Exam 2

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Exam 2
2015-03-03 00:09:36
exam 2
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  1. Normal Anxiety
    a healthy response to stress that is essential for survival
  2. Anxiety disordres tend to be
    persistent and often disabling
  3. Mild anxiety symptoms
    • restlessness
    • increased motivation
    • irritability
  4. Moderate anxiety symptoms
    • agitation
    • muscle tightness
  5. Severe anxiety ss
    • inability to function 
    • ritualistic behavior
    • unresponsive
  6. Panic ss
    • distorted perception
    • loss of rational thought
    • immobility
  7. Separation anxiety disorder
    • the client experiences excessive fear or anxiety when separated from an individual to which the clinient is emotionally attatched
    • normal from 18 months then declining
    • Sleep problems, nightmares, GI disress, headaches

  8. Panic disorder
    the client experiences recurrent panic attacks

  9. Phobias definition
    the client fears a specific object or situation to an unreasonable level

  10. Generalized anxiety disorder (GAD)
    • the client exhibits uncontrollable, excessive worry for more than 3 months
    • Anticipatory, fear the worst
    • Tense, restless, irritable, poor concentration, fear making mistake
    • wear people out
    • need reassureance
    • Sleep disturbances
    • fatigue

  11. Obsessive compulsive disoder
    The client has intrusive thoughts of unreasistic obsessions and tries to control these thoughts with compulsive behaviors (for example, repetitive cleaning of a particular object or washing hands)
  12. Hoarding disorder
    The client has difficulty parting with possessions, resulting in extreme stress and functional impairments
  13. Acute stress disorder
    Exposure to a traumatic event causes numbing, detatchment, and amnesia about the event for at least 3 days but for not more than 1 month

    amnesia, absent emotinal response, decreased awareness of surroundings, depersonalization 

    indications of severe anxiety, such as irritability and sleep disturbances
  14. PTSD
    Exposure to a traumatic event causes intense fear, horror, flashbacks, feelings of detachment and foreboding, restricted affect, and impairment for longer than 1 month after the event. Manifestations may last for years

    Indications of increased arousal sucha s irritability, difficulty with concentration, sleep disturbances

    Avoidance of stimuli associated with trauma, such as avoiding people, inability to show feelings
  15. Panic attacks usually last how long
    15-30 minutes
  16. FOur or more of the following manifestations are present during a panic attack
    • palpitations
    • SOB
    • chocking or smothering sensation
    • chest pain
    • nausea
    • feelings of depersonalization 
    • fear of dying or insanity
    • chills or hot flashes
  17. Social phobia
    the client has a fear of embarrassment, is unable to perform in front of others, has a dread of social situations, believes that others are judging him negatively, and has impaired relationships
  18. Agorophobia
    the client avoids being outside and has an impaired ability to work or perform duties; fear of opens spaces
  19. Manifestations of GAD
    • restlessness
    • muscle tension
    • avoidance of stressful activities or events
    • increased time and effort required to prepare for stressful activities or events
    • procrastination in decision making
    • seeks repeated reassurance
  20. Client responses to Acute stress disorder and PTSD
    fear, helplessness, or horror
  21. Acute Stress Disorder: client persistently reexperiences the event through:
    • distress when reminded of the event
    • dreams or images
    • reliving though flashbacks
  22. PTSD: the client persistently reexperiences that event through:
    • recurrent, intrusive recollection of the event
    • dreams or images
    • reliving through flashbacks, illusions, or hallucinations
  23. Stay or leave during anxiety
  24. It is important to instill hope for positive outcomes during anxiety disorders but to avoid
    false reasurrance
  25. Enahnce client self-esteem (anxiety disorders) by
    encouraging positive statements and discussing poast achievements
  26. Annot teach until
    acute anxiety subsides
  27. Cognitive behavioral therapy
    The anxiety response can be decreased by changinng cognitive distoritions. This therapy uses cognitive reframing to help the client identify negative thoughts that produce anxiety, examine the cause, and develop supportive ideas that replace negative self talk
  28. Relaxation therapy
    used to control pain tension and anxiety
  29. Modeling
    allows a client to see a demonstration of appropriate behavior in a stressful situation. THe goal of therapy is that the client will imitate the behaviro
  30. Systematic desensitization
    • begins with mastering of relaxation techniques
    • Then client is exposed to increasing levels of an anxiety producing stimulus
    • good for clients who have phobia
  31. Flooding
    exposes client to a great deal of an undesirable stimulus in an attempt to turn off the anxiety response. This therapy is most useful for clients who have phobias
  32. Response prevention
    prevents the client from performing a compusive behavior with the intent that anxiety will diminish
  33. thought stopping
    teaches a client to say stop when negative thoughts or compulsive behaviors arise, and substitute a positive thought.
  34. Group and family therapy is beneficial for
    clients who have trauma and stressor related disorders
  35. Eye movement desensitization and reprocessing
    • therapy for clients who have PTSD
    • It encourages eye focus on a separate stimuli while talking of or thinking about the traumatic event
  36. First line treatement for trauma and stressor related disorders
    Zoloft (SSRI antidepresent)
  37. sedative hypnotic anxiolytics
    • Valium
    • meant for short term use
  38. Nonbarbituarate anxiolytics
    • BuSPar
    • used for anxiet
  39. Anticonvulsants are used as
    mood stabalizers for people with anxiety
  40. anxiety is comorbid with _______ percent of clients who have depression
  41. Major depressive disorder
    single episode or recurring episodes of unipolar depression resulting in a significant change in a client's normal function accompanied by at least five of the specific clinical findings, which must occur almost every day for a minimum of two weeks and last most of the day
  42. unipolar depression
    not associated with mood swings from major depression to mania
  43. Specific clinical findings for MDD
    (must have five)

