Anxiety Disorders Flashcards
what are some of the traits of anxiety?
apprehension
uneasiness
uncertainty
dread
real or perceived threat
what is the most common mental illness?
anxiety
what happens with deep level anxiety?
erodes self-esteem/worth
what is mild anxiety?
tension of day-to-day living
increased alertness/awareness/focus
wide perception- think and see things more clear
motivates learning and creativity
what are physical symptoms of mild anxiety?
only slight discomfort
fidgeting
what is moderate anxiety?
more disturbing- know something wrong- nervous/agitated
focuses only on immediate concerns
narrows perceptual field as person, sees, hears, and grasps less
selective inattention
can learn and problem solve- but not as well- will need direction
what is selective inattention?
only certain things are seen and heard- unless pointed out
what physical symptoms happen with moderate anxiety?
increased muscular tension in the neck and shoulder, restlessness, increased HR, increased RR, sweating, mild somatic discomfort: gastric discomfort, headache, urinary urgency
what is severe anxiety?
client can only focus on one specific detail and nothing else
attention span extremely limited; difficulty completing tasks- cannot learn, think, or problem solve- feel dazed or confused
automatic behavior focused on relieving anxiety
what are the symptoms of severe anxiety?
increased physical and emotional symptoms
headache, nausea, dizzy, insomnia, trembling, hyperventilation, impending doom/dread
what is panic?
dread and terror- fight, flight, freeze
person unable to communicate or function effectively
no learning or comprehension- unable to focus on even 1 detail
may lose contact with reality- psychosis- experience hallucinations or delusions
worse somatic symptoms
what are some behaviors with panic?
screaming
pacing
running
shouting or extreme withdrawal- greatly increased vital signs
can feel as if the person is having a heart attack
what are the physical symptoms of anxiety?
heart pounding
flushing
SOB
dizziness
sweating
headache
dry mouth
stomach pains
nausea
diarrhea
muscle aches/pains
restlessness
inability to relax
what are the psychological symptoms of anxiety?
excessive worry
irritability
impatience
feeling “on edge”
fatigue
vivid dreams
mind racing
mind going blank
indecisiveness
difficulty concentrating
decreased memory
what are behavioral symptoms of anxiety?
obsessive or compulsive behavior
phobic behavior
avoidance of situations
distress in social situations
what are anxiety defense mechanisms?
automatic coping styles that protect from anxiety- lessen discomfort/feel in control
can be unconscious
adaptive or maladaptive
what is the compensation defense mechanism?
covers up for a perceived weakness by strongly emphasizing a feature that he/she considers more desirable
what is the denial defense mechanism?
avoidance of disagreeable realities by ignoring or refusing to recognize them; the simplest and most primitive of all defense mechanisms
what is the displacement defense mechanism?
shift of emotion from a person or object to another, usually neutral or less dangerous, person, or object
what is the dissociation defense mechanism?
the separation of group of mental or behavioral processes from the rest of the person’s consciousness or identity
what is the identification defense mechanism?
process by which a person tries to become like someone he or she admires by taking on thoughts, mannerisms or tastes of that person
what is the intellectualization defense mechanism?
excessive reasoning or logic is used to avoid experiencing disturbing feelings
what is the introjection defense mechanism?
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 in formation of conscience
what is the isolation defense mechanism?
splitting off of emotional components of a thought, which may be temporary or long term
what is the projection defense mechanism?
attributing one’s thoughts or impulses to another person; through this process one can attribute intolerable wishes, emotional feelings, or motivation to another person
what is the rationalization defense mechanism?
offering a socially acceptable or apparently logical explanation to justify or make acceptable otherwise unacceptable impulses, feelings, behaviors, and motives
what is the reaction formation defense mechanism?
development of conscious attitudes and behavior patterns that are opposite to what one really feels or would like to do
what is the regression defense mechanism?
retreat to behavior characteristic of an earlier level of development
what is the splitting defense mechanism?
viewing people and situations as either all good or all bad; failure to integrate the positive and negative qualities of oneself
what is the sublimation defense mechanism?
acceptance of socially approved substitute goal for a drive whose normal channel of expression is blocked
what is the suppression defense mechanism?
a process often listed as a defense mechanism, but is conscious counterpart of repression; it is intentional exclusion of material from consciousness; at times, it may lead to repression
what is the undoing defense mechanism?
act or communication that partially negates a previous one; a primitive defense mechanism
when is anxiety pathologic?
interferes with life- achievement of goals or satisfaction, or reasonable emotional comfort
it’s out of proportion to situation creating it
interferes with social, occupational, or other important areas of functioning
what gender is anxiety disorder more prevalent in?
women
who is at high risk for anxiety disorders?
