Maryville University NURS 661 Exam 3 MegaDeck Questions And Answers 2022

Who is at highest risk of suicide? White, elderly men Schizophrenia Single, never married, divorced, recently widowed Previous attempts Adolescents with depression, bullied, or family hx of suicide Who is most likely to succeed at committing suicide? Older while males What are some protective factors for suicide? Having children Religion Stronger alliances with medical providers and therapists What is lethality? the probability that a person will successfully complete suicide What is intent? Effective expectations for desire of active death What is a suicide attempt? Includes all willful, self-inflicted life-threatening attempts that have not led to death What is suicidal ideation? thinking about suicide, usually with some serious emotional and intellectual or cognitive overtones Where in the brain do we theorize violence and aggression originate? Prefrontal cortex How to assess for homicidal ideation? Do you have homicidal ideation? Who do you want to kill? How do you plan to do this? Do you have access to the means necessary? Do you intend to commit the act? What legal follow up is needed for homicidal ideation? Duty to warn Based on state laws Obsession 1. Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress 2. The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e. by performing a compulsion) Compulsion 1. Repetitive behaviors or mental acts that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly 2. The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation, however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive Obsessive-Compulsive Disorder (OCD) A. Presence of obsessions, compulsions, or both B. The obsessions or compulsions are time-consuming (e.g. take more than one hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning C. The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance or another medical condition D. The disturbance is not better explained by the symptoms of another mental disorder PANDAS Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections OCD common co-morbid conditions MDD (Major depressive disorder) Skin Picking Hair Pulling Most Common Compulsions Checking Ordering Arranging Washing/cleaning Hand-washing Flipping lights Counting Differentiation between OCD and eating disorders Those with eating disorders will be counting calories, focused on weight loss or maintaining a specific weight Treatment for OCD Cognitive Behavioral Therapy Pharmacological Treatment for OCD First line treatment-SSRI (Luvox, fluoxetine) Second-line treatment TCA with serotonergic properties (clomipramine) SNRI or MAOI Augmentation with benzos, lithium, or Buspar DSM-5 Body Dysmorphic Disorder Preoccupation with perceived flaw on body taht is not observed by others Repetitive behaviors such as mirror checking, excessive grooming, skin picking, reassurance seeking, clothes changing Clinical significance Differentiation from eating disorder BDD common preoccupations Facial flaws genitalia Differentiation between BDD and eating disorders BDD is more obsessed with one specific body flow, not the entire body Differentiation between BDD and OCD OCD may have food rituals but not obsession on a specific body flaw Treatment for BDD Cognitive Behavioral Therapy Pharmacological treatment of BDD Clomipramine and fluoxetine reduce symptoms in about 50% of patients DSM-5 Hoarding Disorder A. Persistent difficulty discarding or parting with possessions, regardless of their actual value B. This difficulty is due to a perceived need to save the items and to distress associated with discarding them C. The difficulty discarding possessions results in the accumulation of possessions that congest and clutter active living areas and substantially compromises their intended use. D. The hoarding causes clinically significant distress or impairment in social, occupational, or other important areas of functioning E. The behavior is not attributable to another medical condition F. The hoarding is not better explained by the symptoms of another mental disorder Hoarding Treatment Cognitive Behavioral Therapy Hoarding Pharmacological Treatment SSRI (difficult to treat with medication) Hoarding Safety Issues Falls Fires Stuff falling on them Infections Health hazards Cleaning hazards DSM-5 Trichotillomania A. Recurrent pulling out on one's hair, resulting in hair loss B. Repeated attempts to decrease or stop hair pulling C. The hair pulling causes clinically significant distress or impairment in social, occupational, or other important areas of functioning D. The hair pulling or hair loss is not attributable to another medical condition E. The hair pulling is not better explained by the symptoms of another mental disorder Automatic Trichotillomania Automatic response, the patient doesn't even know they are doing it Forced Trichotillomania Conscious response, patient knows they are doing it to relieve