Anxiety Disorders

Question 1

Mental health defined

Answer 1

How would you recognize Mental Health vs Mental Illness?

Question 2

Define mental health

Answer 2

Mental health is defined as “a state of well being in which an individual realizes their own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to their community” - if not able get up and not able function as would like to func - effects with relationships, jobs, careers, schools
**From the World Health Organization (2014)
Basically with illnesses people are dealing how impacting daily life, able do things want do and things normally do (get up, interact, go to school/work) - start with that with indivs to see how doing with daily life

Question 3

Difference stress vs anxiety

Answer 3

A stressor is an external pressure that is brought to bear on the individual - everyone experiences stress; create probs with indiv
relationship between the person and the environment that is appraised by the person as taxing and/or exceeding their resources and endangering their well being.
RESOURCES DEPELETED!!!
Anxiety is the subjective emotional response to that stressor - something happening in life surrounding you and you react and often with anxiety; when get stressed one subj and emotional responses is anxiety; nobody escapes life without anxiety but hope not get point where stops dead in tracks; all mental illnesses on a spectrum; all experience anxiety but if where get to panic and cannot function but all functioning on spectrum - depression same way and schizophrenia (disasociation) and daydreaming (disasociation) vs hearing voices; some people get to where tilts and some people able manage it

Question 4

Epidemiological stats

Answer 4

Anxiety disorders are the most common of all psychiatric illnesses - depression people seek treatment more than anything else but anxiety very common
They are more common in women than men - children from low SES with all stressors that creates have it more often; more women seek treatment than men and throws numbers off
A familial predisposition probably exists with really high anxiety - learn how react to stressors around us

Question 5

Anxiety

Answer 5

A diffuse apprehension that is very vague in nature and is associated with feelings of uncertainty and helplessness; often cannot explain it
Very common in society
Extremely common in our society - depression number 1 diagnosed type mental illness; anxiety there but in spectrum not lot seek treatments
A mental and/or physical
Reaction to perceived threats.
Theory being Anxiety disorders occur when an individual lacks sufficient resources to cope with stress - little bit anxiety is good; heightens awareness but when over the top and starts getting towards severe anxiety and panic get into probs; when in past situations, ask what worked for you in past, try again or see if need do diff way because diff situation
When with someone describing anxiety/situation creating anxiety start with and ask what done in past to help when needed cope with stress - starting point not say help right now but starting point to review with them
Mild anxiety is adaptive and can provide motivation for survival and not bad; heightens awareness

Question 6

Levels of anxiety

Answer 6

Peplau’s Four Levels of Anxiety

Question 7

Peplau’s Four Levels of Anxiety (Levels of anxiety)

Answer 7

Mild: seldom a problem; get up and function
Moderate: perceptual field starts to diminish(es); not really able take it all in
Severe: perceptual field is so diminished that concentration centers only one detail or on many extraneous details; only deal with what is front of you
Panic: the most intense state of anxiety; where you feel like dying and real sense of doom

Question 8

Adaptive responses to anxiety and interventions - Mild:

Answer 8

Increased alertness, sharpens the senses, sometimes enhanced learning, increased blood pressure; having this is good
To have this often will increase learning and is good - more aware senses and enhanced learning - want to keep at this level
Working with indivs experiencing this and worried get out of hand talk about how prob-solve that to keep them at this level and help them relax; help someone so stays at this level
Fairly common - all have mild anxiety; can work in favor
Interventions:

Question 9

Interventions: (Adaptive responses to anxiety and interventions - Mild:)

Answer 9

things help to relax so stays here and not moves up
Use cognitive strategies, stress management and px.solving, open ended questions - listen to them (what means for them, px presents), best intervention is listening and identifying stress management

Question 10

Moderate anxiety

Answer 10

When Perceptual field starts to diminish(es), attention span decreases, may needs help with px. solving, pupils dilate, little bit fear, purposeless activity/anxiety, palpitations, muscle tension, fidgeting
Interventions (working with indiv): Use relaxation techniques (imp identify what relaxes that indiv because individualized - engage in convo), teach coping strategies. Listening to client and know what relaxes so when have moderate anxiety can use relaxation techniques - engage in convo on what relaxes them
Note: Encourage them to be verbalization of feelings - working with someone and go down levels anxiety imp for you to stay calm; imp for you when have client who has moderate level of anxiety you calm yourself down and BE CALM - react to that in + way; talk slower and softer as talking to them hopefully to bring some anxiety down

