(Class 3,4,6 & 9) (25.3% of final exam) Stress, anxiety and anxiety disorders, Trauma and trauma informed care, Obsessive compulsive disorder, and Eating disorders

Fear

guilt/shame

Irritable

Anger/explosive anger

difficulty accessing positive emotion

Exaggerated negative emotions

Mistrust

Easily startled

Overreactions to stimuli (threatening or nonthreatening)

Difficulty sleeping

Development symptoms of PTSD after exposure to trauma from 3 days to 1 month after a traumatic event

Assess Safety

Obtaining history and physical examination

Education

Brief psychotherapy sessions

Acute symptom management

Trauma focused therapy

Medications

Severity of symptoms

Level of daily functioning/decline in functioning

Emotional response

Mood affect

Coping skills

Strengths assessment

a time-limited event that triggers adaptive or nonadaptive response to maturational, situational, or traumatic events

Developmental

Situational

Traumatic

Accident

Self-inflected

Violence by others

Bodily Injury

Harassment

Embarrassment

Child abuse

SA

Domestic violence (witnessing or experiencing)

Acts of terrorism

Natural disasters

Alcohol and drug use

ED

Mood Disorders

PTSD

SI

Resilience

Appraisal

Development of intrusive, dissociative, mood, cognitive, or hyperarousal symptoms following exposure to a traumatic event

Involuntary appearances of thought

Nightmares/dreams

Flashbacks

Dissociative rx

May not appear distressing and may be expressed through play

Adjustment disorder

Disinhibited social engagement disorder

Reactive attachment disorder

Debriefing

CBT

EMDR

Stress management

Group therapy

SSRIs

SNRIs

Benzos

BB (propranlol)

Prazosin

nightmares

Safety

Physical

Psychological

Establish goals and wellness plans

Sleep hygiene

Interventions for families

Exercise and yoga

Nutrition

Substance use ed.

Those who may/may not survive

Professionals rescuers

Everyone else impacted

Arousal

Behavior

Cognition

Decrease sensory stimulation, promote calm

provide safety, restructure or rephrase your request

Reality test and give clear info

1. Pre-Disaster

2. Impact

3. Heroic

4. Honeymoon

5. Disillusionment

6. Reconstruction

Realizes

Recognizes

Responds

Re-traumatization

1. Safety

2. Trustworthiness and transparency

3. Peer support

4. Collaboration and mutuality

5. Empowerment, voice, and choice

6. Cultural, historical, and gender issues

Most times not able to acknowledge anxiety

perception is VERY narrowed

scattered attention

sense of Doom or Dread

self-absorbed

purposeless activity

Alarm rx

Resistance

Exhaustion

the amount of physiological changes that have built up from chronic stress.

SAFETY!

Safety

Physical Functioning

Medication and Substance Use

Psychological Assessment

An uncomfortable feeling of apprehension or dread that occurs in response to internal or external stimuli

Separation AD

Selective Mutism

Specific Phobia

Social AD

Panic Disorder

Agoraphobia

Generalized AD

Excessive worry >6 months

restlessness or feeling keyed up or on edge

being easily fatigue

difficulty concentrating or mind going blank

Irritability

Muscle tension

Sleep disturbance

recurrent unexpected panic attacks; persistent concern or worry about additional panic attacks or their consequences and/or a significant maladaptive change in behavior related to attacks

Palpitations,

sweating,

trembling, shaking,

SOB,

feeling of choking,

CP/discomfort,

nausea abd distress,

dizziness,

unsteady, lightheaded, faint,

unreality,

fear of losing control,

fear of dying,

chills or hot flushes,

derealization or depersonalization

mild

moderate

Severe

panic

Able to self-report anxiety

perception widens

usually during appropriate situations

those effected can still move toward their goals (i.e. athletes in competition, or students for exams.)

