DISORDERS
ANXIETY, DEPRESSION & GRIEF
CONDITIONS & DELUSIONS
ANGER, ABUSE & MANIA
PHYSIOLOGY AND BONUS QUESTIONS
100
What is premenstrual dysphoric disorder?
A group of manifestations that occur only in the last week before a client menstruates.
Manifestation of mood lability, irritation, dysphoria, and anxiety that occurs repeatedly during the premenstrual phase and decrease or resolves with menses
100
What're the levels of anxiety and describe them?
Mild anxiety: restless, seeking attention, requiring approval/reassurance, increase in questioning or voicing concern. Ability to function is heightened as thinking becomes more focused and sense becomes more elevated.
ex) student studying for exam
Moderate anxiety: pt increasingly on edge, may be easily frustrated and have moments of increased restlessness, unable to sleep, difficulty concentrating, displays increased worry
ex) pt tosses and turns, unable to sleep due to losing their job
Severe anxiety: overwhelmed with stressors, coping mechanisms do not work, increased restlessness, decreased cognition, emotional response is heightened (anger/irritability), cannot complete simple tasks, intense feelings of dread/doom
ex) parent losing a child, the parent does not know what to do or who to call
Panic: overwhelmed with terror and reaches a point of exhaustion, cannot process stimuli from environment around them, unable to communicate verbally, may become detached, risk for self-harm
ex) someone takes an elevator and becomes stuck between floors
Anxiety becomes a disorder when anxiety occurs at inappropriate times/situations, frequency of anxiety increases, intensity of anxiety affects ability to function, and duration of anxiety is prolonged
100
What is dissociative amnesia?
Inability to recall personal info related to traumatic or stressful events. The amnesia can be of events of a certain period of time or details.
Lack of memory from client name or date of birth to client’s entire lifetime.
Dissociative fugue: a type of dissociative amnesia in which the pt travels to a new area and is unable to remember one’s own identity and at least some of one’s past. Can last weeks to months following a traumatic event.
100
Pharmacological ways to treat anger?
-Antipsychotic meds like benzodiazepines, mood stabilizers, anticonvulsants, antidepressants
-IM injection of B52: diphenhydramine 50 mg, haloperidol 5 mg, lorazepam 2 mg
-other meds like olanzapine, diazepam, chlorpromazine, midazolam, droperidol, lorazepam, promethazine, ziprasidone
100
If I have 4 manifestations what substance use category am I?
Mild substance use disorder: 2-3 manifestations
Moderate substance use disorder: 4-5 manifestations
Severe substance use disorder: 6+ manifestations
200
What is Bipolar disorder?
Mood instability characterized by mania and depression, a cycling of mood: can be between hypomania and mild depressive manifestations; or even severe depression with varying levels of mania or psychosis
-have trouble processing thoughts, pt speaks quick but not thoughtfully, confused thought content, decrease cognitive functioning
-manic episode: may overuse substances, stimulants can exacerbate manic manifestations
Bipolar I: reoccurring mood episodes of mania, depression, hypomania
Hypomania s&s: high energy, high level of creativity, decreased need for sleep, talkativeness
Manic s&s: pressured speech, racing thoughts, flight of ideas, distractible, expansiveness,
grandiosity with poor judgement
depressive s&s: depression, irritability
Bipolar II: cycle between hypomania and depression; manic episodes are not as elevated as in bipolar I. The depressive episodes mimic major depressive disorder, risk for suicide.
Substance/med-induced bipolar disorder: cycle of mania, hypomania, depression episodes brought on by med use shortly after becoming intoxicated or during withdrawal period
200
What are some main differences of grief and depression?
200
What is depersonalization?
Experience of being an outside observer of or detached from oneself (e.g., feeling as if "this is not happening to me" or one were in a dream). Nonspecific feeling that a pt has lost their identity. Self is different or unreal.
Ex. Client described the feeling of floating above the ground.
200
what is mania?
State in which the client demonstrates elevated, expansive, and irritable mood.
Mania manifestations may include inflated self-esteem (grandiosity); racing thoughts or flight of ideas; hyperactivity; poor judgment, such as overspending or hypersexuality; not sleeping; and verbose speech or speaking a lot. Bipolar disorders occur in cycles and over time, and a client experiences episodes of depression and episodes of mania/hypomania.
A manic episode is characterized by:
A distinct period of abnormally elevated or irritable mood, abnormally and persistent increase in energy, lasting at least one week, most of the day, nearly every day.
Three or more of the following must be present during the period of elevated mood.
Inflated self-esteem
Decreased need for sleep
More talkative than usual
Flight of ideas or report of thoughts racing
Easily distracted by report or observation
Increase in goal-directed activity or psychomotor agitation
Increased involvement in activities that have a high rate of injury or painful consequences.