< 45 years old
separated or divorced
low socioeconomic
what happens to around 90% of those with anxiety disorder?
they develop another psychiatric disorder
what happens in elderly people with the combination of depressive and anxiety symptoms?
decreases social functioning and increases somatic symptoms
what are the genetic risk factors for anxiety disorders?
cluster in families
abnormality in gene that controls protein cholecystokinin
if mother has high stress during the pregnancy, it could cause the development of anxiety in the fetus
how are the neurotransmitters with anxiety disorders?
decrease GABA
increase norepinephrine
decrease serotonin subtypes
what are the psychological risk factors for anxiety disorder?
Psychodynamic- Freud
Interpersonal- Sullivan
Cognitive
behavioral-learning
active avoidance
passive avoidance
what is the psychodynamic- Freud theory?
unconscious childhood conflicts repressed
unsatisfactory parent-child relationship (conditional love)
ego defense mechanism used
what is the interpersonal- Sullivan theory?
early needs go unmet
anxiety experienced early in life then is model for anxiety experienced later with unpleasant events occur
what is the cognitive theory with the psychological risk factors for anxiety disorder?
faulty, distorted, counterproductive thinking and perceiving
negative self statements/irritational beliefs
what is behavioral-learning?
learned response that can be unlearned
conditioned response to traumatic event
what is active avoidance?
can’t avoid
engage in behaviors that provide relief or maladaptive coping mechanisms
what is passive avoidance?
staying away
what is normal with separation anxiety?
8 months; peaks at 18 months then should decline
what is the abnormality with separation anxiety disorder?
developmentally inappropriate level of concern of being away from significant other
something horrible will happen- permanent separation
what are risk factors for separation anxiety disorder?
significant loss through death
change in environment
physical or sexual assault
genetic link
what are panic attacks?
sudden onset
rapid, intense, escalating anxiety
apprehension, fear, or terror
feelings of impending doom
intense physical discomfort
unpredictable- does not occur immediately before or on exposure to situation that usually causes anxiety (as with a specific phobia)
how long do panic attacks last?
last few minutes to 15 minutes
what is associated with depression and substance abuse?
panic attacks
how many symptoms needs to be present for it to be called a panic attack?
4 or more
what are the signs and symptoms of a panic attacks?
palpitations, pounding heart; accelerated HR
sweating
tremors- trembling/shaking
SOB or smothering
feeling of choking
chest pain
nausea or abdominal distress
dizzy, lightheaded or faint/unsteady
paresthesias
chills or hot flashes
derealization/depersonalization
fear of dying
fear of losing control or “going crazy”
what is panic disorder?
episodes of panic attacks
recurrent/unexpected
in panic disorder, what are some of the signs and symptoms presented for one month or more?
consistent concern about having another attack
worrying about consequences of having another attack
changing behavior due to of fear of attacks
what can panic attacks often lead to other symptoms?
phobias
between attacks, varying degrees of anxiety
depression
what are specific phobias?
persistent, irrational fear- cued by presence of anticipation of specific object, activity, or situation
exposure or for some just thought= immediate anxiety response or panic attack
persists even if person knows it is unreasonable- powerless
tries to avoid- restrict life- gets in way of functioning
what is agoraphobia?
common with panic attacks
fear of being in places or situations where escape might be difficult (or embarrassing), or help not available fear of leaving home as a result
what is social anxiety disorder/social phobia?
severe fear
anxiety when exposed to social or perform situations
could be evaluated negatively by others
what is the phobia of spiders?
arachnophobia
what is the phobia of animals?
zoophobia
what are animal type phobias?
arachnophobia
zoophobia
what is the natural environment type phobias?
acrophobia
claustrophobia
what is phobia of heights?
acrophobia
what is the phobia of closed spaces?
claustrophobia
what is the blood injection injury type of phobias?
belonephobia
hematophobia
what is the phobia of needles?
belonephobia
what is the phobia of blood?
