All right, everybody. Hello, hello. We're going to be talking about mental health stuff today. What do we got? We're going to talk about bipolar, stress, anxiety disorders, trauma, and dissociative disorders.
So let's get into it. So when you guys think about bipolar disorder, I want you to think about these three that we are mainly going to be focused on. We got bipolar 1, bipolar 2, and psychothemic disorder. Okay.
Don't get confused when you think about bipolar 1 versus bipolar 2. I need you to understand that bipolar 1 will be the one that's more difficult to live with, okay? Bipolar 2 would be, it's going to be difficult to live with either of them, but bipolar 1 will be the most difficult because we'll see in just a second that folks who have bipolar 1, what they're experiencing, not only do they experience the depression that you see here, the severe depression, But then they go all the way up here on this graph and then they experience mania. Okay.
So that's the big distinction between bipolar two and bipolar one. Bipolar one folks, they experience that mania. And when a person's in a manic state, they are not going to be behaving in a way that's even considered to be safe. Okay. So looking here at this graph, you know, this is us, you know, those of us who don't have bipolar disorder, you know, we see our mood kind of fluctuating a little bit, just kind of going up and down, you know, no big deal.
People who have psychothermic personality disorder, you're going to see a bit more of a rapid cycling. They go up, down, up, down, but they never really fully hit that first step of depression all the way at the bottom here, or like in between here. Nor do they experience the hypomania. They're kind of like in between. You look at folks who have psychothermic disorder, these folks, they'll come all the way down, they'll hit that first step of depression, okay?
They'll come all the way back up to normal, they'll hit that first step, or that step of hypomania, okay? They don't generally become manic, though. They come all the way down, so they just keep going back up and down, never really hitting that severe depression, luckily never going beyond hypomania, okay?
Looking at bipolar 2 folks, you see they come all the way down, they hit that first step of depression, they hit that severe depression, they come all the way back up, when they experience that hypomania, you know, they feel like they got a lot of energy, they want to work on some projects around the house, clean the car, wash the cat, wash whatever, lots of energy, okay? But, you know, they're able to control it somewhat. They're not out of control potentially like you would see with someone with mania, all right?
And then once again, you see them coming all the way back down. So when you think about a person who's experiencing bipolar 2 or bipolar 1, what do you guys think? If they're experiencing this severe depression, what's a priority concern that we would have for our patient?
You know, it would probably be the idea that they might be developing thoughts that hurt themselves, right? And we need to ensure that we're helping to keep these folks safe. when they are experiencing that severe depression. Okay.
And we do have this right here, unipolar mania, where these folks, they don't really experience the depressive side. They're only experiencing the highs, just the hypomania, you know, getting close to that mania. But, you know, the key ones I want you to focus on, psychothermic disorder, bipolar II, bipolar I.
All right. So looking at bipolar I, how we are able to characterize somebody with this disorder versus someone with bipolar II. is that we see that they would have a manic episode that lasts for at least seven days or longer within a given period of time.
If that happens, that person would likely be categorized or diagnosed with having bipolar 1. Technically, you could have someone who has bipolar 2, they may go into a manic state for a short period of time, maybe a day or two, a few days, but they would still be diagnosed with having bipolar 2 if, you know, if it's less than if it goes less than seven days okay um right so when you think about bipolar ones go back to bipolar one when we think about folks with bipolar one we know that they can experience that mania we know that they're going to be going full steam because when you're manic you're just you just keep going right you have almost like an unlimited level of energy but you're still a human being you still require what sleep you still require food do you guys think that these folks are going to be feeling very hungry when they're manic Do you think they're going to be feeling sleepy? They probably won't be. So with that in mind, we're going to have to prompt them to say, hey, Jerry, why don't you go lay down and take a nap for a little bit? Why don't you go lay down and relax? Or here, Jerry, here's a ham sandwich.
Here's a chicken sandwich, something with meat, something with high caloric value behind it. You really would not want to give them something like carrots and celery. We're not trying to help them lose weight. Right, the key thing I want you to know is this.
They can't experience psychosis. And one of the reasons why they can experience psychosis is when you're manic and you go day after day after day after not sleeping very well, right? Could you become psychotic?
Yeah, you're going to probably start hearing things, seeing things, having delusional thinking, etc. And we have to be mindful about that when we work with our folks. Okay, all right.
So looking right here at this slide, this is the mania. And when we look at folks with mania, what do we see? We see this extreme drive and energy. They'll have an inflated sense of self-importance. Noticing this idea that they are going to have a reduced sleep requirement.
You know, For them, they can lay down, go to sleep for like a half an hour, 90 minutes, wake back up, and then be right back into the action. Whereas you and me, if you were to only get, what, maybe an hour of sleep on a Monday night, and then you wake up Tuesday, you're probably going to feel pretty poopy, right? And then imagine Tuesday night, you only get another one hour of sleep. How are you going to be feeling by Wednesday? Wednesday night, you get an hour of sleep.
Thursday, how are you going to be feeling? You're going to be like... You're going to feel like you're dead almost, right? You're going to be so tired, so messed up from that lack of sleep, you'll barely be able to function. But these folks, they just keep going.
They'll have the energy. They'll be able to wake up and then get right back into things. The problem is, you know, your brain's not going to be functioning very well when you're not sleeping. And, you know, that's the thing that can lead these folks into that psychosis. So, like I said, it's a really important idea for us to prompt them.
to say, hey, Jerry, why don't you go lay down and take a nap? Why don't you go lay down and relax before we do our group therapy session, et cetera. You'll see folks who have mania, they're going to be talking with this pressured speech. And for those of you who get to go to clinicals and meet these folks in person, you're going to see folks who have bipolar disorder when they're in the manic state, you're not really going to be talking with them. More so, they're going to be talking at you.
Not much of a back and forth in between conversations, mostly just them talking at you. So you're going to see that these folks are going to be very easily distracted. They can become obsessed, you know, over certain goals or things that they think have to be done or accomplished. You know, you might get a patient coming up to you, you know, if you work nights, they come up to you at 2 in the morning. Hey, I need to talk to the doctor right now.
It's really important to call. Yeah, call the doctor. I need to talk to them right now. Really? What is it that you want to talk about?
You know, and they'll say, I need to take. I need to make sure that I have a dietary supplement in the morning for breakfast. They'll be really fixated over these whole things. And as a nurse, you need to make sure that what it is that they're talking about, you have to acknowledge their complaints, you have to acknowledge their concerns, but you need to be mindful about calling the doctor at 2 in the morning simply because the patient wants to have access to dietary supplement, et cetera.
You'll see this purposeless arousal and movement. Many of these folks are embracing thoughts. And one of the key things that we need to be mindful of too with the mania, high risk behavior.
These folks, they will engage in activity such as gambling, having sex with people who they don't know without any protection. Many stories have been told where folks who go into a manic state where they have access to their parents'retirement funds or their own retirement funds. And then they just dump it all into whatever they think is the hottest thing. you know cool investment or whatever and then they lose all their money and um that is the thing that happens sadly with these folks because when they're in this manic state are they thinking clearly are they making good executive decisions you know over their care or their own self you know being in one so well being and whatnot not really okay they genuinely will have difficulty making good decisions and uh you know it can they can really screw their lives up when they're in a manic state some of their behavior that they're doing.
Okay, all right, so here is an acronym called DICFAST you guys can use to help yourselves remember mania. All right, you're seeing that distractibility, indiscretion, grandiosity. Okay, they'll think that they can do things that no others can do.
They may think that they're all powerful. Okay, they're having the plethora of ideas. You're seeing an increase in their activity, the sleep deficit, very talkative. Okay, So looking at depressive characteristics when these folks who have bipolar become depressed, you know, what do you see?
A flat, blunted labile affect possibly, tearfulness, crying, aniridia, anhedonia, okay, lack of energy, inability to experience joy or pleasure. You may see that they experience psychomotor retardation. They may develop these, you know, physical reports of discomfort and pain, and that's, you know, once again due to this idea of somatic issues when you have depression, when you have this negative, you know, feeling or this.
mindset for some period of time, you know, it can lead to development of pain, discomfort throughout the body. Okay, we'll talk more about somatic symptoms later in the term. You may also see that when folks are experiencing their depression, these characteristics with their bipolar, difficulty concentrating, difficulty focusing, problem solving.
They're probably not doing really well with their ADLs, okay? And you're also seeing a disturbed sleep pattern and disturbed eating patterns as well. Okay, so there's a slide there.
Depression assessment. I don't really use this, but it's not bad. Okay. So, cyclothymic disorder.
Hold on one second. Okay, so cyclothymic disorder. When we think about cyclothymic disorder, it can be a bit difficult to distinguish between this disorder and bipolar II.
You know, we see the similarity traits with the hypomania, okay? We see the depression, okay? The psychothemic disorder though is that you don't see folks developing the severe depression that we more commonly see with folks who have bipolar 2. Patients with the disorder tend to have more irritable hypomanic episodes. In children, this disorder can cause sleep disturbances and irritability.
Okay, just the symptoms that we see with this disorder, it can be, you know, difficult, you know, living with this disorder and it can impair some folks'occupational, you know, their occupational or their social activities. So, next looking at the epidemiology, among children and teens, bipolar disorder has a rate of about 1%. It's often very difficult to diagnose in children.
With children, because they're still developing, we still don't know exactly how they're gonna turn out and what's considered to be normal for this person. Many psychiatrists kind of hold off on giving a child the diagnosis of bipolar. Because also it could be something else. It could be something maybe like conduct disorder. So they're sometimes a bit hesitant to give them a diagnosis unless they are for certain exactly what's going on with them.
