25. Anxiety Flashcards
uncomfortable feeling of apprehension or dread in response to internal or external stimuli (could have unknown source)
anxiety
physical sxs of anxiety
- palpitations
- increased BP
- restlessness
- SOB and hyperventilation
emotional sxs of anxiety
- alarmed
- fearful
- tense
cognitive sxs of anxiety
- difficulty thinking
- inability to perceive environment appropriately
factors that determine if anxiety is a sxs of mental disorder
- intensity of anxiety relative to situation
- trigger for anxiety
types of anxiety
- acute
- chronic
- mild
when is anxiety normal
when it is a motivating force that provides energy to carry out tasks
anxiety precipitated by imminent loss or change; threatens one’s security (crisis)
acute anxiety
anxiety that persists over time; due to worrying about everyday situations; leads to GAD
chronic anxiety
anxiety that occurs in normal everyday living; increases perception and improves problem solving
mild anxiety
how does mild anxiety manifest
- restlessness
- irritability
- mild tension-relieving behaviors
how much is too much anxiety
- when out of proportion to situation that is creating it
- interferes w/ social, occupational, or other important areas of functioning
Peplau’s 4 levels of anxiety
- mild: seldom a problem; every day situations
- moderate: perceptual field diminishes
- severe: perceptual field is so diminished that concentration centers on one detail only or on many extraneous details; unable to make connections
- panic: most intense state; unable to process environment
biological theories of anxiety
- serotonin (emotional response) and NE (physical sxs)
- GABA (inhibits neuroactivity -> calming effect)
- HPA axis (anxiety linked to stress hormones)
psychological and social theories of anxiety
- psychoanalytic (defense mechanisms) and psychodynamic theories
- cognitive behavioral theories (attempting to unlearn behavior through experiences)
epidemiology of anxiety
- most common psych illness
- more common in women
- associated w/ other mental or physical comorbidities (depression, CV disease, and respiratory disease)
- most common condition in adolescents
- FHx probably exists
- high rates in caucasians
what can undiagnosed anxiety lead to in children and adolescents
- separation anxiety disorder and/or mutism
- suicidal ideation and suicide attempts
- drug and alcohol dependence
- educational underachievement later in life
coping mechanisms for anxiety
- eating
- drinking
- sleeping
- exercise
- smoking
- crying/laughing
- talking to people they feel comfortable with
- defense mechanisms
sudden onset of extreme apprehension or fear of impending doom; fear of losing one’s mind or having a heart attack
panic attack
fear of being in places or situations from which escape is difficult or help unavailable; most severe form of panic disorder
agoraphobia
diagnostic criteria for panic attacks
recurrent and unexpected panic attacks and 1 month or more after an attack of one of the following sxs
- persistent concern about having another attack
- worry about implication of attack or consequences
- significant changes in behavior because of fear of attacks
risk factors for anxiety
- female, middle aged, low socioeconomic status and widows, separated or divorced
- substance abuse
- smoking tobacco
- severe stressors
several anxiety sxs + experience of separation anxiety during childhood leads to what
panic disorder later in life
emergency care during panic attack
- safe and therapeutic environment
- medication and monitoring of effects
- individual psychotherapy
- psychological testing (MSE)
- administer PRN meds
priority care issues during panic attack
safety because of high risk for suicide
nursing assessment for panic attacks
- rule out life threatening medical causes (sx eval)
- assess for substance use
- self-report scales
- MSE
prevention of panic attacks
- identify physiological arousal
- identify healthy coping thoughts
- reduce stress
interventions for panic attacks
- CBT (deep breathing, meditation, positive self-talk, relaxation techniques)
- grounding techniques (focusing on present moment)
explain the 5 4 3 2 1 method of grounding
- 5 things they can see
- 4 things they can feel
- 3 things they can hear
- 2 things they can smell
- 1 thing they can taste
excessive anxiety or worry about numerous things for at least 6 months; commonly seen w/ depression
generalized anxiety disorder (GAD)
common sxs of GAD
- restlessness
- fatigue
- poor concentration
- irritability
- tension
- sleep disorders
epidemiology for GAD
- may have comorbid dx
- twice in common in women
- insidious onset
- affects all ages
- typical onset in childhood or adolescence; also common after 20 y/o
assessment for GAD
- assess sxs
- diet and nutrition
- sleep patterns
- drug use
prevention of GAD
- psychoeduation on healthy eating, sleep, exercise and impact of substance use
- medications
interventions for GAD
CBT (cognitive restructuring)
common meds used for GAD
- benzodiazepines (most common)
- SNRIs
- buspirone
- beta-blockers
common benzodiazepines (anxiolytics)
- diazepam (Valium)
- lorazepam (Ativan)
- alprazolam (Xanax)
- clonazepam (Klonopin)
- chlordiazepoxidem (Librium)
- oxazepam (Serax)
non-anxiolytic used for anxiety
buspirone (Buspar)
problems w/ benzos
- dependence
- rebound anxiety
pros of buspirone (Buspar)
- non-sedating
- non habit forming
- not a PRN
- good for the elderly
cons of buspirone (Buspar)
takes a longer time to work compared to benzos
non-benzodiazepine hypnotics (also given as sleep aids)
- zolpidem (Ambien)
- zalepon (Sonata)
- eszopiclone (Lunestra)
- ramelteon (Rozerem)
persistent irrational fear of specific objects, activities, or situations
phobia
types of phobias
- specific: response to specific object
- social: result of exposure to social situations or required performance
- agoraphobia
persistent fear of specific objects or situation leading to avoidance behavior
specific phobia
interventions for specific phobias
- anxiolytics for short term relief of anxiety
- exposure therapy (tx of choice)
- systematic desensitization (gradual introduction to phobia)
persistent fear of social or performance situation in which embarrassment may occur
social anxiety disorder (social phobia)
interventions for social anxiety disorder
SSRIs to reduce social anxiety and phobic avoidance
goals for phobias
function adaptively in presence of phobia without reaching panic
responses to extreme external or internal events or stressors; failure to integrate identity, memory, and consciousness
dissociative disorders
types of dissociative disorders
- dissociative amnesia: inability to recall specific event or period of time
- dissociative fugue: unexpected travel away for home; lost identity or formed a new one
- depersonalization disorder: being detached from one’s body; disconnected from reality
- dissociative identity disorder (multiple personality disorder)
- dissociative disorder not otherwise specified