hematophobia
what is the phobia of being buried alive?
taphophobia
what is generalized anxiety disorder?
chronic, unrealistic, excessive anxiety and worry- out of proportion
how long does generalized anxiety disorder go on for?
occurs most days than not/lasts for 6 months or longer
what happens during generalized anxiety disorder?
causes significant impairment in functioning- person can’t control or focus it
what are the signs and symptoms of generalized anxiety disorder?
restless/keyed up or on edge
fatigue easy
difficulty concentrating- mind blanks
irritable
muscle tension
sleep disturbance
what are obsessions?
unwanted, recurrent, intrusive, and persistent ideas, thought, impulses, or images that cannot be dismissed from mind- anxiety and distress
what are compulsions?
unwanted repetitive ritualistic behavior patterns or mental acts that are performed repeatedly
goal of preventing or relieving anxiety and distress caused by obsessions or to prevent a dreaded situation- relief only temporary
what are recurrent obsession and/or compulsions?
severe
time consuming
causes marked distress or significant impairment in daily routines, relationships, or occupational function
what do those with obsessive compulsive disorder recognize?
recognizes that thoughts/actions unreasonable or excessive- but because relief from discomfort- compelled to continue
what are the types of obsessions?
contamination themes
harm to self or others
aggressive themes
sexual themes
scrupulosity/religiosity
forbidden thoughts
symmetry urges
need to tell, ask, confess
what are the types of compulsions?
washing or cleaning
repeating
checking
touching
counting
ordering/arranging
hoarding
praying
what does pandas stand for?
pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections
what are the infectious triggers of PANDAS?
strep
EBV
mycoplasma
lyme
staph
influenza
coxsackie
what are the symptoms of pandas?
OCD
severe food restriction
anxiety, separation anxiety
emotional lability, depression
irritability, aggression, severe oppositional behaviors
developmental regression
deterioration in school work, dysgraphia, loss of math skills
motor or sensory abnormalities, tics, hallucinations, hyperactivity
sleep problems, enuresis, urinary frequency
what is the recurrent pulling of one’s hair that results in hair loss of either the scalp, eyebrows, and eyelashes?
trichotillomania
what is the secret swallowing of pulled hair?
trichophagia
what is masses of digested hair?
Rapunzel syndrome
what is the skin picking disorder usually in the face, head, cuticles, back, arms, legs, and hands/feet utilizing fingernails, biting, nail cutters, and tweezers?
dermatillomania
what does dermatillomania lead to?
pain, sores, scars, and infections
what happens when those with trichotillomania and excoriation disorder feel sense of tension?
they pull or pick and feel release or gratification- no pain is felt
what are risk factors of trichotillomania and excoriation disorder?
correlation with abuse/neglect
body dysmorphic disorder
hereditary
when does trichotillomania and excoriation disorder begin?
usually begins childhood
what is hoarding disorder?
persistent difficulties discarding or parting with possessions regardless of actual value
may have excessive need for continual acquiring of items- can be food or pets and collect items until all surfaces within home are covered
what are the associated signs and symptoms of hoarding disorder?
perfectionism
indecisiveness
anxiety
depression
distractibility
planning and organizing tasks
what are the treatment for hoarding disorder?
therapy and SSRI
what are exaggerated/belief that body is deformed or defective in some specific way?
body dysmorphic disorder
what can be real defect unrealistically exaggerated with excessive concern and repetitive behaviors are present?
body dysmorphic disorder
what are some of the signs and symptoms of body dysmorphic disorder?
insight varies- patient may know this is exaggerated
false assumptions- importance of appearance, fear of rejection, perfectionism
emotions- disgust, shame, depression
high suicide risk
what is the assessment for anxiety disorder?
presence of symptoms of anxiety
need good physical/neurological exam first
screen for self-harm/suicidal ideation
psychosocial assessment
presence of specific symptoms to each of the specific disorders
what are the self-rating anxiety assessment tools?