tension Who's most at risk for trichotilomania? Only or oldest child More common in females Trichotillomania Treatment Cognitive Behavioral Therapy Limited pharmacology- may use naltrexone if they get pleasure from it B12 injections if the patient has a B12 deficiency DSM-5 Criteria for Insomnia A. A predominant complaint of dissatisfaction with sleep quantity or quality, associated with one (or more) of the following symptoms: 1. Difficulty initiating sleep 2. Difficulty maintaining sleep, characterized by frequent awakenings or problems returning to sleep after awakenings 3. Early-morning awakening with inability to return to sleep B. The sleep disturbance causes clinically significant distress or impairment in social, occupational, educational, academic, behavioral, or other important areas of functioning C. The sleep difficulty occurs at least 3 nights per week D. The sleep difficulty is present for at least 3 months The sleep difficulty is occurring despite adequate opportunity for sleep E. The sleep difficulty is occurring despite adequate opportunity for sleep F. The insomnia is not better explained by and does not occur exclusively during the course of another sleep-wake disorder G. The insomnia is not attributable to the physiological effects of a substance H. Coexisting mental disorders and medical conditions do not adequately explain the predominant complaint of insomnia What is NREM Sleep Arousal Disorder? Sleep walking Sleep terrors Sleep related eating Sexsomnia What is REM behavior disorder? similar to sleepwalking, but occurs during REM, no paralysis, acting out your dream Lack of atonia causing a person to act out dreams or nightmares Will wake up confused What part of the brain is responsible for sleep? Suprachiasmatic nucleus of the hypothalamus Treatment for Sleep Disorders Cognitive Behavioral Therapy Sleep Hygiene-what to do the routine that an individual goes through before falling asleep if hungry have a light snack before bed Regular exercise Give self an hour before bed to relax Write down worries Cool dark room Quiet Sleep Hygiene-what to avoid Naps Watching the clock Exercising right before bed Watching TV Eating a heavy meal Drink caffeine late in the day Smoking Alcohol Eat or talk on the phone in bed Stimulus Control Go to bed only when sleepy Use bed only for sleep and sex If unable to fall asleep (usually after 20 minutes) get up and do something relaxing Get up at the same time every day Sleep Restriction Stay in bed only when sleeping If you sleep 5 hours a night, only be in bed for that time Pharmacology of Sleep Primary insomnia: benzodiazepines, zolpidem, eszopicone (Lunesta), zaleplon (Sonata), Belsomra Remeron helps with sleep and depression Trazodone Commonly used Warn male patients of priapism Good for patients who need help falling asleep Sleep Apnea Medication is not recommended for sleep apnea Modafinil Only FDA approved medication to help with wakefulness during the day Prazosin Used for nightmares Sleep Interview How many hours a night of sleep are you getting? How long does it take before you fall asleep? Do you wake frequently during the night? Any nightmares or night terrors? Do you snore? Do you have any episodes of apnea? Any current stressors or worries? Do you take any over the counter medications? What have you tried in the past? Do you drink alcohol? Do you drink caffeine? Cluster A Personality Disorders Schizotypal Schizoid Paranoid Cluster B Personality Disorders Antisocial Borderline Histrionic Narcissistic Cluster C Personality Disorders OCD Avoidant Dependant DSM-5 Paranoid Personality Disorders Pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent. 4 or more of the following 1. Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her 2. Is preoccupied with unjustified doubts about the loyalty of trustworthiness of friends or associates 3. Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her 4. Reads hidden demeaning or threatening meanings into benign remarks or events 5. Persistently bears grudges 6. Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack 7. Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner DSM-5 Schizoid Personality Disorder A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, indicated by 4 more more of the following: 1. Neither desires nor enjoys close relationships, including being part of a family 2. Almost always chooses solitary activities 3. Has little, in any, interest in having sexual experiences with another person 4. Takes pleasures in few, if any, activities 5. Lacks close friends or confidants other than first degree relatives 6. Appears indifferent to the praise or criticism of others 7. Shows emotional coldness, detachment, or flattened affectivity DSM-5 Schizotypal Personality Disorder A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior, beginning by early adulthood and present in a variety of contexts, as indicated by 5 or more of the following: 1. Ideas of reference (excluding delusions of reference) 2. Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms 3. Unusual perceptual experiences, including bodily illusions 4. Odd thinking and speech 5. Suspicousness or paranoid ideation 6. Inappropriate or constricted affect 7. Behavior or appearance that is odd, eccentric or peculiar 8. Lack of close friends or confidants other than first-degree relatives 9. Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self DSM-5 Antisocial Personality Disorder A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years, as indicated by three or more of the following: 1. Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest 2. Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure 3. Impulsivity or failure to plan ahead 4. Irritability and aggressiveness, as indicated by repeated physical fights or assaults 5. Reckless disregard for safety of self or others 6. Consistent irresponsibility DSM-5 Borderline Personality Disorder A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity as indicated by five or more of the following: 1. Frantic efforts to avoid real or imagined abandonment 2. A pattern of unstable and intense relationships characterized by alternating between extremes of idealization and devaluation 3. Identify disturbance: markedly and persistently unstable self-image or sense of self 4. Impulsivity in at least two areas that are potentially self-damaging (e.g. spending, sex, substance abuse, reckless driving, binge eating) 5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior 6. Affective instability due to a marked reactivity of mood 7. Chronic feeligns of emptiness 8. Inappropriate, intense anger or difficulty controlling anger 9. Transient, stress-related paranoid ideation or severe dissociative symptoms DSM-5 Histrionic Personality Disorder A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by 5 or more of the following: 1. Is uncomfortable in situations in which he or she is not the center of attention 2. Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior 3. Displays rapidly shifting and shallow expression of emotions 4. Consistently uses physical appearance to draw attention to self 5. Has a style of speech that is excessively impressionistic and lacking in detail 6. Shows self-dramatization, theatricality, and exaggerated expression of emotion 7. is suggestible 8. Considers relationships to be more intimate than they actually are DSM-5: Narcissistic Personality Disorder A pervasive pattern of grandiosity, need for admiration, and lack of empathy as indicated by 5 or more of the following: 1. Has a grandiose sense of self-importance 2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love 3. Believes that he or she is "special" and unique and can only be understood by, or should associate with, other special and high-status people 4. Requires excessive admiration 5. Has a sense of entitlement 6. Is interpersonally exploitative 7. Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others 8. Is often envious of others or believes that others are envious of him or her 9. Shows arrogant, haughty behaviors or attitudes DSM-5 Avoidant Personality Disorder A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation as indicated by 4 or more of the following 1. Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection 2. Is unwilling to get involved with people unless certain of being liked 3. Shows restraint within intimate relationships because of the fear of being shamed or ridiculed 4. Is preoccupied with being criticized or rejected in social situations 5. Is inhibited in new interpersonal situations because of feelings of inadequacy 6. Views self as socially inept, personally unappealing, or inferior to others 7. Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing. DSM-5 Dependent Personality Disorder A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation as indicated by 5 or more of the following: 1. Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others 2. Needs others to assume responsibility for most major areas of his or her life 3. Has difficulty expressing disagreement with others because of fear or loss of support or approval 4. Has difficulty initiating projects or doing things on his or her own 5. Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant 6. Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself 7. Urgently seeks another relationship as a source of care and support when a close relationship ends 8. Is unrealistically preoccupied with fears of being left to take care of himself or herself. DSM-5 Obsessive Compulsive Personality Disorder A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, as indicated by four or more of the following: 1. Is preoccupied with details, rules, lists, orders, organization, or schedules to the extent that the major point of the activity is lost 2. Shows perfectionism that interferes with task completion 3. Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships 4. Is overconscientious, scrupulous, and flexible about matters of morality, ethics, or values 5. Is unable to discard worn-out or worthless objects even when they have no sentimental value 6. Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things 7. Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes 8. Shows rigidity and stubbornness Personality Disorder Treatment Therapy CBT DBT for borderline personality disorder Pharmacotherapy for Personality Disorders Antipsychotics Mood Stabilizers Not actually treating the personality disorder but the symptoms of the disorder Which personality disorder has the highest risk of suicide? Borderline personality disorder About 10% will make a lifetime attempt of at least once Co-morbid conditions of personality disorders Major depressive disorder Anxiety Phobias Reminiscence Therapy focuses on patient's recall of significant past events Reminiscence Therapy Treats Alzheimer's/Dementia EMDR Developed by Shapiro EMDR is used for PTSD Senses used in EMDR Eye movement Tactile-tapping Auditory-listening Olfactory is not used Psychodynamic Therapy Rooted in developmental therapy, what happens in the past determines what we are doing today. If we can understand that we can then make more conscious decisions. This type of therapy fluctuates between emotional processing with periods of stabilization, restructure defenses and change personality organizations through interpreting feelings, fantasies, and beliefs. Reveal unconscious content, alleviates psychic tension Psychodynamic Therapy Treats Depression Existential crisis Interpersonal Therapy Focuses on couples and families Any interpersonal relationship Interpersonal Therapy Timeframe 12-16 sessions Exposure Therapy Focuses on phobias Solution Focused Therapy The what if Uses the miracle question Goal oriented Used to treat depression, anxiety Supportive Psychotherapy Strengthens defenses, promotes problem solving, restores adaptive functioning, and provides symptom relief Focuses more on feelings, life stressors, and problem solving How do you respond to a patient in public? Walk by Only say hello if they initiate the conversation Don't talk about health-related things Defer patient to clinic/nurse for questions Social Media Don't interact with patients No! No! Set Facebook restrictions as much as possible Don't post pictures and tag patients Washing and straightening make clean houses OCD Interviewing Question OCD Interviewing Question Washing Straightening Mental rituals Checking Hoarding Must have either obsessing or compulsions Obsession recurrent intrusive thoughts, impulses, or images, that cause anxiety that the person tries to suppress Compulsions repeated behaviors or mental acts that the person feels driven to do, these are aimed at reducing distress What area of the brain is most often linked to violence among patients? Prefrontal- cortex Which personality disorder is often associated with self-harming behavior? BPD Know the risk factors associated with suicide among patients Family history of suicide Family history of child maltreatment Previous suicide attempt(s) History of mental disorders, particularly clinical depression History of alcohol and substance abuse Feelings of hopelessness Impulsive or aggressive tendencies Cultural and religious beliefs (e.g., belief that suicide is noble resolution of a personal dilemma) Local epidemics of suicide Isolation, a feeling of being cut off from other people Barriers to accessing mental health treatment Loss (relational, social, work, or financial) Physical illness Easy access to lethal methods Unwillingness to seek help because of the stigma attached to mental health and substance abuse disorders or to suicidal thoughts Single, living alone Be able to identify protective factors among patients at risk for suicide Effective clinical care for mental, physical, and substance abuse disorders Easy access to a variety of clinical interventions and support for help seeking Family and community support (connectedness) Support from ongoing medical and mental health care relationships Skills in problem solving, conflict resolution, and nonviolent ways of handling disputes Cultural and religious beliefs that discourage suicide and support instincts for self-preservation difference between suicidal gestures and self mutilation **INTENT **suicide: experiencing stressors for which they see no escape from, and choose to end life- feel worthless and hopeless ** the infliction of pain reassures them that they are still alive, which is especially true if they are experiencing emotional numbness or are feeling disconnected from the world around them. Additionally, self-injury can result in a rush as a result of chemical changes in the brain, which can easily become addictive and highly dangerous. What is self harm? Self-harm is a form of mutilation while suicide is the deliberate act of taking one's own life.