Anxiety Disorders Flashcards
Separation Anxiety Disorder
The client experiences excessive fear or anxiety when separated from an individual to which the client is emotionally attached.
Anxiety Disorders Recognized and defined by DSM-5
- Separation Anxiety Disorder
- Panic Disorder
- Phobias
- Generalized Anxiety Disorder (GAD)
Panic Disorder
The client experiences recurrent panic attacks
Phobias
The client fears a specific object or situation to an unreasonable level.
Generalized Anxiety Disorder (GAD)
The client exhibits uncontrollable, excessive worry for more than 3 months.
Obsessive compulsive and related disorders
- Obsessive compulsive disorder (OCD)
2. Hoarding disorder
Obsessive Compulsive Disorder (OCD)
The client has intrusive thoughts of unrealistic obsessions and tries to control these thoughts with compulsive behaviors.
Hoarding Disorder
The client has difficulty parting with possessions, resulting in extreme stress and functional impairments.
Trauma and stressor related disorders
- Acute stress disorder
2. Posttraumatic stress disorder (PTSD)
Acute Stress Disorder
Exposure to a traumatic event causes numbing, detachment, and amnesia about the event for at least 3 days but for not more than 1 month following the event.
Posttraumatic Stress Disorder (PTSD)
Exposure to a traumatic event causes intense fear, horror, flashbacks, feelings of detachment and foreboding, restricted affect, and impairment for longer than 1 month after the event.
Risk Factors for Anxiety Disorders:
- Anxiety- Female, OCD= in Men & Women
- Genetics
- Exposure to traumatic event or experience, military combat, threat of death of a loved one.
- Medical condition
- Adverse effects of medications can mimic anxiety
- Substance-induced anxiety.
Manifestations of Panic disorder:
- Typically lasts 15-30 min.
- 4 or more are present during a panic attack
1. Palpitations
2. SOB
3. Choking or smothering sensation
4. Chest pain
5. Nausea
6. Feelings of depersonalization
7. Fear of dying or insanity
8. Chills or hot flashes.
Types of Phobias:
- Social Phobia
- Agoraphobia
- Specific Phobias
Social Phobia
The client has a fear of embarrassment, is unable to preform in front of others, has a dread of social situations, believes that others are judging him negatively, and has impaired relationships.
-excessive blushing, sweating, trembling, rapid HR, muscle tension, Nausea, extreme anxiety.
Agoraphobia
An abnormal and persistent fear of public places or open areas, especially those from which escape could be difficult or in which help might not be immediately accessible.
Specific Phobias
- The client has a fear of specific objects, such as spiders, snakes, strangers
- The client has a fear of specific experiences, such as flying, being in the dark, riding in an elevator, being in an enclosed space.
Generalized Anxiety Disorder
- The client exhibits uncontrollable, excessive worry for more than 3 months.
1. Restlessness
2. Muscle Tension
3. Avoidance of stressful activities or events
4. Increased time and effort required to prepare for stressful activities or events.
5. Procrastination in decision-making
6. Seeks repeated reassurance.
Acute Stress Disorder & PTSD
Precipitating Event
- In both disorders, the client witnesses or experiences an actual event that threatens severe injury or death to the client or others
- The client responds with fear, helplessness, or horror to the event.
Acute Stress Disorder
Onset and Duration
- Manifestations often begin immediately following the traumatic event and persist for at least 3 days.
- Duration is 3 days to 1 month.
Acute Stress Disorder
Reexperience of the event
- The client persistently reexperiences the event through:
1. Distress when reminded of the event
2. Dreams of images
3. Reliving through flashbacks
Acute Stress Disorder
Manifestations
- Dissociative manifestations- Amnesia of the trauma event, absent emotional response, decreased awareness of surroundings, depersonalization.
- Indications of severe anxiety, such as irritability, sleep disturbance.
PTSD
Onset and duration
-Manifestations may occur any time following the traumatic event with potential delays of months or years. The duration of manifestations lasts more than 1 month.
PTSD
REexperience of the event
- The Client persistently reexperiences the event through:
1. Recurrent, intrusive recollection of the event
2. Dreams or images
3. Reliving through flashbacks, illusions, or hallucinations
PTSD
Manifestations
- Indications of increased arousal, irritability, difficulty with concentration, sleep disturbance
- Avoidance of stimuli associated with trauma, such as avoiding people, inability to show feelings.
Nursing Care
- Provide a structured interview, keep client focused on present
- Assess for Comorbid condition
- Provide safety and comfort during crisis
- Remain with the client during the worst of the anxiety
- Preform suicide assessment
- Relaxation techniques
- Identify defense mechanisms that interfere with recovery
Cognitive behavioral therapy
The anxiety response can be decreased by changing cognitive distortions. This therapy uses cognitive reframing to help the client identify negative thoughts that produce anxiety, examine the cause, and develop supportive ideas that replace negative self-talk.
Modeling
demonstration of appropriate behavior in a stressful situation. The goal of therapy is that the client will imitate the behavior.
Systematic desensitization
Begins w/ mastering of relaxation techniques. Then a client is exposed to increasing levels of an anxiety producing stimulus and uses relaxation to overcome the resulting anxiety.
Flooding
exposing the client to a great deal of an undesirable stimulus in an attempt to turn off the anxiety response. Most useful in clients who have phobias.
Response prevention
preventing the client from preforming a compulsive behavior with the intent that anxiety will deminish
Thought Stopping
Teaches the client to say “stop” when negative thoughts or compulsive behaviors arise, and substitute a positive thought.
Eye movement desensitization and reprocessing (EMDR)
Therapy for clients who have PTSD.
EMDR encourages eye focus on separate stimuli while thinking of or talking about the traumatic event.
Medications
- SSRI
- Sedative hypnotic anxiolytics
- Nonbarbiturate anxiolytics
- Betablockers
- Antihistamines
- Anticonvulsants are used a mood stabilizers for anxiety.
SSRI
sertraline (Zoloft)
First line of treatment for trauma and stressor related disorders. Clients who have anxiety can also benefit from other types of antidepressants.
Sedative hypnotic anxiolytics
diazepam (Valium) - short term use
Nonbarbiturate anxiolytics
buspirone (BuSpar) used to manage anxiety
Small Amygdala= ?
Greater risk for PTSD!!!
Amygdala deals with emotionally charged memories
Prefrontal cortex and hypocampus become hypoactive
Classifications of PTSD
- Acute- duration of symptoms is less than 3 months
- Chronic- duration of symptoms is longer than 3 months
- Delayed onset- at least 6 months have passed between the traumatic event and the onset of symptoms.
Psychological Symptoms of PTSD
- Depression
- Anxiety
- Guilt
- Avoidance
- Intrusive thoughts
- Halluninations
Behavioral symptoms of PTSD
- Extreme Rage
- Short Fuse
- Isolating yourself
- Alcohol or Drug abuse
- Always being on guard
- Feeling Numb
- Memory problems
- lack of concentration
- Nightmares
- Unable to sleep or stay awake
- Easily startled
- Low self esteem
- feeling hopeless about the future
- Lack of appetite
- Overeating
- headaches
