Crisis Anxiety Somatoform Dissociative
Crisis Anxiety Somatoform Dissociative
Crisis Anxiety Somatoform Dissociative
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117/ Psyche Lecture
3. Help the person to obtain high level of *Crisis is not a psychiatric illness so pharmacological
functioning. intervention is not a choice. If symptoms occur like
anxiety, panic, sleep disturbances.
STEPS IN CRISIS INTERVENTION: *Anxiolytics/Antianxiety/Minor Tranquilizer are the
1. Assessment drug of choice (Xanax, Valium, Ativan, Klonopin)
2. Planning ----------------------------------------------------------------
3. Implementation
4. Resolution
SUICIDE
- Self-imposed death
SAD PERSON ACRONYM
SEX
- Female attempts (pero takot kaya mostly
ends up not doing it)
- Male attempts and commits suicide
(deretsahan, pag gusto--- tinutuloy)
AGE
- 18 to 25
- 45 above
DEPRESSION/ DEPENDENT PERSONALITY
PREVIOUS ATTEMPT
ETHANOL, ALCOHOLOLICS
MANAGEMENT:
RATIONAL THINKER PSYCHOTIC
1. Display acceptance and concern.
SOCIAL SUPPORT IS LACKING
2. Discuss feelings.
ORGANIZED PLAN
3. Help the person understand the situation
NO SPOUSE
gradually.
SICKNESS
4. Explain that emotions are normal in reaction
to crisis.
5. Avoid assurance. ANXIETY
6. Do not encourage the person to place the Anxiety disorders are the most common of all
blame for the crisis on others. It prevents the mental health disorders. It makes a person feel
patient to face the truth. anxious most of the time, without any apparent
7. Set limits to destructive behavior or self- reason. The anxious feeling may be so
harm. uncomfortable that to avoid them, you may stop
8. Assist patient with ADL. some everyday activity. Occasional bouts of
9. Evaluate and modify nursing intervention if intense anxiety terrifies and immobilize a person.
necessary.
10. Focus on the immediate problem. (Clearly TERMINOLOGY:
identified) 1. Anxiety: It is a response to subjective or
11. Explore alternatives for coping with the crisis. internal danger. Afraid of the unknown
12. Let client participate in choosing an action 2. Fear: It is a response to objective threat or
plan and implement. (mutual goal planning) external danger. Afraid of the known
3. Phobia: It is an exaggerated, abnormal,
NOTE: ------------------------------------------------------- marked fear of non-dangerous object or
*Crisis is generally time limited which should last for situation.
4 to 6 weeks.
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4. Mild anxiety: It is a type of anxiety which is LEVEL OF ANXIETY
caused by the ordinary tension of daily life. 1. Mild Anxiety (+1): type of anxiety which
Perception is very high. caused by the ordinary tension of daily life.
- Character: alert, voice is calm, attentive, Perception is very high. Normal.
confident, calm, secured, relaxed and uses - Alert, voice is calm, attentive, confident,
adaptive coping mechanism. calm, secured, relaxed, and uses adaptive
5. Moderate anxiety: A type of anxiety where coping mechanism.
the patient’s perception continues to be high, 2. Moderate Anxiety (+2): type of anxiety
however, the patient begins to focus only on where the patient’s perception continues to
the situation he is into, excluding other be high, however, the patient begins to focus
issues. only on the on the situation he is into,
- Character: irritable, talk fast, muscle tension, excluding other issues. Narrowing of
frequent urination and sweating. perception.
6. Severe anxiety: A type of anxiety where the - Sympathetic nervous system/ fight or flight is
perception of the patient is inaccurate. The activated, irritable, talk fast, muscle tension,
problem solving is reduced and patient needs frequent urination, and sweating.
assistance. 3. Severe Anxiety (+3): the perception of the
- Character: disoriented, extreme tension, patient is inaccurate / “alanganin”. The
palpitation, hyperventilating, inefficient, problem solving is reduced and patient needs
disoriented, confused, withdrawal assistance/help. Put patient is a room,
7. Panic: A type of anxiety which is intense, separated from others.
disorganize a person functioning and distorts - Disoriented, extreme tension, palpitation,
perception. The patient must have immediate hyperventilating, inefficient, confused,
intervention. withdrawal, poor eye contact, sweating.
- Character: emotionally drained, helpless, 4. Panic (+4): intense, disorganize a person’s
desperate, clumsy, sleepless, and functioning and distorts perception. The
aggressive, exhausted, chest pain, patient must have immediate
negativistic, and hallucinate. intervention.Separate the patient from other
8. Primary gain: It is a way of allowing the patients at once and don’t leave patient in the
patient to relieve his own anxiety. room alone.
