Compensation used to counterbalance perceived deficiencies by emphasizing strengths Conversion cause the unconscious transformation of anxiety into a physical symptom with no organic Denial escaping unpleasant, anxiety-causing thoughts, feelings, wishes, or needs by ignoring their existence Displacement the transference of emotions associated with a particular person, object, or situation to another nonthreatening person, object or situation Dissociation disruption on consciousness, memory, identity or perception of the environment that results in compartmentalizing uncomfortable or unpleasant aspect of oneself Identification attributing to oneself the characteristics of another person or group consciously or unconsciously Intellectualization a process in which events are analyzed based on remote, cold facts and without passion, rather than incorporating feelings and emotion into the processing Projection others the unconscious rejection of emotionally unacceptable features and attributing them to Rationalization justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations that satisfy the teller and listener Reaction formulation when unacceptable feelings or behaviors are controlled and kept out of awareness by developing the opposite behavior or emotion Regression reverting to an earlier, more primitive and childlike pattern of behavior or emotion Repression an unconscious exclusion of unpleasant or unwanted experiences, emotions, or ideas from conscious awareness Splitting the inability to integrate the positive and negative qualities of oneself or others into a cohesive image Sublimation an unconscious denial of a disturbing situation or feeling. Undoing most common in children. When a person makes up for an act of communication All or nothing thinking thinking in black and white, reducing complex outcomes into absolutes Overgeneralizations using bad outcomes as evidence that nothing will ever go right again Labeling a form of generalizing in which a characteristic or event becomes definitive and results in an overly harsh label for self or others Mental filter focusing on a negative detail or bad event and allowing it to taint everything else Disqualifying the positive maintaining a negative view by rejecting information that supports a positive view as being irrelevant, inaccurate, or accidental Jumping to conclusions making a negative interpretation despite the fact that there is little or no supporting evidence Mind reading inferring negative thoughts, responses and motives of others Fortune telling error anticipating that things will turn out badly as an established fact Magnification or minimization exaggerating the importance of something or reducing the importance of something Catastrophizing an extreme form of magnification in which the very worst is assumed to be a probable outcome Emotional reasoning drawing a conclusion based on an emotional state “should” and “must” statements control over external events ridged self-directives that presume an unrealistic amount of Personalization assuming responsibility for an external event or situation that was likely outside personal control Medical model abnormal behavior is the result of a physical problem Somatization psychologic distress manifests in physical problems Therapeutic use of self use of gifts and talents to promote healing in others Transference patient inappropriately displaces onto the nurse feelings and behaviors related to a significant figure in the patient’s past Countertransference figure in nurses past nurse displaces onto the patient feelings and behaviors related to significant Miracle question what if you woke up tomorrow and your illness was gone? What then? Perorientation phase preparations prior to meeting patient Orientation phase introduction, interview, patient expresses thoughts and feelings, identify problems and discuss goals Working phase allows patient to express anxiety, recognize dysfunctional responses, learn new and more adaptive coping behaviors and skills, nurses provide education about disorder, symptom management, medication education and evaluation of progress Termination phase discussed at orientation and working phases, may occur when patient is discharged or when nurse ends work with patient. Summarize goals and objectives achieved, validate experience for patient and nurse, may signify loss for patient and nurse if relationship was lengthy, may awaken feelings of abandonment or rejection in the patient Compensation: Making up for a deficiency in one aspect of self-image by strongly emphasizing a feature considered an asset (e.g., a person who is a poor communicator relies on organizational skills) Conversion Unconsciously repressing an anxiety-producing emotional conflict and transforming it into nonorganic symptoms (e.g., difficulty in sleeping, loss of appetite) Denial Avoiding emotional conflicts by refusing to consciously acknowledge anything that causes intolerable emotional pain (e.g., a person refuses to discuss or acknowledge a personal loss) Displacement Transferring emotions, ideas, or wishes from a stressful situation to a less anxietyproducing substitute (e.g., a person transfers anger over an interpersonal conflict to a malfunctioning computer) Identification Patterning behavior after that of another person and assuming that person’s qualities, characteristics, and actions Dissociation surroundings Experiencing a subjective sense of numbing and a reduced awareness of one’s Regression Coping with a stressor through actions and behaviors associated with an earlier developmental period Informal admission least restrictive, patient free to leave at will Voluntary admission patient applies in writing to MH facility for