Bipolar 1 tends to be a bit more depressive in women, 75% of the time. Bipolar 2 disorder is more commonly seen among females. Bipolar 1 tends to be a bit more depressive in men, 67% of the time.
And bipolar 1 disorder seems to be a bit more common among males. When we think about the onset of age for someone with bipolar, with bipolar 1, usually we might see around the age of 18, bipolar 2, right around 20. But that's, I don't want you guys to think, oh, it has to be, oh, when you're 18, that's when you have bipolar. When you're 20, that's when you have bipolar 2. That's not exactly the case because, you know, you can become a bit older, maybe in your early 20s, mid 20s, or even a little bit later in life, and you can still develop or have bipolar, you know, become somewhat manifested. But, um... you know uh that that's just kind of how it goes uh i do want you guys to understand this idea when we think about bipolar 1 bipolar 2. some folks would normally ask this question professor could you have bipolar 2 disorder and then become diagnosed with bipolar 1 yeah you can um you know people who may have bipolar 2 you know they may never really experience mania before maybe they only get it for a day or two possibly but then later in life or things change maybe they do have that full one week you know episode of mania and um you know once they do develop that that's when they would likely be diagnosed with bipolar one okay um that's how it goes so among children researchers are actively studying differences between adhd and bipolar since the symptoms like you know they can become or be or to be very similar uh one with bipolar disorder more likely to abuse alcohol, drugs, commit suicide.
You know, folks who are using this medication called lithium, you know, they're more likely to develop hypothyroidism, okay. Men with bipolar disorder, they're more likely to have legal problems, more likely to commit acts of violence. So looking at the comorbidity, you know, if you have bipolar disorder, do you have anything else? You probably might, you know, and that's only going to make, you know, their quality of life even more difficult. But you can have bipolar, you can have, you know, panic attacks, eating disorder, personality disorder, etc.
And more than half the people with bipolar disorder will likely also have an additional or other psychiatric disorder as well. So really important to slide here, interventions. When we're working with a patient who is experiencing acute mania, we need to make sure that, excuse me, that we need to make sure. that we are keeping these folks safe, okay? We need to focus on their safety, and we need to maintain their physical health, all right?
When they're in a manic state, they will not be doing a very good job of either of these, okay? We will be constantly asking them, you know, we ask our patients every shift, you know, if they're having any thoughts of hurting themselves, you know, any thoughts of hurting people, but particularly with folks who are experiencing mania, we might ask them, you know, more than once during the shift, you know. We need to keep a close eye on them, all right.
Do what you can to try to reduce stimuli. Offer them quiet time, you know. Try to keep them away from the nurse's station because when you think about the nurse's station, is the nurse's station? nursing station very busy is there a lot of commotion going on over there yeah naturally to someone who is manic they're going to be drawn to that you know to that um that noise that activity you know all that attention that's going on over there they're going to want to go see what's going on and um we want to give them an opportunity to relax to rest okay when we talk with these folks use short simple sentences you know we can use a you know calm voice you know somewhat quiet very loud we're not going to be yelling or shouting at them okay speaking a very matter of fact uh you know what method and um when you give them explanations make sure they're very concise use consistent staff of the same sex and orientation uh have them go for a walk okay you're going to think that why do you want to have to go for a walk professor why is that appropriate well you know when they're in a manic state do you think they're going to be able to sit down and watch a movie with you do you think they're going to be able to sit down and read a book They're not going to be able to do that. All right.
When they're manic, they're just going to be keep going away. Hey, how you doing? My name is Jerry.
What's going on? Hey, why are you here? They are not going to stop. Okay.
They just keep going. And, you know, because they have this level of energy, would it be appropriate to have them go and exercise, you know, on an elliptical or a exercise bike? I don't think so.
Because if you give them that opportunity to go on there, they're going to go pedal to the metal. They're probably going to exercise to the point where they may even hurt themselves. Okay, they can lead, this can lead them, when they're in this manic state, this can lead them to, you know, go into a level of physical exhaustion. Okay, they can literally end their own life because they just keep going full steam like this. And, you know, the idea of taking them for a walk, it's appropriate.
It is an appropriate action because you're letting them burn up some of the excess energy, right? The idea is that if you are going for a walk with the patient, if you're with them, you are going to ensure that they stay safe. You're going to do your job as a nurse, keep your patients safe, and that's the idea. Staying with the patient when they're manic, you are doing a good job as a nurse because you are going to ensure that they are safe.
That the staff member, maybe that you say hey to the CNA or to the LVN or even to your RN buddies, hey, go stay with this patient for a while. That's good. Staying with the patient is a good thing to do to keep your patient safe.
patient safe to keep them alive. So we're going to implement rest periods. We're going to tell them to go lay down, to go relax, try to take a nap, okay?
It's appropriate to provide them some outlets for physical activity. We're not going to say, you know, no physical activity at all. That's like overboard, okay?
But we need to make sure that the physical activity is appropriate and safe, not just for that patient, but for the other patients around them. I would not want to have my manic patient. play ping pong because i know darn well they're gonna spike that ping pong and if someone who's not paying attention walks by they're gonna get nailed in the head with that paddle okay so you know if you want to have them do some stretching activities that's fine but nothing too nothing too vigorous okay also when you're doing activities with them don't make them play a game that's very complicated or very uh heavy in terms like the rules or instructions like i wouldn't want these folks to play monopoly monopoly is too complicated too complex uh for someone to for someone to engage in if they're manic they're not going to want to sit there and wait till their turn etc they're going to want to just you know roll the dice play do everything you know because they'll think it's their turn every time it's someone else's turn uh have them play something simpler okay like checkers okay uh maybe maybe chess but probably not just you know something more straightforward okay we're going to ensure that their nutrition is being met by providing them foods that they can eat on the run you know finger foods okay but they're going to be high calorie finger foods all right many of the times the patients will want to complain about you know things that are going on and that's fine uh you know we'll listen to and we'll act on legitimate you know grievances that they have um you know that's fine we need to reinforce non-manipulative behaviors Okay, sometimes these folks, when they become manic, they can be very manipulative.
They'll say things, they'll do things to try to get you, the nurse, to do what it is they want you to do. And when they start doing some not, you know, some inappropriate, you know, manipulative type of behavior, we gotta shut that down. Okay, otherwise this is gonna persist and it's gonna make your, it's gonna make your job a lot more difficult, so.
Okay, like I was saying, physical exhaustion, death are things that could potentially happen. Okay, like I said, they're not stopping. They're not moving. They won't feel the need to eat or drink or sleep. This can lead to a medical emergency.
So we need to ensure that we're preventing the patient from self-harm, whether it's intentional or accidental. Try to decrease that patient's physical activity level. Ensure that they are having adequate fluid and food intake. Promote adequate amounts of sleep each night.
Assist the patient with any self-care needs. Manage their medications. appropriately.
Okay, so you got a patient here. He's coming down from a manic period. He says, I feel bad about cheating on my wife. What would be the nurse's best response?
When you think about what is the nurse's best response, remember it's always going to be something that sounds therapeutic. Just because it says what is the nurse's best response, in the back of your head, you're thinking, okay, what is also very therapeutic? Are you going to say, oh, don't worry. You can't help it. It's part of your illness.
I don't think that's good. Are you gonna say, let's discuss your feelings with your wife! I don't know if she wants to discuss this with you, the nurse, and the three of you, so...
How about C? Hypersexuality is part of her illness. Let's discuss early signs of a manic episode. That sounds okay. Let's look at the last one.
Last one says, you better be or your wife will divorce you! Well, that's not therapeutic or appropriate at all. So I think you guys can see that C would be the best response. Okay. So now we're looking at medications, okay?
And when we think about bipolar disorder, the main thing that we're going to help to give these, the main medication class of meds we give to help them will be our mood stabilizers, okay? And one of the go-to meds that we're going to consider is going to be lithium, all right? Lithium, it's a really powerful, effective medication, very helpful for, you know, our patients who are experiencing mania, okay?
Lithium produces neurochemical changes in the brain, including serotonin receptor blockade, decreases neuronal atrophy, or it increases neuronal growth for a kind of, maybe it does this, maybe it does that, controls episodes of acute mania, helps prevent the return of mania or depression, decreases the incidence of suicide, which is a really good feature from this medication. Patients are having thoughts to hurt themselves, you get some lithium in them, once it gets to a therapeutic level, that, you know, that those thoughts of suicide kind of go down pretty quickly. This medication though, it is teratogenic, so we don't want to give this medication to our patients who are pregnant, nor do we want them to breastfeed while they're on this medication. And like I was saying, long-term use, folks would likely develop hypothyroidism, and possibly they may develop renal complications as well. So when we think about folks who are taking lithium, understand that the medication, it is not addictive, okay?
If it was, then I'll be taking this medication. you know that's not that's all the cases it's not an addictive medication we need to make sure that we're taking a look at the following labs all right when folks are on lithium we need to ensure that they are not going overboard with their fluid intake the lithium itself may make them feel you know thirsty that's kind of like an effect of the medication but if they start chugging a bunch of water that's not going to you know enable them to be at a therapeutic level with this medication so try to restrict you know their um you know their fluid intake to one and a half to three liters a day make sure that when it comes to their sodium intake you know just as long as they follow a regular sodium intake diet like a regular you know amount of sodium each day that they would normally consume they'll be fine do not let them take less than their regular amount of sodium per day nor do we want to take more sodium per day okay um if we see a decrease in sooner if we see them having you know not enough sodium in their system. This can lead them to develop toxicity.