Mood disturbance requires hospitalization or causes significant impairment in social or occupational functioning.
Not caused by the effects of a substance such as drug abuse, medication, or other treatment for a medical condition.
200
Describe the 3 phases of GAD?
Alarm phase: When the client is exposed to stress, the human body enters an alarm stage (fight-flight-freeze-fawn) where the body’s heart rate increases, the adrenal glands release the stress hormone cortisol- which gives the body extra energy– and the body reaches a heightened acuity to navigate the perceived stressor.
Resistance stage: The body attempts to stabilize and repair itself following the alarm stage. The body autonomic nervous system begins to cautiously downregulate but nonetheless remains in a heightened state of alert. Provided the stressor resolves and there has been no long term consequence to the body’s ability to self-regulate, the individual’s stress response system will return to its functional baseline. The stressor persists to a point beyond the individual’s ability to compensate.
Exhaustion Phase: The body finds itself depleted of energy reserves and unable to self-regulate independently and reliablExhaustion Phase: The body finds itself depleted of energy reserves and unable to self-regulate independently and reliabl
300
What is cyclothymic disorder?
Clients alternate between mania and mild to moderate depression for at least two years.
-manifestations are less severe than those found in bipolar I or II, can be determined if they do not meet dx criteria for depressive disorders of bipolar I/II
300
What are the 4 types of grief and describe them?
Anticipatory- Grief experienced by someone who is expecting the person to die in a specified period of time.
-grief starts when pt is still alive, and continues after death
-causes complicated bereavement: feelings of loss of control while pt is still alive
-not always RT dying: can be experienced through a divorce, a move, or a job change
Disenfranchised- Grief that is not socially acceptable to express or the expression of grief may not be allowed.
-person feels trapped in silence, caught in emotional/physical complexities that are
intense, isolating, leaving them feel abandoned/overwhelmed/risk for suicide/depression
ex) suicide, abortion, pet dying, family member of perpetrator of a homicide, health care
worker grieving the death of a pt
Traumatic grief- A severe form of separation distress that usually occurs following the sudden and unexpected death of a loved one. Resulting in shock and numbness and is often painful, self-blame or guilt, sense of fear or danger, loss of meaning/purpose in life.
-traumatic grief is associated with complicated grief
-children with traumatic grief: can have intrusive memories about death, avoidance behaviors (not talking about it), numbness/withdrawn, increased emotional/physical responses (irritable, anger, trouble sleeping, decreased concentration, stomachaches, headaches, hypervigilance, fears about their safety)
Complicated grief- characterized by intense grief that lasts longer than would be expected according to social norms and that causes impairment in daily functioning
-includes chronic grief (intense), prolonged grief, chronic & prolonged grief, delayed, or
absent grief
- involves difficult progression through the expected stages
- Pt may develop suicidal ideation, intense feelings of guilt, lowered self-esteem
- Somatic complaints persist for extended period of time
- Suicide, violent death
300
What is derealization?
Experience of unreality, distance, or distortion (e.g., "things are not real"). Perception that the environment has changed.
Ex. Client state furniture in room seems to be small or far away
Believes objects in environment are shrinking
300
Who is susceptible to anger?
-Abuse, aggression, and violence can be accompanied by comorbidities such as schizophrenia, psychosis, anxiety disorders, substance use disorders, bipolar disorder with mania, major depressive disorder, ADHD, PTSD, conduct disorders, personality disorders, and neurophysiological disorders like TBIs, tumors of the brain, and inflammatory disorders of the brain
-all of these conditions can elicit a violent episode
-Someone deficient in MAO-A gene are at risk for aggressive behavior, specifically serotonin, 5-HT (they have increased levels)
-this is associated with Brunner syndrome (symptoms of impulsivity, aggression, violence,
mild cognitive impairment)
-X-linked, genetic influence of aggressive behavior
-the brain’s prefrontal cortex, limbic system, and amygdala play an important role in survival, basic emotions, and aggression
-any lesions in these areas can be problematic
300
What is the ACC and describe it?
amygdala-centered circuit
A neural circuit in the brain that both informs and influences the manifestations of fear, panic, and phobia.
When an individual is exposed to fear, the amygdala and the hypothalamus cause changes in the hypothalamic-pituitary-adrenal axis (HPA), which results in hormone release, leading to the survival response (fight, flight, freeze, fawn).
-explains the brain’s role in manifestations of anxiety
400
What is disruptive mood dysregulation disorder and Major Depressive disorder?
Disruptive mood dysregulation disorder: chronic, severe, persistent irritability most of the day with frequent temper outbursts
Major depressive disorder: major depressive episodes marked by severe depressed mood without mania or hypomania episodes, functional changes such as loss of appetite, sleep disturbances, psychomotor changes (decreased energy, difficulty concentrating, difficulty making decisions), may include suicidal ideations
400
what is major depressive disorder and at least 5 DSM criteria that must be met?