admission, patient has the right to request release but an evaluation may be necessary to release and involuntary commitment may occur Involuntary commitment court ordered if mentally ill, safety risk to self or others, gravely disabled, in need of treatment but too ill to ask Emergency commitment hours) Patient rights observation for diagnosis and treatment usually 24-96 hours(LA LAW 72 right to treatment, right to refuse treatment, right to consent to treatment Restraints any material used to restrict body movement, patient MUST be seen by a provider within 1 hour or restraint EVEN IF THEY ARE REMOVED Chemical restraint use of medication to control behavior Seclusion and time out seclusion is staff imposed, time out is patient choice Intentional tort assault, battery, false imprisonment, invasion of privacy, threats, bullying Unintentional tort negligence, malpractice, breach of duty, not meeting standards of care, proximate cause, damages, pain and suffering Ethics study of philosophical beliefs about that is right or wrong in society, hard questions Bioethics study of specific ethical questions or dilemmas that arise in health care Beneficence doing good Autonomy freedom Justice fairness Fidelity loyalty Veracity truth telling Patient centered care recognize the patient as the source of control and full partner in providing compassionate and coordinated care based on respect for the patient’s preferences and needs Quality improvement use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of healthcare systems Safety minimize risk of hard to patients and provide optimal healthcare through both system effectiveness and individual performance Informatics use information and technology to communicate, manage knowledge, migate error and support decision making Teamwork function effectively within nursing and interprofessional teams, fostering open communication, mutual respect, and shared decision making to achieve quality patient care Evidence based practice integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal healthcare NAMI National Alliance on Mental Issues: encourage self-help and promote the concept of recovery, or the self-management of mental illness Issues NAMI tackles: Establishment of a meaningful life, care for comorbid conditions, respond to depression and suicide, manage substance use/abuse, deinstitutionalize care, recognize inadequate access to care, violence against persons with MI Therapeutic milieu French for “middle place” refers to surroundings and physical environment as well as interactions within the environment, recognizes the persons, setting, structure and emotional climate that is important to healing Interpersonal learning members gain insight into themselves based on the feedback from others during later group phases Catharsis shared through experiencing and expressing feeling, therapeutic discharge of emotions is Instillation of hope the leader shares optimism about successes of group treatment and members share their improvements Universality members realize that they are not alone with their problems, feeling or thoughts Imparting of information Altruism participants receive formal teaching by the leader or advice from peers members gain or profit from giving support to others, leading to improved self value Corrective recapitulation of primary family group members repeat patterns in the group that they learned in their families, with feedback from the leaders and peers they learn about their own behavior. Socializing techniques members learn new social skills based on other’s feedback and modeling Imitative behavior habits members may copy behavior from the leader or peers and can adopt healthier Group cohesiveness this powerful factor arises in a mature group when each member feels connected to the other members, the leader, and the group as a whole; members can accept positive feedback and constructive criticism Existential resolution members examine aspects of life that affect everyone in constructing meaning Group consent all that is said in group Group process the dynamic of interaction among members Group norms expectations for behavior in the group that develop over time and provide structure Group themes members’ expressed ideas or feelings that recur and share a common thread. Leader may clarify a theme to help members recognize it more fully Feedback providing group members with awareness about how they affect one another Conflict open disagreement among members. Positive resolution within a group is key to successful outcomes family dynamics the interactions between family members that are affected by a family’s makeup (configuration), structure, function, problem solving, and coping capacity. Manipulating they want instead of asking directly what is wanted, family members manipulate other to get what Distracting to avoid functional problem solving and resolving conflict within the family, family members introduce irrelevant detains into problematic issues Generalizing members use global statements such as “always” and “never” instead of dealing with specific problems and areas of conflict Blaming family members blame others for failures, errors, or negative consequences of an action to deflect the focus from them Placating family members pretend to be well meaning to keep peace on the family. Boundaries clear boundaries are those that maintain distinctions between individuals withing the family and between the family and the outside world Differentiation: the ability to develop a strong identity and sense of self while at the same time maintaining an emotional connectedness with ones’ family of origin Double bind a situation in which a positive command is followed by a negative command which