final psych portion Flashcards
(130 cards)
1
Q
what is the continuum of eating experiences?
A
manifestations of eating disorders overlap significantly and thus may be viewed holistically with a continuum of eating experiences
2
Q
binge eating
A
episodes of uncontrolled, ravenous eating of large amount of food within discrete periods of time usually followed by guilt and purging behaviour
3
Q
body image
A
self-perception of one’s body
4
Q
body image distortion
A
the individual perceives their body disparately from how the world or society views it
5
Q
dietary restraint
A
cognitive effort to restrict food intake for the purpose of weight loss or prevention of weight gain
6
Q
drive for thinness
A
intense physical and emotional process that overrides all physiological body cues
7
Q
interoceptive awareness
A
sensory response to emotional and visceral cues, such as hunger
8
Q
maturity fears
A
feeling overwhelmed by adult responsibilities
9
Q
purging
A
compensatory behaviour to rid oneself of food already eaten by means of self-induced vomiting or use of laxatives, enemas or diuretics
10
Q
psychological characteristics relating to eating disorders
A
difficulty expressing anger, low self-esteem, body dissatisfaction, powerlessness, obsessiveness, compulsiveness, non-assertiveness, cognitive distortion
11
Q
what are some common eating disorder warning signs?
A
constant dieting even when thin, rapid unexplained weight loss/gain, laxative or diet pill use, obsession with calories, food or nutrition, compulsive exercising, hoarding high-calorie food, going to the bathroom right after meals
12
Q
anorexia nervosa
A
life-threatening eating disorder characterized by refusal to maintain body weight appropriate for age, intense fear of gaining weight, a severely distorted body image and refusal to acknowledge the seriousness of weight loss
severity determined by BMI
13
Q
psychological characteristics specific to anorexia nervosa
A
- decreased interoceptive awareness
- sexuality conflict/fears
- maturity fears
- ritualistic behaviours
- perfectionism
- dietary restraint
14
Q
anorexia - restricting type
A
restricts dietary intake
the person does not binge or purge
15
Q
anorexia - binge eating/purging type
A
during the current episode of AN, the person engages in binge eating and purging behaviours
16
Q
typical age of onset of anorexia nervosa
A
14-16 years, highest incidence rates for females 15-19 years
17
Q
muscle dysmorphia
A
eating disorder generally seen in men who obsess on over-exercising or building muscle mass
higher rate in jobs or professions that demand thinness or large muscular bodies
18
Q
risk factors of anorexia nervosa
A
- sports that emphasize leanness
- personal trauma
- abuse
- interpersonal distrust
- family systems
- lack of assertiveness
- fear of expressing feelings
19
Q
can you be certified under the mental health act for eating disorders?
A
the patient will ONLY be certified for MEDICAL REASONS
otherwise, VOLUNTARY on eating disorders unit OR outpatient
20
Q
BMI
A
body mass index
“normal” - 18.5-24.9
anorexia - under 16
overweight - 25-29.9
obesity - 30 +
21
Q
when would you be admitted for an eating disorder?
A
- MEDICAL: less than 75% than ideal weight, severe dehydration
- STARVATION: electrolyte imbalance, syncope, seizures, bradycardia, cardiac BMI under 16
- PSYCH: suicidal, psychosis, OCD, family dysfunction, decreased daily functioning
22
Q
nursing interventions for anorexia nervosa
A
- building trust and establish a therapeutic alliance
- psychoeducation
- weight restoration (start low and go slow)
23
Q
what is refeeding syndrome
A
rare but potentially fatal condition that can occur during refeeding of malnourished individuals
due to the metabolic and hormonal changes that occur due to aggressive nutritional rehab
can cause severe electrolyte imbalances
24
Q
who is at risk for refeeding syndrome?
A
- any pt resulting in rapid weight loss of 15-20% over 3-6 months
- 10 days of low intake or starvation
- pts receiving enteral or parenteral feeds
25
manifestations of refeeding syndrome
hyperglycemia, fluid retention, dysrhythmias, heart failure, respiratory failure, anemia, delirium, weakness
26
how can we prevent refeeding syndrome?
