Final Exam Study Guide.docx

Final Exam Study Guide Mental Health Course 50 questions, 82 seconds per question Chapters: 13, 15, 16, 17, 18, 19, 20, 21, 22 May 2024 Directions: Please use this as a study guide to guide your studying for the final exam in Mental Health Class. Refer to Quiz 3 questions as they might re-appear on...

Final Exam Study Guide Mental Health Course 50 questions, 82 seconds per question Chapters: 13, 15, 16, 17, 18, 19, 20, 21, 22 May 2024 Directions: Please use this as a study guide to guide your studying for the final exam in Mental Health Class. Refer to Quiz 3 questions as they might re-appear on the final. Also, look at questions asked during our lectures as those might re-appear on the final. Good luck studying! Causes of delirium Delirium is a serious disturbance in mental abilities that results in confused thinking and reduced awareness of the environment. It often develops rapidly over hours to days and can fluctuate throughout the day. There are several potential causes of delirium, including: Medical Conditions: Delirium can be caused by underlying medical conditions or illnesses, such as infections (e.g., urinary tract infections, pneumonia), metabolic imbalances (e.g., electrolyte disturbances, dehydration), organ failure (e.g., liver or kidney failure), cardiovascular conditions (e.g., heart attack, stroke), respiratory disorders (e.g., COPD exacerbation), or neurological conditions (e.g., seizures, brain tumors). Medications: Delirium can be a side effect of certain medications, particularly in older adults or those taking multiple medications (polypharmacy). Medications commonly associated with delirium include sedatives, hypnotics, opioids, anticholinergics, benzodiazepines, antipsychotics, and medications with anticholinergic effects. Substance Withdrawal: Delirium can occur during withdrawal from certain substances, including alcohol, benzodiazepines, opioids, and other drugs. Alcohol withdrawal delirium, also known as delirium tremens (DTs), is a particularly severe form of delirium associated with alcohol withdrawal. Infections: Infections, particularly in older adults, can trigger delirium. Common infections associated with delirium include urinary tract infections, pneumonia, sepsis, and systemic infections. Surgery or Hospitalization: Delirium can occur as a complication of surgery, especially in older adults, or because of hospitalization, particularly in intensive care units (ICUs). Factors such as anesthesia, pain medications, sleep disruption, immobility, and environmental stressors can contribute to delirium in these settings. Trauma or Injury: Head injuries, traumatic brain injuries (TBI), or other forms of physical trauma can lead to delirium, especially if there is damage to the brain or disruption of normal neurological functioning. Sleep Deprivation: Prolonged sleep deprivation or disruption of normal sleep patterns can contribute to the development of delirium, particularly in vulnerable individuals. Psychological Stress: Severe psychological stress, such as emotional trauma, grief, or acute psychosocial crises, can precipitate delirium in some individuals. Pre-existing Cognitive Impairment: Individuals with pre-existing cognitive impairment, dementia, or other neurological conditions may be more susceptible to delirium when exposed to triggering factors. Typical time progression to develop Alzheimer’s Disease (AD) Stage 1. No Apparent Symptoms. In the first stage of the illness, there is no apparent decline in memory despite changes that are beginning to occur in the brain. Stage 2. Very mild change. The individual begins to lose things or forget names of people. Losses in short-term memory are common. The individual is aware of the intellectual decline and may feel ashamed, becoming anxious and depressed, which in turn may worsen the symptom. Maintaining organization with lists and a structured routine provide some compensation. These symptoms often are not noticed by others and do not interfere with the individual’s ability to work or live independently. Stage 3. Mild Cognitive Decline. In this stage, there is interference with work performance, which becomes noticeable to coworkers. The individual may get lost when driving his or her car. Concentration may be interrupted. There is difficulty recalling names or words, which becomes noticeable to family and close associates. Stage 4. Moderate cognitive decline. At this stage, the individual may forget major events in personal history, such as his or her own child’s birthday; experience declining ability to perform tasks, such as shopping, cooking, and managing personal finances; or be unable to understand current news events. He or she may deny that a problem exists by covering up memory loss with confabulation (creating imaginary events to fill in memory gaps). Depression and social withdrawal are common. At this stage, the individual requires some assistance to maintain safety. Stage 5. Moderately severe cognitive decline. At this stage, individuals lose the ability to perform some A D L’s independently, such as hygiene, dressing, and grooming, and require some assistance to manage these tasks on an ongoing basis. They may forget addresses, phone numbers, and names of close relatives. They may become disoriented about place and time, but they maintain knowledge about themselves. Frustration, withdrawal, and self-absorption