leaves the recipient confused , trapped, and immobilized because there is no appropriate way to act Family life cycle the family’s developmental process over time, refers to the family’s past course, it’s precent tasks and future course Hierarchy the function of power and its structures in families, differentiating parental and sibling roles and generational boundaries Multigenerational issues the continuation and persistence frome generation to generation of certain emotional interactive family patterns, predictable and almost ritual like patters, repetition of of themes or toxic issues, and repetition of reciprocal patterns such as those of underfunctioners and overfunctioners Scapegoating a form of displacement in which a family member (usually the lease powerful) is blamed for another family member’s distress. The purpose is to keep the focus off the painful issues and the problems of the blamer. in a family the blamer is often a parent and the scapegoat is often the child Sociocultural context the framework for viewing the family on terms of influence of gender, race, ethnicity, religion, economic class, and sexual orientation Triangulation the tendency when two person relationships are conflicted to draw in a third person to stabilize the system through formation of a coalition in which the two joined the third Genogram efficient clinical summary and format for providing information and defining relationships across at least 3 generations within a family. (family tree) Nurse generalist provide counseling to family members utilizing problem-solving approach to address immediate family conflict or crisis related to health or wellbeing CAN BE AN RN Family psychoeducationshare mental health information, especially if a family member has amental illness Advanced practice nurses conduct family therapy sessions to every type of child or adult disorders main biologic therapy electroconvulsive therapy transcranial magnetic stimulation non invasive treatment modality, used MRI strength magnetic pulses to stimulate focal areas of cerebral cortex, used for depression *newer treatment vagus nerve stimulation electrical stimulation of vagus nerve results in increasing the level of neurotransmitters, originally used for epilepsy, improves mood in depression deep brain stimulation electrodes surgically implanted into specfic areas of the brain to stimulate those regions identified to be underactive in depression, used for Parkinson’s but now being used for depression as well light therapy first line treatment for seasonal affective disorder, a subtype of depression caused by decreased daylight in winter exercise mood has biological, social, and psychologic effects by increasing serotonin and improving dopamine involved in fine motor movements, integration of emotions and thoughts, decision making and stimulates the hypothalamus to release hormones norepinephrine (noradrenaline) level in brain affects mood, affects mood, attention and arousal, stimulates sympathetic branch of ANS for fight of flight response to stress serotonin play role in sleep regulation, hunger, mood states, and pain perception, hormonal activity, aggression and sexual behavior histamine involved in alertness, inflammatory response, stimulates gastric secretion GABA plays a role in inhibition, reduces aggression, excitation and anxiety, may play a role in pain perception, has anticonvulsant and muscle relaxing properties, may impair cognition and psychomotor functioning Glutamate is excitatory AMPA plays a role in learning and memory Acetylcholine plays a role in learning, memory, regulates mood, mania, sexual aggression, affects sexual and aggressive behavior stimulates parasympathetic nervous system substance P centrally active SP antagonist has antidepressant and anti anxiety effects in depression. Promotes and reinforces memory. Enhances sensitivity to pain receptors to activate somatostatin altered levels associated with cognitive disease neurotensin endogenous antipsychotic like properties electrocencephalograph (EEG) a recording of electrical signals from the brain made by hooking up electrodes to the subject’s scalp computerized axial tomography (CT) a series of e ray images is taken of the brail and a compiter analysis produced ‘slices” providing a precise 3D reconstitution of each segment magnetic resonance imaging (MRI) a magnetic field is applied to the brain. The nuclei of hydrogen atoms absorb and emit radio waves that are analyzed by computer which provides 3D visualization of the brain’s structure in sectional images functional magnetic resonance imaging measures brain activity indirectly be changes in blood oxygen on different parts of the brain as subjects participate in various activities Positron magnetic tomography radioactive substance is injected travels to the brain and shows up as bright spots on the scan, data collected by the detectors are relayed to a computer which produced images of the activity and 3D visualization of the CNS Single photon emission computed tomography similar to PET but used radionuclides that emit photons. Measures various aspects of brain functioning and provides images of multiple layers of CNS Genetics predisposition for psychiatric disorders especially thought and mood disorders Neurotransmitters norepinephrine, dopamine, serotonin deficiency in depression, excess transmission of dopamine implicated in schizophrenia and thought disorders Amino acid neurotransmitters glutamate, GABA, role of glutamate in schizophrenia GABA implicated in anxiety Mood the way a person feels Affect observable response a person has to his/her feelings Euthymia normal mood and includes a range of expected mood cycles Physiologic process development