- start low and go slow when increasing kcal intake
- MONITOR pt presentation closely
- adjust fluid, electrolyte, vitamin, and mineral requirements based on lab work
- provide thiamine and complete multivitamin
27
bulimia nervosa
eating disorder characterized by recurrent episodes of binge eating and compensatory behavior to avoid weight gain through purging methods or non purging methods such as fasting or excessive exercise
binge eating and compensatory behaviours occurring on average once a week for 3 months
28
psychological characteristics specific to BN
- impulsivity
- boundary problems
- limit-setting difficulties
- dietary restraint
binging and purging often occur in private (secret) and are typically of average weight making it difficult to identify the problem
29
physical assessment findings of someone with bulimia nervosa
- loss of dental enamel
- chipped, or moth eaten teeth appearance
- increased dental caries
- scars on dorsum of hand
- menstrual irregularities
30
lab findings from someone with bulimia nervosa
- fluid and electrolyte imbalances
- metabolic alkalosis (from vomiting) or metabolic acidosis (from diarrhea)
- mildly elevated serum amylase levels
31
the binge-purge cycle
1. hunger
2. binge eating
3. shame, humiliation, failure
4. dieting or purging
32
bulimia nervosa and hospitalization
less likely than those with anorexia nervosa to be hospitalized
dehydration, electrolyte imbalance, depression, suicidality
33
priority care issue for bulimia nervosa
suicidality or self-harm due to impulsivity
34
binge eating disorder
eating disorder characterized by frequent consumption of very large amounts of food, coupled with feelings of being out of control, ashamed and disgusted by the behaviour and experience high body dissatisfaction
* more common than AN and BN
35
psychological characteristics of BED
- negative mood
- self-deprication
- social insecurity
36
risk factors for BED
- low self-esteem
- weak therapeutic alliances
- low mastery and clarification
37
what should we assess for in binge eating disorder pts?
- current BE patterns & triggers
- associated symptoms of gastric distress
- physical mobility, activity and sleep patterns
- cognitive distortions & knowledge gaps
- symptoms of comorbid psychiatric disorders
- MSE & risk
38
what are the priority care issues for BED?f
comorbid obesity, depression and anxiety can contribute to cardiac and other health crises
* also risk of type 2 diabetes in presence of obesity
39
nursing interventions for BED
- building the therapeutic relationship
- psychotherapy (addressing cognitive distortions with CBT)
- encourage clients to record intake, binges and emotions associated
- pharmacological intervention for weight loss (Vyvanse)
- establishing health sleep and coping patterns
40
pica
persistent eating of non-nutritive, non-food substances over a period of at least 1 month
inappropriate to developmental level of individual and not supported culturally or socially
41
rumination disorder
repeated regurgitation of food over a period of at least 1 month, food may be re-chewed, re-swallowed or spit out
does not occur exclusively during the course of anorexia nervosa, bulimia nervosa, or binge eating disorder
42
avoidant/restrictive food intake disorder (ARFID)
eating or food disturbance as manifested by persistent failure to meet appropriate nutritional/energy needs
- significant weight loss
- significant nutritional deficiency
- dependence on enteral feeding or oral nutritional supplements
- marked interference with psychosocial functioning
*** differs from AN: the person LACKS the drive for thinness or body image disturbances
43
purging disorder
recurrent purging behaviour to influence weight or shape in the absence of binge eating
44
night eating syndrome
recurrent episodes of night eating after awakening from sleep or excessive food consumption after the evening meal
45
personality traits
persistent patterns of perceiving, thinking, feeling and behaving that shape the way in which a person responds to the world
46
temperament
recognizable, distinctive, and relatively stable pattern of individual differences that are evident early on in life
47
what are the 5 key traits of personality
O.C.E.A.N
Openness to experience
Conscientiousness
Extraversion
Agreeableness
Neuroticism
48
personality disorder
a diagnosis when the perceptions, emotions, cognition and behaviours of an individual substantially deviate from cultural expectations in a persistent and inflexible way causing distress or impairment
49
personality disorder traits
underlying thoughts, feelings and behaviours that may be intermittent and interfere interpersonally without obvious impairment
50
what is required for a diagnosis of a personality disorder?
behaviours and characteristics must persistently occur to such an extent that they interfere with functioning (socially and occupationally)
51
what are some common features of personality disorders?
