SUBJECT: LECTURE: IMPORTANT DATE: (equations, laws, etc.) NOTES Anxiety Stages To reduce anxiety Anxiety prevent or diminishunwanted primarysymptoms are fear mostcommon d x chronic persistent womenexperience it more often tanxiety Identifythe use of defense mechanism whether it is healthy t with prevalence common thoughts or feelings age within adolescents or detrimental what is healthy for one maynot befor Normalanxietyresponse realisticintensity t duration forthe situation followedbyrelief another behaviors intended toreduce orpreventmoreanxiety Abnormalanxietyresponse appropriateforsituation symptomspersist can lead to canbeused tohelpidentifywhichunderlying problem separation anxietydisorderand or mutuism suicidal ideation attempts hascausedtheanxiety ofapprehension Anxiety is or dread in response tointernal or externalstimuli an uncomfortablefeeling that determine if it is of a mentaldisorder intensity parenthood Drug alcohol dependence Educational underachievement Panicdisorder Factors a symptom early Extremeoverwhelmingformofanxiety usually happenswhenperson is placed a lifethreatening situation rt situation Panic is normal during periods of threat Abnormal when experienced in situations of norealphysical or psychologicalthreat Triggers mm Mild socialanxiety or shyness Moderate more persistent inabilityto controlworrying majority of thedays inweek noteveryday Severe intensitydebilitating tachycardia socialwithdraw Panic cognitive physicalsymptomsimpairment cannotretaininfo loosecontrolofshittpiss Panicattack sudden discrete periods of intense fear or discomfortwith significant physical cognitive symptoms usually peak in about 10mins but can last up to 30 mins beforereturning to normal onset20 to 24 yrs Éttgg5sof palpitations chestdiscomfort Feel of impendingdoomor or losingcontrol Physical y rapidpulse nausea dizzinesssweating paresthesias trembling or shaking feeling deesnpersate suffocation g fear cognitive disorganized thinkingirrational communication depersonalization poor SUBJECT: LECTURE: IMPORTANT DATE: (equations, laws, etc.) NOTES Panicattackcontinued person limit socialfunction with this may willneedsupport fromfamily encouragement Teamwork Needsafe therapeuticenvironment Med monitorforeffects psychotherapy prioritycareissues safety ofhigh because risk of suicide Panic Control Tx systemic desensitazation Implosivetherapy allow clients toreviewtheunpleasant situationthatcauses theanxiety Exposuretherapy Benzoshelpacutephasebutdoesn't treat Firstpriority issuicide prevention Assess for depression physicalsymptoms dizzinesshyperventilation Help pt relax anxiety becomfortable discussingfears Teach relaxationtechniques Promote physicalactivity Positive self talk SSRIS Benzo Pharmacologic interventions SNRIs anxiolytic Anti Buspar During emergency care staywith duringpanicattack pt reassureyouwon'tleave Giveclear directions theycanretain minimalenvironment stimulation AdministerPRNanxiolyticdrugs pt torent Allow if hopelessness Sense of ill being uneasiness demoralization fearofimminentdisaster In orderDx musthave itforatleast6month Insidious onset Manycomplainofbeingchronicworriers allages exhibit milddepressivesymptoms may Affects Highlysomatic GI chest pain experiences poorsleephabitsirritability trembling twitching poorconcentration exaggeratedstartleresponse Nursing care is similar topanicdisorder Meds Antidepressants CognitiveBehavioraltherapy Pharmacologicalinterventions SSRIs GeneralAnxietydisorder GAS Feeling offrustrationdisgust w life Antianxietyagents Nursing interventions of anxiety helptargetspecificareas reducing theimpactofanxiety Agoraphobia fear oranxietytriggered bytwo ormore situations Believed somethingterriblemighthappen escapewillbedifficult Mayoccur with panic disorders butconsidered separate disorder Anxiolytics t Exposure therapy given for specific phobias SocialAnxiety