Depressive includes brain function and processes neurons , neurotransmitters, growth and sadness, despair, decreased will to live, suicidal thoughts Manic euphoria, agitation, delusions, risk for suicide Exemplars of depressive disorders disruptive mood dysregulation disorder, major depressive disorder, persistent depressive disorder, postpartum disorder, premenstrual dysphoric disorder, situational depression, psychotic depression, suicide Exemplars of manic disorders bipolar 1, bipolar 2, cyclothymia, suicide Risk for bipolar disorder genetic, hypothyroidism, Bipolar I most severe shifts in mood, energy, and ability to function alternating between periods of normalcy and deep depression Mania intense mood disturbances, persistent elevation, expansiveness, irritability, energy and euphoria, increased goal-directed activities which may become a psychiatric emergency with decreased eating, sleeping and perpetual motion Bipolar II experiences at least 1 hypomania and 1 major depressive episode Hypomania low level and less dramatic mania, euphoria, and increased functioning that lasts at least 4 days. No psychotic episode with hypomania but may experience psychosis with depressive episode Cyclothymic hypomania to mild depression for 2 years in adults, 1 year in children. May develop into a bipolar disorder Adolescent bipolar ADD/ADHD common 1 in5 will attempt suicide, substance misuse common as form of self treatment, Disruptive mood dysregulation disorder Introduced in 2013 in response to increased number of children and adolescents diagnosed with bipolar disorder. These youngsters did not go on to develop bipolar disorders in adulthood although many did have major depressive disorders or anxiety disorder. Symptoms of disruptive mood dysregulation disorder constant and severe irritability and anger in individuals between 6 and 18 years old, onset usually before 10 years. Temper tantrums with verbal or behavioral outbursts out of proportion to situation at least 3 times a week at home, in school, or with peers Persistent depressive disorder feelings of depression occur most of the day for the majority of days lasting at least 2 years in adults or 1 year in children Symptoms of persistent depressive disorder change in appetite or eating habits, difficult to maintain relationships or jobs, may have episodic major depression Premenstrual dysphoric disorder newest addition to diagnostic system, cluster or symptoms that occur the week before onset of menses causing problems severe enough to interfere with ability to work or interact with others Symptoms of premenstrual dysphoric disorder mood swings, irritability, depression, anxiety, feeling overwhelmed, difficulty concentration. May include low energy, overeating, hypersomnia or insomnia, breast tenderness, aching, bloating, and weight gain. Symptoms disappear at onset of menses Depressive disorder related to another medical condition medications used to treat medical conditions related to affect on body systems, pain Major depressive disorder one of the most common psychiatric disorder lasting a minimum of 2 weeks and may last 5-6 months, chronic depression may last more than 2 years and may have recurrent episodes. Risk factors for major depressive disorder Suicidal ideation genetic, biochemical, hormonal, inflammation issues thoughts, talk, art, notes about suicide Major distinction between depression and adjustment disorders a specific psychosocial stressor can be identified for adjustment disorder (loss, personal tragedy, change in life style, maturationak crisis success or gain) PTSD affects children and adults experiencing or witnessing traumatic events. Can be caused by any trauma. Flashbacks and dreams about that trauma are common Attachment disorder rare, in children caused inhibited or emotional withdrawal or may show no normal fear of strangers and may try to bond with anyone Acute stress disorder become PTSD occurs between the traumatic event and one month after, if unresolved can Adjustment disorder milder than PTSD and acute stress disorder, caused by a stressful event Psychosis abnormalities in 5 different symptomatic domains; delusions, hallucinations, disorganized thought, disorganized or abnormal motor behavior, and negative symptoms, syndrome of neurocognitive symptoms that impairs cognitive capacity leading to deficits of perception, functioning and social relatedness Physiologic process may be acute or chronic, recurring, poor outcomes associated with untreated psychosis, involves neurotransmitters in brain Primary psychosis schizophrenia spectrum and other psychotic disorders Secondary psychosis toxic psychosis, dementia, medical illness, toxins, drugs, and medications Delusions fixed beliefs that are not amenable to change in light of conflicting evidence Hallucinations perception like experiences that occur without an external stimulus Disorganized thinking most commonly inferred from speech, defined by derailment, loos association, tangentiality and incoherence Disorganized/ abnormal motor behaviormarkedly abnormal behavior ranging from agitation to catatonia that is commonly situationally incongruent Negative symptoms absence of something that is supposed to be there; apathy (avolition), blunted affect, absence or reduced thought (alogia), loss of pleasure or joy (anhedonia) are more complex and difficult to treat Schizophrenia a group of related disorders with a wide range of severity and symptoms that are chronic, debilitating and devastating. Altered cognition, altered perception, and/or impaired ability to determine reality Positive symptoms presence of something that should not be present, hallucinations, delusions, paranoia, detached from reality, disorganized