Milieu Therapy
An inpatient treatment approach involving professionals and staff members encouraging a person with a severe mental disorder to engage in prosocial and therapeutic activities.
Interpersonal Psychotherapy
a form of psychotherapy that focuses on helping clients improve current relationships.
Behavior Therapy
A type of therapy that assumes that qisordered behavior is learned and that symptom relief is achieved through changing overt matadaptive behaviors into more constructive behaviors
Cognitive Therapy
therapy that teaches people new, more adaptive ways of thinking and acting; based on the assumption that thoughts intervene between events and our emotional reactions.
3 Stages of Group Development
Initial - superficial communication
Working - Real work is done
Termination - provides opportunity to learn to deal with issues
4 Types of Anxiety
Mild
Moderate
Severe
Panic
Mild Anxiety
Adaptive and motivates for change / Awareness heightened /Learning enhanced /Seldom a problem
Moderate Anxiety
hyper-alert, complains of being uptight, impaired problem solving ability.
Severe Anxiety
Feeling that something bad is about to happen
perceptual field marked narrowed,. focus on SINGLE SMALL DETAIL or SCATTERED detail of a situation, CANNOT CONNECT between events
Panic Anxiety
Unable to focus /Loss of contact with reality is possible /Wild, desperate actions or extreme withdrawal/Feelings of TERROR or of “going crazy”
GAD
General Anxiety Disorder, excessive anxiety and worry, occurring more days than not for at least 6 months.
GAD S/S
-restlessness, being easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance
GAD Tx
Best treated w/ SSRl’s, Buspirone HCL, and Effexor (Venlafaxine)
PTSD
Posttraumatic Stress Disorder, an anxiety disorder associated with serious traumatic events and characterized by such symptoms as survivor guilt, reliving the trauma in dreams, numbness and lack of involvement with reality, or recurrent thoughts and images
PTSD Tx
-SSRls and benzos for sleep, nightmares, irritability
Benzodiazepines
anti-anxiety drugs that depress the central. nervous system, reduce activity, and induce relaxation and sleep; often prescribed to relieve tension, muscular strain, sleep problems, anxiety, and panic attacks (eg. valium)
Benzodiazepine S/E
tolerance and dependence within a few weeks Anterograde amnesia
Benzodiazepine examples
Valium (diazepam), ativan (lorazepam), Xanax (Alprazolam), Serax (oxazepam), Klonopin (clonazepam), Librium (chlordiazepoxide)
Benzo Antidote
Flumazenil (Romazicon): competitive antagonist of benzodiazepine receptor
-given IV for overdose or reversal
Somatoform Disorders
disorders characterized by physical symptoms for which no known physical cause exists
Conversion Disorder
a mental disorder characterized by the conversion of mental conflict into somatic forms (into paralysis or anesthesia having no apparent cause)
Dissociative Disorders
disorders in which conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings
Dissociative Amnesia
sudden loss of memory usually following a particularly stres sful or traumatic event
Dissociative Fugue
The sudden loss of memory for one’s personal history, accompanied by an abrupt departure from home and the assumption of a new identity
Dissociative Identity Disorder
also called multiple personality disorder
Depersonalization Disorder
dissociative disorder in which individuals feel detached and disconnected from themselves, their bodies, and their surroundings
Bipolar Disorder
Characterized by episodes of mania nd depression with periods of normal mood and activity in between
Lithium carbonate
Therapeutic range
0.8 to 1.2 mEq/L
SSRI
selective serotonin reuptake inhibitor (antidepressant drug)
SSRI Examples
Fluoxetine (Paxil), Sertraline (Zoloft), Fluvoxamine (Luvox), Citalopram (Celexa), Escitalopram (Lexapro)
SSRI S/E
dry mouth, blurred vision, sedation, insomnia, sexual dysfx
Tricyclic Antidepressants
used for the treatment of clinical depression, OCD, most common adverse effects are sedation and anticholinergic-like effects
Tricyclic effectiveness
occur within 1 to 4 weeks after therapy is initiated
Anticholinergic side effects
blurred vision, dry mouth, tachycardia, constipation, urinary retention
MAOI
early type of antidepressants used as last resort due to numerous side effects and food restrictions
MAOI avoid
tyramine; aged cheeses, fava beans, yeast extracts, aged meats, high-yeast beers, liver, chianti wine, vermouth, aged liquors.
MAOI S/E
- insomnia (sometimes sedation), arousal
- postural hypotension
- dry mouth, blurring of vision, constipation
- anorgasmia, impotence
- tremors, twitching,
- weight gain
- hypertensive crisis (severe occipital headache, prolonged rise in BP)
NMS
Neuroleptic maliignant syndrome. Rare but life threatening effect of antipsychotic medications. Signs: Extreme rigidity and Catatonia. Any patient who suddenly becomes rigid or unresponsive requires medical evaluation
EPS
pseudo-parkinsonism, acute dystonia, akathisia, and tardive dyskinesia.
Pseudo Parkinsonism
Stooped posture, Shuffling gait, Rigidity, Bradykinesia, Tremors at rest, Pill-rolling of hand
Acute dystonia
Facial grimacing
Involuntary upward eye movement
Muscle Spasms of tongue, face, neck
Akathisia
Restless
Trouble standing still
Paces the floor
Feet in constant motion, rocking back and forth
Tardive dyskinesia
Protrusion and rolling the tongue
Sucking and smacking movements of lips Involuntary movements of body/ extremities
Delusions of persecution
dstorted sense of paranoia (“The government is watching me.”)
Delusions of Grandeur
an exaggerated sense of self that has no basis in reality
Somatic Delusions
client believes that their body is changing, which has no basis in reality
Alcohol withdrawal time
24 - 48 hours
Alcohol withdrawal tx
chlordiazepoxide (Librium)
Withdrawal delirium peak
- time
- duration
peak 48 - 72 hrs
duration 2 - 3 days
Asperger Disorder
A pervasive developmental disorder in which individuals display profound social impairment and restricted or unusual behaviors, but without language delays seen in autism.
Anxiety
response to stress
Panic Disorders
recurrent panic attacks
Phobias
Fear of a specific object or situation to an unreasonable level
Non-medication tx for Anxiety Disorders
- cognitive retraining
- behavioral therapy
- eye movement desensitization therapy (EMDR)
- Group and Family Therapy (PTSD)
Behavioral Therapies
- relaxation
- modelling
- step-wise desensitization
- flooding
- thought stopping
OCD
Obsessive-Compulsive Disorder
Repetitive thoughts lead to repetitive acts to relieve anxiety
Acute stress disorder
traumatic event causes numbing, detachment and amnesia about event for < 4 weeks.
Anxiolytics (Benzo’s)
am’s and pam’s (addictive)
Xanax
Valium
Ativan
Anxiolytics Non-Benzo’s)
BuSpar (non-addictive)
Antidepressants
Zoloft
Elavil
Remeron
allows rest when panic attacks occur while sleeping