    • Depressed mood
    • Difficulty sleeping or excessive sleeping
    • INdecisiveness
    • Decreased ability to concentrate
    • Suicidal ideation 
    • Increased or decrease in motor activity
    • Inability to feel pleasure
    • INcrease or decrease in weight or more than five percent of total body weight over one month
  44. Psychotic features (MDD)
    • the presence of auditory hallucinations
    • presence of delusions
  45. Postpartum onset (MDD)
    a depressive episode that begins within four weeks of childbirth and may include delusions, which may put the newborn infant at high risk of being harmed by the mother
  46. Seasonal characteristics (MDD)
    seasonal affective disorder which occurs during inter and may be treated with light therapy
  47. Dysthymic diorder
    • milder form of depression 
    • early onset (childhood, adolescence)
    • Lasts at least 2 years in length for adults 
    • 1 year in length for children 
    • Contain at least three clinical findings of depression and may later develop into a MDD
    • "I have always felt this way..."
  48. Premenstrual dysphoric disorder
    • depressive disorder associated with the luteal phase of the menstrual cycle
    • Manifestations:
    • emotional liability 
    • persistent or severe anger and irritability 
    • lack of energy
    • overeating
    • difficulty concentration
  49. Acute MDD
    Severe clinicial findings of depression 

    • Treatment 6-12 weeks in duration 
    • Potential need for hospitalization 
    • REduction of depressive manifestations is goal
    • Assess suicide risk
  50. Coninuation phase of MDD
    INcreased ability to function 

    • Treatment is 4-9 months in duration 
    • Relapse prevention through education, meds, and psychotherapy is the goal
  51. Maintenance phase of MDD
    Remission of manifestations