are common. Stage 6. Severe cognitive decline. At this stage, individuals may be unable to recall the name of their spouse or may misidentify people (e.g., thinking a child is their spouse). Disorientation to surroundings is common, and the person may be unable to recall the day, season, or year. The person is unable to manage A D L’s without assistance. Delusions often become apparent, such as maintaining the belief that one must go to work even though they are no longer employed. Urinary and fecal incontinence are common. Sleeping becomes a problem. Psychomotor symptoms include wandering, obsessiveness, agitation, and aggression. Symptoms seem to worsen in the late afternoon and evening—a phenomenon termed sundowning. Communication becomes more difficult with increasing loss of language skills. Institutional care is usually required at this stage. Stage 7. Very severe decline. In the end stages of A D, the individual is unable to recognize family members. He or she most commonly is bedfast and aphasic. Problems of immobility, such as decubiti and contractures, may occur. Differences between major neurocognitive disorder (NCD) and mild NCD Neurocognitive disorder (N C D) is classified in the D S M-5 as either mild or major. Mild N C D has been known in some settings as Mild Cognitive Impairment and is particularly critical because it can be a focus of early intervention to prevent or slow progression of the disorder. Major N C D constitutes what was previously described as dementia in the D S M-I V-T R. In progressive neurodegenerative conditions, these two diagnoses may serve to identify earlier and later stages of the same disorder Know social skills training for patients with schizophrenia and other psychotic disorders – what does it include? Social skills training: Use of role play to teach client appropriate eye contact, interpersonal skills, voice intonation, posture, and so on; aimed at improving relationship development Know the causes of hallucinations and delusions – think about what neurotransmitter causes them Hallucinations and delusions can have various causes, including neurotransmitter imbalances in the brain. For example, excessive dopamine activity is associated with hallucinations and delusions in conditions such as schizophrenia, while serotonin imbalances may contribute to hallucinations and delusions in conditions like psychosis and mood disorders. Additionally, disruptions in other neurotransmitter systems, such as glutamate and gamma-aminobutyric acid (GABA), can also play a role in the development of hallucinations and delusions. Other factors contributing to hallucinations and delusions include structural brain abnormalities, neurological conditions, substance use, sleep deprivation, and certain medical conditions. Know examples of loose associations, paranoid delusions, magical thinking, and delusions of reference Loose Associations: Loose associations, also known as derailment or tangential thinking, refer to a thought process where ideas shift from one subject to another in an unrelated or only loosely connected manner. In severe cases, it can be indicative of disorganized thinking, a symptom commonly associated with schizophrenia. An example of loose associations might be: "I need to go to the store to buy milk. The cat was meowing loudly last night. Did you know that the moon is made of cheese? I wonder if there's a sale on cheese at the store." Paranoid Delusions: Paranoid delusions involve irrational beliefs that others are plotting against or intending harm towards oneself, often without evidence to support these beliefs. Paranoid delusions can be a symptom of various mental health conditions, including schizophrenia and paranoid personality disorder. An example of a paranoid delusion might be: "My neighbors are spying on me through hidden cameras in my apartment. They're trying to steal my ideas and sabotage my work." Magical Thinking: Magical thinking involves beliefs that one's thoughts, words, or actions can influence events or outcomes in ways that defy logic or rationality. While magical thinking can be a normal part of childhood development, it can also be a symptom of certain mental health disorders, such as obsessive-compulsive disorder (OCD) or schizotypal personality disorder. An example of magical thinking might be: "If I don't step on cracks in the sidewalk, my mom won't get sick." Delusions of Reference: Delusions of reference involve beliefs that neutral or unrelated events, objects, or behaviors are personally significant or directed towards oneself. Individuals experiencing delusions of reference may perceive harmless or coincidental occurrences as having special meaning or relevance to them. This symptom is commonly associated with schizophrenia and other psychotic disorders. An example of delusions of reference might be: "The news anchor on TV is talking directly to me. He keeps mentioning my name and sending me secret messages about the government spying on me. Causes of substance-induced psychotic disorder directly attributable to substance intoxication, withdrawal, or after-exposure to a medication or toxin Symptoms you’d want to intervene with when a patient is taking antipsychotic medications Extrapyramidal symptoms: Pseudo parkinsonism (stiff muscles, shuffling gait) Akinesia (freezing mid movement) Akathisia (inability to remain still) Dystonia (involuntary muscle