NURS 124 - Mental Health Quiz 5 Study Guide

Mental Health Quiz 5 ● PTSD is more Neurological rather than physical Intervention Related to Trauma-Related Disorders in Children ● Stage 1: Establish trust and provide safety and stabilization ● Stage 2: Reduce aro ...

Mental Health Quiz 5 ● PTSD is more Neurological rather than physical Intervention Related to Trauma-Related Disorders in Children ● Stage 1: Establish trust and provide safety and stabilization ● Stage 2: Reduce arousal and regulate emotion through symptom reduction ● Stage 3: Catch up on developmental and social skills; develop a value system ● Interventions include: ○ Always Promote feelings - through art and play ○ Coordinate with multi disciplinary team ○ Involve caretakers in 1:1s, unless they are the cause of trauma ○ Eye movement desensitization and reprocessing (EMDR) ● Pharmacology include: ○ Methylphenidate (Ritalin) ■ Help with confrontation and attention ■ CNS ■ Use for ADHD patients ■ Administer last dose of the day before 4pm ■ Intermediate drug; Last for 6-8 hours and given 1-2 times daily ■ Give it in the morning after breakfast ■ Teach patient who use transdermal medication to place patch on one hip daily in the morning and leave it for no longer than 9 hours. ○ Sertraline (Zoloft), escitalopram (Lexapro) ■ Help stabilize mood and used for depression ■ Used on 6 years and older ○ Lorazepam (Ativan), alprazolam (Xanax) ■ Help with anxiety Acute Stress Disorder (ASD) ● Immediately after a highly traumatic event ○ Feelings of Detachment ○ Anxiety ○ Irritability ○ Sleep disturbance ○ Anorexia ● Symptoms persist for 3 days ● Diagnosis made within a month ● After 1 month ○ When acute isn’t resolved, it becomes ptsd ○ People usually reexperiences past events NURS 124 MENTAL HEALTH QUIZ 5 STUDY GUIDE Post Traumatic Stress Disorder (PTSD) ● Disturbed/disintegrated response to significant trauma ● Re-experiencing of trauma/traumatic event in the form of recollections, nightmares, & ‘flashbacks’ ○ Explain physical symptoms are R/T psychological state.** ○ Screen for depression ● People will have HYPERVIGILANCE!!!<---know this shit* for the exam Categories of PTSD ● Acute: symptoms last less than 3 months. ● Chronic: symptoms last 3 months or more. ● Delayed onset: at least 6 months have elapsed between trauma and the occurrence of symptoms Treatment of PTSD ● SSRI to help Minimize flashbacks and nightmares ● Anti-anxiety to Decrease physiological arousal ● Sleep-aids for insomnia ● Individual/Group Psychotherapy ● Animal Therapy/Dog, etc. ● Interventions for a child with PTSD ○ Involve caretakers in 1:1’s, unless they are the cause of trauma Trauma Related to Adult disorder ● Anger is an expected emotion ● Example of Positive adjustment ○ Friend die, and you learn to adjust to their death after a year ○ Husband and wife divorce and become friends after 2 years Dissociative Disorders ● Mental disorders that involve experiencing a disconnection and lack of continuity between thoughts, memories, surroundings, actions, and identity ● Depersonalization ○ Focus on self ○ Feelings of detachment, dream like state, feeling of being un real ○ If someone said I feel like flying away, as a nurse you want to get the person to engage in physical activity to bring them back to reality ○ Patient also tend to look at life through a mirror ○ Symptoms ■ Feeling that you’re outside observer of your thoughts, feelings, your body ● “Floating in the air above yourself” ■ Feeling like a robot or that you’re not in control of your speech or movements ■ The sense that your body, legs, or arms appear distorted, enlarged or shrunken, or that your head is wrapped in a cloud ■ Emotional or physical numbness or your senses or responses to the world around you ■ A sense that your memories lack emotion or they may/may not be your own memories ● Derealization disorder ○ Focus on the outside world ○ A feeling of being detached from one’s surroundings ○ Symptoms ■ Feelings of being alienated from or unfamiliar with your surroundings ● “Like you’re living in a movie or a dream” ■ Feeling emotionally disconnected from people you care about ● As if you were separated by glass ■ Surroundings appear distorted, blurry, colorless, twodimensional, or artificial, or heighten awareness and clarity, of your surroundings ■ Distortions in perception of time ● Recent events feeling like a distant past ■ Distortion of distance and size and shape of objects ● Dissociative Amnesia ○ Inability to recall important personal information ○ Dissociative fugue ■ Subtype characterized by sudden, unexpected travel and inability to recall one’s identity ● I cannot recall who I am, why I am living here, where I am from. ● Forget previous life or returns to previous life and