5 Anxiety Disorders & OCD Flashcards
1
Q
What is normal anxiety? (2)
A
- ) A normal response to the threat of injury
2. ) A normal response to developmental changes
2
Q
Who experiences anxiety?
A
everyone!
3
Q
Normal anxiety is an __ __.
A
emotional process
4
Q
Anxiety, which is an __ process, is a warning of __ and __ threat
A
adaptive
internal; external
5
Q
What are examples of internal and external threats? (5)
A
- Bodily damage/ pain
- Possible punishment
- Separation from loved ones
- Threats to status or success
- Threats to unity or wholeness
6
Q
Anxiety prompts a person to take necessary steps to prevent __ or __ __.
A
threat
lessen consequences
7
Q
Does this describe fear or anxiety?
Deal with a threat
A
Anxiety
8
Q
Does this describe fear or anxiety?
More insidious (not quite clear, uneasy feeling)
A
Anxiety
9
Q
Does this describe fear or anxiety?
Uncertainty to the outcome
A
Anxiety
10
Q
Does this describe fear or anxiety?
More sudden
A
Fear
11
Q
Does this describe fear or anxiety?
Diffuse, unpleasant vague sense of apprehension
A
Anxiety
12
Q
Does this describe fear or anxiety?
An alerting signal
A
Anxiety
13
Q
Does this describe fear or anxiety?
Warnings of impending danger
A
Anxiety
14
Q
Does this describe fear or anxiety?
Response to a known, external, or known threat
A
Fear
15
Q
Does this describe fear or anxiety?
Response to an unknown or vague threat
A
Anxiety
16
Q
Is this fear or anxiety?
“Thinking about going in the battlefield”
A
Anxiety
17
Q
Is this fear or anxiety?
“Bullet whizzing by your head”
A
Fear
18
Q
Is this fear or anxiety?
The impending - what is going to POSSIBLY happen
A
Anxiety
19
Q
Is this fear or anxiety?
IN THE MOMENT
A
Fear
20
Q
What are AUTONOMIC symptoms of anxiety? (13)
A
- Muscle tension
- Headache
- Perspiration
- Palpitations
- Tightness in the chest
- Stomach discomfort
- Restlessness
- Uneasiness
- Dizziness
- SOB
- Insomnia
- Feeling weak in the knees
- Loss of Appetite
21
Q
What BEHAVIORAL symptom of anxiety does this describe?
- ) Staying awake, alert more
- ) seeing if there is danger around
- ) Got your guard up
A
Vigilance
22
Q
Other general BEHAVIORAL symptoms of anxiety include __ or ___ behaviors
A
cautious ; avoidant
23
Q
What are COGNITIVE symptoms of anxiety?
A
Changes and/or distortions in:
- ) thinking
- ) perception
- ) learning
24
Q
What are examples of changes/distortions in thinking, perception, learning? (3)
A
- Time and Space
(ex: “it felt like forever”) - Persons and meaning of events
- Selective attention
25
Anxiety is considered ABNORMAL or PATHOLOGICAL when: (2)
1. It is out of proportion to the situation that is creating it
2. Interferes with social, occupational, or other important areas of function
26
What differs between Normal vs. Pathologic Anxiety? (4)
1. Intensity and duration
2. Trigger
3. Emotional Response
4. Coping
27
__ __ are the most common of all psychiatric disorders
Anxiety disorders
28
1 in __ people meet diagnostic criteria for at least one anxiety disorder
4
29
Are anxiety disorders more common in women or men?
| What is the ratio?
Women
| 2 to 1
30
50% report onset of anxiety disorder in __ or __
childhood
| adolescence
31
35% of healthy people report having had a __ __ in the past year
panic attack
32
Anxiety disorders: 12-month prevalence of __%
18%
33
DSM 5 Anxiety Disorders ( 10)
1. Separation Anxiety Disorder
2. Selective Mutism
3. Specific Phobia
4. Social Anxiety Disorder (Social Phobia)
5. Panic Disorder
6. Agoraphobia
7. Generalized Anxiety Disorder
8. Substance/Medication-Induced Anxiety Disorder
9. Anxiety Disorder Due to another medical condition
10. Other specified anxiety disorder
34
Give two examples of medical conditions that can cause anxiety disorder:
1. Pheochromoctyoma
| 2. Hyperthyroidism
35
Neurobiology of Anxiety Disorders:
| Norepinephrine -
increased
| - poorly regulated noradrenergic system
36
Neurobiology of Anxiety Disorders:
| Cortisol -
increased
| - hypothalamic-pituitary-adrenal axis
37
Neurobiology of Anxiety Disorders:
| Serotonin -
decreased
| - increased turnover in prefrontal cortex, nucleus accumbent, amygdala, and later hypothalamus
38
Neurobiology of Anxiety Disorders:
| Gamma Aminobutyric Acid (GABA)
decreased
39
Neurobiology of Anxiety Disorders:
| Corticotropin-Releasing Hormone (CRH) -
- mediates the stress response
| CRH increased activates HPA (hypothalamic-pituitary-adrenal axis) and increased release of cortisol and DHEA
40
Neuroanatomy of Anxiety:
| ______ is the primitive center of the brain and says "Is this a threat?"
Amygdala
41
Neuroanatomy of Anxiety :
| What role does the hippocampus play?
memory related to fear responses
42
Neuroanatomy of Anxiety :
| What is the role of the locus ceruleus?
Arousal
43
Neuroanatomy of Anxiety:
| Role of the brainstem?
respiratory activation, heart rate
44
Neuroanatomy of Anxiety:
| Role of the frontal cortex?
cognitive interpretations
45
Neuroanatomy of Anxiety:
| Role of the thalamus?
integration of sensory stimuli
46
Neuroanatomy of Anxiety:
| Role of the basal ganglia?
tremor
47
Neuroanatomy of Anxiety
| Role of the Hypothalamic-Pituitary-Adrenal Axis (HPA) ?
increased cortisol levels
48
Panic disorder is characterized by __ __ __
recurrent panic attacks
49
What is a panic attack?
An abrupt surge of intense fear or intense discomfort that reaches a peak within minutes
50
Is the onset of a panic disorder predictable or unpredictable?
unpredictable
51
Panic disorder is manifested by __ __, __ or __
intense apprehension
fear
terror
52
Panic disorder is associated with feelings of __ __
impending doom
53
Someone with panic disorder experiences intense __ __
physical discomfort
54
Must there always be a trigger for panic disorders?
no
55
A.) Give examples of a panic response.
B.) Give an example of an emotional response
A.) Move, duck, freeze, fight back
B.) Fear
56
How many % of adults and adolescents experience a 12 month prevalence of panic disorder?
2-3%
57
Is panic disorder more common in males or females?
| Ratio?
Females
| 2:1
58
There is a __ prevalence of panic disorder in children under 14
low
59
For panic disorder, there is a gradual __ in adolescence and __ in adulthood
increase
peaks
60
There is a __ in the prevalence of panic disorder in older adults over 64
decline
61
What is the median age for the onset of panic disorder?
20-24
62
What are the four categories of predisposing factors of panic disorder?
1. Genetics
2. Biological
3. Neurochemical
4. Psychosocial
63
Predisposing factors for Panic Disorder: Genetics
Concordance rates for identical twins is __ %
Risk for the disorder in a close relative is __-__%
30%
10-20%
64
Predisposing factors for Panic Disorder: Biological
The neuroanatomical pathological involvement are located in the:
1.
2.
there is an abnormal regulation of __ __ __
1. limbic system
2. hippocampus
brain noradrenergic systems
65
Predisposing factors for Panic Disorder: Neurochemical
Increased ___
Decreased __ and __
norepinephrine
GABA; Serotonin
66
Predisposing factors for Panic Disorder: Psychosocial
Childhood experiences of __ and __ __
___ in the months preceding their first panic attack
sexual; physical abuse
stressors
67
Comorbidities associated with Panic Disorder (9)
1. other anxiety disorders like agoraphobia
2. major depressive disorder
3. bipolar disorder
4. etoh abuse
5. cardiac arrhythmias
6. hyperthyroidism
7. asthma
8. COPD
9. irritable bowel syndrome
68
Most effective treatments for panic disorders:
pharmacotherapy and CBT
69
Treatment of Panic disorders;
Pharmacotherapy -
What are the 2 drugs approved for treatment of panic disorder by the FDA?
Xanax (Alprazolam) and
| Paxil (Paroxetine)
70
Treatment of Panic disorders;
Pharmacotherapy -
All ___ are effective for panic disorder
SSRI's
71
Treatment of Panic disorders;
Pharmacotherapy -
You want to use __ until SSRI is effective
Then, taper __ slowly over __-__ weeks
Have pt on SSRI for __-__ months
Provide _____
benzodiazepines
benzo
4-10 weeks
6-12 months
psychoeducation
72
Prolonged use of benzodiazepines can cause pt to __ __ and cause __/__
develop tolerance
addiction/dependency
73
Name 7 nursing interventions for someone with panic disorder:
1. Stay with client to offer reassurance
2. Calm non-threatening directive approach
3. Low stimuli
4. Administer medication as ordered
5. When anxiety is reduced, begin to explore etiology
6. Teach signs and symptoms of escalating anxiety
7. Teach coping mechanisms (deep breathing)
74
A fear cued by the presence or anticipation of a specific object or situation is
phobia
75
What are 3 phobic disorders ?
1. Agoraphobia - a condition in which people avoid ordinary places and activities for fear of a panic attack
2. Social Anxiety Disorder (Social Phobia)
3. Specific phobia
76
Prevalence of Specific Phobia
1. 12-month prevalence __-__%
2. __% in children
3. __% in 13-17 y/o's
4. Older individuals __-__%
5. Females to male ratio:
1. 7-9%
2. 5%
3. 16%
4. 3-5%
5. 2:1
77
Course of Specific Phobia
1. Develops following...
2. Usually develops in...
3. Children may express fear by...
1. a traumatic event
2. early childhood prior to age 10
3. crying, tantrums, freezing, or clinging
78
Excessive fears are common in children but are usually __ and only __ __
temporary
mildly impairing
79
Specific phobia is characterized by ...
fear of specific objects or situations that could conceivably cause harm
80
The reaction of specific phobia is __, __, and __
excessive
unreasonable
inappropriate
81
Specific phobia must interfere or restrict:
activities of daily living
82
In specific phobia, fear or anxiety is circumscribed to the presence of a particular __ or __
situation
| object
83
In specific phobia, the individual ___ avoids the situation or object
actively
84
What are the treatments for specific phobia? (5)
1. behavior therapy
2. psychotherapy
3. hypnosis
4. supportive therapy
5. family therapy
85
Treatment for specific therapy: Behavior therapy
| What specific type of therapy is used here?
Exposure therapy - which consists of systematic desensitivation and flooding
86
Treatment for specific therapy: Psychotherapy
What specific type of therapy is used here?
insight oriented therapy
87
Name this disorder.
Characterized by an excessive fear or situations in which a person might do something embarrassing or be evaluated negatively by others.
social anxiety disorder (social phobia)
88
In social anxiety disorder (social phobia), fear may be defined such as __ __
performance anxiety
89
In social anxiety disorder (social phobia), person has marked intense fear of __ __
social situations
90
Prevalence of social anxiety disorder:
1. 12 month prevalence __% in adults and children
2. Prevalence __ with age
3. Higher in __
1. 7%
2. decreases
3. Females
91
Course of social anxiety disorder:
1. Median age of onset __
2. Onset may follow a __ __ such as __.
3. Onset in adulthood is __
1. 13
2. stressful event; bullying
3. rare
92
Psychotherapy and pharmacotherapy treatment for social phobia:
(4)
1. SSRI's
2. Benzodiazepines
3. SNRI (Effexor, Venlafaxine)
4. Buspar (Bupspirone)
93
Treatment for social phobia associated with performance (2)
1. Beta blockers Inderal (Propanolol), Tenormin (Atenolol)
| 2. Ativan (Lorazepam) or Xanax (Alprazolam)
94
Name this disorder.
| Characterized by fear of being in places or situations from which escape might be difficult.
Agoraphobia
95
In agoraphobia, there is marked anxiety or fear of the following situations:
(6)
1. using public transportation
2. being in open spaces
3. being in closed spaces
4. standing in line or being in a crowd
5. being outside of the home alone
6. fear or not having control
96
Prevalence of Agoraphobia
1. 12 month prevalence is __ % in adolescents and adults
2. 2 to 1 ratio of __ to __
1. 1.7%
| 2. females to males
97
Course of Agoraphobia
1. Onset of symptoms usually in the __ -__'s
2. Course typically __ and __
3. Impairment can be __
1. 20-30's
2. persistent; chronic
3. severe
98
Name this Disorder.
| Characterized by persistent unrealistic and excessive chronic free-floating worry and anxiety
Generalized anxiety disorder (GAD)
99
GAD occurs...
more days than not for at least 6 months
100
GAD is not attributable to __ __ __
specific organic factors
101
Symptoms of GAD cause clinically significant __ or __ in __, __, or other important areas of functioning.
distress; impairment
| social; occupational
102
Anxiety in Generalized Anxiety Disorder is associated with: (6)
1. restlessness or feeling keyed up or on edge
2. being easily fatigued
3. difficulty concentrating or mind going blank
4. irritability
5. muscle tension
6. sleep disturbance
103
12 month Prevalence of GAD
1. __% among adolescents
2. __% among adults
3. Lifetime prevalence is __
1. 0.9%
2. 2.9%
3. 9.0%
104
Prevalence of GAD:
| Females are __ as likely to develop
twice
105
Prevalence of GAD:
| peaks in __ __
middle age
106
GAD course:
1. __ symptoms are common
2. ___ complaints
3. often __
4. Frequent __ related exacerbations
1. depressive
2. somatic
3. chronic
4. stress
107
"Period prevalence" is the proportion of a population that...
Which people are included in this period?
has the condition at some time during a given period (ex: 12-month prevalence)
People who already have the condition at the start of the study period as well as those who acquire it during that period.
108
What are the treatments of GAD?
A.) Psychotherapy which includes:
1. CBT
2. Supportive
3. Insight oriented psychotherapy
B.) Pharmacotherapy
109
What are the drug classes used to treat GAD?
1. SSRI's
2. Benzodiazepines
3. Buspar (Buspirone) - anti-anxiety medication
110
Which SSRI's are used to treat GAD?
1. Paxil (Paroxetine)
2. Lexapro (Escitalopram)
3. Cymbalta (Duloxetine)
4. Effexor (Venlafaxine)
FDA Approved
111
Which benzodiazepines are used to treat GAD?
1. Xanax (Alprazolam)
2. Ativan (Lorazepam)
3. Klonipin (Clonazepam)
112
In substance/medication-induced anxiety disorder, anxiety or panic are a direct result of the physiological consequences of:
(4)
1. intoxication
2. withdrawal
3. exposure to a medication
4. substance
113
The involved substance in substance/ medication-induced anxiety disorder has to be capable of __ __
producing symptoms
114
List the associated substances involved in substance/medication-induced anxiety disorder
(10)
1. alcohol
2. caffeine
3. cannabis
4. phencyclidine
5. other hallucinogen
6. opioid
7. sedative, hypnotic or anxiolytic
8. amphetamine (or other stimulant)
9. cocaine
10. other (or unknown) substance
115
These associated substances are substances in the ...
DSM 5 that carry codes for the disorder
116
In Anxiety Disorder Due to Another Medical Condition, what are the predominant clinical symptoms?
panic or anxiety
117
In Anxiety Disorder Due to Another Medical Condition, symptoms (of anxiety) are best explained the...
associated physical condition
118
In Anxiety Disorder Due to Another Medical Condition, the __ __ precedes __
medical condition
anxiety
119
What medical conditions are known to include anxiety? (5)
1. Endocrine disease
2. Cardiovascular Disorders
3. Respiratory Illness
4. Metabolic disturbances
5. Neurologic disorders
120
During your assessment of anxiety disorders it is important to distinguish between what two things?
