Anxiety Flashcards

1
Q

What is Anxiety?

A
  • Feeling of uneasiness, apprehension uncertainty, dread.
  • Deep level: erosion self-esteem/worth.

Most common mental illness

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2
Q

Mild Anxiety

A

SX: only slight discomfort, fidgeting

  • Increases alertness/ awareness/ focus
  • Tension of day-to-day living.
  • Motivates learning plus creativity.
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3
Q

Moderate Anxiety

A
  • More disturbing – know somethings wrong – nervous/agitated.

SELECTIVE INATTENTION: only certain things are seat in her, unless pointed out.

Physical sx: muscular tension, restlessness, increased heart rate and respiratory rate, sweating , mild somatic (gastric discomfort, headache urinary agency.)

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4
Q

Severe Anxiety

A
  • Patient can only focus on one thing and nothing else.
  • Attention span is extremely limited.
  • Can’t learn think or problems off – feel dazed or confused.
  • Increased physical plus emotional symptoms: headache, nausea, dizziness, insomnia, trembling, hyperventilation, impeding doom/ dread.
  • Autonomic behavior focused on relieving anxiety
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5
Q

Panic

A

FIGHT OR FLIGHT ( FREEZE )

  • Person unable to communicate or function effectively.
  • May experience psychosis (can’t tell what’s real or not) – hallucinations or delusions.
  • Behaviors: screaming, pacing running shouting or extreme withdrawal. Increase vital signs.
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6
Q

Compensation ( Defense mechanism)

A

Covers up for a perceived weakness, by strongly, emphasizing a feature that he/she considers more desirable.

Ex: a businessman perceive, his small physical stature negatively. He tries to overcome this by being aggressive, forceful and controlling in his business dealings.

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7
Q

Denial ( defense mechanism )

A

Avoidance of disagreeable realities, ignoring, or refusing to recognize them, the simplest and most primitive of all defense mechanisms.

Example, Miss P has just been told that her breast biopsy indicates malignancy. When her husband visits her that evening, she tells him that no one has discussed the laboratory results with her.

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8
Q

Displacement: Defense mechanism

A

Shift of emotion from a person or object to another, usually neutral or less dangerous person or object.

Example a four-year-old boys angry, because he had just been punished by his mother for drawing on his bedroom walls. He begins to play war with his soldier, toys and has to fight with each other.

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9
Q

Dissociation: Defense mechanism

A

The separation of a group of mental or behavioral process from the rest of the persons, consciousness or identity

Example: a man is brought to the emergency room by the police, and is unable to explain who he is, and where he lives or works.

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10
Q

Identification: defense mechanism

A

Process by which a person tries to become like someone else he or she admires by taking on thoughts, mannerisms or taste of that person.

Example: Sally, a 15 year old has her hairstyle like that of her young English teacher, whom she at admires.

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11
Q

Intellectualization: defense mechanism

A

Excessive reasoning, or logic is used to avoid experiencing disturbing feelings.

Example: a woman avoids, dealing with her anxiety in shopping malls by explaining how shopping is a frivolous waste of time and money.

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12
Q

Introjection: defense mechanism

A

Intense identification, in which a person incorporates qualities or values of another person or group into his/her own ego structure. It is one of the earliest mechanisms of the child, important information of conscience.

Example: 8-year-old Jimmy tells his three year old sister “don’t scribble in your book of nursery rhymes, just look at the pretty pictures” thus expressing his parents values

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13
Q

Isolation: defense mechanism

A

Splitting off of emotional components of a thought which may be temporary or long-term.

Example: a medical student dissects a cadaver for her anatomy course, without being disturbed by thoughts of death.

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14
Q

Projection: defense mechanism

A

Attributing one starts or impulse to another person. Through this process, one can attribute intolerable wishes, emotional feelings, or motivation to another person.

Example: A young woman who denies she has sexual feelings about her coworker, accuses him without basis of trying to seduce her.

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15
Q

Rationalization: defense mechanism

A

Offering a socially acceptable or apparently logical explanation to justify or make acceptable otherwise unacceptable impulses, feelings, behaviors, and motives.

Example: John tells an examination and complains that the lectures were not well organized or clearly presented.

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16
Q

Reaction formation: Defense Mechanism

A

Development of conscious attitudes and behavior patterns that are opposite to what one really feels or would like to do.

Example: A married woman feels attracted to one of her husbands, friends, but treats him rudely .

17
Q

Regression: defense mechanism

A

INVOLUNTARILY exclusion of a painful or conflictual, thought impulse or memory from awareness. It is primary ego defense, and other mechanisms tend to reinforce it.

Example: Mr. R does not recall hitting his wife when she was pregnant.

18
Q

Splitting: defense mechanism

A

Viewing people and situations as either all good or all bad. Failure to integrate the positive in a negative qualities of oneself.

Example: a friend tells you that you are the most wonderful person in the world one day and how much she hates you the next day.

19
Q

Sublimation: defense mechanism

A

Acceptance of socially approved substitute goal for a drive whose normal channel of expression is blocked.

Example: ED has an impulsive and physically, aggressive nature. He tries out for a football team and becomes a star tackle.

20
Q

Suppression: defense mechanism

A

CONSCIOUS EFFORT
-it is the international exclusion of material from consciousness.