And that's one of the key things that we have to be careful of with lithium is that the lithium level in their system can become toxic if they are not having enough sodium in their system, if they are having issues where they're having a high level of sodium coming out of the system, such as from vomiting, diarrhea. That can lead them to become toxic as well. And the problem is when folks become toxic with lithium, that will likely make them want to vomit and experience diarrhea. So you can have someone who's taking lithium and maybe they're taking a medication like as, you know, written by the provider. But at some point in time, they start having the vomiting or diarrhea.
You know, why is that? Is that because the dosage was too high and now they are at a toxic level with their lithium? Or maybe they ate some food that wasn't prepared appropriately, and maybe that's the reason why they're having the vomiting and diarrhea. Either way, if they experience vomiting and diarrhea while on lithium, we're going to tell that patient to say, Hey, Jerry, hold your next dose. Let's come have you see the provider immediately so we can check you out and see what's going on.
Okay. They might be experiencing the vomiting and diarrhea for some other issue. Okay.
Or they could be experiencing it because the lithium levels is simply, I mean, the lithium dose was simply just too high. Okay. All right. So make sure that folks who are on lithium, make sure that they take this medication with food.
Okay, otherwise they're going to experience GI upset and you have to empower them with this education that they experience vomiting and diarrhea and they need to stop the med. Okay, so here are the lithium indications. When we think about folks who are on lithium, you know, a normal range that we'd like to see folks at, you know, it could be, you know, 0.5, 1.2. All right, that's normal.
That's fine. The whole. the main thing is that we don't want them to get to which number 1.5 because if they are 1.5 they are now toxic okay and when they're toxic what do you see you're going to see the diarrhea you're going to see the vomiting you'll also see nausea you're going to see them having you know issues with thirst you know polyuria muscle weakness uh fine hand tremors should say fine not find it's a typo there my bad uh slurred speech lethargy okay You may have folks who are experiencing advanced signs of toxicity. You see their lithium level is 1.5 to 2.0. You're going to see that they're going to have mental confusion, sedation, poor coordination, course tremors, worsening GI distress, you know, with regard to their diarrhea and their vomiting.
Okay, severe signs of toxicity 2.0 to 2.5. They're seeing extreme polyuria of dilute urine. They may have tinnitus, giddiness, jerking movements, blurred vision, ataxia, seizures, severe hypotension.
you know stupor leading possibly to a coma um they can eventually go into they can possibly die from this they can go to a coma and they can die once they get to 2.5 you know 2.5 or higher all right so other medications that we could use to help our folks we got carbamazepine uh valproic acid now we got the metrogine all right and you see how the prog acid is uh bold and red i want you guys to look up about prog acid And I want you guys to know what kind of lab value we're going to be looking at while a patient is on this medication. Okay, I want you guys to look it up in your books and know that for next week or the following week when you get tested. Okay, so these medications, they slow the entrance of sodium and calcium back into the neuron, thus extending the time it takes for the neuron to return to its active state, potentiates the inhibitory effects of gamma-contraic acid, inhibits glutamic acid, which in turn suppresses CNS excitation. Other medications that we can use, we have our anticonvulsants like clonazepam. Okay, we can use gabapentin, topiramate.
We may use benzos, other benzos, such as lorazepam. Okay, antidepressants. These can be used mainly when they are in that depressive state. All right, we'll give them SSRIs.
But we have to be mindful that we're not giving them these SSRI medications when they are in a manic state because that can prolong their mania. All right, so we don't want them to take these SSRI meds. If we begin to see or if we determine that, yeah, they're manic at this point.
Okay. All right. So other interventions we could use, we spoke about this in the previous week. You know, some folks, they potentially may benefit from, you know, ECT.
But, you know, in my experience, I think I've only ever seen patients, you know, receive ECT for their depression at Glendale, Venice. But I wouldn't rule out completely that, you know. This will work for a patient with bipolar.
I just personally never got to see that though. Okay, next we're on to understanding and managing responses to stress. Okay, think about stress.
What comes to mind, right? It could be your neighbors. It could be your family, right?
It could be your children. Okay, it could be your work. Maybe you're relocating. All right, all these things can lead to stress.
So think about stressors. It could be So that's physical response and psychological response. We have our fight versus flight response. And when you think about fight versus flight, you know, people, maybe they're in this, maybe they're at Costco and some guy comes up to you and, you know, starts to threaten you and wants to get into a fight. Well, if you're a guy, you're going to be like, all right, bro, let's go.
Right. And ladies are smarter than us. What you guys are going to do.
You're going to be like, uh-uh, I just got my nails done. My hair is done. I'm not doing any of this stuff.
You guys are going to be smart. You're going to just get the heck away from that person. Save yourself a lot of trouble.
So different responses between fight or flight. All right key terms I want you to understand when you think about distress distress, you know, it's the root word itself. It's you know It's an unpleasant kind of issue to be stuck in, right? It's very distressing to take an exam, which you haven't studied for, right? It's very distressing.
The term here called eustress, this is something that's, you know, quite the opposite of distress. With eustress, you know, you're feeling stressed, but the idea is that the end result will be something beneficial or something that you'd like or something that's good, okay? Maybe you're packing up to go on your vacation.
and you're worried about, okay, who's going to take care of the dog? Okay, I've got to deal with this. I've got to make sure that the water plants are going to be watered and et cetera. You know, all that kind of stuff, that's more in line with eustress. The end result of something that's going to be happening will be something really great.
You're going to get to go on vacation. You know, as opposed to distress, oh, my God, I'm going to fail this class, or, oh, my God, I'm going to get fired, or, oh, my God, you know, that's the difference between the two. Okay, so thinking about stress.
You know, we have folks who can experience acute stress. All right. It's, you know, in the short term, maybe they're experiencing apprehension, unhappiness, sorrow, decrease in their appetite, increase in their respiratory rate, their heart rate, cardiac output, blood pressure, increase in their metabolism, glucose use, depressed immune system.
People that experience prolonged stress, okay, stress that goes on longer than it, you know, than they would like it to, they're going to possibly develop issues with chronic anxiety or panic attacks. Maybe they are going to experience depression. chronic pain, sleep disturbances.
You might see weight gain or weight loss. These folks will be at an increased risk for MI or stroke. More likely they will exhibit signs of poor diabetes control, hypertension, fatigue, irritability, decreased ability to concentrate. These folks who experience prolonged stress, they are going to be at an increased risk for infection. Okay, now we have a general adaption center by Hans Selye.
That's stage one, the alarm reaction. Stage two, resistance. Stage three, exhaustion.
Neat. Okay, then we get the management of stress. All right, so what do we do to help manage stress? Well, we can do some cognitive techniques like cognitive reframing. This is a technique that consists of identifying and then disputing irrational or maladaptive thoughts.
We have behavioral techniques where we help the patient learn how to relax. We have them engage in meditation, guided imagery. Breathing exercises, okay?
Progressive muscle relaxation. Maybe they can engage in some physical exercise, right? What else can we do?
Well, we can have them engage in journal writing. They could do priority restructuring. They could use some biofeedback.
Maybe engage some mindfulness. They can, you know, use some assertiveness training. Sometimes... you know folks maybe let's say you're a waiter uh working in a restaurant and um the manager fires all the other waiters okay or for whatever reason you're the only waiter working there um is that a sustainable way in which that person could work as the only waiter or waitress in that in that restaurant no right they need to be assertive and they say hey boss look you gotta hire more people this is ridiculous i can't do this all on my own Assertiveness training is something that folks may need to engage in.
You know, some folks may be, you know, naturally more assertive than others. This can be something where we see that it could be a cultural thing too, you know, but we need to be, we need to consider that assertiveness training could be a good option for some folks given their situation. Other stress reduction techniques, maybe they can engage in their individual hobbies.
I like Magic the Gathering, but I haven't been able to play Magic the Gathering because, you know, COVID-19. So that's a real bummer for me for the last year and a half. But, you know, so, you know, hopefully folks can engage in their, you know, their hobbies.
That will definitely help them with managing their stress. Some folks will engage in, you know, music therapy, pet therapy, right? Music is a really good thing.
I've been listening to some good music recently. So the neurotransmitter we're looking at regarding this topic here, it's serotonin. And we're seeing that it's affecting our mood, sleep, sexuality, or sexual drive, appetite, metabolism.
We said it's more active in stressful situations. So mediators of the stress response. Some things can... be more of a stressor to others you know i kind of discovered that as i get older you know certain things that used to stress me out when i was younger um don't stress me out so much now now that i'm older i think too like if you've encountered a stressor before and now it's rearing its ugly head and coming back for you to deal with it again the third or fourth time you know it's probably not Shouldn't be as stressful, you know, the third or fourth time going around on it, you know, but, you know, we're all different. Key thing, though, too, I think it's your perception on the matter.
Some people see a given stressor as like the end all be all to their existence almost. And that can cause them to become or experience, you know, more stress perhaps than, you know, somebody else who sees that stressor much differently. OK, who perceives the situation, make them more realistically. OK. your own individual temperament will be a mediator to your stress response.
Having social support, that's a big thing. When we think about mental health and you know anybody who has mental health issues, if you have a really strong social support group, you know friends, family, you're probably likely to do or handle things better compared to people who have no social support at all. Okay, some folks may participate in support groups okay and And when we look at our culture, you know, cultures are going to be different. And, you know, it could be a cultural thing in the way in which people will respond to, you know, stress.
And some folks may have spirituality or religious beliefs. Maybe they think that, you know, it's maybe they think that God's challenging them. God wants them to deal with this, you know, truly stressful event, but to overcome it, right?
God's challenging you. and they would like you to, you know, basically overcome it and show your strength and et cetera. Could be seen in a negative way.
