Anxiety Disorders Flashcards
What is the most common psychiatric illness?
Anxiety Disorders
Anxiety
Anxiety is an uncomfortable feeling of apprehension or dread that occurs in response to internal or external stimuli; it can result in physical, emotional, cognitive, and behavioral symptoms.
Primary symptoms of anxiety disorders
fear
anxiety
A normal emotional response to anxiety consists of three parts:
- physiologic arousal,
- cognitive processes, and
- coping strategies
Who experiences anxiety disorders most?
Women experience anxiety disorders more often
than men
What are the levels of anxiety?
- Mild
- Moderate
- Severe
- Panic
Level 1 of anxiety
Mild
Level 2 of anxiety
Moderate
Level 3 of anxiety
Severe
Level 4 of anxiety
Panic
Mild anxiety is characterized as
motivational
Moderate anxiety
feeling something is definitely wrong;
nervousness/agitation; difficulty concentrating; able to be
redirected
Severe anxiety
trouble thinking and reasoning; tightened
muscles; increased vital signs; restless, irritable, angry
Panic anxiety
fight, flight, or freeze response; increased vital
signs; enlarged pupils; cognitive processes focusing on
defense
Learning is impossible.
One of the most common conditions of children and teens
Anxiety disorders
GENERALIZED ANXIETY DISORDER
patients with generalized anxiety disorder (GAD) feel frustrated, disgusted with life, demoralized, and hopeless.
They experience a sense of ill-being and uneasiness and a fear of imminent disaster.
Diagnostic criteria for GAD
GAD is characterized by excessive (and irrational) worry and anxiety (apprehensive expectation) for at least 6months.
Ultimately, excessive worry and anxiety cause great distress and interfere with the patient’s daily personal or social life.
Symptoms of Anxiety Disorder include:
Muscle tension
Fatigued
Concentration problems
Restlessness
Irritability
Sleep disturbances
Panic
Panic is a normal but extremely overwhelming form of anxiety, often experienced when an individual is placed in a real or perceived life-threatening situation.
Panic Attacks
Panic attacks are characteristic of panic disorder.
A panic attack is a sudden, discrete period of intense fear or discomfort that reaches its peak within a few minutes and is accompanied by significant physical discomfort and cognitive distress
Physical Symptoms of panic attacks
The physical symptoms include palpitations, chest discomfort, rapid pulse, nausea, dizziness, sweating, paresthesias (burning, tickling, pricking of skin with no apparent reason), trembling or shaking, and a feeling of suffocation or shortness of breath.
Cognitive Symptoms of panic attacks
Cognitive symptoms include disorganized thinking, irrational fears, depersonalization and a decreased ability to communicate.
Usually, feelings of impending doom or death, fear of going crazy or losing control, and desperation ensue.
DIDD
depersonalization
(being detached from oneself),
People at increased risk of panic disorders are:
Increased risk is associated with being female, middle aged, of low socioeconomic status, and widowed, separated, or divorced
Diagnostic Criteria for Panic disorder
At least one of the attacks has been followed by 1month (or more) of one or both of the following:
Persistent concern or worry about additional panic attacks or their consequences (e.g., losing control, having a heart attack, “going crazy”)
A significant maladaptive change in behavior related to the attacks (e.g., behaviors designed to avoid having panic attacks, such as avoidance of exercise or unfamiliar situations)
What is the first priority when caring for a person with a panic disorder?
Suicide prevention
Remembering that the patient experiencing a panic attack is in crisis, nurses can take several measures to help alleviate symptoms, including the following: five things
- Stay with the patient and maintain a calm demeanor. (Anxiety often produces more anxiety, and a calm presence will help calm the patient.)
- Reassure the patient that you will not leave, that this episode will pass, and that they are in a safe place. (The patient often fears dying and cannot see beyond the panic attack.)
- Give clear concise directions using short sentences. Do not use medical jargon.
- Walk or pace with the patient to an environment with minimal stimulation. (The patient in panic has excessive energy.)
- Administer PRN (i.e., as-needed) anxiolytic medications as ordered and appropriate. (Pharmacotherapy is effective in treating those patients with acute panic attack.)
Nursing Process for anxiety;
- Assessment
- Interventions
Nursing assessment includes: 5 thing part a
- Hamilton Rating Scale for Anxiety
- History
- General appearance and motor behavior
- Mood and affect (depersonalization, derealization)
- Thought processes and content (disorganized
thoughts, loss of rational thinking)
Nursing assessment includes: 5 thing part b
- Sensorium and intellectual processes (confusion,
disorientation) - Judgment and insight
- Self-concept (self-blaming, consumed with worry)
- Roles and relationships (avoidance of others)
- Physiological and self-care concerns (sleeping, eating)
HAMILTON RATING SCALE FOR ANXIETY
Max Hamilton designed this scale to help clinicians gather information about anxiety states. The symptom inventory provides scaled information that classifies anxiety behavior and assists the clinician in targeting behaviors and achieving outcome measures.
Nursing Interventions for anxiety
- Promoting safety and comfort
- Using therapeutic communication
- Managing anxiety
- Providing client and family education
Specific phobia disorder:
Specific phobia disorder is marked by persistent fear of clearly discernible, circumscribed objects or situations, which often leads to avoidance behaviors.
Agoraphobia
is fear or anxiety triggered by about two or more situations such as using public transportation, being in open spaces, being in enclosed places, standing in line, being in a crowd, or being outside of the home alone
Social Anxiety Disorder (Social Phobia)
Social anxiety disorder involves a persistent fear of social or performance situations in which embarrassment may occur.
What is used to treat those with social anxiety disorder?
SSRIs are used to treat those with social anxiety disorder because they significantly reduce social anxiety and phobic avoidance.
What is used to treat those with phobic anxiety
Benzodiazepines are also used to reduce anxiety caused by phobias.
The treatment of choice for specific phobia is exposure therapy.
What is recommended as the first drug option in the treatment of pts with panic disorder?
The SSRIs are recommended as the first drug option in the treatment of patients with panic disorder.
Examples of SSRIs
Fluoxetine (Prozac)
Sertraline (Zoloft)
Paroxetine (Paxil)
Paroxetine (controlled release) (Paxil CR)
Example of SNRIs
Venlafaxine (extended release)
Example of Benzodiazepines
Alprazolam (Xanax)
Clonazepam (Klonopin)
lorazepam (Ativan)
Administering and Monitoring Benzodiazepines
Treatment may include administering benzodiazepines concurrently with antidepressants for the first 4weeks and then tapering the benzodiazepine to a maintenance dose.
This strategy provides rapid symptom relief but avoids the complications of long-term benzodiazepine use.
