Download Anxiety-Based Disorders

The 4 D’s (a patient’s behaviors should be questioned with ALL of the following 4 questions, if the
patient answers yes to AT LEAST 2 out of the 4 then they may be facing a mental disorder)
1.
2.
3.
4.
Does the behavior deviate from societal/cultural norms?
Does the behavior cause severe distress
Does the behavior cause the person to be dysfunctional in everyday life?
Does the behavior cause the person to be a danger to themselves or others?
Anxiety-Based Disorders
-feelings of anxiety
-feelings of inadequacy
-avoidance of dealing with problems
-constant worrying, mood swings, physical symptoms (headaches, sweating, weakness, fatigue)
Generalized Anxiety Disorder
A. Excessive anxiety and worry, about a number of events or activities
B. Individual finds it difficult to control the worry
C. The anxiety and worry are associated with three (or more) of the following six symptoms
a. Restlessness or feeling on edge
b. Fatigue
c. Difficulty concentrating
d. Irritability
e. Muscle tension
f. Sleep disturbance
D. Anxiety causes significant distress
E. Anxiety causes the person to be dysfunctional in daily life
Phobic Disorder
A.
B.
C.
D.
Marked fear or anxiety about a specific object or situation
Phobic object or situation provokes immediate fear or anxiety
Phobic object or situation is actively avoided
The fear or anxiety of the object or situation is much greater than the actual danger the object or
situation poses.
E. The fear, anxiety or avoidance is persistent, typically lasting for 6 months or more
F. The fear, anxiety or avoidance causes severe distress
G. The fear, anxiety or avoidance causes the person to be dysfunctional in daily life
Panic Disorder
-
Recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense fear or
discomfort that peaks within minutes, during which time FOUR or more of the following must
occur:
o Pounding heart, accelerated heart rate
o Sweating
o Trembling or shaking
o Sensations of shortness of breath
o Feelings of choking
o Chest pain
o Nausea
o Dizziness, light-headed
o Chills or heat sensations
o Tingling sensations or numbness
o Feeling detached from one-self
o Fear of going crazy
o Fear of dying
Obsessive-Compulsive Disorder
-
-
Presence of obsessions, compulsions or both:
o Obsessions are defined as:
 Recurrent thoughts, urges, or images that are experienced, at some time during
the disturbance, as unwanted, and that in most people cause anxiety or distress.
 The person attempts to ignore such thoughts, urges, or images, or to neutralize
them with some other thought or action.
o Compulsions are defined as:
 Repetitive behaviors (hand washing, ordering, checking, etc.) or mental acts
(praying, counting, repeating words, etc.) that the person feels driven to perform
in response to an obsession.
 The behaviors or mental acts are aimed at preventing or reducing anxiety or
distress, or preventing some dreaded event or situation; however, these behaviors
or acts are not connected in a real way to actually prevent or reduce anxiety from
the situation.
The obsessions or compulsions are time-consuming or cause distress for the person.
Mood Disorders
-
Intense depression that lasts for a significant amount of time
Lack of control of one’s emotions
Feelings of helplessness, and hopeless
Emotions hamper the ability to function effectively.
Lost sense of reality
Major Depressive Disorder
-
Depressed mood or a loss of interest or pleasure in daily activities for more than two weeks.
Mood represents a change from the person's baseline.
Impaired function: social, occupational, educational.
Specific symptoms, at least 5 of these 9, present nearly every day:
o
o
o
o
o
o
o
o
o
Depressed mood most of the day, nearly every day, as reported by self
Lost interest or pleasure in all, or almost all, activities most of the day, nearly every day.
Significant weight loss or gain, or decrease or increase in appetite nearly every day.
Insomnia or hypersomnia nearly every day (difficulty or delay in falling asleep or
excessive sleep).
Psychomotor agitation (such as pacing, inability to sit still, pulling on skin or clothing) or
retardation (such as slowed thinking, speech or body movement) nearly every day that
can be observed by others.
Fatigue or loss of energy nearly every day.
Feelings of worthlessness or excessive, inappropriate, or delusional guilt nearly every
day.
Diminished ability to think or concentrate, or indecisiveness, nearly every day.
Recurrent thoughts of death (not just fear of dying), recurrent suicidal thoughts without a
specific plan, or a suicide attempt or a specific plan for committing suicide.
Bipolar Disorder
A Major Depressive Episode includes at least 5 of the following symptoms occurring over the same
2-week period and must include either #1 or #2:
1. Depressed mood most of the day, nearly every day, as reported by self
2. Lost interest or pleasure in all, or almost all, activities most of the day, nearly every day.
3. Significant weight loss or gain, or decrease or increase in appetite nearly every day.
4. Insomnia or hypersomnia nearly every day (difficulty or delay in falling asleep or excessive sleep).
5. Psychomotor agitation (such as pacing, inability to sit still, pulling on skin or clothing) or retardation
(such as slowed thinking, speech or body movement) nearly every day that can be observed by others.
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive, inappropriate, or delusional guilt nearly every day.
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day.
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal thoughts without a specific
plan, or a suicide attempt or a specific plan for committing suicide.
A Manic Episode includes a period of at least one week during which the person is in an
abnormally and persistently elevated or irritable mood. This period of mania must be marked by
three of the following symptoms.
1. Inflated self-esteem
2. Decreased need for sleep.
3. Intensified speech (possible characteristics: loud, rapid and difficult to interrupt, a focus on sounds,
theatrics and self-amusement, non-stop talking regardless of other person’s participation/interest,
angry tirades).
4. Rapid jumping around of ideas or feels like thoughts are racing.
5. Distractibility (attention easily pulled away by irrelevant/unimportant things).
6. Increase in goal-directed activity (i.e. excessively plans and/or pursues a goal; either social,
work/school or sexual) or psychomotor agitation (such as pacing, inability to sit still, pulling on skin
or clothing).
7. Excessive involvement in pleasurable activities that have a high risk consequence.
Schizophrenia
Schizophrenia
-
-
Two or more of the following, each present for a 1-month period. At least ONE of these must be
1, 2, or 3.
o Delusions (Fixed beliefs that don’t change even with conflicting evidence)
o Hallucinations (perception-like experiences that occur without an external stimulus)
o Disorganized speech (may switch from one topic to the next, answer questions with
absolute non-sense)
o Grossly disorganized behavior (childlike “silliness”, unpredictable movements,
maintaining an inappropriate or bizarre posture, complete lack of verbal and motor
responses.)
o Negative symptoms
 reductions in the expression of emotions in the face, eye contact, speech, and
movements of the hands, head and face that normally give an emotional
emphasis to speech
 decrease in motivation for work or social activities
 decreased ability to experience pleasure
Level of functioning in one or more major areas, such as work, relationships, or self-care, is
below the level achieved before the symptoms arose.
Personality Disorders
-
Unable to establish meaningful relationships with other people
Unable to assume social responsibilities
Unable to adapt to their social environment
Signs of self-defeating personality patterns
Antisocial Personality Disorder
-
-
A pattern of disregard for and violation of the rights of others, occurring since age 15, as
indicated by 3 or more of the following:
o Failure to conform to social norms by repeatedly behaving in illegal ways.
o Repeated lying, use of aliases, conning others for personal profit or pleasure
o Impulsive or fails to plan ahead
o Irritable and aggressive, show by getting into repeated physical fights.
o Reckless disregard for safety of self or others
o Consistent irresponsibility, show by repeated failure to show consistent work behavior or
honor financial responsibilities
o Lack of remorse for people a person has hurt, mistreated, or stolen from.
The person is at least 18 years old
Multiple Personality
-
Presence of two or more distinct personality states
sudden alterations in sense of self
recurrent gaps in the recall of everyday events or important personal information
Feeling that a person has become an observer of their own speech and actions which they may
feel powerless to stop.
Sometimes voices are experienced as multiple, perplexing, independent thought streams over
which the person has no control
Strong emotions, impulse and even speech may suddenly emerge
Feelings that attitudes, emotions, behaviors and even body are not theirs or under their control
Narcissism
-
Need for admiration, and lack empathy, indicated by five or more of the following:
o Has grand sense of superiority
o Preoccupied with fantasies of unlimited success, power and beauty
o Believes that he or she is special and unique and can only be understood by other special
people
o Requires excessive admiration
o Has a sense of entitlement
o Takes advantage of others to achieve their own goals
o Unwilling to recognize or identify with the feelings and needs of others
o arrogant
Borderline Personality Disorder