disorder persistent fear of social or performance situations in whichembarrassment occur SSRIs toreducesocial anxiety may t phobic avoidance Benzo to reduceAnxietycausedbyphobias SUBJECT: LECTURE: IMPORTANT ECT DATE: (equations, laws, etc.) Electroconvulsivetherapy Need to be medically cleared or consentform prior SE Short Term Memory Therapeutic mechanism unknown Effective tx forpts w severedepression NOTES Depression Major Depressiveorder Meds Depressedmoodlasting minimum Medications of 2weeks Antidepressants Sls sleepdisturbances changes inappetite Firstlinetherapy SE Nausea headacheCnsstimulation anergia SexualDysfunction Dixmade if MDAlast2yearsinadult or 1year TricyclicAntidepressants TCAs Neurotransmittereffects inchildren tadolescents SedativeEffectsdueto blockedofhistamine receptors characterized mood sadness of feeling SE changepositionsslowlytominimize byrecurring swings before w eeks dizzinessdueto orthostaticchanges or sensitivitytorejectioninthefinal Anticholinergiceffects theonset ofmensesbegins SSRI treats this twoweekspriortomenstrualcycleptgetphysical preywomen Toxiceffect urinaryretention severe symptoms Theweek ofperiodemotionalsymptoms constipationseekmedattention disorder mood Disruptive dysregulation Severeirritability outburstsoftemper MAOIs onsetbeginstheage of 10whenchildren have Mnorepinephrine dopamineserotonin towards verbal unconventionaldepression Indications and physically or are aggressive rages panicdisorde others orproperty sociatphobia example orthostatic hypotension weight occursfrequently 2 3x aweek Seasonal AffectiveDisorder SAD edema Intracranial hemorrhage for Mooddisturbances usuallyhappensduring SE Interacts withTCA t SSRI Avoidfoods withtyramineBeer cheese thewinterseason Tx Lighttherapy effectiveformildtomoderateseasonal mm helpful Not of depression Remission othertreatments forptswhoarenotseasonallydepressed Electroconvulsivetherapy Assessmenttoolfor Depression PHQ 9 Assess forsuicidalpotential focus on pt's strengthex ggendatgoplayfoccer phases gain C 2 month withabsenceof main symptoms partialremission Psychotherapy CBT stimulation t.fm IPT gnethcerapy Transcranialmagnetic fields tostimulatebraintoimprovesymptoms Nervestimulation implantabledevice Vagus Exercise produceserotonin Maitenance preventrecurrence 2 months nosymptomsfullremission Discontinuation Maintenancetx Continuation Medsbecontinued to 4 9months freefrom recurrence 9 12months SUBJECT: LECTURE: IMPORTANT (equations, laws, etc.) Anorexia NOTES DATE: Bulimia Bum Anorexia Nervosa Chronic I yearrelapse rate of 50 Twotypes restricting Binge and purgingtype BulimiaNervosa repeated episodes of binge eatingfollowed inappropriate compensatory behavior selfinducedvomiting misuseof laxativesdiuretics by fasting or excessiveexercise Bingeeatingdisorder Nocompensatory behavior Eatingdisorders are common in atheletes Ho of obesity lowselfesteem from society psychological pressure distorted bodyimage Anorexia NervosaFindings prevalent in women SIS Lanugo thin hair coolextremities poor skinturgordentalerosion t caries muscle weakness for constipationamenorrhea at least 3 cyclesenlargement of parotid glands mottling of the skint edema Complication refeeding syndrome Interventions Suicidal ideation first psychosocial interventions pharmacologicalinterventions integrativemedicine massage yoga promotion healthteaching t health therapy safety teamwork Psychotherapy Individualtherapy Grouptherapy Family therapy a weightWWL or ptsusuallymaintain lowwat k slightlyhigher Inifffflargemffggotid glands dentalerosion and caries if this pt Mostcommon in female Average age 15 18 Twotypes Purging Nonpurging Intervention Teamwork safety Pharmacological counseling healthteaching healthpromotion Psychotherapy Binge Eating Eats a largeportion of food in a short period of time usually I to 2 hrs No compensatory behavior 46 55 age Risk for