Major depressive disorder: major depressive episodes marked by severe depressed mood without mania or hypomania episodes, functional changes such as loss of appetite, sleep disturbances, psychomotor changes (decreased energy, difficulty concentrating, difficulty making decisions), may include suicidal ideations
400
what is acrophobia, zoo phobia, agoraphobia and chuuchainzophobia?
fear of heights, animals and spaces
400
what are the 4 types of abuse and describe them?
emotional abuse- The intentional infliction of mental anguish through means of intimidation and humiliation.
-used to exert control
-s&s: changes in usual behavior (social withdrawal), loss of self esteem, anxiety from presence of certain people, report of verbal/mental mistreatment
physical abuse- The intentional infliction of bodily harm or pain on others.
-kicking, hitting, slapping, pushing, strangling
-s&s: bruising, lacerations, burn marks, wounds in various stages of healing, ripped/torn
clothing, broken glasses, disheveled hair
Neglect- The failure of a caregiver to provide needed food, clothing, shelter, medical care, or supervision to the degree that the child's health, safety, and well-being are threatened with harm.
-s&s: unattended/untreated health problems, dehydration/malnutrition, poor hygiene,
hazardous/poor living conditions, desertion of a vulnerable individual, report of abandonment
Economic abuse- exploitation, misuse of another person’s financial resources, with or without permission.
ex) stealing, forging checks, promising to pay bills but keep money for themselves,
falsifying wills or financial records
-s&s: sudden banking/account changes, abrupt changes in funds, possessions, wills,
victim not remembering signing financial records, report of exploitation
400
What is the CSTC and describe it?
cortico-striato-thalamo-cortical circuit (CSTC)
A neural circuit in the brain that both informs and influences the manifestations of worry, apprehension, and obsessive thought.
appears to create a loop within the brain that is activated when an individual ruminates, obsesses about something, or has a delusion. There are several neurotransmitters involved, including serotonin, GABA, dopamine, glutamine, and norepinephrine, which affect the loop process. This loop and these transmitters are important components in the role pharmacology plays in controlling anxiety
500
What is Panic Disorder?
Experiencing distinct and extreme periods of physiologic and psychologic hyperarousal.
Usually unexpected and occurs for no apparent reason
Panic attacks may be an aspect or any anxiety disorder
Results in changed behaviors, including:
Avoidance of situations, people, or events that may trigger attack
Worry another attack will occur
Attacks are time limited with a peak of intensity of fear or anxiety
500
What is the anxiety cycle and Seyle's general adaptation syndrome?
Trigger (health issues, meds, stress)
anxious thoughts (I cant do it!)
feelings/emotions (fear, worry, panic that arise from anxiety)
physiological response (increased HR, sweating, nausea, feeling faint)
-also increased blood to the heart, muscles, brain to increase ability to function/think
behavioral response (avoiding situations, withdrawing from people, aggression)
Seyle’s General adaptation syndrome:
Alarm phase: pt exposed to stressed causes fight-flight-freeze-fawn alarm stage. HR increases, the adrenal glands release stress hormone cortisol (giving body extra energy)
ex) MVA causes pt to have tachycardia, tachypnea, hypervigilance
Resistance stage: the body attempts to stabilize/repair itself, the autonomic nervous system begins to downregulate but remains at a heightened state of alert, eventually returning to functional baseline as long as the body can self-regulate due to no long-term consequences
ex) military service member successfully navigates a 6m combat deployment without
illness/injury
Exhaustion phase: body finds itself depleted of energy reserves and unable to self-regulate independently/reliably
ex) child that experiences parental violence for 5+ years is more prone to colds/viruses
500
What are the 11 types of illusions?
-ideas of reference: attaches events/personal significant to them
ex) someone talking about their next meal, person thinks they are talking about them
-persecution: feels singled out for harm my others
ex) thinks they are being hunted down by FBI
-grandeur: believes they are all powerful/important
ex) thinks they are god
-somatic: believes their body is changing in an unusual way
ex) stomach is turning to stone, they are growing a third arm
-jealousy: thinks partner is cheating on them even tho there is no factual proof
-being controlled: thinks an outside force is controlling their body
-thought broadcasting: believes their thoughts can be heard by others
-thought insertion: thinks other’s thoughts are being inserted into their own mind
-thought withdrawal: believes their thoughts are being removed by someone else
-religiosity: obsessed with religious beliefs
-magical thinking: believes their actions/thoughts can control a situation and affect others
ex) wearing a certain hat makes them invisible to others
500
What are risk factors for abuse, aggression and violence? What are predictors of violence?
500
What are the 6 types of trauma and describe them?