Maybe some folks will think that God is punishing them and that they deserve to be punished and that this is what they get for, you know, fill in the blank, right? So it can be a bit of a double-edged sword sometimes, but it depends on how, you know, people use, you know, it depends on how their spirituality, their religious beliefs are utilized. you know when it comes to particular stressors okay all right next round to anxiety and obsessive compulsive related disorders okay so when you guys think about anxiety you know people you know we're generally seeing some kind of threat to our biological self okay or maybe our self-concept and uh when people have you know anxiety they can have you know a realistic threat you know they're perceiving they're perceiving this realistic threat as something to be you know mindful about um Their response to it will be proportionate. It'll be appropriate. We're not really seeing any dysfunctional behavior.
Folks who have neurotic anxiety, they perceive an unrealistic threat. Their reaction will be out of proportion to that given threat. And even if that threat is removed or taken away from their position or from them, they're still going to be responding to that stimuli even though it's not there anymore. Folks with neurotic anxiety, you're going to be seeing impaired functioning. too so looking at the levels of anxiety we got mild we got moderate we got severe we got panic okay and when you think about mild anxiety we probably all experience mild anxiety at some point in life you know it's no big deal before your final exam your proctor etc uh you're gonna maybe experience what feelings of discomfort restlessness irritability maybe patient a bit apprehensive okay what do you do some folks you may bite their nails maybe they do some foot finger tapping, fidgeting, lip chewing, you know, nothing too serious, nothing too, you know, cause for alarm with mild anxiety, okay?
Then you get the folks who have moderate anxiety. So for these folks, you know, you're seeing difficulty with their concentration. Maybe they're going to be pacing around the floor or pacing around the, you know, around the unit, around their home, okay? Maybe they're reporting feeling tired. If you were to check their, you know, vitals, you're going to see an increase in their pulse, the respiratory rate, their perspiration.
Maybe they even start to have a bit of shaking. Maybe they'll see that they have gastric discomfort, headaches, backache, urinary urgency, maybe difficulty sleeping, changes in their voice pitch, and maybe some vocal tremors. Then you've got folks who have severe anxiety.
And for folks who have severe anxiety, these folks, they're not going to be doing pretty good. They're not going to be in a good place. They may appear to be dazed and or confused. Maybe they're going to say, or maybe they'll have this feeling of impending doom or dread. Maybe they experience withdrawal.
Maybe they're talking in a loud or in a rapid manner. You'll see this endless activity. Maybe they're kind of like washing, it looks like they're washing the dishes, but they're just kind of like smearing grease on the plate because they're not really washing it.
Maybe it looks like they're folding clothing. but they're just kind of like flopping them over or they're just they're not really doing anything but it looks like they're doing something that's kind of like that anus activity Maybe they'll say that their heart's pounding out of their chest. Maybe they are appearing to be hyperventilating. This day is confused. Maybe they're talking.
When they're talking, they may not be talking in a way in which they're completely flipping out. They might be talking loudly because of how they're feeling. Or they could be saying, I don't know why my wife left me.
I don't understand. But if they're reporting physical ailments, right, like their heart's pounding out of their chest, okay, that's severe. But there's something beyond severe. That's panic.
And when we think about panic, these folks, they're really off the deep end, okay? These folks, you're going to be seeing a dysfunction in their speech. They will be showing irrational thinking. Maybe they become what appears to be somewhat psychotic. You know, they're going to say.
My dad, my dad, he's coming into town. He can read my thoughts, so I have to be really good. If I'm not thinking the right thing, you know, he'll know what I'm thinking.
And I'm like, wow, you know, unless you became Jean Grey or Professor X, you can't read other people's thoughts. You don't know what they're thinking. But when they're saying something like this, you can hopefully recognize, yeah, that's delusional thinking there. Okay, they're not, they're, they're, they're. clearly beyond severe at this point okay you're seeing this extreme fright or horror severe hyperactivity um you know flight response the they can get to the point where they become straight up immobile they don't move okay and i think that's like one of the worst things people can experience when they experience this panic level of anxiety all right um you know with all the you know with all the mass shootings and things like that happening you know in the united states you have to be You have to be able to move, okay?
You can't just freeze up like that. But, you know, hopefully we don't experience that. But we do see that when people experience panic, they will literally become immobile. They'll just stand there. You'll see that they may have dilated pupils, severe shakiness, this inability to sleep.
Okay, so when we assess these folks, we're trying to work with them. We're trying to understand, you know, what is their level of anxiety? What caused their anxiety? You know, if something that caused their anxiety is something that we can identify, maybe we can remove that thing that's causing their anxiety. Maybe we can remove it away from them, and that will help them.
Okay, are they having any kind of cognitive distortions? Are they, you know, what type of coping behaviors have they used in the past? Is what they're feeling, is it fear or is it anxiety?
And when you think about fear, fear is a response to... a perceived threat that is consciously recognized as a danger. Anxiety, you know, it's an emotional response to anticipation of danger, even though they don't know exactly what it may be.
Okay, next we're on to mild-moderate anxiety intervention. So we're going to use active listening. We want to demonstrate to the patient that we have a willingness to help them, that we are going to use specific communication techniques, you know, to de-escalate them, to help them feel, you know, more comfortable, more safe. We're going to evaluate past coping mechanisms, what they've done in the past to help with them, to help keep themselves calm. When you engage these folks, provide a calm presence.
Recognize that the patient is in distress. Try to explore alternatives to problem-solving situations. Try to encourage the patient to participate in activities such as exercise or something that may temporarily relieve feelings of their inner tension. Looking at severe panic. With these folks, are these, what do you think?
Do you think they're going to be safe when they're in panic mode or when they're in severe anxiety mode? Probably not. So, but these folks, if you have the opportunity to stay with them, that's going to be pretty good.
Actually, you know, if you have a patient who's having any level of anxiety, whether it's mild or moderate, severe or panic, if you have an opportunity to stay with that patient, would that be the best thing for you to do? I think it would be because if you stay with the patient, what are you doing? Are you keeping them safe?
Are you keeping them alive? Are you fulfilling your prime directive as a nurse if you do that? Yes, you are.
Okay. But particularly with the folks who are having severe panic, you want to stay with them. You got to ensure that they keep them, that you're helping to keep themselves safe. Okay.
They may do something, maybe they lash out at somebody or they, you know, wig out or do whatever. You got to make sure that they're not hurting themselves or hurting other people or hurting somebody else who might. beat the poop out of them.
I've seen situations like that. Okay, try to provide a quiet environment. Try to minimize the stimulation if you're able to. Use medications and restraint, but only after less restrictive interventions have failed. Okay, just because, you know, they are clearly, you know, in panic mode doesn't mean you get to throw them in restraints just like that.
You know, always try something else before we do restraints. Restraints are like the last thing that we try to do. You can encourage gross motor activities such as walking. or other forms of exercise.
Set limits by using a firm, short, and simple statement. Understand that repetition will likely be necessary because they're not processing very well. You may need to tell them 10, 20, 30 times, you know, about what's going on before they can really process it and understand it. Okay. Try to direct the patient to acknowledge reality.
Focus on what is present in the environment. That's a good intervention from these folks. Okay. So, When we think about anxiety, understand that when folks have anxiety, if they don't deal with it, if they're not able to resolve what's causing them to be anxious, it can develop into other things. It can develop into an anxiety disorder.
Maybe they're having panic attacks, phobias. Maybe it can go into somatoform disorder, where they think or they feel that there is something going on with them. physically, you know, but when we check them out and look at them, there's no organic cause to their pain or discomfort or what they're feeling.
Okay? Um, alright. They may develop a dissociative disorder.
And we'll talk about dissociative disorders in just a bit. Okay? So here are some of the anxiety disorders we're going to cover really quick.
We got acute stress disorder, PTSD, separation anxiety disorder, panic disorder, generalized anxiety disorder, phobia, cystic compulsive disorder, body dysmorphic disorder. hoarding disorder, hair pulling, and skin picking disorders. Okay, so first up we got acute stress disorder. Okay, so when you think about acute stress disorder versus PTSD, you know, we understand what causes PTSD, right? It's going to be a really traumatic, terrible event.
Being present at a mass shooting, right? That's definitely a thing that can, you know. cause PTSD.
The thing is, you know, how do we say that this person has PTSD versus acute stress disorder? And, you know, when it comes to PTSD versus acute stress disorder, they are a bit different. So let's say it's Monday, I was at a tragic event, you know, this place, you know, at the park, whatever, you know, I experienced this traumatic event, and Two weeks later, you know, I'm having issues where I'm detached, I'm having difficulty, you know, thinking about, you know, what had happened, or maybe I'm having horror or flashbacks, you know, all this fun stuff. But it's not been, it's only been two weeks. So within that time frame, we would recognize that this person is experiencing what?
Acute stress disorder. Okay. If the symptoms persist and they go beyond, beyond 30 days. what would you say that this is that this would then become ptsd okay um you know and when we think about ptsd ptsd can last for years um you know and looking at the individual you know some people are just kind of hardwired you know on their brains a little bit differently you can have two people who were both present at this traumatic event in the park right uh one person has acute stress disorder and then the other person develops ptsd the other person you know they are able to resolve you know the issue and what happened with it they don't develop btsd um it's just you know we're all unique we're all different but not everybody will develop things you know similarly um even though they were right there or they pretty much you know shared the same experience and all that stuff um you know we are unique so next topic we have separation anxiety disorder and this starts usually before the age of 18. um and we're seeing Folks develop this excessive anxiety when they become away or when they are away from their home or a significant other and to be diagnosed it must last for at least four weeks in children and adolescents and six months or more in adults.
