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ANXIETY DISORDERS
Individuals experience a degree of anxiety that is so high that it interferes with personal, occupational, or social functioning. ANXIETY DISORDERS are the most common
CONCEPT form of psychiatric Disorder in the USA.
OBSESSIVE-
TYPES/ PANIC DISORDER GENERALIZED ANXIETY PHOBIAS COMPULSIVE POST-TRAUMATIC STRESS DIRORDER (PTSD)
SUBTYPES DISORDER (GAD) DISORDER (OCD)
1.The patient experiences recurrent panic 1. More than 6 months of 1. The client fears a 1. The client has intrusive 1. Exposure to a traumatic event causes intense fear,
attacks uncontrollable, excessive, unrealistic specific object or situation thoughts of unrealistic horror, flashbacks, feelings of detachment and
2. Episodes typically last 15-30 minutes worries (inadequacy in interpersonal to an unreasonable level. obsessions and tries to foreboding, restricted affect, and impairment for longer
3. Four or more of the following symptoms relationships, job responsibilities, Phobias include: control these thoughts with than 1 month after the event. Symptoms may last for
are present: finances, health of family members, -SOCIAL PHOBIA compulsive behaviors, years.
-Palpitations, SOB, Choking or Smothering household chores, and lateness for -AGORAPHOBIA which are repetitive – -ACUTE PTSD: Symptoms last less than 3 months-
Sensation, Chest Pain, Nausea, Feelings of appointments) -SPECIFIC PHOBIAS: ritualistic- CHRONIC PTSD: Symptoms last more than 3 months
Depersonalization, Fear of Dying, Chills or 2. GAD causes significant impairment -Fear of specific objects -Clients who engage in SYMPTOMS:
Hot Flashes, Fear of going crazy, Decreased in one or more areas of functioning. (snakes, spiders, constant ritualistic behaviors -Recurrent, intrusive recollection of event
perceptual and cognitive abilities 3. At least 3 of the following symptoms strangers) may have difficulty meeting -Dreams or images
FEATURES 4. Pt may experience Changes in Behavior are present: -Fear of specific self-care needs-If rituals -Reliving through flashbacks, illusions, or hallucinations
and/or Persistent Worries about when the next -Fatigue experiences (flying, being include constant -Irritability, difficulty with concentration, sleep
attack will occur -Restlessness in the dark, riding an handwashing or cleaning, disturbances, avoidance of stimuli associated with
5. May experience Agoraphobia due to fear of -Inability to Concentrate elevator, being in an skin damage and infection trauma, inability to show feelings.
being in places where previous panic attacks -Irritability enclosed space) may occur. (it differs from Acute Stress Disorder in that ASD occurs
occurred. -Muscle Tension after exposure to a traumatic event, causing numbing,
*MAY BE CONFUSED WITH A HEART -Sleep Disturbances detachment and amnesia about the event for NOT MORE
ATTACK 4. Characterized by Remissions and than 4 weeks following the event, with symptoms lasting
*DOES NOT NECESSARILY FOLLOWS AN exacerbations (no acute anxiety attack) from 2 days to 4 weeks)
STRESSFUL, IDENTIFIABLE EVENT
1. Perform a thorough Physical and Neurological examination to help determine if anxiety is primary or is secondary to another psychiatric disorder, a medical condition, or substance use.
2. Assess Risk for Suicide
ASSESSMENT
3. Perform psychosocial assessment (To help client identify the problem to be addressed by counseling (stressful marriage, recent loss, stressful job or school situation)
4. Assess coping mechanisms
5. Use a standardized assessment scale, such as Hamilton Rating Scale for Anxiety.
EXPECTED 1. Client uses coping mechanisms to prevent panic anxiety when stressful situations occur.
OUTCOMES 2. Client verbalizes acceptance of life situations over which he or she has no control
3. The client is able to recognize signs of anxiety and intervene to prevent panic levels
1. Ensure Safety
In General, Interventions for Anxiety disorders attempt to: 2. Stay with the client and provide support (Provide reassurance, use therapeutic communication skills, use
INTERVENTIONS open-ended questions, encourage client to verbalize feelings)
1. Reduce Anxiety 3. Use relaxation breathing techniques as needed
2. Increase Self Esteem 4. Reduce environmental stimuli
3. Increase Reality Testing 5. Encourage physical activity like walking
4. Enhance Coping Mechanisms 6. Administer medications as prescribed (SSRIs, TCAs, MAOIs, Benzodiazepines (anxiolytics), Beta Blockers,
5. Instill Hope Mood stabilizers)
6. Relaxation Therapy 7. Instill hope (but avoid false reassurance)
8. Enhance Self Esteem by encouraging positive statements about self and discussion of past achievements.
9. Postpone teaching until acute anxiety subsides: clients with panic attack or severe anxiety are unable to
concentrate or learn.