9. Secondary gain: It is a way of supporting or - Intervention (dependent): the doctor
helping others to relieve their anxiety. It is prescribes medicines for patient to be calm.
beneficial to the patient at times. - Intervention (independent): Pakalmahin
10. Burnout: physical exhaustion. muna bago mag-intervention.
- Emotionally drained, helpless, desperate,
DIFFERENT WAYS OF OBSERVING ANXIETY: clumsy, sleepless, aggressive, exhausted,
Change in tone of voice. chest pain, negativistic, hallucinate,
Tremors disorganized, distorted, terrorized.
Increase RR
Increase PR ETIOLOGY:
Avoidance of topic 4-6 ang nasa ppt ni ma’am
Blocking of communication 1. Biological factor
Restlessness 2. Psychoanalytic theory
Vomiting 3. Interpersonal theory
Diarrhea 4. Increase of epinephrine and norepinephrine.
Palpitation 5. The earliest emotional trauma felt by a
Rate of speech person was during his birth.
Frequent urination
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117/ Psyche Lecture
6. Mostly universal of all emotions, warning of
danger. MEDICATION:
- Antianxiety/ Minor Tranquilizer/
WAYS OF COPING ANXIETY: Anxiolytics: Librium, Valium, Ativan, Serax
1. Adaptive: able to solve problem. Can cope. - Undesirable effects of Benzodiazepines 3
2. Pallative: temporarily decrease anxiety. D’S
Example: Sinabi ng teacher na next Monday 1. Drowsiness
may quiz. Si Tekla nagreview siya ng 2. Dizziness
Wednesday and Saturday. Pero night before 3. Decrease B/P
the quiz, may nagyaya kay Tekla na magbar
at uminom. Pumunta naman si Tekla. No drug is totally safe and absolutely free of
Napuyat nga lang siya na pumasok sa school toxic effect.
kinabukasan. Nalate rin siya pero nakaexam Toxic effect sometimes can be apparent after
pa din. Kaya niyang idecrease ung anxiety a week or months after taking the meds.
kasi nagreview naman siya ahead of time. Check clients V/S it can cause orthostatic
3. Maladaptive: unsuccessful attempt to hypotension.
decrease anxiety without solving it. If a client have a multiple physical and
Example: Sinabi ng teacher na next Monday
psychiatric problems frequently occur
may quiz. May nagyaya kay Mijo na mag
together, and may require several treatment
samgyup, pumunta naman siya without
with drugs, multiple drug therapy is referred
reviewing. Ngayon hindi nga nagreview si
to as “poly pharmacy”.
Mijo, at sinasabi nalang niyang “Okay lang
Anxiolytics has a calming effect.
yan” kahit apagpullat or apagpasa lang ung
grade niya sa subject na ito.
Factors altering drug response can be: age,
sex, body mass, environment, time of
4. Dysfunctional: unsuccessful way of
administration, psychological, genetic
relieving anxiety and decrease minimal
functioning. It is not use for minor stresses of everyday
Example: Sinabi ng teacher na next Monday life, it can cause addiction.
may quiz. Alam ni Pia na may quiz Avoid using with OTC drugs it may alter the
kinabukasan pero naglakwatcha pa rin siya potency of the drug.
the night before the quiz. Late siyang umuwi. Avoid stopping the meds abruptly because of
Sa sobrang puyaty niya, d na siya the side effects
nakapagreview, d na rin siya nakapasok, d
na rin nakapag quiz. NURSING MANAGEMENT:
1. Accept patient’s behavior. (Trust)
NURSING DIAGNOSIS: 2. Provide calm and quiet environment.
Altered family process Reduce stimulation. (Identify cause of
Altered health maintenance anxiety)
Altered nutrition: less/more than body 3. Discuss the feelings. (To increase
requirements. recognition to what is happening to them.)
Decision conflict 4. Listening. (Trust and assess suicidal
Decrease self esteem tendencies.)
High risk for trauma 5. Plan an activity for the patient and use of
Impaired adjustment hobbies. (Help patient release nervous
Ineffective individual coping energy/ increase self-esteem)
Impaired verbal communication 6. Promote relaxation technique. (Reduce
Impaired social interaction anxiety)
Powerlessness
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THERAPY: 6. Plan an activity for the patient.
- Recreational 7. Acceptance of positive or negative feeling of
- Relaxation the patient.
- Group therapy 8. Develop adaptive coping responses. To
practice new behavior to face their problem.
ANXIETY DISORDER-- TYPES OF ANXIETY:
A. Generalized Anxiety Disorder (GAD) MEDICATION:
B. Panic disorder - Minor tranquilizer. (Ativan)
C. Phobic disorder - Antidepressant (Tofranil)
D. Post-traumatic stress disorder
THERAPY:
A. *GAD: “FREE FLOATING ANXIETY” - Recreational (decrease tension)
- Excessive unrealistic anxiety of 6 months - Relaxation (promote comfort)
period or years. - Group therapy (focus in stress mngt.,
ETIOLOGY: SAME AS IN ANXIETY problem solving to increase self-esteem)
18 SYMPTOMS OF GAD
shaky easy fatigability B. PANIC DISORDER:
dry mouth chills - It is an intense fear of discomfort which last
hot flashes insomnia for few minutes. Attack occur “out of the blue”
muscle aches shortness of the severity will make the patient unfit and
nausea and breathing incapable.
abdominal irritability
distress hot flashes ETIOLOGY:
frequent urination difficulty of Hereditary increased in serotonin
restlessness concentrating
dizziness difficulty of SYMPTOMS:
startled response swallowing Same as GAD
sweating Chest pain
Choking feeling
Going crazy
NURSING DIAGNOSIS: Numbness
Alteration in concentration Unable to move and suicidal.