Example: a young man at work is thinking so much about his date that evening it is interfering with his work. He decides to put it out of his mind until he leaves the office for today

21
Q

Undoing: defense mechanism

A

Or communication that partially negates a previous one; a permitted defense mechanism.

Example: Larry makes a passionate declaration of love to Sue on a date at their next meeting, he treats her formally and distantly

22
Q

Separation Anxiety disorder

A
  • Normal: 8–18 months, then it should decline.
  • Abnormal: developmentally, inappropriate level of concern, being away from significant other.

Risk factors:
- significant loss through death
- change in environment,
- physical or sexual assault
- genetic link.

23
Q

Panic Attacks

A

UNPREDICTABLE: does not occur immediately before or after exposure to situation causing anxiety.

  • Sudden Onset: rapid, intense, escalating, anxiety ( apprehension, fear, or terror)
  • 4 or more symptoms must be present to call it a panic attack:
    increased heart rate per patient’s sweating, tremors, shortness of breath or smothering, feeling of choking chest pain, nausea or abdominal distress, dizzy, lightheaded, faint, parenthesia, chills or hot flashes, derealization depersonalization fear of dying fear of losing control or going crazy.

Episodes of panic Attacks
- recureent / unexpected
- consistent concern about having another one
- often leads to phobias

24
Q

Agoraphobia

A

Fear of being in places or situations where there is no escape –> develops fear of leaving the home

** common with panic attacks **

25
Q

Social Anxiety disorders / social phobias

A

Severe fear/ anxiety when exposed to social performance situations
- selective mutism ( children )

26
Q

Other phobias

A

animal, environment (claustrophobia ) , blood, situation ( buried alive )

27
Q

Generalized Anxiety Disorders

A
  • Chronic, unrealistic, excessive anxiety and worry - out of proportion
  • Occurs most days / last 6 months or longer
  • Cause significant impairment in functioning

Sx:
depression, restless, fatigue easily, difficulty concentrating, irritable , sleep disturbance, muscle tension

28
Q

Obsessive Compulsive Disorder (OCD)

A

A.) OBSESSIONS = unwanted, recurrent, intrusive, and persistent ideas/ thoughts that cant be dismissed from mind = anxiety and distress

B.) COMPULSIONS = unwanted repetitive ritualistic behavior patterns or mental acts that are performed repeatedly ( goal is to prevent/ relieve anxiety caused by obsessions –> provides temporary belief )

29
Q

Excoriation Disorder ( type of OCD )

A

Skin picking - dermatillomania
- usually face, head, cuticles , tweezers
- lead to pain, sores, scars, infections

30
Q

Trichotillomania ( type of OCD )

A

Hair pulling disorder
- Leads to hair loss ( scalp, eyebrows, eyelashes )
- Trichophagia = secret swallowing of pulled hair

31
Q

Hoarding Disorder ( type of OCD )

A

Persistent difficulties discarding or parting w/ possessions

  • get worse with age

TX: therapy + SSRI

32
Q

Body dysmorphic Disorder

A

An exaggerated belief that body is deformed or defective in some specific way.

a. False assumptions: importance of appearance, fear of rejection, perfectionism

b. Emotions = disgust, shame, depression

c. HIGH SUICIDE RISK / response to tx is limited

d. Common hx: abuse / neglect

if it involves weight or fat = eating disorder

33
Q

Defense Mechanism used in Anxiety Disorders

A
  1. Phobias: Displacement
  2. Compulsion: Undoing
  3. Obsession:
    • Reaction- formation=of avoids and expresses exact opposite negative feelings
      - Intellectualization
34
Q

Nursing interventions for anxiety

A
  1. Assist client to identify anxiety
  2. Promote Safety and Comfort= ensure privacy and move to a quiet place
  3. DURING PANIC
    • ALWAYS REMAIN W/ PATIENT, use soothing calm voice, brief, firm, simple directions w/ repetition, deep breathing, relaxation
  4. After anxiety is lessened - use therapeutic communication
  5. Client/ Family education= teach ways to manage anxiety + triggers and sx of escalating anxiety
35
Q

what is the first line treatment for Anxiety

A

ANTIDEPESSANTS

  1. SSRI- paroxetine, fluoxetine
  2. SNRI- venlafaxine, duloxetine

Other:
- Noradrenergic agents: Antihypertensive= helps w/ somatic sx ( Propranolol, alpha 2 receptors )

36
Q

Anti-anxiety agents

A
  • MOA: depresses CNS
  • Contraindications: no combo w/ other CNS depressants, no preg, caution w/ elderly, hx of abuse or addiction
  • Interactions: ETOH, narcs, herbal depressants, decreased effects w/ tobacco and caffeine
  1. BENZODIAZEPINES ( Alprazolam- xanex, diazepam- valium )
    • high abuse potential, dont stop abruptly
  2. NONBENZODIAZEPINE ( Buspirone- buspar)
    • doesnt depress CNS
    • Used as long term treatment
    • no abuse potential
    • not recommended if hepatic and renal impairment
  3. ANTIHISTAMINES
  4. SEDATIVE- HYPNOTIC ( nonbenzodiazepine)
    • SE: hallucinations, confusion, suicidal thoughts