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Peplau’s Classic 4 Levels of Anxiety

1) Mild - slight discomfort. a persons sees, hears, and grasps more information, and problem-solving becomes more effective. (low tension EX: nail biting, foot or finger tapping) – best for taking tests.
2) Moderate - perceptual field narrows, and some details are excluded. Thinking clearly is hampered. Selective attention. Physical symptoms occur = (tension, pounding HR, increased pulse & RR, perspiration, gastric upset, HA)
3) Severe - perceptual field is greatly reduced. Scattered thoughts. Behavior is automatic and the aim is to stop or reduce the stress. Learning and problem-solving are not possible at this level. Dazed and Confused. (increased HR, trembling, hyperventilation, a sense of impending doom)
4) Panic - results in disturbing behavior. are no longer able to process information and lose touch with reality. (Symptoms: Confusion, shouting, screaming or withdrawal, erratic, uncoordinated, and impulsive, hallucinations, lack of ability to learn) -- Exhaustion.


Positive Symptoms vs Negative Symptoms(Clinical Manifestations)
-Positive and Negative symptoms

- Positive Symptoms
+ Hallucinations (type)
+ Delusions
+ Bizarre Behaviors – includes movements like waxy flexibility
+ Loosening Associations–disorganized speech

-Negative Symptoms
--Affective flattening
--Alogia (poverty of thought)
--Avolition (loss of motivation)
--Anhedonia (loss of interest in activities)
--ADL decline, social isolation and withdrawal (Asociality)


What part of the brain maintains homeostasis?



What structure in the brain is referred to as “the emotional brain?”

Limbic system


What does an extrapyramidal symptom (EPS) mean?

Abnormal involuntary movements


Name the 4 monoamine neurotransmitters in the brain:

Serotonin, Norepinephrine, Histamine, and Dopamine


Explain how (brain chemistry) benzodiazepines work on anxiety:

GABA is the major inhibitory (calming) neurotransmitter in the CNS. Benzodiazepines promote activity by binding to specific receptor sites in GABA


What is eustress?

Good stress


What is distress?

Negative energy that causes problems


Describe the stress response:

It is the “fight or flight response. It is a survival mechanism by which our body and mind become immediately ready to meet a threat or stress


What is posttraumatic stress disorder (PTSD)?

Occurs in people
who have experienced a highly traumatic event which often involves a threat of death or serious injury to self or others, including feelings of intense fear, helplessness, or horror that can often disrupt a person’s ability to carry out ADLs


How is acute stress disorder different from PTSD?

Resolution of the symptoms resolves within 1 month


Describe the levels of anxiety:

1) Mild- normal everyday living.
2) Moderate- selective attentions were an individual sees, hears, and grasps less information than someone not in that state.
3) Severe- perceptual field is greatly reduced and hyperventilation is classic symptom.
4) Panic- most extreme level resulting in markedly disturbed behavior.


Describe the most important properties of defense mechanisms:

Defenses are a major means of managing conflict and affect. They are relatively unconscious, discrete from one another, and adaptive as well as pathological. Although defenses are often the hallmark of major psychiatric syndromes, they are reversible


Defense mechanisms are automatic coping styles to protect individuals from anxiety and save face by blocking feelings, conflicts, and memories. Which defense mechanism is used in a healthy way?

Sublimation and Altruism


What are the 3 functions of the limbic system?

Appraisal of emotional stimuli, initiation of emotional responses (Fight or Flight) with sympathetic nervous system activated and cessation of reactivity after external stressors subside and restores the nervous system to a state of homeostasis via parasympathetic system


What is agoraphobia?

Intense, excessive anxiety about or fear of being in places or situations where help might not be available and escape might be challenging.


In this chapter which disorder is new in the DSM-V?



Which drugs are used to treat the somatic and psychological symptoms of anxiety?



Name other classes of medications used to treat anxiety disorders?

