anxiety Flashcards
anxiety
vague feeling of dread or apprehension that is different than fear
fear
feeling afraid or threatened by identifiable stimulus representing danger
stress
wear and tear of life on the body
general adaptation syndrome
physiologic aspects of stress
alarm reaction stage
preparation for defense
resistance stage
blood shunted to areas needed for defense
exhaustion stage
stores depleted; emotional components unresolved
positive anxiety reactions
guided imagery
relaxation and refocusing
deep breathing
negative (maladaptive)
tension headaches
pain syndromes
mild level of anxiety
special attention; increased sensory stimulation, motivation
moderate level of anxiety
something definitely wrong; nervousness/agitation; difficulty concentrating; able to be redirected
severe level of anxiety
trouble thinking and reasoning; tightening muscles; increased vital signs; restless, irritable, angry
panic level of anxiety
fight, flight, or freeze response; increased vital signs; dilated pupils, cognitive processes focusing on defense
working with an anxious patients tips
self-awareness of anxiety level, help the client label emotions and identify anxiety, assessment of persons anxiety level, low, calm, soothing voice, careful use of touch
interventions for mild and moderate anxiety
encourage problem solving with client
help the client identify thoughts/feelings preceding the anxiety
assist in developing alternate solutions to the problems
provide positive outlets for dissipating excess energy
interventions for severe anxiety and panic
use of short, simple, easy to understand sentences and low pitched voice, remain with the person, lower persons anxiety level to moderate or mild before preceding, safety during panic level, short term use of anxiolytics
altruism
emotional conflicts and stressors are addressed by meeting the needs of others
sublimation
substituting constructive and socially acceptable activities for unacceptable strong impulses
humor
emphasizing amusing or ironic aspects of the stressor
suppression
conscious denial of a disturbing situation/feeling
types of anxiety disorders
agoraphobia, panic disorder, specific phobia, social phobia, generalized anxiety disorder (GAD)
biologic theories of anxiety disorders
genetics
neurochemical theories
psychodynamic theories of anxiety disorders
intrapsychic/psychoanalytic theories (freud and defense mechanisms)
interpersonal theories (sullivan, peplau)
behavioral theory
generalized anxiety disorder
excessive worrying and anxiety at least 50% of the time that lasts for 6 months or more; unable to control the worrying and anxiety
symptoms of GAD; how many sx are needed for dx
uneasiness, irritability, muscle tension, fatigue, sleep alterations, difficulty thinking
tx for GAD
combination of medication and therapy; meditation and mindfulness training
types of CBT used for tx GAD
positive reframing, decatastrophizing, assertiveness training
types of medication used for tx of GAD
anxiolytics and antidepressants
positive reframing
turning negative messages into positive ones
decatastrophizing
making more realistic appraisal of situation
assertiveness training
learning to negotiate interpersonal situations
use of anti anxiety drugs
anxiety, anxiety disorders, insomnia, OCD, depression, posttraumatic stress disorder, alcohol withdrawal
mechanism of action of anti-anxiety
mediation of GABA (benzos)
partial agonist activity at serotonin receptors (buspar)
examples of benzos
diazepam, alprazolam, chlordiazepoxide, lorazepam, clonazepam, oxazepam
fast onset benzos
diazepam
intermediate onset benzos
alprazolam, chlordiazepoxide, lorazepam
slow onset benzos
clonazepam, oxazepam
longest duration benzos
diazepam (20-100), clonazepam (18-50)
middle duration benzos
lorazepam(10-20hr), alprazolam (6-12hr)
short duration benzos
chlordiazepoxide (5-15hr) oxazepam (4-15hr )
benzodiazepine side effects
physical, psychological dependence, CNS depression, hangover effect, tolerance
buspirone side effects
dizziness, sedation, nausea, headache
anti-anxiety drug patient teaching topics
safety measures, avoidance of alcohol and caffeine, avoidance of abrupt discontinuation, drug may lose its effectiveness over time, do not take with antacids (buspar)
gerontological considerations for anxiety
often associated with another condition, such as depression, dementia, physical illness or medication toxicity or withdrawal
phobias (GAD most common)
treatment of choice for anxiety in geriatrics
SSRIs
panic disorder
discrete episodes of panic; no stimulus for panic response; peaks in late adolescence to mid-30s
treatment for panic disorder
cognitive behavioral techniques, deep breathing and relaxation, benzos, SSRIs, tricyclic antidepressants, antihypertensives (clonidine, propranolol)
phobias
intense illogical persistent fear out of proportion to the situation or circumstance
categories of phobias
agoraphobia, specific phobias, social phobia (social anxiety disorder)
agoraphobia
extreme fear of crowded places
treatment for phobias
behavioral therapy; positive reframing, assertiveness training, systematic desensitization, flooding
medications