Question 11

Severe anxiety

Answer 11

More diff for indiv to func as highly as would likely to
Only Focus on only one detail at a time, severely limited attention span, some physical sxs. fairly commonly associated with severe anxiety - back aches, stomach aches. Interferes with daily life; No learning, behavior aimed at relieving anxiety
Interventions: Encourage physical activity to stimulate large muscle groups - take a walk (get away from the situation if can) and release energy from fight/flight/freeze - diff for people to do what want to do because this stops them from doing what they want to do
Note: importance of having structured tasks are useful for them - helps feel like have control, point out reality - what actually going on in the environment, use short, firm, & simple statements but do it in a very supportive way; importance of being calm when working with them
NOTE: Chronic anxiety can lead to multiple physical health issues. - possibility to create multiple physical health issues for indivs - chronic back pain/headaches

Question 12

Panic

Answer 12

Final/last level
Panic disorders/attacks
Complete inability to focus, misperception of environment is common, fear dying or going insane, (if prolonged may lead to exhaustion) - if do not get out of situation feel like going to die or going insane; lot fear embedded with panic anxiety; panic attacks fear of not knowing when will happen; always on guard; feel like going to die
Interventions: in panic or going into one: Decrease stimuli/environment (quiet place), stay with the person, use quiet voice, assist person to perform relaxation breathing (breathe with me), provide nutrition/hydration, safety, safety, safety - horrible situation - real concern with a panic attack; say name and going to breathe together and reassure them and never leave them alone and talk through it
Need your help and need stay with them and need you to remain calm

Question 13

Summary 5 properties of defense mechanism - pg 138

Answer 13

Defense mechanisms are:

Question 14

Defense mechanisms are: (Summary 5 properties of defense mechanism - pg 138)

Answer 14

Good and bad - need to protect us in any situation at the moment; in trouble if stuck in defense mechanisms and not face reality - become issue for people; need them
Good as long as not using for long time
Really are used to help us
Prob if get stuck in mechanism; most not on conscious basis unless understand self and self-awareness and know doing it
1.Major means of managing conflict
2. Most Relatively unconscious
3.Discrete from one another
4.Hallmarks of major psychiatric syndromes, which are reversible
5.Adaptive as well as pathologic - denial common; rationalization; get through initial shock; stay in denials if not ever recognize need deal with situation

Question 15

A few defense mechanisms: how these relate to ID, EGO, SuperEGO

Answer 15

At the mild to moderate level, the ego calls on defense mechanisms for protection, such as:

Question 16

At the mild to moderate level, the ego calls on defense mechanisms for protection, such as: (A few defense mechanisms: how these relate to ID, EGO, SuperEGO)

Answer 16

Compensation -
Rationalization
Denial
Reaction formation
Displacement
Identification -
Regression
Intellectualization -
Repression
Introjection
Sublimation
Isolation
Suppression
Projection
Undoing

Question 17

Compensation - (At the mild to moderate level, the ego calls on defense mechanisms for protection, such as: (A few defense mechanisms: how these relate to ID, EGO, SuperEGO)

Answer 17

cover up perceived/real weakness by emphasizing trait one considers more desirable

Question 18

Rationalization (At the mild to moderate level, the ego calls on defense mechanisms for protection, such as: (A few defense mechanisms: how these relate to ID, EGO, SuperEGO)

Answer 18

Making rationales for reason did not do well
Excuse to justify things/shoulds in life - rationalize why not happen

Question 19

Reaction formation (At the mild to moderate level, the ego calls on defense mechanisms for protection, such as: (A few defense mechanisms: how these relate to ID, EGO, SuperEGO)

Answer 19

Prevent unacceptable/undesirable thought/behaviors from being expressed by exaggerated/voicing the exact opp behaviors
Not honest how really feel and complete opp how really feel
Present undesirable feeling - something do not like about them and if ask about person not honest how really feeling; complete opp how feel; react in exact opp in how feel; shoulds get in way

