Chapter 15 Anxiety and Obsessive Flashcards
Agoraphobia
Intense excessive ANXIETY or FEAR about being:
-in places or situations
from which escape might be difficult or embarrassing or
-where help might not be available
Agoraphobia = word derivative
agora = greek for open phobia = fear
Agoraphobia
what is avoided? AND why?
- *Feared places are AVOIDED.**
- *To control anxiety.**
Agoraphobia
Examples of what is avoided
Being ALONE OUTSIDE
Being ALONE at HOME
Car, bus, or airplane.
BRIDGES
ELEVATORS
ANXIETY
Who has it?
Everyone
it is a universal human experience
Anxiety
what type of emotion is it
BASIC HUMAN EMOTION
ANXIETY
Feeling of apprehension, uneasiness, uncertainty, or dread from a
PERCEIVED or REAL threat. What is their reality?
ANXIETY vs FEAR
ANXIETY = vague sense of dread related to unspecified or unknown danger
FEAR= reaction to a SPECIFIC danger.
GAS
what is it?
General Adaptation Syndrome - Hans Selye. ARE
Alarm
Resistance
Exhaustion
FIGHT OR FLIGHT
Cannon
DSM-5 Anxiety Disorders
Name 5
- *Separation Anxiety Disorder**
- *Panic w or w/o Agoraphobia**
- *Specific Phobias**
- *SAD - Social Anxiety Disorder**
- *GAD - General Anxiety Disorder**
Anxiety Disorders can be caused by +________+ and _____________-
another medical condition - ie hyperthyroidism
substance/medication induced -
COMPULSIONS - Anxiety Disorders related to
abnormal selective over attention obsessions
Name 5
COMPULSIONS
Obsessive Compulsive Disorder OCD
Body dysmorphic disorder
Hoarding disorder
Hair pulling (trichotillomania)
Skin picking (excoriation)
COMPULSIONS
RITUALISTIC BEHAVIORS individuals feel driven to perform in an attempt to reduce anxiety or prevent and imaged calamity. Only temporary relief so repeated again and again.
Body Dysmorphic Disorder
Imagined body defective part which results in obsessional thinking and compulsive behavior
Anxiety Disorders
Separation Anxiety
Panic with or without agoraphobia
Specific phobia
Social Anxiety Disorders (SAD)
General Anxiety Disorder (GAD)
Anxiety - Maladaptive coping
Smoking
Eating too much
Drinking
Drugs
Sleeping too much
Avoidiing behavior
Denial
Peplau’s 4 levels of anxiety
Mild, moderate, severe and panic
What are nursing interventions for anxiety based on?
Level of anxiety
anxiety is the initial response to a ________threat
psychic - their perception
Mild anxiety - 4 aspects
Occurs in everyday living
Perceive reality in sharp focus
Heightened awareness
CAN learn NEW behaviors and take in ALL stimuli
MIld Anxiety - sx
slight discomfort
irritability
mild tension-relieving behavior (nail biting)
Mild anxiety - can you teach/learning?
yes
Moderate Anxiety
Decreased perceptual field (immediate task only)
Can learn new behavior but only with assistance
Another person can redirect the person to a task
Moderate Anxiety -Symptoms
Tension
pounding heart
Inc HR and RR
sweating
Mild somatic sx GI, H/A, urinary urgency
GAS beginning to be activated
Severe Anxiety
Focus on only one detail or many scattered details
Difficulty with noticing environment
Feeling of dread or terror
Cannot be redirected to task
Learning is NOT possible, Not a good time for teaching
Severe Anxiety - symptoms
H/A headache
Nausea
Dizziness
insomnia
pounding heart
hyperventilate
sense of impending doom or dread
May go to ER thinking they have a heart attack
Panic Anxiety
Most extreme level of anxiety
marked disturbed behavior
may lose touch with reality (delusions, distorted perceptions, hallucinations
does not respond to efforts to calm
physical immobility
muteness - not able to speak
physical behaviors - erratic, uncoordinated, impulsive, pacing, running, shouting, screaming
my bolt/ run aimlessly
expose self to injury and others
safe environment - someone with them.
Panic Attack - first concern
Safety
Must remain with them
Anxiety Disorders - 2 main biological factors that affect them
brain function - metabolic, substances
genetic influences - get a family history, anyone else have anxiety disorder,
What is most important in determining response to an intervention?
The patient’s feelings and perceptions about the situation.
What is most important in determining response to an intervention?
The patient’s feelings and perceptions about the situation.
Defense Mechanisms/coping style
protect from anxiety
maintain self-image by blocking feelings, conflicts, and memories
repression, denial, displacement, regression, sublimation
short term/initial may help but overuse - maladaptive
Defense Mechanisms - name 5
repression, denial, displacement, regression, sublimation
Repression
ego keeps disturbing/threatening thoughts from becoming conscious
Denial
Blocking external events from awareness.
If situation too much to handle, person refuses to experience it.
Displacement
Satisfying an impulse with a substitute object when one is faced with stress.
Upset with boss, goes home hits wife.
Regression
Movementment back in psychological time when faced with stress.
Sublimation
satisfying an impulse with a substitute object
ie aggression with sport
what is most common psychiatric disorder in USA
Anxiety
40 million adults
MORE COMMON IN WOMEN
Anxiety D/x
what else to assess for?