speech, bizarre behavior Avolition apathy and lack of motivation Alogia absence or reduced thought Anhedonia loss of pleasure or joy Cognitive symptoms core of disorganized behaviors and confusion, impaired working memory of the brain, confusion, inability to maintain attention and disturbances in executive functioning Affective symptoms depressive symptoms, anxiety, dysphoria, irritability, unstable mood Speech alterations looseness of association, word salad, clang association, neologism, echolalia Subtypes of schizophrenia paranoid, disorganized, catatonic, undifferentiated, residual Schizophreniform disorder level of functioning s/s schizophrenia but lasts less than 6 months, may return to previous Schizoaffective disorder uninterrupted period of illness with major depression, mania, or mixed concurrent with s/s schizophrenia Delusional disorder functioning general theme but not severe enough to impair occupational or daily Brief psychotic disorder, shared psychotic disorder sudden onset of at least one of; delusions, hallucinations, disorganized speech, disorganized behavior, of catatonia lasting more than one day but less than one month, then returning to normal Schizophrenia at least one psychotic symptom such as hallucinations, delusions and/or disorganized speech or thought that disrupts normal activities of school, work, family, social interactions and self care. Risk factors for schizophrenia vulnerability 80% genetic: multiple genes on different chromosomes increase Prodromal phase of schizophrenia Acute phase of schizophrenia one month to one year before first episode mild to disabling Stabilization phase of schizophrenia movement toward baseline, continued outpatient care, crisis centers available if needed, may go to group home during this time Maintenance or residual condition is stable and new baseline established, decreased positive symptoms continued negative symptoms, periods of exacerbation common Intervening with hallucinations special attention to command voices regarding violence or suicide which would require close monitoring in a safe space – remove all potential objects of self-harm Intervening with delusions avoid questioning the delusion, focus on helping patient fell safe; do not try to prove that the delusion is not real Intervening with associative looseness do not pretend to understand, use “I” statements, use short sentences, try to tie communication to possible triggers Personality individual’s characteristic pattern of relatively permanent thoughts, feelings, and behaviors that define the quality of experiences and relationships Personality disorders long standing, pervasive, maladaptive, patterns of behavior when relating to others, deviates from expectations within the individual’s culture, inflexible, has onset in adolescence or early adulthood and leads to distress or impairment Diathesis-Stress Model Diathesis is the genetic and biologic vulnerabilities and includes personality traits and temperament. Temperament may refer to calm or anxious. Stress refers to the influence of environment on personality. Includes past experiences, patterns of interaction, and exposure Cluster A personality disorder paranoid, schizoid, schizotypal, concurrent with psychosis Cluster B personality disorder histrionic, narcissistic, affective, anxiety, ptsd Cluster C personality disorder avoidant, dependent, OCD Paranoid personality (cluster A) distrust, suspicious, hypervigilant, anticipates hostility Schizoid personality (cluster A) socially withdrawn, expressionless, odd, eccentric, does not enjoy close relationships Schizotypal personality (Cluster A) inappropriate affect strange, unusual, magical thinking, strange speech patterns, Histrionic personality (Cluster B) flamboyant, and colorful personality excitable and dramatic, high functioning, extroverted, Narcissistic personality (cluster B) lack of empathy feelings of entitlement, exaggerated belief of one’s importance, Avoidant personality (cluster C) extremely sensitive to rejection, feel inadequate, socially inhibited, low self esteem Dependent personality (Cluster c) cared for, fear of separation submissive, clinging behavior and overwhelming need to be Obsessive compulsive personality (cluster c) limited emotional expression, stubbornness, perseverance, indecisiveness, preoccupation with perfection and control, rigidity, and inflexible standards for self and others; because these actions are right Obsessive compulsive disorder obsessive thoughts and repetition or adherence to rituals, aware that these thoughts and actions are unreasonable Antisocial personality (sociopaths) (cluster B) disregard for and violation of rights of others, antagonistic behavior toward others, deceitful, manipulative for personal gain hostile disinhibited with leads to risk taking behaviors, impulsivity, and disregard for responsibility, minimal capacity for intimacy Borderline personality disorder severe impairment in functioning, instability in emotional control, impulsivity, self image distortions, unstable moods, and unstable relationships, self destructive behavior, suicide attempts, or self harm as in cutting, substance abuse, promiscuous sexual behavior, or property damage Splitting may be used as primary defense or coping style, inability to see both positive and negative aspects of others (loving or despising) Reactions to acute stress uneasiness, sadness, loss of appetite, suppression of immune system, increased metabolism, hypertension, infertility, impotence, anovulation, increased energy, decreased memory and learning , increased cardiovascular tone, increased risk blood clots, stroke, increased cardiopulmonary tone S in STOP mindfulness technique stop what you are doing, put