    • May last for years
    • Prevention of future depressive episodes is the goal
  52. depressive disorders are twice as common in
    females between the ages of 15-40
  53. seratonin deficiencies
    affects mood, sexual, sleep, hunger, pain
  54. NOrepinephrine deficiency
    affects attention and behavior
  55. Symptoms of depression
    • Anergia
    • Anhedonia (lack of pleasure in normal activities)
    • Anxiety 
    • Sluggishness
    • unable to relax and sit still
    • Vegative findings 
    • constipation 
    • sleep disturbances
    • decrease in sex
    • fatigue
    • GI
    • pain 
    • Affect- sad blunted face
    • Poor grooming/ lack of hygiene
    • Psychomotor retardation(slow movement, slumped)
    • psychomotor agitation( restlessness, pacing, finger tapping)
    • social isolation
    • slowed speech 
    • delayed response
  56. Counseling for depression
    • problem solving
    • increasing coping abilities
    • changing negative thinking to positive
    • increaseing self-esteem
    • assertiveness training
    • using community resources
  57. CLient teaching for antidepressants
    • do not discontinue suddenly
    • therapeutic effects not immediate
    • avoid hazardous activies due to sedation
    • notify provider of suicidal thoughts
    • no alcohol
  58. Psycotherapy may include
    • cognitive-behavioral therapy- changing neg to pos
    • interpersonal therapy- focus on personal relationships that contribute to depressive disorder
    • group therapy
    • family therapy
  59. St. John's wort for depression
    • adverse: photosensitivity, skin rash, rapid hr, GI, abdominal pain
    • can react with medications such as SSRI (fatal seratonin syndrome)
  60. LIght therapy
    • first-line therapy for seasonal affective disorder
    • inhibits nocturnal secretion of melatonin
    • Exposure of the face to 10,000 lux light box 30 min a day, once or two divided doses
  61. Electroconvulsive therapy
    • used for depression
    • requires special nurse
    • May be used to subdue extreme manic behavior in BIPOLAR when therapy such as lithium has not worked
    • May be used for clients whoa re suicidal or those who have rapid cycling
  62. Transcranial magnetic stimulation
    • used for depression that is resistant to other forms of treatment
    • uses electromagnetic stimulation of the brain
  63. Vagus nerve stimulation
    • uses implanted device that stimulates vagus nerve
    • can be used in people who have depression that is resistant to at least four antidepressents
  64. Disruptive Mood Regulation
    • ages 6-18
    • not due to another reason
    • tantrums/outbursts
  65. Altruism
    The belief in or practice of disinterested and selfless concern for the well-being of others
  66. Conversion
    Defense mech where ideas, conflics, or impulses are manifested by various bodily symptoms such as paralysis, that have no physical cause
  67. Displacement
    taking it out on someone else
  68. Devaluation
    The attribution of exaggerated negative qualities to self or others
  69. Intellectualization
    focusing on the intellectual component instead of the emotional or stressful components of a situation
  70. Rationalization
    rationalizing unnacceptable behavior or feelings in a rational or logical manner
  71. Reaction formation
    opposite feelings or impulse or behavior (acting like you like someone you hate)
  72. Projection
    taking our own unacceptable qualities and feelings and ascribing them to other people
  73. INtrojection
    unconsious adoption of the ideas or attitudes of others
  74. Splitting
    object or idea is separated into two or more parts in order to remove its threatening meaning. black and white, all good or all bad
  75. Somatization
    experience and communicate psychological stress in the form of medical symptoms
  76. Sublimation
    allows us to act out unacceptable impulses by converting these behaviors into a more acceptable form (kick boxing for aggression)
  77. Panic Attack:
    • Sudden onset
    • Extreme apprehension
    • Fear
    • Impending doom
    • Terror
    • Decreased perceptions/warped sense of reality
    • PHysical discomfort
    • "having a heart attack"
    • SOB, chocking, nausea
    • Lasts only a few minutes
    • "thought life, thought life, thought life"??
  78. Obsessions
    thoughts, impules, mental images, often upsetting, persistent, recurring, cant control them, causes severe anxiety
  79. Compluses
    driven to ritualstic behavior in attempt to reduce anxiety or avoid imagined disaster
  80. Body dysmorphic disorder
    • Can appear normal but pathologically preoccupied with imagined defective body part with OCD symptoms
    • may be aware of it or not
    • dont respond well to drugs
    • thoughts may be secretive
  81. Trichotillomania common in
  82. OCD related medical conditions
    • postencephalic syndrome
    • postanoxic event
    • traumatic brain injury
    • Huntingtons disease
    • seizures
    • cerebral infarctions
    • Following parkinsons meds(gambling, sex, spending)
  83. Bipolar disorders usually emerge
    in late adolescence/early adulthood but can be dx in the school age child as well
  84. Bipolar can mimick ______ in children
  85. Acute bipolar
    • Acute mania
    • Treatement:
    • hospitalization may be required,
    • reduction of mania and client safety is goal
    • risk of harm to self and others is determined
    • one on one may be required
  86. Continuation bipolar
    • remission of clinical manifestations
    • treatement is generally 4-9 months
    • relapse prevention
  87. Maintance bipolar
    • increased ability to function
    • treatement generally continues thorught the clients life and is centered around prevention of future episodes
  88. Mania-
    • an abnormally elevated mood
    • expansive
    • irritable
    • usually requries hospitalization
  89. Hypomania
    • a less severe episode of mania
    • lasts 4 days at least
    • accompanied by three to four findings of mania
    • hospitilzation not required
  90. Mixed episode
    • manic episode and episode of major depression
    • Marked impairment in function
    • may require inpatient to prevent self harm and harm to others
  91. Rapid cycling
    four or more episodes of acute mania within 1 year
  92. Bipolar 1
    1 or more episodes of mania alternating with major depression
  93. Bipolar 2
    one or more hypomanic episodes altnerating with major depressive episodes
  94. Cyclothymia
    The client has at least 2 years of repeated hypomanic manifestations that do not meet the criteria for hypomanic episodes alternating with minor depressive episodes
  95. Comorbid conditions of BIPOLAR
    • substance use
    • anxiety
    • eating
    • ADHD
  96. Risk factors for BIPOLAR
    • genetics, immediate family member
    • stress, major life change
    • neurobiological and neuroendocrine disorders
  97. Mood disorders questionnaire
    standardizd tool that places mood progression on a continuum for hypomania (euphoria) to acute mania (extreme irritability and hypoeractivity) to delerium (completely out of touch with reality)
  98. Acute manic Episode interventions
    • SAFETY
    • suicide assessment
    • Decrease stimulation w/o isolation
    • no noise
    • possible restraints
    • frequent rest periods
    • outlets for physical activities
    • no high level of concentration or detailed instruction activites
    • Suprvise choice of clothing
    • provide portable nutrition
    • step by step hygeine and dress reminders
    • calm, matter of fact, specific approach
    • concise explanations
    • limit setting
    • expectations
    • avoid power struggles