contraction) Oculogyric crisis (extraocular movements) Antiparkinsonian agents may be prescribed to counteract E P S. Priority nursing intervention when patient is having command hallucinations for self-harm When a patient is experiencing command hallucinations instructing them to harm themselves, immediate intervention is necessary to ensure their safety. The priority nursing intervention in this situation is to implement measures to prevent the patient from acting on the hallucinations and harming themselves. Here are some steps a nurse can take: Maintain a Safe Environment: Ensure that the immediate environment is free from objects that could be used for self-harm, such as sharp objects, medications, or anything else that could pose a risk to the patient's safety. Stay with the Patient: Provide constant supervision and stay with the patient at all times to monitor their behavior and intervene if they attempt to harm themselves. Engage in Therapeutic Communication: Use a calm and non-confrontational approach to communicate with the patient. Validate their feelings and express empathy while gently redirecting their thoughts away from the hallucinations. Assess the Severity of Hallucinations: Determine the frequency, intensity, and duration of the command hallucinations. Assess whether the patient has a plan or intent to act on the hallucinations. Implement Suicide Precautions: Depending on the severity of the situation and the patient's level of risk, consider implementing suicide precautions such as one-to-one observation, removal of potential means of self-harm, and close monitoring of the patient's behavior and mood. Involve the Treatment Team: Notify the patient's healthcare provider, psychiatrist, or mental health team immediately to inform them of the situation and request further assessment and intervention. Administer Medications as Ordered: If the patient is on antipsychotic medications or other psychotropic medications, ensure that they are administered as prescribed to help manage the hallucinations and stabilize the patient's condition. Document the Incident: Document the patient's behavior, the content of the hallucinations, the interventions implemented, and the patient's response to those interventions in the medical record. Provide Emotional Support: Offer emotional support and reassurance to the patient. Encourage them to express their feelings and concerns, and provide information about coping strategies and resources for managing distress. Develop a Safety Plan: Collaborate with the patient and the treatment team to develop a safety plan that includes coping strategies, support resources, and steps to take if the patient experiences worsening symptoms or urges to self-harm in the future. Symptoms associated with major depressive disorder Persistent sadness, loss of interest or please in things you use to do, sleep disturbances, fatigue, weight changes, difficulty concentrating, Know the FDA approved antidepressants for adolescents As of my last update in January 2022, the U.S. Food and Drug Administration (FDA) has approved certain antidepressant medications for the treatment of major depressive disorder (MDD) in adolescents. It's important to note that while these medications have FDA approval for use in adolescents, they should be prescribed and monitored by a qualified healthcare provider who can carefully assess the individual's symptoms, history, and treatment needs. Here are some FDA-approved antidepressants for adolescents: Fluoxetine (Prozac): Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) antidepressant that has been approved by the FDA for the treatment of MDD in adolescents aged 8 years and older. It is also approved for the treatment of obsessive-compulsive disorder (OCD) and bulimia nervosa in adolescents. Escitalopram (Lexapro): Escitalopram is an SSRI antidepressant that has been approved by the FDA for the treatment of MDD in adolescents aged 12 years and older. Sertraline (Zoloft): Sertraline is an SSRI antidepressant that has been approved by the FDA for the treatment of MDD in adolescents aged 6 years and older. It is also approved for the treatment of OCD in adolescents. Fluvoxamine (Luvox): Fluvoxamine is an SSRI antidepressant that has been approved by the FDA for the treatment of MDD in adolescents aged 8 years and older. It is also approved for the treatment of OCD in adolescents. Paroxetine (Paxil): Paroxetine is a selective serotonin reuptake inhibitor (SSRI) antidepressant that has been approved by the FDA for the treatment of MDD in adolescents aged 12 years and older. It is also approved for the treatment of panic disorder, social anxiety disorder, and generalized anxiety disorder in adolescents. Citalopram (Celexa): Citalopram is an SSRI antidepressant that has been approved by the FDA for the treatment of MDD in adolescents aged 12 years and older. Difference between dysthymia and major depressive disorder Characteristics of persistent depressive disorder, or dysthymia, are similar and perhaps milder than MDD. There is no evidence of psychotic symptoms. The essential feature is a chronically depressed mood (or possibly an irritable mood in children or adolescents) for most of the day, more days than not, for at least 2 years (1 year for children and adolescents). The diagnosis is identified as early onset (occurring before age 21 years) or late onset (occurring at age 21 years or