Beck Anxiety Inventory or Hamilton Anxiety Rating Scale
what defense mechanism is utilized in phobia?
displacement defense mechanism- transfer of emotions to another
what defense mechanism is utilized for compulsion?
undoing- make up for an act; intrusive thoughts
what defense mechanisms are utilized for obsession?
reaction-formation- avoids and expresses exact opposite of negative feelings
intellectualization- attends to all details, but not feelings
what are the nursing diagnoses for anxiety disorder?
anxiety (moderate, severe, panic)
fear
ineffective coping
social isolation
powerlessness
disturbed sleep pattern
fatigue
hopelessness
chronic low self-esteem
self-care deficit
impaired skin integrity
imbalance nutrition
what are the nursing interventions for anxiety disorders?
promote safety and comfort- ensure privacy
move to less stimulation
coping enhancement
hope inspiration
self-esteem enhancement
relaxation therapy
nutrition/fluid intake
personal hygiene/grooming
elimination
sleep
what are the nursing interventions for someone during panic?
remain with the client always
soothing calm slow voice
brief, firm, simple directions with repetition
deep breathing/relaxation
what are the nursing interventions for after the anxiety has lessened?
use therapeutic communication to discuss
what are the client and family education a nurse can provide about anxiety disorders?
teach ways to manage anxiety and triggers/symptoms of escalating anxiety
what are nursing interventions for phobias?
explore perception of threat
discuss reality of situation
find alternative coping strategies
what are therapist interventions for those with phobias?
systemic desensitization
flooding (implosion therapy)
what is exposes the person to their phobia and find coping strategies on how to deal with it?
systematic desensitization
what are the nursing interventions for obsessive-compulsion disorder?
in beginning of treatment- allow time for rituals; don’t be judgmental or disapproving
provide structure- gives security
gradually decrease time for ritual- diminish anxiety by replacing ritual with adaptive coping mechanisms- give positive reinforcement
recognize and reduce family accommodation behaviors
what are the types of therapy for OCD?
exposure and response prevention
cognitive behavioral therapy
what is exposure and response prevention therapy?
exposure of fear hierarchy
feared objects, activities or situations are ranked according to difficulty- begin with mildly or moderately difficult exposures, then progress to harder ones
what can successfully treat symptoms by disrupting the abnormal patterns of brain activity?
deep brain stimulation for OCD
what are nursing interventions for trichotillomania and excoriation disorder?
be non-judgmental
let them know they can stop
habit reversal therapy
awareness training
competing response training
social support and stress management techniques
what is habit reversal therapy?
recognizes urges, thoughts or sensations the precede behavior
what is competing response training?
substitute another response for hair pulling
what are the psychopharmacology treatments for anxiety disorders?
SSRIs- paroxetine, fluoxetine, escitalopram, fluvoxamine, sertraline
SNRI- venlafaxine, desvenlafaine, duloxetine
noradrenergic agents- antihypertensive- propranaolol and clonidine
what are the first line of defense for anxiety disorders?
SSRIs and SNRIs
what helps with the somatic manifestations during anxiety disorders?
noradrenergic agents
what are the actions of anxiety agents?
depress subcortical levels of the CNS
potentiate inhibitory effects of GABA
what are the contraindications of antianxiety agents?
no combo with other CNS depressants
no pregnant or lactation
caution with elderly, debility, hepatic or renal dysfunction
history of drug abuse or addiction
what are the interactions of antianxiety medications?
alcohol
narcotics
herbal depressants- Kava Kava and Valerian
decreased effects with tobacco and caffeine
what are the side effects of antianxiety benzodiazepines?
drowsiness
confusion
lethargy
ataxia
reduced motor coordination
sedation
“hangover” effects
orthostatic hypotension
paradoxical excitement
dry mouth
nausea/vomiting
what abrupt discontinuation may result in a recurrence of the target symptoms (rebound insomnia or anxiety)?
benzodiazepines
what does not depress CNS and a serotonin receptor/partial agonist?
nonbenzodiazepine- buspirone
how long does buspirone take to work?
2-4 weeks
what are the side effects of buspirone?
dizziness
orthostatic hypotension
headache
drowsiness
nausea
paradoxical excitement
dry mouth
what are the examples of antihistamines that are used for anti-anxiety medicaitons?
hydroxyzine
diphenhydramine
what are the side effects of antihistamine?
drowsiness
confusion
lethargy
what are utilized for short-term sleep aid, usually only a few days to two weeks?
sedative-hypnotic
what are the side effects of sedative-hypnotic medications?
hallucinations
abnormal behavior
severe confusion
suicidal thoughts
vivid or abnormal dreams
daytime drowsiness
dizziness
ataxia
double vision or other vision problems
agitation