Altered role performance
Anxiety NURSING DIAGNOSIS:
Distractibility SAME AS GAD
Distress Alteration in concentration
Fear Altered role performance
Guilt Anxiety
Social isolation Distractibility
Distress
NURSING MANAGEMENT/CARE: Fear
1, 2, 4, 6, 8 ang nasa ppt ni ma’am Guilt
1. Calm and quiet environment. Social isolation
2. Stay with the patient and talk about their
fears. NURSING MANAGEMENT/CARE:
3. Decrease level of anxiety. 1. Stay with the patient.
4. Listen to the patient. 2. Allow pt. to cry.
5. Support your patient. 3. Provide calm/safe environment.
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4. Communicate with the pt. SYMPTOMS: Same as Panic disorder.
5. Speak in short, simple sentence and give one Same as GAD
direction at a time. Chest pain
6. Ask perception or fear. Choking feeling
Going crazy
MEDICATION: Numbness
- Antidepressant Unable to move and suicidal.
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E. POST TRAUMATIC STRESS DISORDER NURSING MANAGEMENT:
(PTSD): 1. Develop trust. (Suspicious, withdrawn)
- Pinakagrabeng type 2. Offer great deal of empathy and support.
- Withdraw from others because they cannot (I have not been through it but the more you
live with them or because of the tell me the better I will understand your
embarrassment. situation and experience.)
- 3. Help reestablish relationship that can
ETIOLOGY: provide support and assistance. (Family,
- War couple counselling)
- Natural or man-made disaster 4. Safe environment. (outburst/ out of control)
- Fires 5. Encourage participation in sports,
- Accidents recreational activities or any healthy
- Illness outlet for stress. (Healthy outlet for stress)
- Rape 6. Educate him with regards to his medication.
- Assault 7. Recapitulation of each memory from least to
- Major personal losses in business the most painful.
SYMPTOMS: MEDICATION:
Avoidance - Minor tranquilizer (decrease painful
Numbness emotions)
Shortness of breathing - Lithium
Restlessness - TCA
Dizziness - MAO
Sweating
Palpitation THERAPY:
Rapid speech - social activity (rebuilt social skills)
Withdrawal - recreational
Pacing - exercise program group
Irritability
Restlessness NOTE: -------------------------------------------------------
Nightmares *Psychotic medicines + alcohol = BIG BIG NO
Survivors guilt ----------------------------------------------------------------
Hallucination
F. ACUTE STRESS DISORDER:
NURSING DIAGNOSIS: - Symptoms are similar to PTSD but develop
Alteration in nutrition within the first month after the extremely
Anxiety threatening situation.
Impaired social interaction
Ineffective breathing pattern MEDICATION:
Ineffective individual coping - Antianxiety (Minor tranquilizer/ Anxiolytics)
Powerless Serax, Librium, Valium, Ativan
Risk for injury It has a calming effect
Sleep pattern disturbances It is not use for minor stresses of
everyday life, and can cause addiction.
COMMON DEVELOP PROBLEMS: IV meds 1 to 5 minutes
suicidal ideas or attempt IM 15 to 30 minutes
substance abuse
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EFFECTS OF BENZODIAZEPINES 3 D’S
Management: Acupuncture, Physical
1. Drowsiness therapy, Relaxation & pain management
2. Dizziness technique.
3. Decrease B/P c. Hypochondriasis
Check VS, it can cause orthostatic Physical symptoms are interpreted as
hypotension severe and can cause the client’s life.
Example: prick lang sa finger, feel nila
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DISSOCIATIVE IDENTITY DISORDER: - Behavior: “switching” (blinking & rolling of
ANXIETY RELATED DISORDER eyes, headache, covering/hiding of face,
- The most extreme manifestation of a twitching) occurs from one alter to another.
dissociative disorder and it involves multiple
parts of the personality existing within one MANAGEMENT:
person. These have evolved as separate 1. Interact with the patient. (trust)
personality states as the only feasible way for 2. Keep them safe. (decrease anxiety)
a child to cope with ongoing trauma and 3. Provide non-demanding, simple routines.
abuse. (decrease anxiety)
- It is the “splitting off” an idea or emotions from 4. Encourage to do things for them self.
one’s consciousness. (thrill seeker)
- Defense Mechanism (DM) is repression, 5. Assist in decision making. (decrease
because the conscious personality cannot stress)
handle anxiety. 6. Stress management
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