Question 20

Displacement (At the mild to moderate level, the ego calls on defense mechanisms for protection, such as: (A few defense mechanisms: how these relate to ID, EGO, SuperEGO)

Answer 20

Getting mad at work and kicking the dog at home
Misplace the emotion onto something else

Question 21

Identification - (At the mild to moderate level, the ego calls on defense mechanisms for protection, such as: (A few defense mechanisms: how these relate to ID, EGO, SuperEGO)

Answer 21

attempt when try increase self worth by acquiring self-attributes and characteristics of indiv admire
Take on attributes on someone really admire - can be + - the characteristics; prob when be them and creepy for them and is bad

Question 22

Regression (At the mild to moderate level, the ego calls on defense mechanisms for protection, such as: (A few defense mechanisms: how these relate to ID, EGO, SuperEGO)

Answer 22

Going back to earlier level of developmental behaviors that worked for you at that point; comfort measures and go back to that
Revert back to something worked for past and often developmentally; go back to comfort level; regress back developmentally

Question 23

Intellectualization - (At the mild to moderate level, the ego calls on defense mechanisms for protection, such as: (A few defense mechanisms: how these relate to ID, EGO, SuperEGO)

Answer 23

attempt to avoid expressing actual emotions associated with stressful situations by using intellectual processes, words, logic; trying to be really smart and way push people away and use terms because felt not smart around person and not know how have real convos
Get away from the feeling and get into your head
Distances people and keeps people away somewhat

Question 24

Repression (At the mild to moderate level, the ego calls on defense mechanisms for protection, such as: (A few defense mechanisms: how these relate to ID, EGO, SuperEGO)

Answer 24

involuntarily/unconsciously block unpleasant feelings and experiences
Used in people who have Dissociative disorders (multiple personality) repress something bad in life
On unconscious level pushing things out of membery

Question 25

Denial (At the mild to moderate level, the ego calls on defense mechanisms for protection, such as: (A few defense mechanisms: how these relate to ID, EGO, SuperEGO)

Answer 25

Denying the reality

Question 26

Sublimation (At the mild to moderate level, the ego calls on defense mechanisms for protection, such as: (A few defense mechanisms: how these relate to ID, EGO, SuperEGO)

Answer 26

Rechannel drives (sexual/phys impulses) that socially unacceptable and convert to something socially acceptable

Question 27

Suppression (At the mild to moderate level, the ego calls on defense mechanisms for protection, such as: (A few defense mechanisms: how these relate to ID, EGO, SuperEGO)

Answer 27

On Conscious level; voluntarily block unpleasant feelings/experiences from awareness; push back until later time
Consciously suppress all going on until later

Question 28

Projection (At the mild to moderate level, the ego calls on defense mechanisms for protection, such as: (A few defense mechanisms: how these relate to ID, EGO, SuperEGO)

Answer 28

Very common
Friend who describing another friend who really mad at and as listening think that is a lot how I would describe you
Happens is indiv attributes feelings/impulses that is unacceptable not want to be like attribute to another person; project own feelings/thoughts/actions as if someone else doing it and not recognize it in theirself
Take feelings/thoughts unacceptable to you and attribute it to others
Calling the kettle black - project own weaknesses on someone else - identifying their weaknesses rather than owning them

Question 29

Undoing (At the mild to moderate level, the ego calls on defense mechanisms for protection, such as: (A few defense mechanisms: how these relate to ID, EGO, SuperEGO)

Answer 29

Disagreement with someone and then sending flowers/sweet text; try negate/cancel out experience that not so pleasant
Want make it better

Question 30

A client hates her mother because of childhood neglect. The nurse determines which client statement represents the use of the defense mechanism of reaction formation?
A. “I don’t like to talk about my relationship with my mother.”
B. “My mother hates me.”
C. “I have a very wonderful mother whom I love very much.”
D. “My mom always loved my sister more than she loved me.”