older). Major depressive disorder (MDD) is characterized by depressed mood or loss of interest or pleasure in usual activities. Evidence will show impaired social and occupational functioning that has existed for at least 2 weeks, no history of manic behavior, and symptoms that cannot be attributed to use of substances or a general medical condition. The diagnosis will also identify the degree of severity of symptoms (mild, moderate, or severe) and whether there is evidence of psychotic, catatonic, or melancholic features. How would you explain light box therapy to a patient "Light box therapy, also known as light therapy or phototherapy, is a treatment method that involves sitting near a special light box that emits bright light. This therapy is often used to help treat certain mood disorders, particularly seasonal affective disorder (SAD), as well as other conditions such as sleep disorders and certain skin conditions. The light emitted by the light box mimics natural sunlight, and the therapy is typically administered for a specific duration each day, usually in the morning. The idea behind light box therapy is to expose the eyes to this bright light, which can help regulate the body's internal clock and circadian rhythm, as well as affect certain brain chemicals that are linked to mood. During light box therapy sessions, you would sit within a certain distance from the light box, usually around 16 to 24 inches away, with your eyes open but not looking directly at the light. You would typically engage in activities such as reading, working, or eating while exposed to the light. The duration and timing of light box therapy sessions can vary depending on your specific condition and treatment plan, but they typically last between 20 to 30 minutes each day, and treatment may continue for several weeks or months. It's important to use a light box that meets specific criteria for brightness, spectrum, and safety, so it's recommended to consult with a healthcare provider before starting light box therapy. Your healthcare provider can help determine if light box therapy is appropriate for you, recommend the appropriate type of light box, and provide guidance on how to use it safely and effectively. While light box therapy can be an effective treatment for certain conditions, it may not be suitable for everyone, and it's important to discuss the potential risks and benefits with your healthcare provider before starting treatment." Purpose of taking a full health assessment on patients with depression Conducting a full health assessment on patients with depression serves several critical purposes in guiding their care. Firstly, it enables healthcare providers to establish an accurate diagnosis by thoroughly evaluating the patient's symptoms, medical history, and current health status. This comprehensive assessment aids in identifying any underlying medical conditions, such as chronic illnesses or substance use disorders, that may contribute to or exacerbate depression symptoms. Additionally, the assessment helps healthcare providers develop a personalized treatment plan tailored to the individual's needs, considering factors such as medication options, psychotherapy approaches, and lifestyle modifications. By assessing risk factors and monitoring treatment progress over time, healthcare providers can ensure the patient receives appropriate care, support, and interventions to effectively manage depression and promote overall health and well-being. What does Beck’s Cognitive Therapy include? Beck's Cognitive Therapy, also known as Cognitive Behavioral Therapy (CBT), is a structured and goal-oriented approach to psychotherapy that aims to help individuals identify and change negative thought patterns and behaviors that contribute to psychological distress. Developed by Dr. Aaron T. Beck, this therapeutic approach is grounded in the cognitive model of psychopathology, which suggests that dysfunctional thinking patterns play a central role in the development and maintenance of mental health conditions such as depression and anxiety. Beck's Cognitive Therapy typically involves several key components, including collaborative identification of negative thoughts and beliefs (cognitive restructuring), behavioral activation to counteract avoidance and withdrawal, problem-solving skills training, and techniques for challenging and modifying maladaptive cognitive distortions. Through systematic exploration and challenge of irrational beliefs and cognitive distortions, individuals learn to develop more adaptive ways of thinking and coping with life stressors, leading to symptom reduction and improved emotional well-being. Beck's Cognitive Therapy is evidence-based and widely used in the treatment of various mental health disorders, with numerous studies demonstrating its effectiveness in helping individuals achieve lasting symptom relief and improved quality of life. Highest nursing priority when a patient is admitted to hospital for depression The highest nursing priority when a patient is admitted to the hospital for depression is ensuring the patient's safety, including conducting a thorough risk assessment for self-harm or suicide and implementing appropriate interventions to prevent harm. Symptoms of lithium toxicity Be aware of side effects and symptoms associated with toxicity. Notify the physician if any of the following symptoms occur: persistent nausea