We're seeing this developmentally inappropriate and or excessive fear or anxiety concerning the separation either from that individual or from that location. Okay, recurrent excessive distress when anticipating or experiencing the separation from the home. from that person, persistent and excessive worry about losing that major attachment. You may see that they will become reluctant. They will maybe not want to leave the house, or maybe they don't want to leave that person's presence.
Maybe they'll develop sleep disturbances and nightmares. You're probably going to be seeing some physical symptoms, GI disturbances, pain, nausea, vomiting, headaches. Next, we're on to panic disorder. So for someone to have panic disorder, we need to see four or more of the following during their panic attack.
Palpitations, shortness of breath, feelings of being choked or smothered, chest pain, nausea, feelings of depersonalization. maybe the fear of dying or losing their own mind okay uh chills or hot flashes so what we're gonna do with these folks well we're gonna do some interventions we're gonna uh you know basically do what we can to try to reduce their anxiety promote safety uh stay with the patient that's always going to be a good option because if you do that you're keeping them alive keep them safe take their vital signs maybe their vital signs are getting up there okay maybe there's a maybe there might be a medication that would be appropriate to give them if their vital signs are spiking that high. Maintain a calm manner.
Make sure that the patient has a paper bag possibly to breathe into if they're hyperventilating. You can use short, simple sentences. Be firm with a voice that's somewhat directive. Try to refocus their energy. Make sure to stabilize low.
Try to decrease noise if you're able to. Direct other patients to head off to the room for a little bit. or have this patient go to their room okay thinking about general anxiety disorder with generalized anxiety disorder we're seeing this uncontrollable this excessive worrying uh for six months or longer okay and the key thing is this is the excessive worrying all right uh folks who have this disorder it can cause you know significant impairment in their ability to do their work do their job study and school work um and uh For folks to have this diagnosis, we're going to be seeing three or more of the following.
Okay, once again, feeling nervous, irritability, being on edge, having the sense of impending danger or doom, having this increased heart rate, breathing rapidly, sweating, trembling, feeling weak or tired, difficulty concentrating, having trouble sleeping, experiencing GI problems. Folks who have GAD, because this is an ongoing issue, they're not likely to... basically wake up one day and say, oh, my generalized anxiety disorder is all gone.
Like, that's not likely going to be the case. These folks are going to be living with this more likely probably forever. So what do you think?
Do you think you want to give these folks benzos, like lorazepam, whenever they're feeling anxious? Well, lorazepam is pretty heavy hitting, isn't it? Do you think you should just give people lorazepam willy-nilly whenever they feel like they want it or need it? These folks, they're going to be feeling anxious when?
How often? Like all the time. I don't really think it would be a good idea for these folks to be using benzos, you know, as their primary way of dealing with their anxiety. Maybe they could have a PRN dose of once a day or once every other day or something like that. Hopefully that's how often they would take it.
We don't like our patients taking benzos, you know, willy nilly every single day of the week. That's not appropriate. That's not what it's intended uses for. More likely we're going to get this.
person who has this disorder, maybe something like Buspirone, Buspir, this medication that's a, you know, just medication that's given daily and that would probably be more, that would probably be more appropriate to give them than to give them benzos. Okay, right, so interventions, working with these folks with GAT, teach activities that promote relaxation, okay, maybe they can do a warm shower, do some exercising, teach them progressive relaxation, they can use imagery, help them structure their day, that's an appropriate, uh, you know activity for them to do um they can use positive self-talk they can do reframing they can do prioritizing they can use humor yoga meditation uh pr medications you know those would be kind of like a last resort um only for when they feel like they are losing control or things they you know it's too much for them to handle should we happen to use um peer and meds like benzos okay scheduled meds like beast prone those would be fine that's appropriate it's good okay next we got Phobic disorders. So, phobia, it's an irrational fear of a specific object, activity, or situation that results in compelling desire to avoid a particular object or perhaps a situation.
People with phobias will likely experience panic, terror, dread when they come into contact, you know, with that phobic, you know, element. All right, so here are some of the phobias that, you know, more commonly seen. We have social phobias. We have agoraphobia. arachnophobia, agoraphobia, acrophobia.
Aerofobia, Arachnophobia, Nictophobia, Thanatophobia, Thanatophobia, huh, sounds like a Marvel character, right? We've got Astrophobia, Glossophobia, Monophobia, Misophobia, Pyrophobia, and Zoofobia. There are many other phobias out there, but these are the ones that are more commonly seen.
The ones I bold and read, I think you really want to be familiar with those, because I feel like those are pretty, they're pretty commonly seen. uh you know within the population um yeah i think i think i probably have acrophobia i'm like heights like you know like oh it's not going to impair my ability to do my job but um what do you guys think you think if you worked uh for the um like the telephone prepare folks or powerline folks uh do you think they can do their job if they have acrophobia probably not no they're gonna have to have uh they're going to get this stuff under control if they have acrophobia and they want to continue with their job. So, all right. So what do we do with these folks who have phobias?
Well, one of the best things we're going to do is systematic desensitization. Okay. Exposes them to a series of increasingly anxiety-provoking situations, beginning with the least threatening. Okay.
Visualizing is usually the least anxiety-provoking thing that we're doing with these folks. We can have them engage in reciprocal inhibition, where their anxiety or fear is paired with a literal opposite feeling. Okay, we could do cognitive restructuring. I like this one a lot too.
This helps to reframe, reframe or relabel a frightening situation or object. We can do flooding or implosion where we're basically exposing them or bombarding them with a lot of that particular content or material, whatever it is that they have a phobia to. Obviously, when we do flooding or implosion, we're doing so with the patient's consent.
We're not going to just dump a bucket of spiders on them and be like, ha ha, flooding, ha ha. Like, that would be terrible. Okay. We could do thought stopping and thought stopping is pretty good because this helps them to basically, you know, help them in their own mind. Try to stop what it is that they're feeling, you know, have them maybe think, you know, about something different.
But it's an option. Don't get confused the terms thought stopping versus thought blocking. Okay.
Don't want to get tripped up on that. Make sure you know your terminology. If you're not getting the terminology well. If we're not able to recall it or keep it in your mind, you know, proctor exam is gonna take advantage of you on that, so make sure we remember our vocabulary.
Here's a practice question. You got a patient with a somatic syndrome disorder. They even started on relaxation and has identified how their negative assumptions make their symptoms worse.
Currently, he believes his palpitations in his chest are due to a heart attack. Okay, he thinks he's having a heart attack. He has a high pulse rate. The nurse is teaching him cognitive reframing. So which of these examples demonstrates cognitive reframing?
If you were to say, I must have very high blood pressure due to blocked arteries for me to feel like this, that's not cognitive reframing. He still thinks that, you know, he's having a heart attack. He's still, you know, he's still like not thinking correctly about what's really going on with him. If you were to say, I might consider at the farthest he could have made a very critical mistake. Uh, no.
What if you were to say this instead? A good explanation of how I'm feeling might be the extra coffee and the stress I'm under at work. Yeah, that's probably more accurate as to what's going on. You're not having a heart attack.
It's, you know, but that would be an appropriate action or appropriate answer. This one here, I'm sure there's something wrong, but I can tough it out because my family doesn't die of heart attacks. No, he's not.
No, we know that C is going to be the most appropriate to recognize that this patient is now using cognitive reframing. Okay. Next, we got obsessive compulsive disorder. We have, when it comes to these terms here, obsession, this is basically their recurring thoughts that they're having. Compulsion is their feeling where they are compelled to act.
And, you know, they may engage in particular rituals. And when they engage in these rituals, it could be them washing their hands. It could be them flipping a light switch on or off or something.
These rituals that they are doing, they are doing these to basically, you know, reduce their own anxiety. That's what's really going on when they do this. Okay.
It's a way for them to exhibit some control over their life. But is it really practical? Do you guys think it's appropriate?
Like, I'm going to go wash my hands, guys. I'm Jerry. I'm going to wash my hands for half an hour.
I'll see you in half an hour. No, you got stuff to do. You don't have time to wash your hands for half an hour. That's like not appropriate, right?
But if you give these folks that opportunity, they will do it. They will. wash their hands they will do that kind of uh you know activity like that so different types of obsession um could be something where it's can you know they think it's you know they're contaminated maybe it's sexual nature aggressive maybe they're engaging in hoarding activity they're saving their money okay but they won't they won't spend it even though the house needs you know money to be spent on it for repair work they ain't spending their money okay maybe it's uh you know related to religious issues uh ideology or etc um often saying though that it could be something that's uh exactly this everything has to be displayed just correctly that the forks and the knives are just like this or this wall painting is displayed properly.
Other types of compulsive symptoms can include them cleaning, checking, repeating, counting, ordering, putting things into particular order, hoarding, reassurance seeking. So it's difficult because these folks, once the obsessive compulsive behavior starts, doesn't really stop. And then as it persists and goes on longer and longer without intervention, it only becomes more and more difficult for these folks to stop. Okay, but the good news is that there are some medications that we use to help these folks. And when we think about the medications that we're going to use, we're thinking, what, SSRIs.
Go ahead and take a look at your medication list that I gave you guys, and you'll see that on the list under antidepressants, you get to the anti-obsessional med list section. You're going to see that almost all the medications are literally SSRIs. Okay, so.
When you get these patients who are engaging in this type of activity, this behavior, you know, maybe they're turning their light switch on and off repeatedly or they're washing their hands, you know, they're going to wash their hands for half an hour. What do you think? You're going to say, okay, go ahead, wash your hands for half an hour. I'll be back. I'm going to take a lunch break.
I'll come back. Are we going to do that? No, that's totally not appropriate, right?