forget the life while missing ● Dissociative Identity Disorder ○ Was known as multiple personality disorder ■ Characterized by the presence of (a person’s identity fragmenting into) two or more distinct personality states. ■ People with this condition are often victims of severe abuse ○ Most detrimental thing is that patient might hurt themselves ○ Most important concept is self destruction ○ DIAGNOSIS: RISK FOR SELF HARM** ○ Teach patient to Avoid caffeine, alcohol, nicotine, chocolate and soda ● Pharmacological Intervention ○ FDA approved SSRI: Sertraline (Zoloft) or paroxetine (Paxil) ○ Topiramate (Topamax) ■ 25 – 50mg Helps with nightmares ○ Alpha-blocker: Minipress (Prazosin (isnt this the generic name)) 1 – 2mg ■ Used for “flash backs” and nightmares ○ Trazodone ■ Insomnia without nightmares ○ Beta-blocker: Inderal (propranolol (isnt this the generic name)) ■ Used after traumatic events ○ Risperidone / Quetiapine ■ Hypervigilance ■ Intrusive thoughts ○ Avoid Benzodiazepine - habit forming ○ Lamotrigine (Lamictal) ■ Helps with anger ● Somatization ○ Symptoms expressed in place of anxiety, depression, or irritability ● Somatic symptom disorder (SSD) ○ One or more distressing symptoms ○ When patient is stress and manifest as physical symptoms ○ EX: Patient experienced a traumatic events and 3 days they’re unable to walk ○ Tx: antidepressants ● Illness anxiety disorder (previously hypochondriasis) ○ Hypochondriasis is when patient is not sick but think they are sick ○ Make sure to set limits with them because they will keep asking you to check vital signs and check if they are okay ○ “I took your BP 3times, we can do it again in about an hour or so” ● Conversion disorder ○ Neurological symptoms in the absence of neurological diagnosis (functional neurological) ○ You are really sick but you don’t believe that you are sick ○ Physical symptoms relieve the anxiety ○ Patients are resistance to accepting help ○ Sxs: paralysis, blindness*, movement and gait disorders, numbness, paresthesias, loss of vision or hearing, or episodes resembling epilepsy ○ “La belle indifference” vs. distress ■ Unconcerned with symptoms caused by a conversion disorder ● Assessment: ○ Advantage:Increased attention, disability benefits, or release from unpleasant responsibilities ○ Ineffective coping is the only diagnosis that can be used for all mental diagnosis** ● Outcome Identification ○ Patient can see concrete evidence of progress ● Key Element for effective treatment ○ Always conduct a physical exam. ○ Set Realistic and reasonable goal for patient ○ Establish therapeutic relationship ○ Provide a safe, nonthreatening, routine environment ○ Relaxation techniques ■ Music therapy ■ Guided imagery ■ Breathing techniques ■ Exercise ■ Healthy diet PTSD Dissociative elements ● Numbness, feeling unreal, amnesia Factitious Disorder ● Pretend to be sick to avoid consequences ● EX: Pretend to be sick to get the attention from the spouse ● Compulsivity ● Factitious Disorder is a Voluntary Control and SSD is due to stress ● ALWAYS ASSESS FOR Secondary gains ○ Any advantage - increased attention, disability benefits, or release from unpleasant responsibilities Munchausen Syndrome ● Person repeatedly and deliberately acts as if he or she has a physical or mental illness when he or she is not really sick. ● Self-directed/Imposed on self Munchausen Syndrome by Proxy ● Person most especially the mother, gains attention by seeking medical help for exaggerated or made-up symptoms of a child in his or her care. ● Other-directed/ Imposed on others ● If the pt tells you “I broke my kids arm to get out of work” report it, document it, protect the child or elderly – get social authorities involved ● Make sure to Always provide a safe environment Tic Disorders ● Stereotypic movement disorder ○ Repetitive, purposeless movements for 4 weeks or more ● Sudden nonrhythmic, involuntary, rapid motor, and repetitive movements or vocalizations ● Tourette’s disorder ○ Multiple motor tics and at least one vocal tic for more than 1 year ○ Onset may be as early as 2 years, but occurs most commonly around age 6 or 7 ○ Child is not faking - symptoms ■ Comes and goes ■ Change frequency and severity ● Persistent motor or vocal tic disorder ○ Single or multiple motor/vocal tics, but not both for more than one year ● Provisional tic disorder ○ Single or multiple motor and/or coal tics for less than one year ● Treating tic disorders ○ Behavioral techniques ○ Medications ○ Deep brain stimulation (DBS) ● Tourette affects the Basal Ganglia, frontal lobes and cortex) ● Assessment: Vocal tics include words or sounds such as squeaks, grunts, barks, sniffs, snorts, coughs, and, in rare instances, a complex vocal tic involving the uttering of obscenities.