things down for a minute T in STOP mindfulness technique take a breath. Breathe normally and naturally and follow your breath coming in and out of your nose, you can even say to yourself “in” as your breathe in and “out” as you breathe out to help with concentration O in STOP mindfulness technique observe your thoughts, feeling and emotions. You can reflect about what is on your mind and also notice thoughts that are not facts, and they are not permanent. If the thought arises that you are inadequate, just notice the thought, let it be and continue on. P in STOP mindfulness technique proceed with something that is important to you in the moment, whether that is talking with a friend, appreciating you children, or walking while paying attention to the world Crisis perception or experience of a situation as intolerable difficulty that exceeds current resources and coping mechanisms; period of psychologic disequilibrium resulting from a traumatic event or situation 4 components of crisis specific, unexpected, perception of threat, need for change identified Lindemann’s normal grief patterns Preoccupation with the lost ones, identification with the lost one, expressions of guilt and hostility, disorganization in daily routine, and somatic complaints. Intervention therefore should be grief therapy and grief work ROBERT’S Seven Stage Model of Crisis Intervention 1) plan and conduct crisis assessment including fatalities; 2) establish rapport and relationship; 3) identify major problems; 4) deal with feelings and emotions with active listening and validation; 5) generate and explore alternatives; 6) develop and formulate an action plan to resolve crisis; 7) follow-up plan and agreements following resolution of crisis. Types of crises maturational, situational, adventitious Peplau’s mild anxiety first level, sharp senses, increased motivation, heightened awareness, ehanced learning, optimal functioning Peplau’s moderate anxiety second level, narrowed perceptional field, less alert, decreased concentration, decreased problem solving, muscular tension, restlessness Peplau’s severe anxiety concentration progressively narrowed, severe impairment of attention, severe cognitive impairment, physical symptoms, emotional symptoms Peplau’s panic anxiety complete lack of focus, tendency to misperceive environment, marked change in baseline behavior, marked functional impairment, emotional and behavioral dysregulation Anxiety subjective distressful experience activated by perception of threat which has potential physiological and psychological etiology and expression; universal human experience, feelings of apprehension, uneasiness, uncertainty, or dread resulting from real or perceived threat or unknown danger, body reacts to fear in similar manner Separation anxiety disorder developmentally inappropriate levels of concern over being away from a significant other, characteristics include harm avoidance, worry, shyness, uncertainty, fatigability, lack of self-direction, accompanied by a level of discomfort and disability that impairs social and occupational functioning, does not respond well to psychotherapy including CBT Phobias persistent, irrational fear of an object, activity or situation characterized by high level of fear and anxiety compromising ADLs in order to avoid the situation, usually negative or traumatic experience provoked the phobia to develop Social anxiety disorder social phobia, provoked by social or performance situation that may be evaluated negatively by others, causing them to avoid social situations or become extremely anxious in social situations parental shyness may increase child’s anxiety in social situations due to modeling of parental actions, social isolation may be extreme and substance use is common Panic attacks and panic disorders sudden onset of extreme apprehension, fear, usually associated with feelings of impending doom, may feel like a heart attack, or losing their mind, usually subsides in a matter of minutes Agoraphobia fear of open spaces, being alone inside or outside, traveling, being on a bridge, most often develops in late adolescence or early adulthood, more common in females Generalized anxiety disorder excessive worry, out of proportion to event or situation, may effect children, teens or adults, leading to procrastination or avoidance, sleep disturbances, and fatigue. May be accompanied by other anxiety disorders or depression Coping enhancement facilitation of cognitive and behavioral efforts to manage perceived stressors, changes or threats that interfere with meeting life demands and roles Hope inspiration enhancing the belief in one’s capacity to initiate and sustain actions Self esteem enhancement assisting a patient to increase his or her personal judgment of self-worth Relaxation therapy use of techniques to encourage and elicit relaxation for the purpose of decreasing undesirable signs and symptoms such as pain, muscle tension or anxiety Body dysmorphic disorder Hording disorder preoccupation with imagined defective body part attaining and keeping objects and things regardless of need or value Trichotillomania and excoriation disorder with OCD hair pulling, skin picking, excoriation, occurs in children Addiction compulsive, abnormal dependence on a substance or behavior which has advers psychological, physical, economic, social or legal ramifications Substance induced disorders involve direct effects of substance Substance use disorders cognitive, behavioral and physiological symptoms associated with long term use; incudes intoxication, craving, tolerance, and withdrawal when substance is withheld Substance induced disorders temporary and reversible, caused by intoxication and immediate effects of