and vomiting, severe diarrhea, ataxia, blurred vision, tinnitus, excessive output of urine, increasing tremors, or mental confusion. Highest priority for relapse prevention with bipolar disorder – think medication adherence The highest priority for relapse prevention with bipolar disorder is promoting medication adherence through comprehensive education, close monitoring, and ongoing support to ensure the patient maintains a consistent medication regimen. Nursing intervention for weight loss associated with bipolar disorder mania (to promote nutrition) Provide client with high-protein, high-calorie foods. Maintain an accurate record of intake, output, and calorie count. Difference between mania and hypomania Severity: Mania is a more severe mood state compared to hypomania. Manic episodes involve extreme highs in mood, energy, and activity levels, often to the point of impairing functioning or requiring hospitalization. In contrast, hypomania is a milder form of mania, characterized by elevated mood, increased energy, and heightened productivity, but without the severe impairment in functioning or psychotic features typically seen in full-blown manic episodes. Duration: Manic episodes typically last for at least one week or require hospitalization due to their severity. In contrast, hypomanic episodes are shorter in duration, lasting at least four consecutive days. Impact on Functioning: Mania often leads to significant impairment in social, occupational, and other important areas of functioning. Individuals experiencing mania may engage in reckless or risky behaviors, experience relationship or financial problems, or have difficulty maintaining employment or attending school. Hypomania, while still characterized by increased energy and productivity, typically allows individuals to maintain a relatively normal level of functioning and may even enhance performance in some areas. Psychotic Features: Manic episodes can include psychotic features such as hallucinations (perceiving things that are not there) or delusions (false beliefs). Hypomania, by definition, does not involve psychotic features. Recognition of Symptoms: Individuals experiencing hypomania may be less likely to recognize their symptoms as problematic compared to those experiencing full-blown mania. This lack of insight can sometimes delay or prevent individuals from seeking treatment for hypomanic episodes. Risk of Progression: Hypomania is often considered a precursor to full-blown manic episodes in individuals with bipolar disorder. While not all individuals who experience hypomania will go on to develop mania, it is an important marker of the illness and may require intervention to prevent further escalation of symptoms. Risk of patient with bipolar disorder taking an antidepressant The risk of a patient with bipolar disorder taking an antidepressant is the potential to induce manic or hypomanic episodes, necessitating careful monitoring and consideration of mood stabilizers in conjunction with antidepressant therapy to mitigate this risk. Common side effects from taking lithium for bipolar disorder Thirst and Increased Urination: One of the most common side effects of lithium is increased thirst and urination (polyuria). This occurs because lithium affects the kidneys' ability to concentrate urine, leading to the excretion of excess fluids. Weight Gain: Some individuals may experience weight gain while taking lithium, particularly with long-term use. Weight gain can be a concern for some individuals and may require dietary and lifestyle modifications. Tremor: Hand tremor, particularly a fine tremor, is a common side effect of lithium. Tremors may be more pronounced at higher doses or during periods of dehydration. Nausea and Vomiting: Nausea and vomiting are common side effects, especially when starting lithium treatment or when the dose is increased. Taking lithium with food or dividing the dose can help reduce these symptoms. Fatigue and Drowsiness: Some individuals may experience fatigue, lethargy, or drowsiness while taking lithium, particularly during the initial phase of treatment. These symptoms often improve with time as the body adjusts to the medication. Dizziness: Dizziness or lightheadedness may occur, especially when standing up quickly. It's important to stand up slowly to minimize the risk of falls. Dry Mouth: Lithium can cause dry mouth, which may contribute to increased thirst and dental issues such as cavities or gum disease. Maintaining good oral hygiene and staying hydrated can help alleviate dry mouth. Acne or Skin Changes: Some individuals may experience acne, skin rash, or other skin changes while taking lithium. These side effects are usually mild and resolve with continued treatment. Thyroid Function Changes: Lithium can affect thyroid function, leading to hypothyroidism (underactive thyroid) or less commonly, hyperthyroidism (overactive thyroid). Regular monitoring of thyroid function is important for individuals taking lithium. Kidney Function Changes: Long-term use of lithium can affect kidney function in some individuals, leading to decreased kidney function or other kidney-related issues. Regular monitoring of kidney function is essential for individuals taking lithium. Symptoms of generalized anxiety disorder (GAD) versus panic disorder Symptoms of panic attack are Sweating, trembling, shaking., Shortness of breath, chest pain, or