissociative identity disorder
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Existence of two or more distinct sub-personalities (multiple personality disorder)
Associated with childhood trauma |
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Explain what is meant by the term “psychosomatic illness"
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“its all in their head” it is thought that the mind and body are in relation which causes the illness without organic cause
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Identify the three central features of somatoform disorders.
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1. Symptoms that suggest a physical disorder but no medical findings to support it
2. Strong presumption that the symptoms are linked to psychobiological factors 3.Do not see disorder as being abnormal or wrong |
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Explain the concept of dissociation and the theorized steps.
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a. Dissociation is when the person feels like they are observing the things going on, not experiencing them. Out of body experience.
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Compare and contrast the essential features differences between the somatoform and dissociative disorders.
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-Somatoform: take psychological symptoms and translate into a physical symptom. Feeling somethin-Dissociative: disruption of mental function of consciousness, memory, identity, or perception of environment. Thinking something.
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Distinguish somatoform disorders from malingering and factitious disorder.
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a. Somatoform disorders are not a conscious occurrence. They are not doing it on purpose. Whereas malingering and factitious disorders are on purpose.
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preoccupation with imagined deformed body
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Body dysmorphic disorder
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defects in voluntary motor sensory functions such as blindness, paralysis, movement disorder, numbness, paresthesia, loss of vision/hearing, or episodes resembling epilepsy
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Conversion disorder
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alteration in presence of self while reality testing remains intact
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Depersonalization disorder
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fear that they are contracting disease
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Disease conviction
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fear that they may acquire the identified disease
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Disease phobia
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inability to recall personal info often due to a traumatic or stressful event
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Dissociative amnesia
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sudden, unexpected travel away from customary locale and inability to remember identify and information about the past
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Dissociative fugue
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two or more distinct personality states take over behavior recurrently
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Dissociative identity disorder
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Factitious disorder
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consciously pretend to be ill and get emotional needs met and attain the status of “patient”
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excessive preoccupation with physical health in absence of pathology
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Hypochondriasis
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Internalization
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To make internal, personal, or subjective
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affect or attitude of inappropriate unconcern about symptoms that is seen when symptoms are unconsciously used to lower anxiety
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La belle indifference
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Malingering
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conscious effort to deceive others often for financial gain, pretending to have symptoms
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Munchausen’s syndrome
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person purposefully produces symptoms of disease in order to illicit help from medical personnel
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disorder where testing rule out organic cause of pain, leads to significant impairment
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Pain disorder
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anxiety relief from use of defense mechanisms
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Primary gain
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Psychosomatic
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interaction of mind and body
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advantages from symptoms of relief behaviors employed. Ex: increased attention
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Secondary gain
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expression of psychological stress through physical symptoms
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Somatization
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pt chronically and persistently complains of multiple physical problems that have no physical origin interfere with the day to day life
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Somatization disorder
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Grounding techniques
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coping strategy that is designed to "ground" you in or immediately connect you with the present moment.
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Factitious and malingering disorders are not _________ disorders
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somatoform
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Are anger and aggression universal emotions?
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Yes- Anger and aggression can be identified across cultures via facial expressions
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anger and aggression represent the last two stages of a response that begins with _______ and then ________
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vulnerability
dis-ease |
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anger and aggression are responses to ____ _____ or ____ ____ ______
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perceived threat
loss of control |
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Anger
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emotional response to the perception of frustration or desires, threat, or challenge
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Aggression
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harsh physical or verbal action reflecting rage.
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Drive & instinct Theory
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Once thought of anger as an innate driving force and repression was harmful. Not true! Expressing anger leads to increased anger and negative physiological changes. This can actually damage the heart. Physiological changes not present when anger is restrained and problem solving used instead.
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It is believed that learned aggression has two intrinsic rewards:
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keeping the angry person in control and providing relief from pent-up distress.
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Behavioral theory for anger and aggression
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children can learn aggression by imitating others.
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Cognitive theory for anger and aggression
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When people appraise events as threatening, that cognition leads to the emotional and physiological arousal necessary to take action. This is true whether or not the cognition is correct
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Biological theory for anger and aggression
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some people may be biologically predisposed to anger & aggression.
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Several indicators of the Biological theory have been found.
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Low levels of serotonin are implicated in aggression. When the Amygdala is stimulated, rage results. Neurobiological disorders are also associated with anger such as brain tumors, Alzheimer’s, temporal lobe epilepsy.