substance withdrawal affects CNS causing physiological and psychological/behavioral effects of either; may include depression, anxiety, or psychosis Substance use disorder consequences occur over time as a cumulative effect, combines abuse and dependance; each substance has its own disorder Alcohol withdrawal syndrome begins within 6-9 hours after last dose, altered mental status, tremors, seizures, tachycardia, hypertension, cardiovascular collapse, then causes bradycardia and hypotension Substance use disorder pathological use of a substance that leads to impaired control, social impairment, risky use, and physical affects such as intoxication, tolerance and withdrawal Intoxication under the influence, high, manifestations depend on substance used, amount and effect on the body and brain Tolerance larger doses are needed to attempt to achieve the same effects as originally obtained, the individual is never able to achieve the same effect as obtained with initial dose Withdrawal physiological symptoms that occurs when an individual stops using or prior to next dose, symptoms are specific to the substance used, may be mild or life-threatening S/S caffeine intoxication restlessness, nervousness, excitement, agitation, inexhaustibility, rambling speech, gi symptoms, diuresis, tachycardia, and other dysrhythmias S/S caffeine withdrawal no significant medical problems, may have headaches, drowsiness, irritability, and GI symptoms S/S marijuana intoxication heightened sensations, depersonalizations, and impaired motor skills, delirium, dry eyes, increased appetite, tachycardia S/S marijuana withdrawal usually occurs about a week after last use; irritability, anger, aggression, anxiety, pressed mood, may include abdominal pain, sweating, fever, chills, headaches S/S Hallucinogens/Intoxicants profound disturbance in reality and are associated with flashbacks, panic attacks, psychosis, delirium, and mood disorders. Occur naturally in some mushrooms or plants or are man-made synthetics. Schedule 1 drugs; psychologic and behavioral changes, impaired judgment, hallucinations, tachycardia, blurred vision, tremors, incoordination S/S hallucinogens withdrawal impairment of normal functioning for weeks, months, or years with flashbacks of original symptoms S/S Phencyclidine (PCP) intoxication medical emergency, individual may be assaultive, unpredictable, and have hypertension, tachycardia, ataxia, muscle rigidity, seizures, coma, hyperthermia may occur S/S inhalant Intoxication small doses cause disinhibition and euphoria. High doses cause fearfulness, illusions, hallucinations, and distorted body image, aggression or apathy, impulsivity and impaired judgment. May cause physical responses such as nausea, depressed reflexes, diplopia, stupor, and unconsciousness with high doses and long lung exposure (EVAPS!) Opioid use disorder Prescription opioid drugs, heroin; chronic relapsing disorder with increasing tolerance to increased doses, results in significant impairment in life roles, interpersonal relationships, and puts individuals in physically hazardous positions including early death S/S Opioid Intoxication psychomotor retardation, drowsiness, slurred speech, altered mood, impaired memory and attention, coma S/S opioid Withdrawal mood dysphoria, N/V, diarrhea, muscle aches, fever, insomnia beginning 6-8 hrs after last dose of morphine, heroin, or methadone; meperidine withdrawal begins 8-12 hours after last use and lasts about 3 days. Sedative, hypnotic, and antianxiety medications use disorder Prescription sleeping pills and antianxiety medications. Craving is typical. Brain depressants affect role performance and relationships. S/S sedative, hypnotic and antianxiety medication Intoxication slurred speech, incoordination, unsteady gait, impaired thinking and judgment, nystagmus; inappropriate aggression and sexual behavior, may lead to coma S/S sedative, hypnotic and antianxiety medication withdrawal autonomic hyperactivity, tremors, insomnia, agitation, anxiety, grand mal seizures. Half-life of drug of choice indicates length of time to withdrawal and end of withdrawal Stimulant use disorder Amphetamine-type, cocaine, and other stimulants produce euphoria and high energy, craving and tolerance develops causing reduced ability to function; S/S stimulant Intoxication individuals feel superhuman, elated, euphoric, and sociable; hypervigilant, anxious, tense, and angry. May have chest pain, arrhythmias, changes in blood pressure, respiratory depression, coma S/S stimulant Withdrawal tiredness, vivid nightmares, increased appetite, insomnia or hypersomnia, psychomotor retardation or agitation, depression and suicidal thoughts during withdrawal Tobacco use disorder Craving, persistent, and recurrent use and tolerance that happens quickly S/S tobacco Withdrawal distressing irritability, anxiety, depression, difficulty concentrating, restlessness, insomnia Alcohol use disorder Alcohol Is a sedative but initially causes euphoria probably due to decreased inhibitions Types of problematic drinking: binge drinking, heavy drinking, S/S alcohol Intoxication Based on alcohol level in blood caused by number of drinks, frequency of ingestion, alcohol content in drinks, food intake, physical condition, familiarity with alcohol use S/S alcohol Withdrawal tremors (shakes or jitters), agitation, loss of appetite, N/V, insomnia, impaired cognition, blood pressure and pulse increased, If psychosis develops it is a medical emergency due to risks of seizures, delirium (DTs), and unconsciousness; seizures may develop 12-24 hours after alcohol cessation Systemic effects of alcohol abuse Peripheral neuropathy, alcoholic myopathy, cardiomegaly, esophagitis and esophageal