Answer 30

Answer: C
The client hides her negative unacceptable feelings by the exaggerated expression of positive feelings. This is an example of the defense mechanism of reaction formation
Gushing all over their mom

Question 31

How do I know anxiety is a prob

Answer 31

When anxiety is out of proportion to the situation.
Prob - When anxiety interferes with social life, occupational life, or other important areas of functioning - daily functioning; with all mental illnesses
What causing difficulty in daily life

Question 32

Extended anxiety/chronic anxiety

Answer 32

Anxiety at the moderate to severe level that remains unresolved over an extended period of time (anxiety for long period time) can contribute to a number of physiological disorders such as migraine headaches, irritable bowel syndrome, and cardiac arrhythmias - phys things can happen because chronic anxiety

Question 33

Anxiety disorders in DSM-5

Answer 33

DSM-5 very imp to psych; all psych disorders in this; anxiety large disorder and things listed underneath it
Number diff anxieties
Specific Phobias:
Obsessive-Compulsive Disorders:
Generalized Anxiety Disorders:
Panic Disorder:
Social Anxiety Disorder:
Agoraphobia:
Body Dysmorphic Disorder:
Trichotillomania (Hair-Pulling Disorder):
Hoarding Disorder:

Question 34

Specific Phobias: (Anxiety disorders in DSM-5)

Answer 34

severe fear of an identifiable object (specific or social) - identify what afraid of

Question 35

Obsessive-Compulsive Disorders: (Anxiety disorders in DSM-5)

Answer 35

(recurrent) ritualistic thoughts or actions - obsession is thoughts; song in head and cannot get it out of head; compulsion is actions - have do certain things certain number times
Obsessive - cannot get thought out of head
Compulsive - doing certain things number times

Question 36

Generalized Anxiety Disorders: (Anxiety disorders in DSM-5)

Answer 36

(GAD) excessive worry (over 6 months + period) - fairly common
Have meet requirements

Question 37

Panic Disorder: (Anxiety disorders in DSM-5)

Answer 37

(recurrent unexpected) attacks followed by significant behavior change; bothers people most that not sure when going to happen but have severe rxn and feel like going to die; with someone stay with them to reassure them
Fear is never know when it will happen and cannot avoid situations that trigger it and drives even more anxiety because never know when happen

Question 38

Social Anxiety Disorder: (Anxiety disorders in DSM-5)

Answer 38

Fear will be negatively evaluated/judged by others; seeing more and more; prob with this - tendency close self in; not go out because fear of negatively judged - stops going out and being involved socially

Question 39

Agoraphobia: (Anxiety disorders in DSM-5)

Answer 39

Fear of being in places without escape - people in panic attack; people with this not want be in places small enclosed places cannot get out

Question 40

Body Dysmorphic Disorder: (Anxiety disorders in DSM-5)

Answer 40

Characterized by the exaggerated belief that the body is deformed or defective in some specific way; this is what is wrong with body and not see that but they do and that is how see their body
With eating disorders - See body very differently than other people around them see their body

Question 41

Trichotillomania (Hair-Pulling Disorder): (Anxiety disorders in DSM-5)

Answer 41

The recurrent pulling out of one’s own hair that results in noticeable hair loss; see often as a result of being anxious

Question 42

Hoarding Disorder: (Anxiety disorders in DSM-5)

Answer 42

There is persistent difficulty discarding or parting with possessions, regardless of their actual value; they have defined value to the possessions and impacts their life significantly
Make them throw things away/give away anxiety increases

Question 43

Generalized anxiety disorder

Answer 43

Fairly common one seen
Excessive anxiety and worry, occurring more days than not for at least 6 months about a number of events or activities. - anxiety/worry over it
The individual finds it difficult to control the worry.
There is impairment in their functioning. - not able do things want do one day to day basis
Symptoms may include things such as restlessness, fatigue, difficulty concerntrating, muscle tenstion, sleep disturbances. To be diagnosed with GAD: Must have 3 or more of these symptoms according to the DSM-5; cannot sleep; not easily diagnosed; have go on for awhile; always in state of worry

Question 44

Possible etiology: anxiety disorders

Answer 44

Not one thing that causes anxiety; if was would be much easier to treat

Question 45

Assessment of anxiety

Answer 45

Intensity of symp of anxiety
Duration
Frequency
Imp question to assess - Does it affect your life/functioning that would include social, occupational, or other life functions - not able do things want do and want get to point where can do things want to do