- impaired metacognition
- maladaptive emotional response
- impaired self-identity and interpersonal functioning
- impulsivity and destructive behaviours
52
Cluster A personality disorders
ODD/ECCENTRIC
- paranoid personality disorder
- schizoid personality disorder
- schizotypal personality disorder
53
Cluster B personality disorders
Cluster B personality disorders
DRAMATIC/UNPREDICTABLE
- antisocial personality disorder
- borderline personality disorder
- histrionic personality disorder
- narcissistic personality disorder
54
Cluster C personality disorders
ANXIOUS/FEARFUL
- avoidant personality disorder
- dependent personality disorder
- obsessive-compulsive personality disorder
55
treatment for cluster A PDs
if they are content, can maybe just let them be!
psychotherapy is most effective
can use antidepressants or antipsychotics if there are overlap of symptoms
56
treatment for cluster B PDs
counseling and therapy (DBT)
medications may be used to treat specific symptoms but not the disorder itself
57
borderline personality disorder (BPD)
characterized by affective instability, identity disturbances, unstable relationships, cognitive dysfunctions, impulsivity, self-injurious behaviours, risk for suicide
58
what are the 6 behavioural patterns seen in BPD
1. emotional vulnerability
2. self-invalidation
3. unrelenting crisis
4. inhibited grieving
5. active passivity
6. apparent competence
59
nursing interventions for BPD
- management of medications
- regular sleep patterns
- nutrition
- safety measures
- cognitive strategies
- limit setting
- community resources
60
all or nothing thinking
only seeing things in black or white, with no shades of grey
"If I don't get a perfect evaluation, I am a failure"
61
overgeneralizatio
the assumption that one error/problem means a lifetime of the same error/problem
"If I lose this job, I will never succeed in making a living"
62
mental filter
filtering out the good things that happen and retaining only the negative
"When I received that award, I could see that Jane didn't think I deserved it"
63
magnification/minimization
over exaggeration of fears, imperfections, or errors
"There is absolutely no way I could have passed that exam, I've totally blown the course"
64
jumping to conclusions
concluding things that are not justified based on available evidence
"I saw Peter yawn during my presentation, everyone was bored"
also includes mind reading/fortune telling
"my coworker didn't say hello to me today because she's starting to dislike me"
65
labelling
putting a negative label on yourself or others, a way to believe that no one can change
"My roommate is a slob, I have to keep everything tidy"
66
personalization and blame
making yourself feel responsible for things out of your control
"It is my fault our team lost the game. If only I hadn't dropped the ball in the first half"
67
should/must statements
thinking only in terms of "should" or "must"
"I must make no mistakes during the skill laboratory, no matter what"
68
discounting the positive
refusing to credit the positive aspects of situations
"John said that I looked great today. He must think I look terrible most days"
69
emotional reasoning
believing something must be true because one "feels" it so strongly, ignoring any evidence to the contrary
"I know I've had people in my life who say I'm a good person, but it's hard to believe because I feel like I'm so bad"
70
treatment for cluster C PDs
- best treated in group therapy (typically in community)
- CBT used to deal with cognitive distortions, emotional reasoning and personalization
- strength-based approach
- psychotropic medications (anxiolytics and antidepressants) may be used in conjunction with therapy to treat depression, anxiety and sleep disturbances
71
difference between signal signs and signal symptoms
SIGNAL SIGNS: observable behaviours and styles of interaction which may prompt the interviewer to look further
SIGNAL SYMPTOMS: client's reported complaints of symptoms typically associated with a personality disorder
72
paranoid personality disorder
DISTRUST, SUSPICION
Heightened sense of fear and vulnerability
Tx: psychotherapy
73
schizoid personality disorder
SOCIAL DETACHMENT, EMOTIONAL RESTRICTION
Anxiety due to forced contact with others