10. Teach to limit nicotine and caffeine
11. Promote sleep with comfort measures
PANIC DISORDER: GENERALIZED ANXIETY PHOBIAS OBSESSIVE- POST-TRAUMATIC STRESS DISORDER (PTSD)
DISORDER (GAD) COMPULSIVE
MEDICATIONS DISORDER (OCD) 1. SSRIs
1. SSRIs 2. TCAs
2. Benzodiazepines 1. SSRIs 1. SSRIs 1. SSRIs (Especially 3. Benzodiazepines
*SSRIs are First line 3. TCAs 2. TCAS 2. Benzodiazepine Luvox) 4. SNRIs
for all anxiety 4. MAOIs 3. Buspirone (Buspar) s 2. TCAs (Especially 5. MAOIs
Disorders except 5. Beta Blockers 4. SNRIs 3. Buspirone Anafranil) 6. Beta-Blockers
AAA (see bellow) 6. Depakote (Valproic Acid) 5. Depakote (Valproic Acid) (Buspar) 7. Carbamazepine (Tegretol)
4. Beta Blockers
*Benzodiazepines 5. Gabapentin
shouldn’t be used to (Neurontin) +
treat GAD: this is a + + +
chronic disease and +
benzos should only
-Cognitive-Behavioral
be used for short
Cognitive-Behavioral Cognitive-Behavioral Therapy Behavioral -Family
periods of time, like Therapy Cognitive-Behavioral Therapy -Group Therapy with survivors
in Acute Anxiety *No Benzodiazepines Therapy
Attack (AAA)
***BIPOLAR DISORDER IS ASSOCIATED WITH THE HIGHEST RATE OF SUICIDE OF ANY PSYCHIATRIC
DISORDERS.
• A single, recurrent, or chronic episode (s) • A milder form of depression that
of depression resulting in a significant usually has an early onset, such as
CONCEPT change in the client’s normal functioning childhood or adolescence
(social, occupational, self-care) (Chronic Depressed Mood) IT
accompanied by at least 5 specific LASTS:
symptoms. • More than 1 year (for Children
• These symptoms must happen almost every and Adolescents)
day, last most of the day, and occur • More than 2 years (For Adults)
continuously for a minimum of 2 years. • Contains at least 3 symptoms of
depression, and may, later in life,
become Major Depressive
Disorder
• Depressed Mood • Depressed Mood
• Insomnia/Hypersomnia • Insomnia/Hypersomnia MANIA HYPOMANIA
• Decreased ability to concentrate • Decreased ability to concentrate
• Anergia (Lack of Energy) • Anergia 1. Severe enough to cause a marked impairment in 1. Associated with an unequivocal change in
• Significant weight loss or gain (of more • Decreased Self Esteem occupational activities, usual social activities, or functioning that is uncharacteristic of the person
than 5% of body weight in 1 month) • Feelings of Hopelessness and relationships. when not symptomatic
• Indecissiveness Despair
• Decreased/Increased Appetite OR 2. The disturbance in mood and the change in
• Increase or Decrease in motor activity functioning are observed by others
• ****Suicidal Ideations **** 2. Necessitates hospitalization to prevent harm to self
Specifiers (Features)
• Anhedonia (Inability to feel pleasure in or others, or there are psychotic features
FEATURES
life) 3. Absence of marked impairment in social or
• Early Onset (before 21 y/o)
Specifiers (Features): 3. Symptoms are not due to direct physiological effects occupational functioning.
• Late Onset (21 years or older) of substance (drug abuse, medication, alcohol) other
• Atypical Features (Appetite medical condition (hyperthyroidism) 4. Hospitalization not indicated
• PSYCHOTIC FEATURES (Hallucinations, changes, weight gain,
Delusions etc) Hypersomnia, extreme sensitivity
• POSTPARTUM ONSET (Begins within 4 to perceived interpersonal 5. Symptoms are not due to direct physiological effects
weeks of childbirth, known as Postpartum rejection) of substance (drug abuse, medication, alcohol) other
Depression) medical condition (hyperthyroidism)
• SEASONAL FEATURES (SEASONAL
AFFECTIVE DISORDER –SAD-)
(Generally occurring in fall or winter, and
remitting in Spring)
• CHRONIC FEATURES (Episode lasts over
2 years)
A personality disorder is an enduring pattern of inner experience and behavior that: 1. Deviates markedly from the expectations of one’s culture 2. Is pervasive, maladaptive and
inflexible, 3. Has an onset in adolescent or early adulthood 4. Is stable over time and 5. Leads to distress or impairment
CONCEPT
ALL PERSONALITY DISORDERS have four common characteristics:
-Inflexibility/maladaptive responses to stress
-Disability in social and professional relationships
-Tendency to provoke interpersonal conflict
-Capacity to cause irritation or distress in others
MILIEU THERAPY: When individuals with PDs are in hospital, partial hospitalization, or day treatment settings, Milieu Therapy is a significant part of treatment.
The primary goal of Milieu Therapy is affect management in a group context. Community meetings, coping skills groups, and socializing groups are all helpful for these clients.
MISC CASE MANAGEMENT: CM is beneficial for clients who have PDs and are persistently and severely impaired. In Acute Care Facilities: CM focuses on obtaining pertinent history from current or previous
providers, supporting integration with the family/significant other, and ensuring appropriate referrals to outpatient care.
In long-term outpatient facilities, case management goals include reducing hospitalization by providing resources for crisis services and enhancing the social support system.
SCHIZOPHRENIA
• Schizophrenia is a group of psychotic disorders that affect thinking, behavior, emotions, and the ability to perceive reality.
CONCEPT • The term “Psychosis” refers to the presence of hallucinations, delusions, or disorganized speech or catatonic behavior.
• The typical age at onset is late teens and early twenties, but schizophrenia has occurred in young children and may begin in later adulthood.