Exam 2

a healthy response to stress that is essential for survival

persistent and often disabling

• restlessness
• increased motivation
• irritability

• agitation
• muscle tightness

• inability to function 
• ritualistic behavior
• unresponsive

• distorted perception
• loss of rational thought
• immobility

• 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

DSM

the client experiences recurrent panic attacks

DSM

the client fears a specific object or situation to an unreasonable level

DSM

• 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

DSM

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)

The client has difficulty parting with possessions, resulting in extreme stress and functional impairments

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

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

15-30 minutes

• palpitations
• SOB
• chocking or smothering sensation
• chest pain
• nausea
• feelings of depersonalization 
• fear of dying or insanity
• chills or hot flashes

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

the client avoids being outside and has an impaired ability to work or perform duties; fear of opens spaces

• 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

fear, helplessness, or horror

• distress when reminded of the event
• dreams or images
• reliving though flashbacks

• recurrent, intrusive recollection of the event
• dreams or images
• reliving through flashbacks, illusions, or hallucinations

STAY

false reasurrance

encouraging positive statements and discussing poast achievements

acute anxiety subsides

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

used to control pain tension and anxiety

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

• begins with mastering of relaxation techniques
• Then client is exposed to increasing levels of an anxiety producing stimulus
• good for clients who have phobia

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

prevents the client from performing a compusive behavior with the intent that anxiety will diminish

teaches a client to say stop when negative thoughts or compulsive behaviors arise, and substitute a positive thought.

clients who have trauma and stressor related disorders

• therapy for clients who have PTSD
• It encourages eye focus on a separate stimuli while talking of or thinking about the traumatic event

Zoloft (SSRI antidepresent)

• Valium
• meant for short term use

• BuSPar
• used for anxiet

mood stabalizers for people with anxiety

70

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

not associated with mood swings from major depression to mania

(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

• the presence of auditory hallucinations
• presence of delusions

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

seasonal affective disorder which occurs during inter and may be treated with light therapy

• 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..."

• 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

Severe clinicial findings of depression 

• Treatment 6-12 weeks in duration 
• Potential need for hospitalization 
• REduction of depressive manifestations is goal
• Assess suicide risk

INcreased ability to function 

• Treatment is 4-9 months in duration 
• Relapse prevention through education, meds, and psychotherapy is the goal

Remission of manifestations

• May last for years
• Prevention of future depressive episodes is the goal

females between the ages of 15-40

affects mood, sexual, sleep, hunger, pain

affects attention and behavior

• 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

• problem solving
• increasing coping abilities
• changing negative thinking to positive
• increaseing self-esteem
• assertiveness training
• using community resources

• do not discontinue suddenly
• therapeutic effects not immediate
• avoid hazardous activies due to sedation
• notify provider of suicidal thoughts
• no alcohol

• cognitive-behavioral therapy- changing neg to pos
• interpersonal therapy- focus on personal relationships that contribute to depressive disorder
• group therapy
• family therapy

• adverse: photosensitivity, skin rash, rapid hr, GI, abdominal pain
• can react with medications such as SSRI (fatal seratonin syndrome)
• NO FOODS WITH TYRAMINE

• 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

• 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

• used for depression that is resistant to other forms of treatment
• uses electromagnetic stimulation of the brain

• uses implanted device that stimulates vagus nerve
• can be used in people who have depression that is resistant to at least four antidepressents

• ages 6-18
• not due to another reason
• tantrums/outbursts

The belief in or practice of disinterested and selfless concern for the well-being of others

Defense mech where ideas, conflics, or impulses are manifested by various bodily symptoms such as paralysis, that have no physical cause

taking it out on someone else

The attribution of exaggerated negative qualities to self or others

focusing on the intellectual component instead of the emotional or stressful components of a situation

rationalizing unnacceptable behavior or feelings in a rational or logical manner

opposite feelings or impulse or behavior (acting like you like someone you hate)

taking our own unacceptable qualities and feelings and ascribing them to other people

unconsious adoption of the ideas or attitudes of others

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

experience and communicate psychological stress in the form of medical symptoms

allows us to act out unacceptable impulses by converting these behaviors into a more acceptable form (kick boxing for aggression)

• 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"??

thoughts, impules, mental images, often upsetting, persistent, recurring, cant control them, causes severe anxiety

driven to ritualstic behavior in attempt to reduce anxiety or avoid imagined disaster

• 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

children

• postencephalic syndrome
• postanoxic event
• traumatic brain injury
• Huntingtons disease
• seizures
• cerebral infarctions
• Following parkinsons meds(gambling, sex, spending)

in late adolescence/early adulthood but can be dx in the school age child as well

ADHD

• 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

• remission of clinical manifestations
• treatement is generally 4-9 months
• relapse prevention

• increased ability to function
• treatement generally continues thorught the clients life and is centered around prevention of future episodes

• an abnormally elevated mood
• expansive
• irritable
• usually requries hospitalization

• a less severe episode of mania
• lasts 4 days at least
• accompanied by three to four findings of mania
• hospitilzation not required

• manic episode and episode of major depression
• Marked impairment in function
• may require inpatient to prevent self harm and harm to others

four or more episodes of acute mania within 1 year

1 or more episodes of mania alternating with major depression

one or more hypomanic episodes altnerating with major depressive episodes

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

• substance use
• anxiety
• eating
• ADHD

• genetics, immediate family member
• stress, major life change
• neurobiological and neuroendocrine disorders

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)

• 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