Question 46

Coping strategies

Answer 46

Things do and encourage people to do this
Simple but hard to do and why if anxious need someone around to help out
Seek out supportive person/people
Distraction Skills - go do something else; go take a walk; what worked in the past
Vent strong emotions: appropriately & safely
Think through one’s options: use and help px.-solving tech
Perform gentle physical activities i.e. exercise to release energy (walking, stretching)
Use Relaxation techniques (02: Importance of deep Breathing) - getting air into brain; breathe beginning, middle, so O2 continues to stay level; getting O2
Journaling: diversion activities i.e. paints, exercise; proven very effective; great therapy for indivs
Cognitive therapy: replace worried self statements with positive self talk or statements
Deep Breathing: Inhale: 2, 3, 4; Hold: 2, 3, 4, ; Exhale: 2, 3, 4,; Rest: 2, 3, 4; extremely helpful for anxiety and other areas of life
Mindfulness: 5, 4, 3, 2, 1; extremely helpful for anxiety and other areas of life; addresses 5 senses

Question 47

Mindfulness: 5, 4, 3, 2, 1; extremely helpful for anxiety and other areas of life; addresses 5 senses (Coping strategies)

Answer 47

5 Things you can see
4 Things you can touch
3 Things you can hear
2 Things you can smell
1 Thing you can taste

Question 48

Nursing objectives when working with clients

Answer 48

Decrease anxiety and help be able do things want do in life - type things create anxiety - teach relaxation techniques that help them
Objective when working with someone with anxiety is that their anxiety decreases
Assist to decrease client’s anxiety
Present positive & hopeful attitude (they can feel better)
Assure client they are not going crazy; hope can realize that but when in panic stage is hard
Help client identify anxiety and decrease via therapeutic activities
Teach relaxation techniques that can do on own and help focus on solving one problem at a time
Group & 1:1 therapy - very helpful
Treatment - not yank out increases anxiety because doing it to decrease anxiety; do it in steps

Question 49

Treatment modalities

Answer 49

Individual/Group Psychotherapy
Cognitive Therapy - turn stinking thinking around
Behavior:
Group Therapy
Psychopharmacology -
Self-Care:

Question 50

Behavior: (Treatment modalities)

Answer 50

(desensitization - has fear and give small steps and slowly introducing to thing causing anxiety and fear, implosion)

Question 51

Psychopharmacology - (Treatment modalities)

Answer 51

antianxiety meds

Question 52

Self-Care: (Treatment modalities)

Answer 52

well-balanced diet, enough sleep

Question 53

A newly admitted client, diagnosed with obsessive-compulsive disorder (OCD), spends one hour packing and unpacking, folding and refolding personal belongings. What is the most likely reason for this behavior?
A. It relieves anxiety
B. It fosters organizational skills
C. It delays meeting unfamiliar people in the day room
D. It makes the client feel good

Answer 53

Answer: A
OCD is characterized by recurrent thoughts or ideas (obsessions) that an individual is unable to put out of his or her mind and actions that an individual is unable to refrain from performing (compulsions). This behavior directs the client away from the underlying anxiety and focuses the client on a repetitive activity such as packing and unpacking, folding and refolding personal belongings.

Question 54

For the last year, a college student, continually and unrealistically worries about academic performance and relationships. The student is irritable and suffers from severe insomnia. This behavior is associated with which diagnosis?
A. Agoraphobia
B. Generalized anxiety disorder (GAD)
C. Phobia disorder
D. Obsessive-compulsive disorder (OCD)

Answer 54

Answer: B
GAD may be diagnosed when excessive, unrealistic worry and anxiety become chronic and last for at least six months. The anxiety experienced is generalized rather than specific. The anxiety is not associated with a specific object as in phobia or event as in PTSD
GAD may be diagnosed when excessive, unrealistic worry and anxiety become chronic and last for at least six months. The anxiety experienced is generalized rather than specific. The anxiety is not associated with a specific object as in phobia or event as in PTSD.