Why don't we say, Jerry? why don't you wash your hands for let's wash your hands for five minutes instead okay or something that's more practical like 30 minutes is that's a bit much 10 minutes i feel like we're giving them too much time maybe but the goal will be that you work them down you know to a smaller and smaller amount so if there's maybe if they're used to washing their hands for 30 minutes maybe you can cut it down to 15 minutes okay but try to cut it down quick because you know we're not going to go like okay you get 29 minutes instead of 30. Like that's no, that's not even doing anything. I've been doing it like that.
So, uh, it's important to also don't interrupt them from the ritual. They're washing their hands. You're not going to grab them, pull the patient away. All right, Jerry, you had enough time to wash your hands.
Like that's, that's not appropriate. You're only going to make them feel, they're only going to make them more anxious. Um, you know, and you're not helping the situation.
Okay. We know that when they become more stressed out, uh, their desire, the, you know, for them wanting to do their rituals will increase. increase.
So it would be appropriate for us to provide them with structure, provide them with routine activities for them to engage in. They would definitely benefit from cognitive behavioral therapy. And one thing I like to think about too is when I have folks who have this kind of OCD kind of behavior, what's going to help them in the long run? Do you think it's going to help them in the long run if they continue to only do these rituals? No, because the rituals, it's not a...
It's not an appropriate means to try to deal with the problems that they have in their life. I think that if I were to have a person who's like this, I would like to have this person engage in some social activity with another patient or other patients or other people. I think that would be more appropriate because we want to get these folks back to behaving the way in which human beings behave, and that is what? Being social. We are social creatures.
We like to talk to other people, engage people. Maybe not for us. long periods of time okay but you know to have that social interaction uh i think that's going to be a big uh that'll be probably a bigger help uh for them definitely compared to them just continuing their ritual activity okay um but we're not gonna interrupt the ritual we'll try to say all right jerry you have two more minutes okay and then we have to go and start doing our daily activities for today okay cool next we got body dysmorphic disorder so Folks who have this disorder, they're going to have this preoccupied idea. They are going to think that there is a defect within their physical appearance or that something may be out of proportion or is considered to be an abnormality. For them, the belief will be considered to be extreme, but they are understand this they are not considered to be delusional.
They could maybe experience social isolation. Maybe they become very self-conscious. For some folks, depending on how they have to put themselves together to make them feel comfortable before they go outside the house, this could become a very time-consuming issue. Many of these folks may seek cosmetic surgery to correct uh this perceived defect that they think that they have so i'm sure if i were to say hey guys who can you tell me what type of what celebrity uh do you think you can think of who has this disorder i'm sure a lot of you guys are going to write a lot of bunch of names of people i've never even heard about but i know for sure i could say who i know likely had this disorder probably michael jackson right with his nose and uh yeah he just you get kept basically kneel in his nose nothing nothing was wrong with his nose but um But for these folks, they think that their appearance, they think that it's not appropriate or that there's something wrong with it. So most of the time, there's nothing wrong.
So it sucks. Next, we got hoarding disorder. So when it comes to hoarding disorders, generally, I have you guys watch an episode of Hoarders. But hoarding disorder, it's a thing.
You know, you're not going to get to see these folks in the hospital because they're probably not going to require inpatient care often. But when these folks are hoarding, they're going to be hoarding things that have little to no value. OK, their problem is that they can't.
It's extraordinarily difficult for them to throw things away, for them to give up these possessions that, for the most part, a lot of it could be equivalent to straight up trash. Like they are some folks who hoard. They are literally hoarding trash like the, you know, the wrappers from, you know, a fast food place or whatever.
Just hoarding garbage, you know, some of these folks. Sometimes you might see people who hoard things, they'll try to hoard things that may have some value. And that's, you know, but often it's going to be things that have like little to no value. So when they are getting these things and they're trying to get them discarded, they're going to experience severe anxiety. when trying to discard out these items.
Great difficulty categorizing or organizing things to be you know what's to keep, what's to throw away, what's to donate. Very indecisive about what to keep or where to put them. They're going to experience distress when people you know come over to the house to see their living conditions and their living conditions are going to be really terrible.
Okay they're going to be pretty gnarly if it's not overrun with mice, rats, bugs, etc. It may be difficult for you to simply navigate and walk around throughout the house because there's just so much stuff. They're going to experience very high levels of suspicion when other people are in the house touching their items.
They may have obsessive thoughts where they think they're going to run out of a particular item. They'll even check the trash because they accidentally think that there were things that were accidentally discarded. And they may end up keeping the whole trash bag and the whole everything in there.
It's pretty. pretty messed up. So yeah, functional impairments, the loss of living space, social isolation, family or marital discord, financial difficulties, health hazards, you know, all that fun stuff. I think my dad, he was, I'm pretty sure he was a hoarder. Yeah, he was a hoarder.
I'm kidding. He was a hoarder. And he would go around like trying to collect things that were like literally of no value, like to me or to anybody else, you know, but he would collect them or get them because he thought, or he would say he could use this or that.
And the acquisition of said things made him feel more comforted. Okay. It made him feel, it made him feel good about himself and about what he had just, you know, gotten.
I remember one day he came home with something and then showed it to my mom. And then she's like, what the hell are you going to do with this? You know?
And it was basically, it was like a, it was a square one foot by one foot, quarter inch thick piece of copper, a big piece of copper. And I was like, what? what are you doing with this and he's like this is worth forty dollars and copper is worth money copper does have value you know and it's like really she's like it's worth forty dollars like yeah and she's like why don't you go and sell it and go buy some go buy some damn dinner look at his face he got so mad you know i was laughing so damn funny but um that's that's the thing these folks they're going to hoard things they're going to accumulate and acquire more and more you know things But the reality of it is that these things are likely to be of no value.
Am I a hoarder? Are you a hoarder? I don't think so.
I mean, I like to collect things. I like to collect Magic the Gathering cards. Nothing makes you feel more accomplished than buying something for like $100 or $200 and then watching the value go up to like $1,000 to $2,000 because it's a collectible. It'll never be reprinted or et cetera.
So I like that, but I don't think I'm a hoarder. I think having grown up, you know, with my dad observing his behaviors and stuff, I'm pretty sure, like, I'm gonna, like, not become a hoarder. Like, you know, I just don't like the idea of it. Living my life where I'm constantly like on the go looking for stuff like that.
But yeah, so anyways moving on Here's an example of what a hoarder would look like she or she is living in their house with all this stuff there She's like this is fine. This is fine You can just imagine a little all little critters that are just hiding in there, you know running it out eating all that food that's sitting in the kitchen sink and just right but for these folks, you know, they they consider this to be okay. They consider this to be normal or appropriate. And yeah, it sucks.
So next we're going to be looking at hair pulling and skin picking disorders. We have trichotillomania. This is a disorder that causes people to pull hair from their scalp or their eyelashes, the eyebrows, pubic area, underarms, their beard, chest, legs, anywhere where there's hair.
They're going to rip it off. Next we got dermal pneumonia. This is where we're seeing this compulsive picking of the skin and this can result in tissue damage. And I knew a co-worker, he's not a co-worker, he's a medical doctor I used to work with at Glendale Adventist. He would pick at his nose and it happened many years ago.
Basically he would pick at his nose, pick at his nose, and then basically he just ended up losing the entire nose because he would just pick at it so much, you know, what was left of it had to be removed. And the reason, you know, what caused this was that his wife divorced him. And that's when they said that upon the first divorce he had with this woman, that's when they said that he started doing this dermal domenia, sort of picking at his nose. The wife divorced him.
And then... She ran into the arms of another man, and that other man was her biological cousin. And I'm pretty sure the medical doctor, he was pretty devastated over that. But then she got tired of her cousin, and she married him again. She went back, she married the doctor again, and then things were great.
And then she was with him for a while, and she divorced him again. And then she went back to the cousin, you know. And then that's when this neurothelmania just went overboard, and he literally... self mutilated and ruined his nose.
His nose is like completely gone. So he has to put a bandage over his nose and when he talks, he talks like this. That's how it sounds because he doesn't have a nose. Yeah, so it's pretty tragic. Sucks.
So here's some pictures here. The trichleomania and the dermothelomania. So this is what happens when we have issues, you know with you know with our anxiety and you know we're not uh you know handling it appropriately this is what some folks may engage in so um yeah i just thinking about this if i was a nurse and i was doing med surge there was no no way i would not be like triple gloved up right because you know all the potential infections you get from handling anybody like yes but some people like you know some nurses you know one of my when i was doing my rotations i think for med search or critical care is what they call the norm program.
I did remember meeting a nurse who appeared to have this disorder because whenever I got to see her with her gloves off her fingers looked just almost like this you know and stress right. So what are we going to do with these folks what can we do to help them we can get them SSRIs. SSRIs they are going to be our first line defense or trauma or stressor related issues.
Secondary benefit of treating comorbid depressive disorder. So SSRIs, we got what? We got paroxetine, fluoxetine, the psilopram, fluvoxamine, sertraline.
We might also give them maybe some MAOIs. This is reserved for treatment-resistant conditions because of the life-threatening hypertensive crisis that we know can follow if they don't maintain that appropriate dietary restriction, try to avoid those foods high in tyramines. So what meds?