An intense fear of abandonment
A pattern of unstable intense relationships, such as idealizing someone one moment and then
suddenly believing the person doesn't care enough or is cruel
Rapid changes in self-identity and self-image that include shifting goals and values, and seeing
yourself as bad or as if you don't exist at all
Periods of stress-related paranoia and loss of contact with reality
Impulsive and risky behavior, such as gambling, reckless driving, unsafe sex, spending sprees, binge
eating or drug abuse, or sabotaging success by suddenly quitting a good job or ending a positive
relationship
Suicidal threats or behavior or self-injury
Wide mood swings lasting from a few hours to a few days
Inappropriate, intense anger, such as frequently losing your temper, being sarcastic or bitter, or
having physical fights
Dementia
Alzheimer’s disease
-Criteria are met for either probable or possible Alzheimer’s disease as follows:
- Evidence of Alzheimer’s disease from family history or genetic testing
- Onset between ages 40 and 90 years old
-All three of the following are present:
- Clear evidence of decline in memory and learning
- Steadily progressive, gradual decline in cognition.
- No evidence of other cognitive mental degenerative disorders
EATING DISORDERS
Binge-Eating Disorder
-
-
The disorder is characterized by both of the following:
o Eating, in a discrete period of time, an amount of food that is definitely larger than what
most people would eat in a similar period of time under similar circumstances
o A sense of lack of control over eating during the episode
The disorder is associated with THREE or more of the following:
o Eating much more rapidly than normal
o Eating until feeling uncomfortably full
o Eating large amounts of food when not feeling physically hungry
o Eating alone because of feeling embarrassed by how much one is eating
o Feeling disgusted with oneself, depressed, or very guilty afterward
Anorexia Nervosa
-
Restriction of energy intake leading to low body weight
Intense fear of gaining weight or of becoming fat or persistent behavior that interferes with
weight gain, even though at a significantly low weight.
Disturbance in the way in which one’s body weight or shape is experienced.
Bulimia Nervosa
-
-
The disorder is characterized by the following:
o Eating, in a discrete period of time, an amount of food that is definitely larger than what
most people would eat in a similar period of time under similar circumstances
o A sense of lack of control over eating during the episode
Recurrent inappropriate behaviors in order to prevent weight gain, such as self-induced vomiting,
misuse of laxatives, diuretics, or other medications; fasting, or excessive exercise.
ADHD
-
Persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning
or development, as characterized by: Inattention OR Hyperactivity
o Inattention: six or more of the following symptoms are persistent:
 Often fails to pay close attention to details or makes careless mistakes
 Often has difficulty paying attention during an event or activity
 Often does not seem to listen when spoken to directly
 Often does not follow directions and fails to finish work, chores, or duties in the
workplace
 Often has difficulty organizing tasks and activities
 Avoids, dislikes, or is reluctant to engage in tasks that require mental effort
 Loses things necessary for tasks or activities
 Is often easily distracted by thoughts and ideas
 Forgetful in daily activities
o Hyperactivity and impulsivity: Six or more of the following symptoms are persistent
 Fidgets or taps, hands or feet, or even squirms in seat
 Often leaves seat in situations when remaining seated is expected
 Often runs about or climbs in situations where it’s inappropriate
 Often unable to play or engage in leisure activities quietly
 Is often “on the go” acting as if “driven by a motor”
 Often talks excessively
 Blurts out an answer before a question has been completed
 Has difficulty waiting his or her turn
 Interrupts or intrudes on others
Treatments (Decide on a treatment and explain your decision)

