Ch 15 Anxiety & OCD Flashcards
cause unknown
anxiety
cause is known
fear
perceptual field -heightened
focus- flexible & aware of anxiety
Problem solving- able to work effectively towards goal & examine alternatives
Ability to learn- Yes
can alert a person that something is wrong & can stimulate appropriate action
Somatic complaints- slight discomfort, attention seeking behaviors, restlessness, easily startled, irritability or impatience or mild tension relieving behaviors
Mild Anxiety
Perceptual field- narrowed; grasps little of what is going on
focus- on source of anxiety; less able to pay attention
Problem Solving- able to problem solve; but not at optimal ability
Ability to learn- yes
can stimulate a person that something is wrong & can stimulate appropriate action
Somatic complaints- voice tremors, change in voice pitch, poor concentration, shakiness, increase in R, P & muscle tension, somatic complaints, more tension relieving behaviors
Moderate Anxiety
Perceptual field- greatly reduced & distorted
focus- on details or one specific detail; attention is scattered
Problem Solving- feels impossible, unable to see connection between events or details
Ability to learn- NO
prevents problem solving; unproductive behavior perpetuates vicious cycle
Somatic complaints- feelings of dread, confusion, purposeless activity, sense of impending doom, more intense somatic complaints, diaphoresis, withdrawal, loud & rapid speech, threats & demands
Severe Anxiety
Perceptual field-unable to attend to the environment
focus- is lost; may feel unreal or that the world is unreal
Problem Solving- completely unable to process what is happening; disorganized or irrational reasoning
Ability to learn- NO
prevents problem solving; unproductive behaviors perpetuate vicious cycle
Somatic complaints- experience of terror, immobility or severe hyperactivity or flight, unintelligible communication or inability to speak, somatic complaints increase, severe withdrawal, hallucinations or delusions, likely out of touch with reality
Panic
tapping, pacing, shaking foot, biting nails or lip
relief behaviors
relaxation training modeling systematic desensitization flooding response prevention thought stopping
behavioral approaches to reduce stress
cognitive reframing
journal
humor
cognitive approaches to reduce stress
Simple
Empathetic
Feeling
Confrontational
Four forms of Assertive communication
going to bed 30-60 mins earlier exercise 30 mins a day decrease caffeine listen to music pets massage
other forms of stress reduction
Help pt ID anxiety
Anticipate anxiety provoking situations
Use normal language to show interest
Encourage pt. to talk about feelings
Avoid closing off avenues of communication important to pt.
Ask questions to clarify what is being said
Encourage problem solving with the pt.
Explore behaviors that have worked in the past to release anxiety
Provide outlets for working off excess energy
Assist in developing alternative solutions to a problem through role play or modeling
Ask Open-ended questions
Give broad openings
Provide calm presence
Mild-Moderate Anxiety Intervention
Maintain calm manner Remain with the person Minimize environmental stimuli Use low pitch voice & speak slowly Clear, simple statement; repetition Reinforce reality if distortion occurs Listen for themes in communication Attend to physical & safety needs Provide opportunities for exercise When pacing, offer high calorie fluids Assess need for seclusion
Severe-Panic Anxiety Intervention
denying that you have a problem after being confronted with factual info
psychotic denial
automatic coping styles that protect people from anxiety
defense mechanisms
shelfing it
supression
releasing tension
sublimation
helping others
altruism
finding humor
humor
won’t accept
denial
cheaters
projection
verbal or physical
acting out
covert aggression
passive-aggression
love/hate, teenage
splitting
others are worse
devaluation
idol
idealization
removal from environment
dissociation
short-man syndrome
compensation
physical impairment
conversion
taking it out on someone else
displacement
mimicking
identification
“voices”
introjection
excuses
rationalization
behaving opposite of true feelings
reaction formation
reverting
regression
burying deep
repression
making amends
undoing
pt. inability to realize that they are ill which is caused by the illness itself
anosognosia
difficulty in experiencing, expressing & describing emotional responses
alexithymia
developmentally inappropriate levels of concern over being away from significant other
Harm avoidance, worry, shyness, uncertainty, fatigability & lack of self-direction, headaches & GI disturbances
Separation Anxiety
Anxiety Disorders
persistent, irrational fear of something that leads to avoidance