Tx: CBT, group therapy
74
schizotypal personality disorder
ODD BELIEFS, SOCIALLY ISOLATIVE
odd interpretation of illness, anxiety because of forced contact with others
Tx: psychotherapy, CBT, group therapy
75
antisocial personality disorder
DISREGARDS RIGHTS OF OTHERS
anger, entitlement masking fear
Tx: psychoanalytic therapy, CBT
76
histrionic personality disorder
EXCESSIVE ATTENTION-SEEKING BEHAVIOUR, EMOTIONALITY
threatened sense of attractiveness and self-esteem
Tx: psychotherapy
77
narcissistic personality disorder
GRANDIOSITY, NEED FOR ADMIRATION, LACK OF EMPATHY
anxiety caused by doubts of personal adequacy
Tx: psychotherapy
78
avoidant personality disorder
SOCIAL INHIBITION D/T FEAR OF REJECTION OR HUMILIATION
heightened sense of inadequacy, low self esteem
Tx: psychoanalytic therapy, CBT, group therapy
79
dependent personality disorder
EXCESSIVE NEED TO BE TAKEN CARE OF, SUBMISSIVE AND CLINGING BEHAVIOUR
fear of abandonment, helplessness
Tx: psychotherapy, CBT, DBT, group therapy
80
obsessive compulsive personality disorder
PREOCCUPATIONS WITH ORDERLINESS, PERFECTION, CONTROL
fear of losing control of bodily function and emotions
Tx: CBT
81
psychoanalytic therapy
"talk therapy" with focus on uncovering and resolving unconscious emotions and memories
82
what is the first line tx for BPD?
DBT
83
self-care and personality disorders
effective in reducing distress, improve resilience and physical health, and improved coping with stressors
can help reduce common symptoms of cluster A, B and C personality disorders such as mood changes, impulsive behaviour, anxiety and irritability
84
what are the five core elements of mindfulness?
1. attention & awareness
2. present-centeredness
3. external events
4. cultivation
5. ethical mindedness
85
acceptance based treatments
learning to be open to reality and acknowledge things as they are
acknowledging the feeling, experience or situation then identifying ways to cope, experience or change the feeling/situation
86
CBT
psychotherapy focused on identifying, analyzing and ultimately changing the habitually inflexible and negative cognitions about oneself, others and the world
intersection of thoughts, emotions and behaviours
87
what are the 3 levels of cognition
1. CORE BELIEFS (ones view of self, others and the world)
2. INTERMEDIATE BELIEFS (attitudes, rules, or expectations and assumptions that influences one's perception, affect and behaviours)
3. AUTOMATIC THOUGHTS (initial and most superficial response)
88
DBT
combines cognitive and behavioural strategies in which patients actively formulate treatment goals to change the target behaviours
89
describe the stages of DBT
PRE-TREATMENT: orient to DBT
STAGE 1: commitment, safety and stability (focus on life-threatening, quality of life interfering, or therapy interfering behaviours)
STAGE 2: symptom reduction (trauma/PTSD, eating disorders, anxiety disorders, mood disorders)
STAGE 3: regulating emotions through acceptance and change (low self-esteem, relationship difficulties, problem-solving, inadequate quality of life)
90
self-harm
self-inflicted actions that cause damage to body tissue
91
suicidal ideation
thoughts, ideas and feelings about wanting to die and how to die
92
suicidal plan
plan or plans to die by suicide
93
suicidal behaviour
any self-inflicted behaviours with the intent to die
94
suicide attempt
self-destructive behaviour that did not result in death but had the expectation of death
95
suicide
completion of death by self
96
5 types of abuse
physical, emotional, sexual, child abuse, elder abuse
97
criminal code
IMMEDIATE RISK - 911
when you suspect a crime has occurred, might occur or someone is exhibiting behaviour that indicates a lack of wellbeing and unpredictability
98
adult guardianship act
NEGLECT/ABUSE
when you are concerned an adult is being abused, neglected or is self-neglecting and unable to seek support/assistance on their own due to:
- physical restraint
- physical handicap
- illness, disease, injury
99
public guardian and trustee
FINANCIAL LEGAL RISK
you have reason to believe that an adult is not capable of managing his or her financial and legal affairs and there is imminent risk to his or her assets
100
who are vulnerable groups for abuse?