The two broad categories of therapy:

Psychotherapy: technique of patients telling the therapist about their problems, and the
therapist listens and tries to help them understand those problems or assists them in
changing the behaviors related to the problem.

Biomedical therapies: the treatment of psychological disorders by altering brain
functioning with physical or chemical interventions.

Psychoanalysis- goal of the approach is to help the patient understand the unconscious through
discussing dreams, fantasies, slips of the tongue, perceptions of inkblots, etc. and then to resolve
any conflicts with the conscious mind and the unconscious mind.

Behavior Therapy- goal is to make appropriate use of positive and negative consequences for
behavior in order to change the way a patient acts.

Group Therapy- stresses the interaction among and support of peers when discussing mental
problems. Goal of therapy is to provide emotional support to individuals by allowing them to
share in the lives of others who have similar problems.

Client-centered Therapy- stresses the belief in the inner worth and potential of all human
beings. The goal of this therapy is to help people resolve their own mental problems rather than
depending on the direct advice of someone else, since they are considered to have the potential to
understand and direct themselves.

Electroconvulsive Therapy- use of electric shock to cause seizures in patients. Has shown to
lessen the symptoms severe depression.

Prefrontal Lobotomy-brain surgery in which nerve pathways are cut in the frontal lobes of the
brain. If enough brain tissue is damaged in these areas, the emotions of the patient are affected.

Drug Therapies- Researchers have been finding many drugs which combat specific chemical
imbalances in patients with mental disorders.
Recommendation of Lifestyle Changes
List 2 lifestyle changes your team recommends that the patient take and explain your team’s reasoning
behind the recommendations
Roles