We got Phanosine. channels like for me right those generic names hard to pronounce so we try to treat somatic and psychological symptoms of our patients you know who have anxiety disorders we can give them benzos but like i was saying guys benzos they are meant for temporary use temporary and short period time frames what we're thinking uh we do not want our patients to be on benzos for a long period of time um That's generally not the case. Maybe the only exception I would say that I've seen, you know, would be for folks who have bipolar disorder who, you know, need the medication to help keep them somewhat stable, you know. That's like a scenario where we can get them long-term use benzos, but for everyone else, we try to avoid benzos because long-term use of benzo, guys, you need to be mindful about is that patients can like, they're going to be at increased risk for developing dementia, okay, if they're doing long-term use benzos, all right. So, benzos will not be appropriate for folks who are pregnant or for folks who have issues with substance abuse problems because this medication does become addictive.
You get into this medication, you're on it for a month or longer or two weeks, I think it's like at least two weeks or longer, but usually a month or longer using this, you're going to become dependent on it. And you guys note that when patients are on benzos, if they were to stop using benzos when they've been on it for a long time, you know that can that can lead to benzo withdrawal that's life-threatening okay um so we have to be careful about that so benzos we got the brisopam clonazepam diazepam laprosalam all right other medications that we could use for anti-anxiety like i was saying earlier buspirone buspar all right that's a good medication that they can take that's scheduled but they'll take it every day and then we have hydroxyzine vistro this medication is going to be used as a prn and hydroxyzine is basically an antihistamine medication. It's not going to be nearly as powerful, I guess you could say, as the benzos, but it's an option. It's something that can help with anxiety and definitely something that would be probably more appropriate for some of our patients. Don't want to just pop benzos left and right.
Okay, so here they are again, these benzos, chlordiazepoxy. We're going to be talking about that later in the term when we talk about alcohol withdrawal. So we'll get into chlordiazepine and toxin in a bit.
Okay, so here's that buspirone. This medication binds to serotonin and dopamine receptors, less potential for dependency. It can be used for panic disorder, OCD, obsessive-compulsive disorder, social anxiety disorder, PTSD, along with generalized anxiety disorder.
Here's a little picture. You guys can take a picture of it if you'd like. I thought it was cool.
I'm not going to. I'm not going to put one. But good stuff. Let's just take a look at that for a few more seconds. All right.
So when it comes to defense mechanisms, we've been kind of covering defense mechanisms throughout the term. So there's nothing really new so much that I need to say on this stuff. You know, we really want to make sure we're building up our understanding regarding defense mechanisms because you will be seeing them. like I said, throughout my quizzes and on the proctor and on the vinyl.
So here they are for you one more time. Remember this is a video, you guys can pause it, go back and forth whenever you like. Okay, I like this picture here of displacement.
You know, you see that guy up there, he's mad at some, maybe, maybe his boss yelled at him, and then, you know, when he's angry and upset, what does he do? He goes and takes out that anger on something that's less uh you know not as threatening right it goes and takes out the dog and goes and kicks the dog okay common defense mechanism we see there all right so this is all terminology and i gave you guys that information i think already for those stuff so nothing new here Yeah, projection is a really common defense mechanism. We see this a lot. People are attributing their own unacceptable motives or characteristics to another person or to a group, often, you know, but it just appears to be like they're blaming, okay? So it's kind of common that we see this projection.
Reaction formation, this is where like, you know, imagine there's this dude and he's in high school, he's got a crush on this girl and that girl she has a boyfriend already you know normally people like that guy who has the crush on the girl that guy would see that boyfriend he would think man that guy sucks he's a loser oh man look at his hair whatever he'll find something to say that he doesn't like about that person okay that's normal that's how human beings will generally you know operate people who are doing re-exformation that guy would look at the boyfriend and say if he's this is re-exformation he'd say man That guy's pretty cool. Yeah, I know he's dating that girl, but man, he's a cool guy. Being really friendly towards that person, but in reality, we know that he doesn't like him because that's how he should be.
Another good example of reaction formation would be a patient comes up to you, Jerry comes up to you and says, Nurse, there's Kevin. I hate my roommate. He's terrible.
He farts, he snores, he's just the worst, and he's so loud and obnoxious. I hate him so much. I hate him, you know? I hate Terry.
He's just the worst person ever. Then here comes Terry walking past me and Jerry. Terry says, oh, hey, Jerry.
And then Jerry says to Terry, oh, hey, Terry. Hey, man, here, you want some of my cookies? Have some of my cookies. And I'm watching this.
I'm like, dude, you just told me how much you hated Terry, and now you're giving them your cookies? Man, I don't share my cookies with nobody, but he's sharing his cookies with Jerry, right? That's another example of reaction formation. Okay, cool.
Sublimation, this is where people, you know, instead of doing something inappropriate back towards somebody else, you know, or, you know, because something bad happened to them, maybe they go do something productive. Maybe they go and write a short story about something, or maybe they go to the gym to go work out, okay, instead of doing something inappropriate, because they got yelled at at work or something to that effect, right? Cool.
Splitting, when we think about splitting, you know, let's say you go to work with a patient one night and you give them their medications early and then they say, oh, you're the best nurse. You're so great. You're so wonderful.
You're just the best, right? And then the next night you work again, the patient's there, but you're getting an admission, a discharge, patients are flipping out, out of control. So now when you give the patients their medications, this patient gets their medication last, right?
They're going to say to you, you're the worst nurse ever. You abandoned me. You betrayed me.
You're the worst. Right? That's this idea of splitting.
You're either all great or all terrible. And we need to make sure that the team members on the staff on the unit know that this patient is engaging in this behavior. Because if they don't understand or don't know it, they're going to think that the complaint that the patient is making, they might think that it's legitimate.
Okay? And, you know, so we need to make sure that the team is aware of this kind of behavior. So it can be really unpleasant.
dealing with patients who are engaging in splitting activity. Suppression, this is where they are consciously, think of the example of the jack-in-the-box. Suppression is you standing on that jack-in-the-box with your hands on it like, nope! You're deliberately not letting that jack-in-the-box pop out.
That's this idea of suppression. You're actively controlling it, actively denying this impulse, this idea of this thing from coming out. Undoing, I think I gave you guys this example earlier too, where you're working with the, I'm sorry, this mom comes home from work and then she yells at her kid and she feels bad, so she goes and buys the kid a bunch of toys, right?
Thus undoing that negative interaction with that. But could it be the opposite? Maybe she goes and buys this kid a bunch of toys and the kid's like, yay, so happy, wee, toys, right? And then the next day she looks at the kid and she's like, man, screw this kid. She goes and gets all those toys and throws them away, right?
That's an example of undoing. Okay, cool. So don't just think it's only, don't just think you do something bad, then you do something good.
You can do something good, then you do something bad. Thus, undoing that initial action. All right.
Next, trauma, stressor-related dissociative disorders. Okay, so when it comes to trauma-related disorders in children, we know that they might develop, what, PTSD. Okay.
We know that they could develop reactive attachment disorder, where it's consistent pattern of inhibited, emotionally withdrawn behavior due to a lack of bonding experience with the caregiver by the age of eight months. Maybe they have disinhibited social engagement disorder, where they have no normal fear of strangers. They seem unfazed in response to being separated from their caregiver.
They will willingly just go off of people who they don't know and go home with them like they are their new dad, you know. And I know you guys know this example. You guys all remember being young little... boys and girls going to the grocery store, right?
You're walking around the grocery store and then you're walking next to your mom or dad or you think it's them. And then you stop and you look up at them and you're like, oh my God, you're not my mom or you're not my dad, right? What feeling would you get? You'd be like horrified.
You'd be scared, right? You'd be terrified. Like, who are you?
Right? But for these kids, you know, they'll look up and they'll be like, all right, I guess you're dad now. Let's go get some... Give me some chicken tenders or something. Right?
That's what you're seeing with this disinhibited social engagement disorder. They will just go with that person. They'll walk right into their car, hop up into a vehicle they've never been in, they'll go home with them.
That's a disinhibited social engagement disorder. Okay, some folks have what's called adjustment disorder, and it's usually going to be precipitated by a stressful event. It can be diagnosed immediately or within three months of the exposure to that event.
What we're seeing are cognitive, emotional, behavioral symptoms that negatively impact their ability to function. Another type is called complicated grief. It's manifested by this intense yearning, longing for the deceased person, maybe intense sorrow or emotional pain or preoccupation with that deceased person.
Adjustment disorder itself, it's an emotional or behavioral reaction to a stressful event or change in a person's life. The reaction is considered to be unhealthy or excessive. Possible response to the event or change within three months of it happening.
Stressful events or changes in the life of a child or adolescent. Maybe something like moving, okay, could be a divorce, could be separation. Maybe the loss of a pet, maybe the birth of a sibling, okay. Maybe a sudden illness or restriction on a person's life due to a chronic illness. This can also result in, you know, as an adjustment response to this particular disorder, okay.
Once again, PTSD, main thing I want you guys to remember with PTSD, in order for it to be PTSD, how long does it have to be? greater than 30 days. Okay. If it's less than 30 days, we know that's going to be acute stress disorder.
All right. So events that we know that are likely to be associated with PTSD, rape, intimate partner violence, combat, sexual harassment. Okay. If you're in a serious motor vehicle accident or some other kind of accident where something hurt you or injured you, man-made or natural disaster. Okay.
Being the victim of someone who stalks you. Okay. experiencing a robbery or mugging.
So many folks with PTSD, you know, they're often going to engage in some form of coping. Sadly that can be, you know, through abusing alcohol and or becoming aggressive later as time goes on. Okay, so for PTSD, you know, if we're able to have mental health counselors available at the time of the traumatic event, this can be very helpful.
It may not be possible in certain areas of the world, obviously, but, right. Help objectify, I'm sorry, help objectivity by identifying areas of no control. Assistance to regain control by identification, by identifying past situations that they were able to handle successfully.
Have these folks engage in support groups, group therapy. You know, the idea that back in the day. During World War II, they would call this combat fatigue.