type28M HTN CA More common in Interventions same as Bulimia but includes Bariatricsurgery SUBJECT: LECTURE: IMPORTANT NOTES DATE: (equations, laws, etc.) Bipolardisorder Mania Abnormallyelevated mood grandiose irritability confabulation Manic pts can insomnia manipulative pressuredspeech Episodes last verbosity 1 week makes a splitting Mustset limits w are not appropriate certain behaviorspts noteating spending Hospitalizations is usually required Riskfactors Genetic Hypomania Less severeepisode of mania Episodes last at least 4 days with 3 mania psychological of one episode of full mania 1 week alternating w depression Bipolar II disorder one or more hypomania episodes alternating w major depressive for at least 4 days Cyclothymia At least 2 yrs of repeated episodes but donot meet criteria forepisodes alternating with minor depressive hypomania symptoms Characteristics Mood Labile agitated Irritable Behave Impulsive attention judgment seeking poor flashy Lithium carbonate mood stabilizer Therapeuticlevels ds neuroendocrine substance use Alcohol or drugs PharmalogicalIntervention within 1 year Screeningtool Mood disorder questionnaire MDQ At least stressfulevent Physiological Neurological Hospitalization not required Rapidcycling Four or more episodes of hypomania or acute mania Bipolardisorder I to others Danger demanding lot ofmistakes or more manifestations be htroutegretiver 0.8to 1.4m Maitenance 0.4 to 1 Toxic 1.5 above Egil CI Avoid lowsodium diet CatD in pregnancy Liver disease SevereRenal or cardiacDisease hyporolemia schizophrenia Anticonvulsant Valproate Depakote Lamotrigine 7 555 stopmed notify provider Doubleorblurred rsion Liver toxicity Jaundice IFT before starting carbamenzapine Tegretrol Monitor platelets lookforbruising bleeding gums Avoid oralcontraceptives Warfarin Flight ofIdeas as effects Nystagmus doublevision vertigo gait clang associations otherdrugs pressured speech d t staggering clonzapem Lorazepam atypicalantipsychoticsoigggp.iq othertx Eetsupportgroups safety Healthteaching promotion SUBJECT: IMPORTANT LECTURE: DATE: (equations, laws, etc.) PTSD OCD NOTES occursfollowing exposure to an Obsessions thoughtsimages orimpulses thatpersist actual rear Traumaticevent can include death seriousinjury or sexual violence can belearned fromothers or Compulsions Ritualisticbehaviors which is anattempt in reducing anxiety repeatedexposure symptoms often developwithin OCD Distressfulobsessions t compulsion that interfere w life 4generalsymptoms Excoriation disorder skin picking These usually reduceanxiety Intrusive symptoms avoidance ofperson place orobjectthattriggers NegativeMood orcognition negativethoughts arousal aggressive reckless orself Hyper destructivebehavior at sleepdisturbances or hypervigilance Interventions ECT Fluoxetine Exposure ResponsePrevention pts Basicallyhaving least I month exposeto something that inducesthese behaviors telling them to refrain Behavioraltherapy Thoughtstopping stop CBT makingthem aware of ex Belief of deathfromgerms on Joliet having ptputhands onjoliet feelingofunreality spacing Treatment for Intrusion involvesmemories or dreams nightmare related totheevent canalsobestimulatedthrough noise smell Dissociative Derealization PTSD 3to 6 months after the event usually worse during times ofstress Pts usually have tricistitiditania SSRI's sertraline or threatened traumaticevent out depersonalization unreal Amnesia aboutabuse off label use SSRIS Bad blockers ofprazosin SNRIs Beta inhibitor alpha t Psychotherapy like CBT Ptsd ptmaybelieveno one can be trusted or theyareterrible people has anMrisk ofsuicide recognition treatment lead to Earlysuccessful outcomes self injury substanceabuse Recoverytakesdime Needssupport more SUBJECT: IMPORTANT NOTES LECTURE: (equations, laws, etc.) Personalitydisorder symptomsthat cause distress Personality DisorderCluster A Paranoid