discomfort, Nausea or abdominal distress, Dizziness, chills, or hot flashes, Numbness, or tingling sensations, Derealization or depersonalization, Fear of losing control or “going crazy”, Fear of dying. The symptoms in generalized anxiety disorder are intense enough to cause clinically significant impairment in social, occupational, or other important areas of functioning. The individual often avoids activities or events that may result in negative outcomes or spends considerable time and effort preparing for such activities. Anxiety and worry often result in procrastination in behavior or decision making, and the individual repeatedly seeks reassurance from others. Know what systematic desensitization therapy involves for anxiety disorders Systematic desensitization therapy for anxiety disorders involves gradually exposing individuals to feared stimuli while simultaneously teaching relaxation techniques to reduce anxiety responses, ultimately helping them overcome their fears. Teaching patient about use of benzodiazepines for anxiety When teaching a patient about the use of benzodiazepines for anxiety, it's important to emphasize key points such as the medication's mechanism of action, potential benefits and risks, proper dosage and administration, and the importance of medication adherence. Additionally, patients should be educated about potential side effects, including drowsiness, dizziness, and the risk of dependence or withdrawal symptoms with long-term use, as well as precautions such as avoiding alcohol and operating heavy machinery while taking benzodiazepines. It's essential for patients to understand that benzodiazepines are typically recommended for short-term use and may be prescribed in conjunction with other therapeutic approaches such as psychotherapy or lifestyle modifications for optimal management of anxiety symptoms. Risks associated with benzodiazepines medication – who should not be prescribed them Benzodiazepines should not be prescribed to individuals with a history of substance abuse or dependence, pregnant women, older adults, or those with certain medical conditions such as respiratory disorders, liver disease, or sleep apnea, due to the increased risk of adverse effects and complications associated with their use. Typical age of onset for agoraphobia (fear of panic, helplessness) Agoraphobia typically develops during late adolescence or early adulthood, with the median age of onset typically reported to be in the early to mid-20s. However, agoraphobia can develop at any age, including childhood and later adulthood. When should anxiety be treated? Anxiety should be treated when it significantly impairs an individual's ability to function in daily life or when it causes significant distress. It's normal for everyone to experience some level of anxiety from time to time, especially in response to stressors or life changes. However, when anxiety becomes excessive, persistent, or interferes with important aspects of life such as work, school, relationships, or personal well-being, it may be time to seek treatment. Characteristics of patients with social anxiety disorder Social anxiety disorder is an excessive fear of situations in which a person might do something embarrassing or be evaluated negatively by others. The individual has extreme concerns about being exposed to possible scrutiny by others and fears social or performance situations in which embarrassment may occur. In some instances, the fear may be quite defined, such as the fear of speaking or eating in a public place, fear of using a public restroom, or fear of writing in the presence of others. In other cases, the social phobia may involve general social situations, such as saying things or answering questions in a manner that would provoke laughter on the part of others. Symptoms commonly associated with adjustment disorder (AD) Symptoms commonly associated with adjustment disorder (AD) include emotional distress, such as sadness, anxiety, or irritability, as well as difficulty coping with stressors, changes in behavior, and impaired social or occupational functioning. What psychiatric condition is most likely to be treated with eye-movement desensitization and reprocessing (EMDR)? Trauma related disorders like PTSD Typical recommended length for EMDR treatment The typical recommended length for Eye Movement Desensitization and Reprocessing (EMDR) treatment is generally 8 to 12 sessions, although the duration may vary depending on the individual's specific needs, the severity of their symptoms, and the complexity of their trauma history. Most commonly used treatment for Adjustment Disorder (AD) Individual psychotherapy is the most common treatment for adjustment disorder. Individual psychotherapy allows the client to examine the stressor that is causing the problem, possibly assign personal meaning to the stressor, and confront unresolved issues that may be exacerbating this crisis. In family therapy, the focus of treatment is shifted from the individual to the system of relationships in which the individual is involved. The maladaptive response of the identified client is viewed as symptomatic of a dysfunctional family system. The goal of behavior therapy is to replace ineffective response patterns with more adaptive ones. The situations that promote ineffective responses are identified, and carefully designed reinforcement schedules, along with role