Able to self-report anxiety

Perception narrows

inattentive

those effect benefit from guidance

somatic complaints

impaired problem solving

Can't acknowledge their anxiety

those affected feel like they're dying

feeling of terror

panic disorder symptoms

sympathetic: palpitations

Parasympathetic:

lower BP

Rapid breathing

SOB

Choking feeling

Easily startled

Tremors

FLushed face

Cold sweats

Hot

Styes

Hives

Stummy hurt (ab pain, gastro pain feelings)

Not hungry

Pupil dilation

Increase feelings of urinary urges

Edgy

impatient

Uneasy

Nervous

Tense

wound-up

Anxious

Fearful

Apprehensive

scared

freighted

alarmed

terrified

jittery

jumpy

Displacement

Denial

Suppression

Intellectualization

Anxiety Disorders

Depression

Medical conditions

Family hx

Substance use

Early childhood trauma

Behavioral inhibition

Females

Middle age (onset 20-24 years old)

Low SES

Widowed, separated or divorced

Increase: anxiety states, mania, schizo

Decrease: Depression

Increase: anxiety states,

Decrease: Depression

Increase: Reduced anxiety

Decrease: Anxiety disorders, schizo

SAFETY

Physical functioning

Psychological functioning

Onset

Duration

Situation

Cognitive, behavioral, and social assessment

SSRI's

Takes 4+ weeks to become effective

NOT PRN

may not cover "breakthrough" anxiety

Routine admin (NOT PRN)

NO known abuse potential

Taking with food may help absorption

SSRI

Buspirone

Other (non SSRI) antidepressants

Atypical antipsychotics

Anticonvulsants

potenitates GABA

Anxiety (particularly GAD) and insomnia

Alprazolam, Lorazepam

diazepam, clonazepam

Sedation and CNS depression

(i.e. drowsiness, intellectual impairment, memory impairment, ataxia and reduced motor coordination, paradoxical confusions, agitation or delirium, GI disturbances, worsening mood or lability)

Etoh potentiates CNS depression; could lead to overdose and death

Tolerance develops over time (ONLY PRN)

Psychological dependence more likely to develop with sustained use

Withdrawal may occur is stopped abruptly

Benzos

Atypical antipsychotics

Anticonvulsants

Beta-blockers (olol)

Hydroxyzine

Hydroxyzine

3 MULTIPLE CHOICE OPTIONS

dizziness, sedation, nausea, headache

Cue cards for response

Saying "STOP" when conscious of anxiety during obsessive thoughts

Presence of obsessions, compulsions, or both that impact functioning

persistent, uncontrollable intrusions of unwanted thoughts

Contamination

Pathological doubts

Somatic (Body Dysmorphia)

Depressive mood

unwanted repetitive behavior patterns or mental acts intended to reduce anxiety

Hand washing

Ordering

Checking

Praying

Counting

Repeating words silently

Dysregulation of serotonin

Twin Studies

Fear or anxiety becomes a learned response

Compulsions and obsessions are a conditioned mechanisms to neutralize anxiety

Skin Integrity maintenance

Dermatitis or eczema

Blooding gums

Alopecia

Anxious dread w/ obessioms

depressed

Obsession intrudes persistently into conscious

Obsession is seen as an ego alien (irrational)

50% do not resist compulsion

May become uneasy or anxious when resisting

80% of individuals w/OCD recognize their behavior

Safety

Inform

Manage Medical

Psychoedu

Sleep monitor/encourage

Nutrition monitor/encourage

Arbitrary (do not forbid rituals)

Positive (reward non-ritualistic behavior)

Response Prevention

Graduated Exposure Therapy (GET)

Patient is gradually taught to disengage from ritualistic behavior or thought patterns

Slow exposure to stressful/anxiety inducing situations

SSRIs (Fluvoxamine, Fluoxetine, Sertraline, Paroxetine)

TCAs (Clomipramine, Imipramine)

Use at MAX dose

Min 10-12 weeks

eating more food than most people would eat, in similar circumstances, in within TWO hours AND feeling guilty after

Equally