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_________ is the single # 1 most important predictor of imminent violence
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Hyperactivity
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S/S of escalating abger
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Hyperactivity (pacing, restlessness)
Increased tension (clenched jaw or fist) |
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5 phase aggression cycle
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triggering, escalation, crisis, recovery, post-crisis
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Clients with _____ ____ _____ are at more risk for violence
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limited coping skills
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Clients with a _____ of violence and impulsivity are higher risks for violence.
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history
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Client feelings associated with violence
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Frightened
Humiliated Ignored Insecure Not heard Vulnerable (These feelings may underlie anger) |
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How can the milieu be conductive to violence?
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Overcrowding
Staff inexperience Staff to controlling Arbitrary rules- need same rules for everyone- be consistent Not enough activities |
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How can the milieu reduce violence?
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Solutions (to pt’s problems) with options
Empathy (do not have to have a solution as long as you acknowledge their problem and let them talk it out) without options Empathy with options (best) |
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Rigid, overcrowded units promote...
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violence
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Less rigid units with options and empathy tend to have...
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less violence.
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Staff are at risk for ___ after a violent incident, therefore it’s important to review the situation afterwards
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PTSD
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Managing Behavior: Pre-assaultive Stage
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De-escalation approaches
1.Listen to the patient 2.Use de-escalation techniques 3.Maintain your safety 4.Offer PRN medications |
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De-escalation techniques
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Maintain client’s self-esteem
Remain calm (fake it) Respond early Establish client’s concern Maintain large personal space Give options Non-aggressive posture |
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Many potentially violent situations can be avoided through the use of...
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de-escalation techniques.
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Managing Behavior: Assaultive phase
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1. Seclusion and/or restraint initiated: “Take down”
2. In emergencies nursing staff initiates procedure and obtains M.D. order within 1 hour |
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Seclusion
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involuntary confinement in room from which the patient is prevented from leaving.
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Restraint
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any manual method, or mechanical device, material or equipment attached or adjacent to the patient’s body that he or she cannot easily remove that restricts freedom of movement or normal access to one’s body.
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GOAL for restraints
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never punishment but rather SAFETY!! of patient of others.
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A “show of force” is a technique whereby...
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4-6 staff members assemble within the client’s sight. Often clients will calm down and cooperate when they see many staff members assembled.
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Clients are supposed to be examined within...
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ne hour of seclusion and/or restraints, but they rarely are.
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______ ___ ______form filled out when seclusion/restraints initiated
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“Denial of rights”
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Managing Behavior: Post-assaultive Phase
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1.Talk to client about incident
2.Talk about stressors 3.Explore alternative behaviors 4.Talk with staff and clients about incident |
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Debriefing
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helps the staff learn and validate necessity, it also helps clients differentiate their situation from the client in restraints
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Documentation
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Behaviors during preassaultive phase
Interventions & evaluation Behaviors during assaultive phase Interventions & patient responses Interventions during restraint Reintegration into milieu |
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Medical Interventions for anger and aggression
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BETA BLOCKERS, ANTI-MANIC MEDICATIONS, ATYPICAL ANTI-PSYCHOTICS, SSRI’S
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BETA BLOCKERS
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INDERAL
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Beta Blockers for pts with....
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chronic aggression
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ATYPICAL ANTI-PSYCHOTICS
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Risperdal, Zyprexa, Geodon
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What to do when a client is verbally abusive
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leave room & return at specified time- do not have to stay and take the abuse- If cannot leave, stop talking, finish procedure, leave
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Patients with cognitive deficits are at risk for...
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aggression
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It was once thought that anger was an innate driving force and that repression was harmful. But it was determined to be the opposite found that anger is not beneficial to survival.
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Drive and instinct theory
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What are the 3 stages of aggression?
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Pre-assaultive phase, assaultive phase, post-assaultive phase
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List 4 de-escalation techniques to use with an angry client.
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Maintain client self esteem, remain calm, respond early, establish client concern, maintain large personal space, give options, non-aggressive posture
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Describe the guidelines for the use and monitoring of physical restraints.
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1:1, check cap refill q15 minutes, void/nutrition needs every 2 hours.
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any action or behavior that results in physical or verbal attack
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Aggression
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an emotional response to frustration of desires, a threat to one’s needs, or a challenge
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Anger
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Maintain client self esteem, remain calm, respond early, establish client concern, maintain large personal space, give options, non-aggressive posture
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De-escalation techniques
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ability to handle emotions and thoughts
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Impulse control
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any manual method to immobilize or decrease movements
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Physical restraints
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involuntary confinement alone in a room
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Seclusion
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4 theories of anger and aggression
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drive & instinct theory
behavioral theory cognitive theory biological theory |