Beta-blockers, antihistamines, and anticonvulsants


- Transient –
- Mild –
- Moderate –
- Severe –
- Other depressive disorders

- Transient – Life’s everyday disappointments (your perception of stressors)
- Mild – Normal grief response
- Moderate – Dysthymic disorder
- Severe – Major Depressive disorder (with or without psychotic features)
- Other depressive disorders
• Seasonal affective disorder (SAD)
• Premenstrual dysphoric disorder
• Post-partum depression • Cyclothymia


Major depressive disorder (MDD)—

- Major depressive disorder (MDD)—Single Episode or Recurrent Episodes
• Substantial pain and suffering: psychologic, social, and occupational disability (a change in previous function that can cause significant distress)
• History: one or more major depressive episodes
• No history of manic or hypomanic episodes
• Possible psychotic features


Criteria MDD
• The following occur nearly everyday for most waking hours over the same 2 week period - Must have at least 5 of these symptoms:

• Depressed mood everyday all day
• Anhedonia
• Significant weight loss or gain (5% of body wt.)
• Insomnia or hypersomnia
• Increased or decreased motor activity
• Anergia
• Feeling of worthlessness/inappropriate guilt
• Decreased concentration/indecisiveness
• Recurrent thoughts of death/suicidal ideation (SI)


Dysthymic disorder (DD)
• Early and insidious onset that is less severe than MDD
• Occurs over a 2 year period and present most of the
• Chronic depressive syndrome (chronic sadness)

• Decreased or increased appetite
• Insomnia or hypersomnia
• Low energy or fatigue
• Decreased self-esteem
• Poor concentration or difficulty making decisions
• Feeling hopelessness or despair


Secondary Depression caused by

• Accompanying Illnesses
- Neuroendocrine
- Hormonal Disturbances
- Electrolyte Imbalances
- Nutritional deficiencies
- Other
• Complicated Grieving
• Senescence – most common psychiatric disorder in elderly


• Older adults are grouped by age:
• Risk factors include?
• Most older adults who commit suicide have visited their primary care physician when?
• Recognition and treatment of depression in the medical setting helps prevent?

• Older adults are grouped by age: 65 to 74 years of age, and 75 years and older
• Risk factors include social isolation, solitary living arrangements, widowhood, lack of financial resources, poor health, and hopelessness
• Most older adults who commit suicide have visited their primary care physician the month before the suicide, sometimes that very day
• Recognition and treatment of depression in the medical setting helps prevent suicide in older adults


Adolescents and Younger Adults
• Strongest risk factors,
• Other factors:
• Frequent episodes of?
• Frequent expressions of?
• Family loss,
• Perception of failure:
• Expression of suicidal thoughts when?
• Difficulty dealing with?
• Unplanned?

• Strongest risk factors, 14 to 24 years of age: Substance abuse, aggression, disruptive behaviors,
depression, and social isolation
• Otherfactors:
• Frequent episodes of running away
• Frequent expressions of rage and problems with parents
• Family loss, instability, and withdrawal
• Perception of failure: school, work, social
• Expression of suicidal thoughts when sad or bored
• Difficulty dealing with sexual orientation
• Unplanned pregnancy


Meds that increase depression

• Steroids
• Hormones
• CNS Depressants- Tranquilizers, Sedative/hypnotics
• Antihypertensive
• Antibacterial/Antifungal
• Antineoplastic
• Analgesics/Anti-inflammatory
• Antiulcer


Biological Theories
• Genetic factors –
• Biochemical factors –
-Primary major neurotransmitters:

Biological Theories
• Genetic factors – suicide clusters in families
• Biochemical factors – medications developed from research to target neurotransmitters
- Primary major neurotransmitters
* Serotonin (5HT)
* norepinephrine (NE)
- Note: Dopamine - to a lesser extent is also related to depression


Psychosocial Theories

• The Stress–Diathesis Model of Depression
• Learned helplessness
• Cultural considerations