quiz 2

  1. Four levels of anxiety:
    • Mild: special attention, increased sensory stimulation, motivational, helps someone grow, learn and change
    • Moderate: something definitely wrong, nervousness/agitation, difficulty concentrating, able to be redirected, learning is still possible
    • Severe: trouble thinking, tightened muscles, increased vital signs, restless, irritable, angry
    • Panic: fight, flight, or freeze response, increased vital signs, dilated pupils
  2. Positive reframing
    • turning negative messages into positive ones
    • (cognitive behavior therapy)
  3. Decatastrophrizing
    • Making more realistic appraisal of a situation
    • (cognitive behavior therapy)
  4. Assertiveness training
    • learn to negotiate interpersonal situations
    • (cognitive behavior therapy)
  5. Panic Disorder
    • Discrete episodes of panic with no stimulus/reason
    • Avoidance behavior
    • Primary, secondary gain (sick role is an added benefit for a physical complaint)
  6. Panic Disorder (treatment)
    • CBT
    • deep breathing
    • relaxation
    • benzos
    • SSRIs
    • TCAs
    • antihypertensives (clonidine, propanolol)
  7. CBT
    cognitive behavioral therapy
  8. Phobia
    • Intense illogical persistent fear
    • Includes agoraphobia, specific phobia, social phobia
  9. Phobias (treatment)
    • behavioral therapy
    • positive reframing
    • assertiveness traning
    • systematic desensitization
    • flooding
    • antidepressants
    • anxiolytics
  10. Obsession
    recurrent, persistent, intrustive, unwanted throughts, images, impulses, causing marked anxiety
  11. Compulsions
    ritualistic or repetitive behaviors or mental acts carried out continuously to neutralize anxiety
  12. OCD (treatments)
    • medications (table 13.3)
    • behavior therapy (exposure, response prevention)