Overwhelming & crippling anxiety when faced with object of fear
Specific Phobia
Anxiety Disorders
Fear of open space
Intense, excessive anxiety or fear about being in a place/situation where there may be no escape
Agoraphobia
Anxiety Disorders
Excessive Worry
Anticipates disaster, restless, irritable & muscle tension, puts things off & avoidance, lateness & absence, seeks continual reassurance, sleep disturbance, fatigue, and perseverates about meaningless details
GAD
Anxiety Disorders
Sudden onset of extreme apprehension/fear
Palpitations, chest pain, breathing difficulties, nausea, feelings of choking, shills & hot flashes
Panic Disorder
Anxiety Disorders
Symptoms that occur on a daily basis & may involve issues of sexuality, violence, contamination, illness or death
Marked distress, often feels humiliation & shame regarding behaviors
Onset around 19 years
OCD
Obsessive-Compulsive & related disorders
Preoccupation with an imagined defective body part results in obsessional things & compulsive behaviors
Mirror checking, camouflaging; frequent concerns with skin, hair, nose, stomach, teeth, weight, & breast/chest
Men- body building & genitals
Women- skin, stomach, weight, breast, butt, thighs, legs, hips & toes
more frequent in women
Body Dysmorphic Disorder
Obsessive-Compulsive & related disorders
Accumulation of belonging that have little or no value
Men slightly more likely; may/may not be aware of the problem
tend to begin early in adolescence
Hoarding Disorder
Obsessive-Compulsive & related disorders
One of the oldest recorded psychiatric problems; pain results in anxiety production
Typically head, but can be body, eyebrows, eyelashes, pubic area, axilla & limbs
Trichotillomania (Hair-pulling)
Obsessive-Compulsive & related disorders
Typically the face, damaging their skin
Common areas- face, head, cuticles, back, arms & legs
Excoriation Disorder (Skin-picking)
Obessive-Compulsive & related disorders
symptoms of anxiety are direct physiological result of a medical condition
Hyperthyroidism, PE, or cardiac dyrhythmias
anxiety D/T a medical condition
characterized by symptoms of anxiety, panic attacks, obsessions & compulsions that develop with the use of a substance
alcohol, cocaine, heroin, hallucinogens
Substance-induced anxiety disorder
obsessions & compulsions that develop with the use of a substance or within a month of stopping the use of a substance
Parkinson’s disease meds- gambling, sex urges, out of control spending
substance induced obsessive-compulsive & related disorders
individual’s symptoms of obsessions & compulsions are direct physiological result of a medical condition
postencephalatic syndrome, postanoxic events, traumatic brain injury, Huntington’s, seizures, & cerebral infarctions
Obsessive-compulsive or related disorder due to a medical condition
results in OCD after going through a strep infection with pediatric patients
PANS
Pediatric Acute-Onset Neuropsychiatric Syndrome
Hispanic people
exhibit sudden trembling, faintness, palpitations, out-of-control shouting, heat that moves from the chest to head, & seizure like activity
ataque de nervios
“attack of the nerves”
Determine if anxiety is primary, secondary, medical or substance induced through thorough exam
Detemine current level of anxiety
Assess for potential of self-harm or danger to others
Perform psychosocial assessment
Anxiety & OCD assessment
often used to treat the somatic & psychological symptoms of anxiety disorders
Nurses- monitor for side effects of benzos, including ataxia, sedation & decreased cognitive functioning
Antianxiety (anxiolytic) drugs
cognitive restructuring
- ID automatic negative beliefs that cause anxiety
- explore the basis of these thoughts
- reevaluate the situation realistically
- replace negative self-talk with supportive ideas
Cognitive Therapy
Thought process
exercises for breathing or muscle groups
relaxation training
role model demonstrates appropriate behavior in a feared situation
modeling
gradually introduce to fear object or experience through a series of steps
systematic desensitization
exposure of large amounts of an undesirable stimiulus
flooding
therapist does not allow the pt. to preform the compulsive ritual
response prevention
yell “stop” or snap a rubberband to stop negative thoughts or impulses
thought stopping
cognitive restructuring
psychoeducation
breath restraining
muscle relaxation
cognitive-behavioral therapy
CBT
unconscious childhood conflicts; breakthrough or repressed emotions or thoughts
Freud
unmet needs (emotional distress) disapproval, or transmitted anxiety (via empathy)
Sullivan
classical conditioning; modeling of parent or peers
leaning theory
distortions in perceiving & thinking; a mistake is catastrophic
Cognitive theorists