- people with a mental disorder
- LGBTQ2+
- people in care
- multicultural, immigrants and visible minorities
- children & youth
- intimate partners
- older adults
- indigenous people
- people with disabilities
101
women abuse
domestic abuse, spousal abuse, or intimate partner abuse
102
stalking/harassment
crime of intimidation which causes distress and/or fear
103
battering
repeated physical or sexual violence with the intent of coercive control
104
rape & sexual assault
any form of non consenting sexual activity
105
abuse against men
- men and women report relatively equal rates of spousal violence
- men 3.5x more likely to experience kicking, biting, hitting or being hit with something
* less likely to seek support services
106
what is the age of consent in canada?
16
107
what is the age of consent for someone in a relationship of authority, trust or dependency?
18
108
cycle of abuse
PHASE 1) tension building
PHASE 2) violence erupts
PHASE 3) remorse ensues
109
why do women stay in violent relationships?
- economic or financial dependence
- societal, cultural or religious expectation
- fear of retaliation
- mental health problems
- history of trauma and abuse
- traumatic bonding
110
what is the role of an RPN when working with someone who has been abused or suspected to have been abused?
ASSESS
SAFETY
DUTY TO REPORT
provide resources, can't force anyone who is a competent adult to get help if no imminent risk
111
who does the duty to report apply to?
children, older adults or adults with impaired decision making skills
112
what is "car 86"
emergency service
police and ministry of child and family development together
113
what are some possible indicators of abuse
- vague information about cause of issue
- delay between occurrence of injury and seeking of tx
- inappropriate reactions of significant other or family
- denial or minimization
- discrepancy between history and physical examination findings
114
can you contact the police if you suspect abuse?
if they are a competent adult, you can only contact police if they agree to it
115
priority nursing interventions for a pt suffering from abuse
INFORM, provide resources if they are accepting, explain importance of having a "to-go" bag, book a follow up appt
116
sexual health
a state of physical, emotional, mental and societal well-being related to sexuality
117
sexuality
encompasses [assigned] sex, gender identity and roles, sexual orientation, eroticism, pleasure, intimacy and reproduction
118
sexual orientation
who we are attracted to
119
gender identity
one's sense of being male or female (or outside of that)
120
gender expression
how one outwardly shows one's gender
121
gender diverse
gender roles/expression that do not match social and cultural expectations
122
binary model of gender
classification of sex and gender into two distinct (male or female) categories
outdated
123
spectrum model of gender
acknowledges a spectrum of gender and is not limited to male and female
124
spectrum model 2.0 of gender
goes beyond the spectrum model and acknowledges outside of/beyond male/femaleness
125
gender dysphoria
discomfort or distress that is caused by a discrepancy between their gender identity and gender assigned at birth
significant distress and impairment in social, occupational or other important areas for at least 6 months
126
treatment options for gender dysphoria
- individual therapy/counselling
- education/resources (social, legal or medical affirmation)
- family/couples therapy
- support groups
127
puberty blockers
GnRH used to suppress puberty to prevent secondary sex characteristics to develop
requires a long lasting and intense pattern of gender dysphoria
128
hormone therapy
need to be the age of majority in Canada (18)
either estrogen (male to female) or testosterone (female to male)
129
what are some procedures not covered by MSP?
facial procedures, pectoral implants, hair reconstruction or restoration, liposuction or lipofilling, voice surgery
as well as supportive garments, travel/accomodation for surgeries, other travel expenses
130