modeling, and coaching are used to alter the maladaptive response patterns. Group experiences, with or without a professional facilitator, provide an arena in which members may consider and compare their responses to individuals with similar life experiences. Members benefit from learning that they are not alone in their painful experiences. In crisis intervention, the therapist, or other intervener, becomes part of the individual’s life situation. Because of increased anxiety, the individual with adjustment disorder is unable to problem solve, so he or she requires guidance and support from another to help mobilize the resources needed to resolve the crisis. Crisis intervention is short term, relies heavily on orderly problem-solving techniques and structured activities that are focused on change. Adjustment disorder is not commonly treated with medications, as their effect may be temporary and only mask the real problem, and psychoactive drugs carry the potential for physiological and psychological dependence. Time frame for patient to be diagnosed with AD This response occurs within 3 months after onset of the stressor and has persisted for no longer than 6 months after the stressor has ended. The individual shows impairment in social and occupational functioning or exhibits symptoms that are more than an expected reaction to the stressor. The symptoms are expected to remit soon after the stressor is relieved, or if the stressor persists, when a new level of adaptation is achieved. Somatic Symptom Disorder (SSD) – what is it and how does it present clinically in a patient? Somatic symptom disorder is a syndrome of multiple physical symptoms that cannot be explained medically and are associated with mental. Symptoms may be vague, dramatized, or exaggerated in their presentation, and an excessive amount of time and energy is devoted to worry and concern about the symptoms. Differences between Somatic Symptom Disorder (SSD) and illness anxiety disorder (IAD) Somatic symptom disorder is a syndrome of multiple physical symptoms that cannot be explained medically and are associated with mental. Symptoms may be vague, dramatized, or exaggerated in their presentation, and an excessive amount of time and energy is devoted to worry and concern about the symptoms. Individuals with somatic symptoms of disorder are totally convinced that their symptoms are related to organic pathology and will reject any implication that stress or psychosocial factors play any role. The disorder is chronic, with symptoms beginning before age 30. Anxiety and depression are frequent comorbidities. Illness anxiety is an unrealistic or inaccurate interpretation of physical symptoms or sensations, leading to preoccupation and fear of having a serious disease. The fear becomes disabling and persists despite reassurance that no organic pathology can be detected. Individuals with illness anxiety disorder are extremely conscious of bodily sensations and changes and may become convinced that a rapid heart rate indicates they have heart disease or that a small sore is skin cancer. They are profoundly preoccupied with their bodies and are totally aware of even the slightest change in feeling or sensation. Individuals with illness anxiety disorder are so apprehensive and fearful that they become alarmed at the slightest intimation of serious illness. Even reading about a disease or hearing that someone they know has been diagnosed with an illness precipitates alarm on their part. Purpose of dissociation in dissociative identify disorder (DID) The purpose of dissociation in dissociative identity disorder (DID) is to compartmentalize and manage traumatic experiences, resulting in the creation of distinct identities or personality states that may emerge in response to stressors or triggers. Criteria for dissociative fugue A specific subtype of dissociative amnesia is with dissociative fugue. Dissociative fugue is characterized by sudden, unexpected travel away from a customary place of daily activities, or by bewildered wandering, with the inability to recall some or all of one’s past. An individual in a fugue state may not be able to recall personal identity and sometimes assumes a new identity. Most commonly used medication class for somatic disorders The most commonly used medication class for somatic disorders is selective serotonin reuptake inhibitors (SSRIs), which are prescribed to alleviate symptoms such as pain, fatigue, and other physical manifestations often associated with somatic symptom disorder and related conditions. Explanation of tooth enamel erosion and bulimia Tooth enamel erosion in bulimia occurs due to the frequent exposure of dental enamel to stomach acid during recurrent episodes of binge eating followed by purging, leading to erosion of the protective enamel layer and increased risk of dental decay and sensitivity. BMI in anorexia Weight loss in clients with anorexia nervosa is usually accomplished by reduction in food intake and often extensive exercising. Self-induced vomiting and the abuse of laxatives or diuretics also may occur. Weight loss is excessive. For example, the individual may present for healthcare services weighing less than 85% of expected weight. Other symptoms include hypothermia, bradycardia, hypotension with orthostatic changes, peripheral edema, lanugo (fine, neonatal-like hair growth), and a variety of metabolic changes. FDA