ODB eccentric sus Schizotypal Loner magicalthinker Schizoid emotionally distant Tx prolonged intensivepsychotherapy cautious w grouptherapy Cluster B Antisocial Borderline erraticdramaticafraid of mum Attn seeking overlyemotional lackappreciation forconcerns ofothers TX CBT DBT selfhelpgroup Be aware of transference countertransference Histrionic Narcisstic Limit setting Pharm Depakote Valproate ClusterC Obsessive compulsive forimpulsiveness or rage rigidpreoccupied afraid to takeaction rules or reaction of others Dependent DATE: Avoidant anxious fearful w Tx Safety is importantindividualtherapy SSRI Benzo fortheclient often leadto longterm use of healthcareservices Nopathological explanation Illness anxietydisorder Fearful of developing a serious illness based on misinterpretation of body sensation Ex occasionalcough sees oncologist fear of having lungCA FactitiousDisorder mentalillness bytheclienttoreportphysical t psychological manifestation consciousdecision ConversionDisorderfunctional neurologicaldisorder s's paralysisblindnessmovement gaitdisordernumbness paresthesia loss ofvision orhearing or episodesresembling epilepsy belleindifference person La by caused isunconcernedwsymptom conversion Disorde Ptseizes continuestheactivityfrombefore Tx treatthe symptoms SUBJECT: IMPORTANT LECTURE: (equations, laws, etc.) Alcohol t Drugs NOTES Goal intensetreatment primaryconcern Relapse Alcohol CNS Depressant mildsedation comarespfailureedeath Intoxicationbaseon BAL use CAGEquestionnaire oftimept is given meds toavoid withdraw observed 12 or more willgive certainmeds Benzos P Chlordiazepoxide Alprazolam Diazepam Antidepressants Antipsychotics Maintenance tx Disulfiram Naltrexone usedforalcohol opioids Acamprostate Cocaine effect suddenalertness energy feelingsof self confidencebeing in control sociable reportpanicattack last 1020min letdowneffectirritabledepression CNS stimulation drawl with violentbehaviorstroke contractingHIVhepatitis weightloss toothdecay intense itching RohypnolGHBketamine daterape dog incapacitating causeeuphoricsedative lineeffect anterogradeamnesia Use CIWA Alcoholwithdraw1Meds dependence addictionpsychosismooddisturbances anxietynausea blurred vision dose A malignanthyperthermia musclebreakdown kidney cardiofailure death Restlessness tachycardia death Detoxification period Longterm Ecstasy Aenergy cancausehallucinations confusion Alcohol withdrawl syndrome usuallywithin 12hrs after Deliriumtremens NIV tremors Grand Mal seizures highlyaddictive Acton as peripheralnervoussystem treatsADHD narcolepsy depressionobesity resultsin tachycardia arrhythmiaMBPperipheralhyperthermia Effectsare similar to cocaineod Amphetamine torecoverfromabuse mayrequirelong Rush DATE: tiredness t cravingmore canresultin respfailure severeanxietyrestlessnessagitation intense depressioncraving Longtermuse I norepinephrine crash sleeping 12to 18 hrs concentration anhedonia anergia poor arrest Naltrexone A codeine opium heroin morphine Buprenorphine Naloxone emergency tx ofod Intialdetox gradualreduction ofuse Maintenance methadone therapywithBehavioraltherapy Opioids Morphine counseling SUBJECT: LECTURE: IMPORTANT (equations, laws, etc.) NOTES SexualAssault anyform ofnonconsentingsexualanxiety rapemustsevere femalevictims anyoneofanyagemostare youngadultsmostvulnerable menlesslikely to report mildcovert tosevereovert exhibitionism voyeurism touchingchild'sballst privatearea oralanal vaginal penetration Rope mostsevereform ofsexualassault Tx courtmandated anypt programsforextendedperiod CBT educationaltopics psycho operation ofprograms comprhensiveintervention effort thatincludescriminaljusticesupport SSRI Accountabilityforviolentacts Nursing intervention therapeuticrelationship providesafety stopviolence safetyplanning teachchildrenviolencenot okay manageanger angermanagement copingwanxiety I findingstrength hope DATE: