Anxiety Flashcards
neurotransmitters involved in anxiety
< GABA
possibly epi & norepi
causes of anxiety
gentics neurotransmitter imbalance learned response traumatic experiences untreated depression
anxiety disorders
GAD panic disorder specific phobias social phobias OCD PTSD
generalized anxiety disorder
excessive anxiety about everyday problems occuring more days than not for 6+ months with 3+ of the following symptoms: restlessness fatigue difficulty concentrating irritability muscle tension sleep disturbance
GAD
affects twice as many women as men
highest risk between childhood & middle age
panic disorder
main symptom - recurrent panic attacks
3x more common in women
panic attack symptoms
must have 4+: difficulty breating chest pain feeling of terror choking or smothered feeling tingling/numbness fear of losing control/dying dizziness sweating nausea chills/hot flashes
1+ panic attack is followed by 1+ months of:
persistant concern of additional panic attaccks
persistant worry about implications of attack or consequences
significant change in behavior r/t attacks
specific phobias
marked & persistant fear of a particular object of situation
person realizes fear is excessive
combination of avoidance, anticipations, & anxiety interferes with their ability to function
social phobia
fearful of social situations often accompanied by other anxiety disorders or depression
affects men & women equally
usually begins in childhood/early adolescence
obsessions
recurrent & persistant thoughts, impulses, or images experienced as intrusive & inappropriate tha cause marked anxiety or stress
compulsions
repetitive behaviors
PTSD
person has been exposed to a traumatic event in which they:
- experienced, witnessed, or was confronted w/ an event involving actual/threatened death to self/others
- responded w/ fear, helplessness, horror
PTSD criteria
traumatic event is persistantly re-experienced in 1+ ways:
- recurrent/intrusive distressing recollections of the event including images, thoughts, or perceptions
- recurrent dreams of the event
- flashback episodes
- intense distress & physical symptoms at the panic level
- persistant avoidance of stimuli associated w/ trauma
- persistant symptoms of increased arousal
somatoform disorders
physical symptoms w/o a physiological basis
- physical symptoms are precipitated by a psychological event
- symptoms not controllable
- primary & secondary gain
primary gain
anxiety reduction through the focus on physical symptoms - able to deny psychological stress
secondary gain
increased attention to pt, pt is able to relax more
somatization disorder
many physical complaints; often search many years for tx
- onset generally before 30
conversion disorder
impaired physical health w/o a physical problem
pain disorder
experiences pain where there is no physical basis
- disrupts daily activities
hypochondriasis
pt is preoccupied w/ the fear that something is seriously wrong, regardless of negative test results
dissociation
the mind separates certain memories or thoughts from conscious awareness
- they may surface at a later time
dissociative fugue
a person who suddenly travels to another area and has no memory of their identity
DID (multiple personality)
2+ distinct personalities (alters)
inablility to recall info about past, esp traumatic events
OCD interventions
substitue a physically safe behavior for harmful ones
if not harmful, call attention to the compulsions
acknowledge pt’s feelings but try to redirect interaction
allow specific time periods to focus on obsessions/compulsions and gradually decrease time
panic interventions
provide safe, calm environment
decrease environmental stimuli
stay w/ pt
admin meds as prescribed
listen & encourage to discuss feelings
correc tdistortions
ID thoughts/feelings prior to panic
provide physical activities
phobia interventions
reassure pt - do not have to face phobia until ready
help distinguish actual phobia trigger from problems r/t avoidnce behaviors
explain systematic desensitization
address any avoidance behaviors if they persist after desensitization
PTSD interventions
spend time w/ pt at their pace
remain non-judgemental
listen attentively/avoid interrupting
encourage expression of feelings
somatoform disorder interventions
minimize attn spent on physical complaints & focus on psychological issues
remind pt “if mind feels better, so will body”
gradually connect anxiety to physical complaints
benzo anxiolytic - action
increase GABA
benzo anxiolytic - intentional effects
decrease anxiety
treat pani
alcohol detox
sedation
benzo anxiolytic - side effects
drowsy/confused tolerance -- dependence potentiate otehr CNS depressants aggravate depression orthostatic hypotension dizziness, ataxia pardoxical excitement dry mouth nausea/vomiting blood dyscrasias
benzo anxiolytic - toxic effects
can cause respiratory depression if taken with other CNS depressants
benzo anxiolytic - contraindications
combo w/ other CNS depressants
renal/hepatic dysfunction
hx of drug abuse
depression/suicidal tendencies
benzo anxiolytic - teaching
only take short term
avoid alcohol/CNS depressants
impairs driving
taper off slowly to avoid withdrawal
commonly used benzo anxiolytics
Chlordiazepoxide HCl Diazepam Alprazolam Lorazepam Conazepam
non-benzo anxiolytics - action
acts on serotonin
non-benzo anxiolytics - intentional effects
decrease anxiety
augmentation of antidepressant therapy
non-benzo anxiolytics - side effects
dizziness nausea headache nervous lightheadedness dry mouth diarrhea excitement
non-benzo anxiolytics - toxicity
almost impossible - therapeutic dose 160x less than lethal dose
non-benzo anxiolytics - contraindications
pregnant/nursing
kidney/liver disease
MAIO’s
commonly used non-benzo anxiolytics
Buspirone