    (don't stop a ritual unless it's harmful to the patient -> decreases trauma)
  13. Generalized Anxiety Disorder (GAD)
    • Chronic - longer than 6 months
    • Treat with Buspirone (BuSpar) and SSRIs
  14. Posttraumatic Stress Disorder
    • re-experiencing traumatic event
    • flashbacks
  15. Acute Stress Disorder
    • more dissociative response than PTSD
    • emotional detachment
    • muddled obliviousness to environment
  16. Psychological Crisis
    • An individual's inability to solve a problem, usual coping mechanisms cannot resolve the problem
    • Acute event
  17. Gerald Caplan's 4 Phases of Crisis
    • 1. Initial threat
    • 2. Continuing threat becomes a crisis
    • 3. Crisis intensifies to panic
    • 4. Serious disorganization and assault
  18. Gerald Caplan's Theory
    If an individual is able to constructively solve a crisis, the individual will gain greater personality integration and coping abilities, failure to do so results in disorganization.
  19. Crisis occurance depends on...
    the person's perception of the event.
  20. Tolerance
    need more of the substance to get the same effect
  21. Tolerance break
    • After developing a tolerance, the tolerance is dramatically lowered temporarily
    • Person can overdose easily at this time
  22. Alcohol
    • CNS depressant -> relaxation/loss of inhibitions
    • use: vomiting, unconsciousness
    • overdose: respiratory rate depressed
    • withdrawal: 4-12 hours after cessation, peak on the second day, lasts about 5 days. Use benzodiazepines (Valium) for safe withdrawal
  23. Kubler-Ross's Stages of Grieving
    • 1. Denial
    • 2. Anger
    • 3. Bargaining
    • 4. Depression
    • 5. Acceptance
  24. Disenfranchised grief
    Grief over a loss that is not or cannot be acknowledged openly, mourned publicly, or supported socially.
  25. Complicated Grieving
    Grief that is outside the norm; person may be void of emotion, grieve for prolonged periods, or has ezpressions of grief that seem disproportionate to the event.
  26. Affective/mood disorders
    • Pervasive alterations in emotions that are manifested by depression, mania, or both
    • Interfere with individual's life
    • Alteration in mood, not thought
  27. Depressive Disorders (medications)
    • SSRIs
    • TCAs
    • MAOIs
    • SNRIs
    • NDRI
    • EMSAM (patch version of MAOIs w/o dietary restrictions)
  28. SSRI side effects
    • GI distress
    • low anticholinergic
    • low sedation
    • sexual disfunction
    • orthostatic hypotension (VITALS)
  29. TCA side effects
    • weight gain
    • dry mouth
    • constipation
    • sedation, drowsiness
    • hypotension (VITALS)
    • blurred vision
    • urinary retention
    • sinus tachycardia
    • decreased memory
  30. Serotonin Syndrome
    • occurs from taking a SSRI and MAOI
    • change in mental status (confusion and agitation)
    • fever, shivering, sweating
    • rigidity, jerks (myoclonus), collapse, paralysis, weakness
    • sluggish pupils
    • tachycardia/pnea, hypersalivation
    • treatment: discontinue use, provide supportive treatment, notify physician
  31. Neuroleptic Malignant Syndrome
    • potentially lethal reaction to dopamine blocking/antipsychcotic drugs, usally occus in first 2 weeks of therapy
    • rigidity
    • high fever
    • unstable BP
    • diaphoresis
    • pallor
    • elevated enzymes, especially creatine phosphokinase; leukocytosis
    • changes in mental status; delirium
    • treatment: discontinue use, treat adverse symptoms
  32. Suicidal Ideation (SI)
    direct or indirect suicidal thoughts
  33. Suicidal threats
    direct verbal or written messages of intent
  34. Suicidal gestures
    • actions resulting in minor injury
    • no intention to die
  35. Suicidal attempts
    serious actions with intention to die
  36. Successul suicide
    death of a person who had conscious intent to die
  37. Antidepressants (mechanism of action)
    • Block reuptake of norepinephrine and serotonin
    • SSRIs have fewest side effects (common ones are dizziness, drowsiness, and dry mouth)
    • TCAs and MAOIs take a while to kick in
  38. Bipolar Disorder (meds)
    • lithium (serum lithium maintenance level is 0.5 - 1.5 mEq/L)
    • anticonvulsants raise brain's stimulus threshold
  39. Intoxication
    The use of a substance that results in maladaptive behavior.
  40. Withdrawal
    The negative psychologic and physical reactions that occur when use of a substance ceases or dramatically decreases
  41. Detoxification
    The process of safely withdrawing from a substance
  42. Substance abuse
    Using a drug in a way that is inconsistent with medical or social norms and despite negative consequences
  43. Substance dependence
    Problems with addiction like tolerance, withdrawal, and unsuccessful attempts to quit
  44. Substance Abuse vs. Substance Dependence
    • Abuse: creates problems in social, vocational, or legal areas of a person's life
    • Dependence: creates physical problems like tolerance, withdrawal, and unsuccessful attempts to quit
  45. Symptoms of alcohol/sedative/anxiolytic withdrawal
    • N/V
    • tremors
    • sweating
    • anxiety
    • agitation
    • tactile/auditory/visual disturbances
    • elevated pulse and BP
    • insomnia
    • HA
    • disorientation

    use benzos for safe withdrawal
  46. You can have a fatal withdrawal to...
    • alcohol
    • benzos
    • sedatives
  47. What drug can you use for n/v/d during withdrawal?
    • Clonadine
    • (assess BP!)
  48. Stages of Change
    • precontemplation
    • contemplation
    • determination/preparation
    • action, maintenance
    • relapse/recycle
  49. To avoid Korsakoff's psychosis and Wernicke's encephalopathy...
    give vitamin B1, or thyamine (banana bag)
  50. Stimulant intoxication
    • euphoria
    • hyperactivity
    • hypervigilance
    • talkativeness
    • anxiety, anger
    • hallucinations, grandiosity
    • stereotypic/repetitive behavior
    • impaired jugment
    • tachycardia
    • HTN
    • dilated pupils
  51. Stimulant withdrawal
    • dysphoria
    • fatigue
    • vivid/unpleasant dreams
    • insomnia/hypersomnia
    • increased appetite
    • psychomotor retardation
  52. What is disulfiram (Antabuse)?
    • drug prescribed to create an adverse reaction while drinking:
    • flushing
    • throbbing HA
    • sweating
    • n/v
    • HTN
    • confusion
    • coma/death
  53. Relapse
    The return to drug use after a drug-free period
  54. Harm reduction
    A way of dealing with behavior that damages the health of the person involved and of their community. Goal is abstinence, but it can help reduce drug use and drug-related deaths, disease, and crime.

    • ex. Offering education and referral to drug treatment opportunities.
    • Permitting drug users to exchange used syringes for new ones, or buy new syringes.
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quiz 2