Psych Block 4

• YES!
• Cultural heritage or teaching may determine what is experienced as stressful, how the stress is expressed & what methods are used to deal with it. 

• - passive aggressive
• - acting out
• - dissociation
• - devaluation
• - idealization
• - regression
• - splitting
• - projection
• - denial

stress experienced as positive

Stress resulting from harm, loss, threat, difficulty.

Detrimental to health.

non-specific response to any demand for adaptation.

• 6 weeks-ish
• people can't tolerate it for much longer than that.

4

#1 problem or conflict threatens self concept, sense of adequacy.

• stress continues
• trial & error of coping/defense mechanisms.

Panic is when trial & error fails

Flight or withdrawal used

If the problem still not resolved and anxiety continues to be overwhelming at severe panic levels, serious personality disorganization occurs.

Suicide, depression, subtances, violence

• - Group or social support
• - meditation
• - self hypnosis
• - creative imagery
• - breathing exercises
• - proper nutrition

• - Finding alternative ways to view ideas, events & situation.
• - What you think is what governs your emotions.

• - Own values
• - possible prejudices or counter transference
• - confront psychological issues- "areas remaining unhealed."

- Anxiety is a reaction to an unspecified danger

- fear is a reaction to a specific danger

• - Safety
• - Anxiety reduction

(care, listen, monitor feelings, therapeutic communication, summarize often)

• - Altruism
• - Sublimation
• - Humor
• - Suppression
• - Compensation

• - Repression
• - Displacement
• - Reaction formation
• - Conversion/Somatization
• - Undoing
• - Rationalization

Interruption in some aspect of cognitive function so as to cut oneself off from a painful awareness.

• "Out of body experience"
• completely lose track of time

- Shifting of distressing emotion to its opposite.

"yay! I'm getting divorced, let party!"

Shifting energy of stress or anxiety into physical symptoms.

- Trying to "undo" by doing the opposite behavior.

i.e. becoming altruistic after murdering someone.

• - justification
• - self deception - making an unacceptable behavior seem acceptable. 

- Resistance is covert

Procrastination, ineffectiveness, stubbornness

Potentially destructive

rather than processing feelings and talking, acts them out. 

Physical harm to person when angry.

May be to self or others.

i.e. putting someone else down so person looks good by contrast.

Overvaluing; putting on a pedestal.

When they fall off, own self esteem suffers as well. 

Reverting back to behavior from an earlier time; comforting but less mature.

Throws a temper tantrum because someone ate your cookie.

Unable to see good and bad together - only black & white, all or nothing.

See in others what you cannot tolerate to see in self.

Unconscious, refusal to accept reality or fact.  Acting as if a painful event thought or feeling did not exist. 

Meeting needs of others not martyrdom.

substitution of aggressive and sexual impulses into socially acceptable behavior. 

Like exercise!

laughing at, making jokes about painful feelings or situations.

Intentionally putting aside a painful or distressing situation or feeling. 

Only truly conscious mechanism!

Avoiding feelings of inferiority due to personal deficits by excelling in another area. 

She's good at sewing but I'm good at cooking.

Battery!

unless DTS/DTO

Committing assault!

• - restlessness
• - irritability
• - tension relieving behaviors-fidgeting, nail biting, finger tapping
• - mild sense of discomfort
• - heightened mental focus, alertness!

• - muscle tension
• - heart pounding
• - ^ HR & RR
• - tremors, voice trembling
• - G.I. cramping or nausea
• - selective inattention
• - can still learn & problem solve; helps if another present.
• (Difficult to accomplish Daily Life)

• - somatic symptoms worsen, HA, dizziness
• - insomnia
• - hyperventilation
• - feeling of impending doom
• - dazed and confused
• - problem solving & learning not possible
• - reduced perceptual field

• - severe trembling
• - dilated pupils
• - hyperactive or immobilized
• - may be unable to speak coherently
• - may hallucinate or be dillusional
• - experience total terror
• - may run or be danger to self or others

- Normal, necessary for survival, motivation

- Acute, "State of anxiety" r/t specific situation, loss, or crisis

- Chronic, "trait anxiety", not able to trust that they will be okay.  s/s overreaction, chronic fatigue, insomnia, discomfort in relationships & everyday life.

• 1. Alarm reaction - "fight or flight" prepares body for physical activity, decreases effectiveness of immune system
• 2. Resistance - body adapts i.e. anorexia = v desire for physical activity
• 3. Exhaustion - resistance is reduced, immune system is collapsed & heart attach r/t HTN

• "Father of stress"
• coined the term stress
• came up with GAS (General Adaptation Syndrome)

response to stress is whole body, not just local.

- A diagnostic manual with 5 axis' & over 300 diagnoses.

• Major clinical disorder
• - bipolar, schizophrenia, alcohol dependence, MDD, PTSD, GAD

Personality disorders & Mental retardation

- obsessive compulsive personality disorder

General medical conditions

-arthritis, HTN, diabetes, hepatitis

Environmental/Psychosocial factors

- Divorce, unemployed, no transportation

GAF- Global assessment of functioning, 2 numbers represented as a fraction.

• 1st # - what the assessor has gauged your current functioning level (1-100).
• 2nd # - What the assessor has deemed your past years functioning level (1-100) prior to incident.

• - Admission initiated by someone else
• - 2 or more MD's needed to determine need
• - Need to be DTS and or DTO (danger to self or others)

+ Right to a hearing if admitted +

• Xanax - alprazolam
• Librium - chlordiazepoxide
• Valium - diazepam
• Tranxene - clorazepate
• Ativan - lorazepam
• Serax - oxazepam

They are addicting!  To be used short term

• Buspar
• Benadryl
• Vistaril
• Inderal

• Maturational crisis - new development stage reached w/o completing the previous 1.
• Life transitions - new developmental stage reached with no experience: 1st day of school
• Advantitious crisis - Disaster!
• Situational crisis - external situation where one is not prepared to go thru.  Death of a loved one.

• - Needing to be needed!
• - Pts need to do for themselves

Don't set unrealistic goals for the pt. or yourself.

- Primary

- Secondary

- Tertiary

• Prevention
• - Recognize potential problems in relation to how pt. normally handles stress
• - Teach coping skills: meditation, relaxation, problem solving, decision making
• - Assist pt. in evaluating the reaction of life changes to decrease stress

Reduce stressors during a crisis "damage control".

• Assess w/client her/his problems, coping methods, support & resources
• Set goals
• Plan interventions

• usually in structural environment.
• Goal: Prevent further deterioration & regain optimal functioning

• Includes - rehab centers, intensive outpatient programs, partial hospital programs
• More restrictive environment

• - right to treatment
• - right to refuse
• - Least restrictive environment
• - communicate w/ ppl outside
• - right to no unnecessary restraints
• - right to independent psych eval and status review
• - right to protection from abuse
• - right to have an informed consent & withdrawal
• - Right to confidentiality of records
• - Right to due process
• - Right to individualized treatment plan

An informed consent

*Except if pt. is a danger to self or others*

• Can't give status updates!
• Someone looking for a psych patient needs to be directed to administration.  

Abuse, suicide, intent to harm.

• Duty to warn - the person, the person being threatened and the police
• *Never promise to keep secrets*