anxiety disorders and a medical condition
121
During the assessment of anxiety disorders, what are your disease differentials? (6)
1. Cardiovascular
2. Pulmonary
3. Neurological
4. Endocrine
5. Drug Intoxications/Drug Withdrawal
6. Other conditions
122
Name 6 anxiety screening tools
1. Generalized Anxiety Disorders Scale (GAD-7)
2. Beck Anxiety Inventory (BAI)
3. Hamilton Anxiety Rating Scale (HAM-A)
4. Burns Anxiety Inventory (BAI)
5. Zung Self-Rating Anxiety Scale
6. State-Trate Anxiety Inventory (STAI)
123
GAD-__ subscale (+) go on to GAD-7
Score of __ or more on the GAD-7 or __ or more on the GAD-__ warrant further assessment
2
8
3
2
124
Anti-anxiety agents are considered __ treatments, or treatments in addition to the primary treatment
adjunctive
125
Anti-anxiety agents are usually given in __ situation with use until __ takes effect
acute
SSRI
126
Do anti-anxiety agents have a rapid or slow onset of action?
rapdi
127
Benzodiazepines enhance ___
GABA
128
What are two other types of anti-anxiety agents besides benzodiazepines?
1. Antihistamines Vistaril (Hydroxyzine)
| 2. Buspar (Buspirone) onset of action delayed
129
Name 7 Benzodiazepines
1. Chloridiazepoxide (Librium)
2. Clonazepam (Klonipin)
3. Clorazepate (Tranxene)
4. Diazepam (Valium)
5. Lorazepam (Ativan)
6. Oxazepam (Serax)
7. Xanax (Alprazolam)
130
Benzos must be...
tapered slowly and cautiously
131
Withdrawal from benzos can be ___-______
life-threatening
132
Benzodiazepine caution in the __
elderly
133
Extreme caution/contraindicated in individuals with __ __ __
substance abuse histories
134
What are benzodiazepine side effects? (9)
1. Confusion
2. Drowsiness
3. Lethargy
4. May aggravate symptoms of depression
5. Orthostatic hypotension
6. Paradoxical excitement
7. Potentiates side effects of other CNS depressants (ETOH)
8. Psychological and physical dependence
9. Tolerance
135
Name 6 different SSRI's
1. Paxil (Paroxetine/Paroxetine CR)
2. Prozac (Fluoxetine)
3. Zoloft (Sertraline)
4. Celexa (Citalopram)
5. Lexapro (Escitalopram)
5. Luvox (Fluvoxamine)
136
SSRI's are first line agents for __ __ __
chronic anxiety disorders
137
SSRI's act on the __ system and indirectly on __
serotonin
| GABA
138
SSRI's take __-__ __ to reach symptom control
3-4 weeks
139
SSRI's work best when combined with ___
psychotherapy
140
What are 5 common side effects to SSRI's ?
1. Initial activation, anxiety, insomnia
2. GI: Nausea, diarrhea
3. Sleepiness
4. Emotional Flattening
5. Sexual side effects: decreased libido and difficulty reaching orgasm
141
SNRI's are ...
dual serotonin and norepinephrine reuptake inhibitors
142
name 2 examples of SNRI's
1. Effexor (Venlafaxine)
| 2. Cymbalta (Duloxetine)
143
4 common side effects to SNRI's
1. sexual dysfunction
2. weight gain
3. sedation
4. increased BP (Venalfaxine)
144
8 nursing interventions for anxiety disorders
1. stay with the client
2. offer reassurance of safety and security
3. maintain a calm directive approach to talk about symptoms
4. simple words, brief messages spoken calmly and clearly to explain hospital experiences
5. teach diaphragmatic breathing
6. low stimuli
7. administer PRN meds as ordered, assess for effectiveness and side effects
8. teach relaxation techniques
145
Obsessive-Compulsive disorder is characterized by the presence of __, __ or both the severity of which is significant enough to cause __ or __
obsession
compulsions
distress; impairment
146
In OCD, individual ____ that the behavior is excessive or unreasonable
recognizes
147
What are common compulsions? (5)
1. hand washing
2. ordering
3. counting
4. praying
5. repeating words (silently)
148
Define obsession
a recurrent and intrusive thought, feeling, idea, or sensation
149
Define compulsion
a conscious standardized, recurrent behavior
Ego-dystonic-unwanted, appears irrational
150
12 month prevalence of OCD
1.2%
151
Does OCD occur more frequently in males or females?
equally common in men and women
152
what is the mean age of onset for OCD?
19.5 y/o
153
How many % of cases of OCD start by age 14?
25%
154
__ have an earlier onset of OCD than ___
males
| females
155
Is the onset of OCD usually rapid or gradual?
gradual
156
If left untreated, OCD can become __
chronic
157
OCD is often complicated by __ or __ __
depression
| substance abuse
158
Name 6 DSM 5 Obsessive-Compulsive Disorders
1. Hoarding disorder
2. Excoriation (Skin Picking) Disorder
3. Substance/Medication Induced Obsessive-Compulsive and Related Disorder
4. Obsessive-Compulsive and Related Disorder Due to Another Medical Condition
5. Other Specified Obsessive-Compulsive and Related Disorder
6. Unspecified Obsessive-Compulsive and Related Disorder
159
What are 4 types of OCD treatments?
1. Pharmacotherapy
2. Behavior therapy
3. Family therapy particularly in childhood
4. group
160
Name 2 Pharmacotherapy treatments for OCD
1. SSRI
| 2. Anafranil (Clomiprimine)
161
Name 4 behavior therapy treatment for OCD
1. Desensitization
2. thought stopping
3. flooding
4. aversive conditioning
162
If treatment resistant, what 4 other options are there to treat OCD?
1. ECT
2. Cingulotomy
3. Capsulotomy
4. Deep brain stimulation
163
__ dosing may need to be higher in the treatment of OCD
SSRI
164
For someone with OCD, person is __ by whatever they are doing
disturbed
165
Name this disorder:
| Exaggerated belief that the body is deformed or defective in some specific way
Body Dysmorphic Disorder (BDD)
166
BDD is/ is not observable to others ?
is not
167
In BDD, individual performs repetitive behaviors __ __, __ __, __ __
mirror checking
excessive grooming
reassurance seeking
168
In BDD, __ causes clinically significant distress and impairment
preoccupation
169
Muscle dysmorphia is mostly common in __
males
170
Prevalence of BDD in females
2.5%
171
Prevalence of BDD in males
2.2%
172
Prevalence of BDD in dermatology patients
9-15%
173
Prevalence of BDD in cosmetic surgery (US)
7-8%
174
Prevalence of BDD in international cosmetic surgery
3-16%
175
Prevalence of BDD in adult orthodontia patients
8%
176
Prevalence of patients presenting for maxillofacial surgery
10%
177
mean age of onset of BDD
16-17
178
subclinical symptoms of BDD being on average at age
12-13
179
course of BDD is acute/or chronic?
chronic
180
rates of __ __ and __ are high in both children/adolescents and adults with BDD
suicidal ideation
| attempts
181
Name this Disorder.
| Characterized by the recurrent pulling out of one's hair
Tricotillomania or Hair-Pulling disorder
182
In Tricotillomania, patient has had __ __ to stop
repeated attempts
183
Tricotillomania causes clinically significant __ or __
distress; impairment
184
12 month prevalcne for trichotillomania in adults and adolescents
1-2%
185
Are males or females more affected by trichotillomania?
| ratio?
females
| ratio : 10:1
186
Onset of trichotillomania is usually
puberty
187
usual course of trichotillomania is __
chronic
188
pharmacotherapy for BDD
1. Anafranil (Clomiprimine)
| 2. Prozac (Fluoxetine)
189
pharmacotherapy for trichotillomania
1. SSRI's augmented with pimozide
| 2. Olanzapine
190
Name this disorder.
excessively saving items that others may view as worthless
Having persistent difficulty getting rid of or parting with possessions
leads to clutter that disrupts their ability to use their living or work spaces
hoarding disorder
191
prevalence of hoarding disorder
2-5% of the population
192
In hoarding disorder, patient has impaired __, __, and other important areas of functioning
social
| occupational
193
Potential consequences of hoarding disorder include:
health and safety concerns
fire hazards
tripping hazards
health code violations
194
hoarding disorder is associated with
family strain and conflicts
isolation
loneliness
195
in hoarding disorder, patient is unwilling to have anyone else ...
enter the home
196
in hoarding disorder, patient is not able to perform ...
daily tasks such as cooking and bathing in the home
197
8 nursing diagnoses associated with anxiety and OCDs
1. panic anxiety
2. powerlessness
3. fear
4. social isolation
5. ineffective coping
6. ineffective role performance
7. disturbed body image
8. ineffective impulse control