Question 55

When caring for a client who is experiencing a panic attack, which of the following nursing actions should be implemented?
A. Leave the client alone to maintain privacy
B. Instruct the client regarding unit rules and regulations
C. Sit with the client in the day room to provide comfort
D. Communicate with simple words and brief messages

Answer 55

Answer: D
When communicating with a client experiencing a panic attack, the nurse needs to use simple words and brief messages, spoken calmly and clearly. Any communication that is loud and demanding would only escalate anxiety
Simple questions and stay with them

Question 56

Psychopharmacology: anxiolytics (anti-anxiety) classifications

Answer 56

Close to number 1 types meds prescribed to indivs; lot people on antianxiety and anti-depression; mood disorder meds; give across the board
Highest classifications give everywhere - things need consider (know anti-anxiety)
Benzodiazepines:
Nonbenzodiazepine:

Question 57

Benzodiazepines: (Psychopharmacology: anxiolytics (anti-anxiety) classifications)

Answer 57

Alprazolam (Xanax), lorazepam (Ativan), diazepam (Valium) - pams
Impact GABA - impact felt quickly - give this usually 20-30 min lessening of anxious feeling hopefully; fast acting for someone
Effects are felt quickly (20-30 min feel relief from anxiety)
Common classifications for someone who has anxiety
Directly hit on GABA (one neurotransmitters)
Potential for dependency and abuse

Question 58

Nonbenzodiazepine: (Psychopharmacology: anxiolytics (anti-anxiety) classifications)

Answer 58

Buspirone (BuSpar): takes up to 2-4 weeks to show results-works on serotonin-it has a lower potential for dependency and abuse; not see 20-30 min anxiety go down
Longer acting - not go into effect right away; better used for PRN for extended period of time; takes awhile for affect; imp know because if not know info then stop taking it
Does not alleviate symp that quickly
Helps with anxiety but no dependency issue but need take for longer before see results

Question 59

Anxiolytics (anti-anxieties)

Answer 59

Benzodiazepines (anxiolytics):
Buspirone (BuSpar):

Question 60

Benzodiazepines (anxiolytics): (Anxiolytics (anti-anxieties))

Answer 60

Prescribed for short-term treatment only; not for patients with substance use problems

Question 61

Buspirone (BuSpar): (Anxiolytics (anti-anxieties))

Answer 61

Management of anxiety disorders. Non-addictive; excellent for long-term relief of anxiety symptoms, e.g. GAD - longer period of time

Question 62

Adverse effects of antianxiety agents

Answer 62

Drowsiness, confusion, lethargy

Question 63

Drowsiness, confusion, lethargy (Adverse effects of antianxiety agents)

Answer 63

Tolerance, physical and psychological dependence (does not apply to buspirone) - can become addicted to benzodiazepines; addictive quality to benzo; nonbenzodiazepine - not addictive; consider if addictive personality and history of substance use other classification
Potentiates effects of other CNS depressants (anti-depressant - used with caution)
Orthostatic hypotension - do not jump up quickly because may have this
Dry mouth, nausea and vomiting - common with all meds for psychopharm meds
Note: 10- to 14-day delayed onset of action (with buspirone)

Question 64

What should the nurse plan to teach a client who is taking alprazolam (Xanax) three times a day?
A. That there is a potential for dependence and tolerance
B. The importance of discontinuing alprazolam (Xanax) immediately if addiction is suspected
C. That increased caffeine consumption can enhance the effectiveness of alprazolam (Xanax)
D. That alprazolam (Xanax) is not habit forming

Answer 64

Answer: A
Xanax is a benzodiazepine and has addictive properties. It is the responsibility of the nurse to teach the client about dependence, tolerance, and other signs and symptoms of addiction
Antianxieties act fairly quickly but also cause dependency, N&V; once classification BuSpar not addictive; addictive personality not prescribe addictive ones but BuSpar takes longer to take an effect
Benzos: is a synergistic with alcohol - synergistic means not want take with alcohol when on this because build-up affect because do not mix up well together; both CNS depressants so counter - ask not drink alcohol while on antianxiety - caution not take alcohol while on it

Question 65

How would you recognize Mental Health vs Mental Illness? (Mental health defined)

Answer 65

Mental illness - gets in trouble sometimes; not functioning as well as want to func; cannot get up and go and do things normally do - affects relationships
Can you recognize it: yes and there is a difference