Nowadays, we know exactly what's really going on. Combat exposure can also lead to depression, provide safety with these folks. The idea that, you know, what they thought was really kind of cool and interesting was that if you're able to give people morphine, if you can give people morphine roughly at the time of that traumatic event or shortly after that traumatic event has happened, they are going to be at a lower risk for developing ptsd you know and uh not that nurses and everybody running around is out there in the you know in the public area just packing you know morphine to just dispense like you know pez and whatnot but uh now if we're able to get these folks morphine shortly afterwards the cool thing is that they may not develop uh ptc or you know may not be as severe uh you know in their future right next We're going to talk about dissociative disorders, and these are characterized by involuntary escape from reality. Basically, between their thoughts, their identity, their consciousness, and their memory, there's this dissociation. When folks are experiencing this disorder, they might be aware of sound and smell, but they won't be able to link it to the actual event itself, depending on the type of dissociation they have going on.
There are videos that you'll see on the slides. When we get to this, when we get to that slide, you can pause the video and then basically type out the link into your computer. That way you guys can watch the video at your leisure.
Okay, or I'll just have it posted online for you guys to click on. So, whatever, however you want to do it. Give us the link, professor. Okay, you'll get the link, don't worry. So, dissociative disorders, we've got dissociative identity disorder.
We got dissociative fugue, dissociative amnesia, and depersonalization disorder. So first up we got dissociative identity disorder. So this is also used to be called multiple personality disorder.
And with folks who have this disorder, we're seeing two or more distinct, different personalities within these individuals. And when these personalities, you know, are there, they are going to be able to take control over that person, over their behavior, and basically they're going to, like, become active in a sense. And, you know, in the videos that you're going to watch there on this link, you know, the mom.
She was afraid that social services were going to come in and come take away her child. And watching and observing a person who has this disorder with these different alters, these different personalities taking over and taking control, I could see why child protective services were concerned. There's one personality that's really woo-wee. I would not want to have to deal with that person because they're really like, they seem to be kind of out of it. They're hyper fixated into this.
religious ideology and they're saying things such as evil daughter right she died she was a good she's saying all this weird random stuff you know and as a young girl who's hearing her mother muttering these kinds of things she might think is she talking about me am i the evil daughter like you know i don't know i was watching that uh video it's like yeah i could see definitely why they wanted to come over and come take over you I'm taking her away. It's a good video. It'll really give you the insight to see how these folks behave and whatnot.
But the reality of it is, you know, working in mental health for these years, I've never actually ever met a person who has this personality disorder. I'm sorry, this dissociative identity disorder. This disorder, it's extraordinarily rare. One of the psychiatrists I've worked with at Glendale-Venice, she's worked in the L.A.
area for almost over 40 years. And her entire... time working, she's only ever met two patients that she knows could be diagnosed with this disorder.
All the other patients that she's met, no, they don't have this disorder. So it's pretty rare. The idea is that when people experience sexual abuse or chronic traumatic events, it can lead to this dissociation where these splits become fixated, and then it basically leads to this development of these different alters, these different personalities. When it comes to us treating these folks, one of the end goals that we would have for them would be to reduce the number of their alters. To go from maybe like 10, maybe to get it down to 4 or 5 or 3 if we're really lucky.
Most of the time, these folks are going to need a lot of therapy. We can give them some medications like SSRIs, but for the most part, there's not like one magic medication to... treat this particular disorder. It's a really rare disorder. Interestingly enough, it would seem that folks who have this disorder, they can live at home and work if they're able to work at home, kind of a job.
Like they can still do things on their own, but more likely they might need some kind of assistance. You know, they're going to live at home with somebody who can help care for them, etc. But in the video, it turns out that the mom, and you'll see in the video, she's a Artist she makes art projects art, you know paintings and this kind of stuff and you know She makes really good money and she was able to sell that stuff And that's how she was able to support herself and her daughter all those years. So fast-forward to today the daughter She I think just graduated from law school. She's a lawyer.
So she's she's doing good. The mother is doing great You know her alters they take over and it's interesting because the alters would take over when they're taking over They'll do their own art They'll do their own drawings, and you know that they did it because of, you know, who they are in terms of the alter, you know, in terms of their different personality that you see. But it's really cool. It's really interesting.
Like I said, pretty rare. You're not going to be seeing them pretty often at all. Next, we've got Dissociative Fugue.
So folks who experience dissociative fugue, these are folks who are going to be, you're going to see them experience probably some kind of traumatic event. Maybe somewhat recently, there's a trigger for it. They probably had some kind of traumatic event earlier in their life.
Okay. So when this trigger happens, maybe they get caught cheating on their spouse or something like that, or they get fired from their job, whatever. You know, some traumatic event like that happens.
They're going to wander. They're just going to go away from their home. they're going to go into this state where they don't recognize themselves as who they are.
You might see me, if any of you could recognize me in real life, you might say, hey! Professor Bosefield, you see me at Target, I'll look you dead in the eye and I'll say, I'm not Professor Bosefield. I don't know you. And you'll be like, what?
And then you'll walk away from me. I'll walk away from you. And then maybe then we're still in Target and I'm checking out, I'm paying for my purchase. And then you're going to see me bust out my Target red card with my name on it and I'm going to pay for it.
And you're going to look at me and you're like, what the hell? You're a liar, right? That's what you'll think. But the reality is.
I can, I'll use things that are Kevin Bousfield's, you know, things, but I don't recognize myself as Kevin Bousfield. Okay. That's what you're seeing. They are not able to recognize themselves as who they are. And when they go into this fugue state, the fugue state may last a few days.
It may last a few weeks. Sometimes these folks, they'll come to and they'll be like, where the hell am I? They're going to be in a completely different city, completely different town altogether, perhaps.
Sometimes folks who have this Dissociative Fugue, you know, they may get themselves into trouble. They may get into things that they shouldn't be getting into. The video that you can see right there that you can watch, the woman in this video, she, oh my gosh, one of the times where she goes into a fugue state and when she came out of it, they were pulling her out of a river, like, face down, you know?
And so I don't know what the heck. is going on with her. This isn't something that you get to see very often on the unit, you know, because most of the times when patients who have this disorder, when they have dissociative fugue, they will walk right by you. You're not going to think there's anything wrong with them.
You're going to think they're fine unless you know them, unless you are a close friend or a family member. You are not going to think there's anything wrong with this person because they are not going to appear to be in any form of distress. And it's only when maybe a person who goes into the sphique state they get brought in by a fan member or a friend who knows that they're not well that they're in a fugue state perhaps because they know their history maybe then i'll get to work with them and care for them but um you know other than that it's they're they're not gonna they're not gonna be in a good place you know they can you think they're okay you think they're doing all right care of themselves but watch that video you're gonna see that not always is the case for these folks okay next we got dissociative amnesia And, you know, what we're seeing here are one or more episodes of memory loss of important personal information.
At some point, they just become completely unaware of, you know, who they were. They can't remember, you know, things about them over a particular, you know, amount of their lifetime. In the video you guys can watch there, this woman, she's 40 years old.
She wakes up and she wakes up remembering only herself when she was like in her... teens as a 16 or 17 year old sharing a bunk bed with her sister that's the last thing that she's able to remember at that age being this age 16 being a teenager the reality is she wakes up she has a teenage son who lives with her but she doesn't recognize the son she doesn't even know where the heck she's at she only knows herself as a teenager being 16 years old of age everything else from then on to you know act to that current time none of that's callable to them. So it's pretty trippy. Sadly, like I said, the folks with dissociative fugue not met any patients who've experienced dissociative amnesia. It's kind of a trip.
Next, we have depersonalization disorder. This is a disorder where folks may have feelings of being detached from their body, from their own mental process. maybe having a feeling of being on the outside, you know, observing their own life, being detached from their surroundings.
This disorder is often triggered by severe stress. Diagnosed is based on symptoms after other possible causes have rolled out. Treatment consists of psychotherapy, drug therapy, SSRI medications.
That's going to be the thing that's more likely going to help them. But interesting disorder, depersonalization disorder. So once again, treating these folks we can use antidepressants, SSRIs, maybe we'll give some anxiolytics but like benzos but SSRIs are going to be our primary go-to. When they are experiencing this dissociative crisis, if they're not in a safe place, we need to make sure that we keep them safe. Maybe we're going to be making decisions for them to ensure that we're keeping them safe.
We'll let them make more decisions when they become more independent. But, you know, in the beginning, we may need to do quite a bit to help ensure that they feel safe and supported from us. OK, we can have them utilize grounding techniques, have them be in the here and now, have them utilize mindfulness, physical exercise. OK. These are good activities.
Maybe take a shower, hold an ice cube, counting beads, deep breathing. Ground techniques will be very helpful for these folks. Okay, here's a question. 22-year-old woman is seen in the outpatient mental health clinic complaining of frequent nightmares, feelings of guilt, and poor concentration. During the intake assessment, the nurse learns that the patient was physically abused as a child.
This history and symptoms are most consistent with which anxiety disorder? What do you guys think? Do you guys think this is a panic attack with agoraphobia?
Do you think this is a phobic reaction? Is this obsessive compulsive disorder? What do you think? Maybe this looks more like PTSD. Yes, I think it looks more like PTSD.
Okay, so I did this lecture pretty quick. I guess that's what happens if I just go nonstop without taking breaks and letting you guys give me any feedback. So what I'm going to do is I will post, I'll post the links for you guys to check out the videos. I want you guys to be able to see, you know, some of these folks. how these disorders kind of play out, I think it'll give you some good insight.
So hopefully you enjoyed this lecture. Until I see you in person again, take care. Bye-bye.