Anxiety disorders Flashcards
Disturbances in serotonin , norepinephrine, and gamma-aminobutyric acid (GABA) have been implicated in the pathophysiology of …
anxiety disorders
Fear, particularly important in panic and phobic disorders
Amygdala
Associated with memory related to fear responses
Hippocampus
Arousal
Locus ceruleus
Respiratory activation, heart rate
Brain stem
Activation of stress response
Hypothalamus
Cognitive interpretations
Frontal cortex
Integration of sensory stimuli
Thalamus
Tremor
Basal ganglia
Recurrent attacks, unpredictable, intense fear, feeling of impending doom; intense physical discomfort
Panic disorder
Chronic , unrealistic , excessive anxiety and worry; symptoms existed 6 months or longer .
Generalized anxiety disorder
Fear of being in places or situations from which escape might be difficult ; help might not be available
Agoraphobia without history of panic disorder
Fear of situations in which a person might do something embarrassing or be evaluated negatively by others
Social phobia
Unreasonable fear when in the presence of, or when anticipating an encounter with , a specific object or situation
Specific phobia
Unwanted repetitive behavior pattern or mental acts ( praying, counting) that are intended to reduce anxiety , not to provide pleasure . They may be performed to an obsession or in stereotyped fashion
Compulsions
Recurrent obsessions or compulsions that are severe enough to be time consuming or to cause marked distress or significant impairment
Obsessive-Compulsive Disorder
The development of characteristic symptoms following exposure to an extreme traumatic stressor involving a personal threat to physical integrity or to the physical integrity of others
Posttraumatic Stress Disorder
- Panic anxiety - Panic disoreder ; Generalized anxiety diorder
- Powerlessness -
- Fear - Phobic diosrder
- Social isolation - Phobic disorder
- Ineffective coping - OCD
- Ineffective role performance - OCD
- Posttrauma syndrome - PTSD
- Complicated grieving - PTCD
nursing diagnoses commonly associated with anxiety disorders
Characterized by physical symptoms suggesting medical disease , but without demonstrable organic pathology or known pathophysiological mechanism to account for them .
Somatoform disorders : pain disorder; hypochondriasis; conversion disorder; body dysmorphic disorder
Disruption in the usually integrated functions of consciousness , memory, identity or perception
Dissociative disorders - dissociative amnesia; dissociative identity disorder; depersonalization disorder
Supportive therapy • Group therapy • Cognitive-behavioral strategies • Stress reduction • Relaxation training • Psychopharmacology
four psychological interventions the nurse might use in the treatment of
the patient with a maladaptive psychophysiological response to stress.
particularly effective
treatment for panic disorder
Cognitive-behavioral therapy (CBT) - a patient can gain mastery over panic episodes by identifying and replacing negative beliefs that cause anxiety with positive,
empowering self-talk.
GABA acts by
nhibiting neurotransmitter release at the synapses, thus
preventing neurons from “overfiring.” This decrease in neuronal activity keeps anxiety messages from reaching the brain and produces a calming effect. The opposite effect will occur if the
action of GABA is inhibited; anxiety can increase to cause a panic response.
Alprazolam ( Xanax )
benzodiazepine - antianxiety agent
Chlordiazepoxide (Librium )
benzodiazepine - antianxiety agent
Diazepam ( Valium )
benzodiazepine - antianxiety agent
Clonazepam ( Klonopin )
benzodiazepine - antianxiety agent
Buspirone ( BuSpar )
azaspirodecanediones - antianxiety agent
Depress subcortical levels of the CNS, particularly the limbic system and reticular formation ; may potentiate powerful inhibitory action of GABA.
benzodiazepines action
not known; does not depress the CNS; desired effect through interactions with serotonin , dopamine, and other neurotransmitter receptors
Buspirone action
Used in the treatment of anxiety disorders , anxiety symptoms, acute alcohol withdrawal, skeletal muscle spasms, convulsive disorders, status epilepticus, preoperative sedation
antianxiety agents - indications
- Drowsiness, confusion, lethargy
- Tolerance; physical and psychological dependence
- Potentiate the effects of other CNS depressants
- Aggravation of depression
- Orthostatic hypotension
- Paradoxical excitement (opposite effect)
- Nausea and vomiting
- Dry mouth
- Blood dyscrasias ( unusual bleeding)
benzodiazepines - side effects
same as for benzodiazepines except
- No tolerance
- Delayed onset - 10 days - 2 weeks
Buspirone - side effects
For patients on long-term therapy - Don’t quit taking the drug abruptly - can be life threatening - depression, insomnia, increased anxiety, abdominal and muscle cramps , tremors, vomiting, sweating, convulsions, and delirium
benzodiazepines - Tolerance - interventions
- Antianxiety - antiolytic agents : benzodiazepines + Buspirone
- Antidepressants
Psychopharmacological therapy - anxiety disorders
Used to desensitize individuals to phobic stimuli ; individual is “flooded” with continuous presentation (through mental imagery) of the phobic stimulus until it no longer elicits anxiety
Implosive therapy - flooding
technique for assisting individuals to overcome their fear of a phobic stimulus; there is hierarchy of anxiety producing events through which the individual progresses during therapy
Systematic desensitization