approved medication for binge eating disorder High-dose SSRIs have demonstrated some effectiveness in promoting weight loss for patients with binge eating disorder, but the weight loss was temporary, and weight gain typically occurred after the medication was discontinued. Two medications, topiramate and lisdexamfetamine (a dopamine-norepinephrine reuptake inhibitor, originally used in the treatment of ADHD), have demonstrated benefits in reducing incidents of binge eating. Differences between anorexia and bulimia Anorexia nervosa refers to a prolonged loss of appetite. It is characterized by a morbid fear of obesity. Symptoms include gross distortion of body image, preoccupation with food, and refusal to eat. Body image is a subjective concept of one’s physical appearance based on personal perceptions of self and the reaction of others. The distortion in body image is manifested by the individual’s perception of being fat when he or she is obviously underweight or even excessively thin. Bulimia refers to an excessive, insatiable appetite. Bulimia nervosa is an episodic, uncontrolled, compulsive, rapid ingestion of large quantities of food over a short period of time (bingeing), followed by inappropriate compensatory behaviors to rid the body of the excess calories. The food consumed during a binge often has a high-caloric content, a sweet taste, and a soft or smooth texture that can be eaten rapidly, sometimes even without being chewed. The bingeing episodes often occur in secret and are usually only terminated by abdominal discomfort, sleep, social interruption, or self-induced vomiting. Characteristics of patients with dependent personality disorder Dependent personality disorder is characterized by lack of self-confidence and extreme reliance on others to take responsibility for them. This mode of behavior is evident in the tendency to allow others to make decisions, to feel helpless when alone, to act submissively to subordinate needs to others, to tolerate mistreatment by others, to demean oneself to gain acceptance, and to fail to function adequately in situations that require assertive or dominant behavior. Difference between schizoid and avoidant personality disorders People with schizoid personality disorder appear cold, aloof, and indifferent to others. They typically have a longstanding history of engaging in primarily solitary activities or engaging more with animals than people. They prefer to work in isolation and are unsociable. They can invest enormous affective energy in intellectual pursuits. In the presence of others, they appear shy, anxious, or uneasy. They are inappropriately serious about everything and have difficulty acting in a lighthearted manner. Their behavior and conversation exhibit little or no spontaneity. Individuals with avoidant disorder are awkward and uncomfortable in social situations. From a distance, others may perceive them as timid, withdrawn, or perhaps cold and strange. Those who have closer relationships with them, however, soon learn of their sensitivities, touchiness, evasiveness, and mistrustful qualities. Their speech is usually slow and constrained, with frequent hesitations, fragmentary thought sequences, and occasional confused and irrelevant digressions. They are often lonely, and express feelings of being unwanted. Common self-harm symptoms associated with borderline personality disorder Common self-harm symptoms associated with borderline personality disorder include cutting, burning, scratching, hitting, or other forms of self-injury, often used as a maladaptive coping mechanism to regulate intense emotions or alleviate feelings of emptiness or dissociation. Symptoms associated with obsessive compulsive personality disorder Individuals with obsessive-compulsive personality disorder are inflexible and lack spontaneity. They are meticulous and work diligently and patiently at tasks that require accuracy and discipline. They are especially concerned with matters of organization and efficiency and tend to be rigid and unbending about rules and procedures. Social behavior tends to be polite and formal. They are very “rank conscious,” a characteristic that is reflected in their contrasting behaviors with “superiors” as opposed to “inferiors.” They tend to be very solicitous to and ingratiating with authority figures. With subordinates, however, the compulsive person can become quite autocratic and condemnatory. Relationships common for patient with histrionic personality disorder Characteristics of a patient with narcissistic personality disorder Persons with narcissistic personality disorder have an exaggerated sense of self-worth. They lack empathy and are hypersensitive to the evaluation of others. They believe that they have the inalienable right to receive special consideration and that their desire is sufficient justification for possessing whatever they seek. Overly self-centered Exploits others in an effort to fulfill own desires Mood, which is often grounded in grandiosity, is usually optimistic, relaxed, cheerful, and care-free. Characteristics of a patient with borderline personality disorder Borderline personality disorder is characterized by a pattern of intense and chaotic relationships, with affective instability and fluctuating attitudes toward other people. These individuals are impulsive, are directly and indirectly self-destructive, and lack a clear sense of identity.