erosion, gastritis, pancreatitis, hepatitis, cirrhosis of liver, leukopenia, thrombocytopenia, and cancer Tourettes Genetic neurological disorder, head trauma, carbon monoxide poisoning, pregnancy complications, multiple motor tics and at least 1 vocal tic many times a day Tic sudden, rapid, involuntary, and repetitive movement or vocalization EATING DISORDERS Bulimia, Binge eating Anorexia Nervosa: Bipolar, depressive, and anxiety disorders may coexist, Attention deficit disorder problems with attention, impulsivity, hyperactivity such as fidgeting, squirming, getting up when expected to sit down, loud, disruptive, or dangerous activities Paraphalias group of behaviors that are commonly called sexual deviations including inappropriate sexual fantasies that involve deviant sex acts, inappropriate sexual urges, acting out of fantasies and urges Rape and sexual assault Includes unwanted sexual advances, sexual harassment, rape, incest, sex trafficking, mutilation of sexual organs Violence intentional use of physical force or power, threatened or actual, against oneself, another person or group, or community that either results in or has a high likelihood of resulting in injury, death, psychologic harm, maldevelopment, or deprivation; is pervasive across all borders, ages, religion, ethnicity, financial status, and gender Anorexia nervosa significantly low BMI intense fear of weight gain, distorted body image, restricted calories with Bulimia nervosa recurrent episodes of uncontrollable binging, inappropriate compensatory behaviors, vomiting, laxatives, diuretics, exercises, self image largely influenced by body image Binge eating recurrent episodes of uncontrollable binging without compensatory behaviors, binging episodes induce guilt, depression, embarrassment or disgust Heterogeneous group A group in which a range of differences exists among members Homogeneous group A group in which all members share central traits (e.g., men’s group, group of patients with bipolar disorder) Closed group leave A group in which membership is restricted; no new members are added when others Open group A group in which new members are added as others leave (e.g., inpatient group with transient membership) Subgroup An individual or a small group that is isolated within a larger group and functions separately. Members of a subgroup may have greater loyalty, more similar goals, or more perceived similarities to one another than they do to the larger group. Humanism (patient centered, existential, experiential) Self-actualization; awareness of subjective experience Nondirective, active listening, Socratic dialogue Cognitive-behavioral Specific maladaptive behaviors and thought patterns Goal setting, planning, reinforcing, modeling, and monitoring Psychodynamic (psychoanalytic, Gestalt) Insight; resolution of intrapsychic conflict Listening, interpreting, confronting, probing, working through, directing enactments Psychoeducational Information on specific topics; coping; emotional and practical support Teaching, modeling, organizing, leading discussions, assessing Systems (Adlerian, choice/reality, feminist, family, interpersonal Positive interaction with social and political milieu; balance between individual and society; social equality Modeling, analyzing, strategizing lifestyle investigation, activism Interpersonal learning Members gain insight into themselves based on the feedback from others during later group phases. “When you speak to me that way, I feel intimidated.” Catharsis Through experiencing and expressing feelings, therapeutic discharge of emotions is shared. “This experience allowed me to get in touch with my sadness.” Instillation of hope The leader shares optimism about successes of group treatment, and members share their improvements. “You got better, maybe I can too.” Universality Members realize that they are not alone with their problems, feelings, or thoughts. “You feel that way too? Wow! I am not alone.” Imparting of information Participants receive formal teaching by the leader or advice from peers. “Here is how to take your medication.” Altruism Members gain or profit from giving support to others, leading to improved self-value. “I’m sorry that happened to you. I can help you.” Corrective recapitulation of the primary family group Members repeat patterns of behavior in the group that they learned in their families; with feedback from the leader and peers, they learn about their own behavior. “Is this the way you speak to your wife at home?” Socializing techniques Members learn new social skills based on others’ feedback and modeling. “You took that criticism really well. You didn’t appear to become upset. Maybe I can try that.” Imitative behavior Members may copy behavior from the leader or peers and can adopt healthier habits. “I like the way you answered that question, maybe I can try that next time.” Group cohesiveness This powerful factor arises in a mature group when each member feels connected to the other members, the leader, and the group as a whole; members can accept positive feedback and constructive criticism. “This group has helped me to see that when I complain to my daughter about her father that I am triangulating her by trying to get her on my side. Now I see how unfair this is to her.” Existential resolution Members examine aspects of life (e.g., loneliness, mortality, responsibility) that affect everyone in constructing meaning. “I understand that all of us struggle with the inevitable loss.” Autocratic exerts control over group, does not encourage interaction among members Democratic supports extensive group interaction, empowering Laissez-faire allows group to behave as they choose, no attempt to control group process