Depression
80%
Anxiety comorbidity
MDD and Anxiety
MDD and panic
MDD and OCD
MDD and SAD 37%
MDD and PTSD
Anxiety and genetics
Clusters in families
twin studie panic and ocd
½ people with panic have relative with panic
PTSD and GAD inherited components
Freud and anxiety
threatened breakthrough of repressed ideas from unconscious to conscious
defense mechanisms (ego) used to keep anxiety manageable
defense mechanisms- non adaptive behavior because rigid and repetitive
Intellectualization
defense mechanism
Repression
Accident victim cannot remember the details
Identification
Younger sister copies older sister
Anxiety
Harry Stack Sullivan
Interpersonal theory
Linked to emotional distress when early needs unmet or disapproval
contagious from parent to infant
early life anxiety - prototype for later life
Anxiety - behaviorist theory
anxiety learned response to environmental stimuli - classical conditioning
kid anxious when abusive mom is around,
anxious around all wome
anxiety - cognitive theorist
anxiety caused by distortions in an individual’s thoughts and perceptions
CBT treatment
Assessment for Anxiety
ask direct and specific questions
what makes you feels anxious,
when do you feel anxious
what do you avoid
Self assessment
impact on you
if you work with anxious client, watch not taking on that anxiety
self-awareness and self-care
might feel anxiety, fear, anger, frustration, hopelessness
may withdraw from patient and patient withdraws from you.
Cultural Considerations
must consider it with dx
shame in the culture
expression influenced by culture - a weakness, self-medicate
Generalized Anxiety Disorder (GAD)
excessive worry:
inadequacy in interpersonal relationships
job responsibilities
finances
health of family members
Social Anxiety Disorder (SAD)/Social Phobia
severe anxiety provoked by exposure to a social or performance situation that could be evaluated negatively by others.
Ie fear of public speaking
SAD - risk factors
childhood mistreatment
adverse childhood experiences
shyness inheritable
double risk genetic transmission if parent has
Anxiety - Self-Care
Prayer, meditation, exercise, mindfulness, walking, writing, music, deep breathing,
Anxiety - Medications
SSRI’s BZO’s and non- BZO’s
How are they different?
PTSD, GAD, Panic, Phobia, OCD, PTSD
Separation Anxiety Disorder
normal part of development 8-18 months
usually dx prior to 18 years old
causes:death, change in schools, sexual trauma
developmentally inappropriate level of concern from being away
Adult Separation Anxiety
Begin as a child or adult
problems with romantic relationships, usually unmarried
harm avoidance, worry, shyness, uncertainty, lack of self-direction
significant discomfort
does not respond well to most psychotherapy or CBT
SAD
Social Anxiety Disorder is not
Seasonal Affect Disorder
Panic Disorder
Extreme of Disorder
Main characteristics
palpitations
trembling shaking
pounding heart
somatic fear of unknown illness
sweating
chest pain
abdominal distress, weak, numbness, detached, fear of death, fear of going crazy
agoraphobia
may feel that it could happen again
something will happen, they feel they will be out of control, not able to escape
Specific phobias
irrational fear of an object, activity, or situation
that leads to avoidance
treatment - is exposure
SSRI
OCD
cyclic
obsession, anxiety, compulsion, relife, then obsession again
OCD - timing
allow time for them reasonable
OCD - obsessive-compulsive disorder
Obsession -thoughts, impulses, or images that recur and cannot be dismissed from the mind. Concerns about : cleanliness, hoarding, worry about contamination, harm to people
Compulsions: ritualistic behaviors individual driven to perform to reduce anxiety, time consuming, rigid rules, can interfere with adl’s, relationships
sexuality questioned, violence, contamination, illness, death
GAD
Lasts for more than 6 months
excessive anxiety or worry, difficulty making decisions, fear of making mistage
GAD
Not as intense as panic
excessive worry restless, sleep disturbance, spend large amounts of time preparing, lateness, absence, overall isolation
PTSD
characterized by persistent re-experiencing of highly. traumatic event that involved actual or threatened death or serious injury which the individual responded with intense fear, helplessness or horror.
Actual or perceived threat
veterans, car accidents
Flashbacks
dissociative experience event relived
PTSD symptoms
Acute Stress Disorder
acute onset
with 1 month
resolves in 4 weeks
substance-induced anxiety disorder
panic attacks
obsessions compulsions
Medically induced anxiety
symptoms are directly related to the medical condition
direct - hyperthyroid anxiety
blood sugar low
Treatment for Anxiety - drugs
SSRI TCA (more side effects )
GAD - BZ, buspirone (2 weeks) TCA if also depressed
Phobias -BZO, beta blockers, SSRI
Panic, SSRI, BZO. TCA. MAO
OCD, - SSRI, MAO
PTSD- antidepressants - clonidine
BZO highly addictive - avoid if SUD Short period of time
BUSPIRONE - not prn - 2weeks non addictive BZO
BZO - work fast 20-30 minutes, addictive
no acute withdrawal
Kava Kava
Liver enzymes
interactions
St. John’s Wort
Seratonin syndrome
too much seratonin with an SSRI
Milieau Therapy
Everything in the environment when hospitalized
SSRI
Citalopram - celexa. Escitalopram - lexapro
Fluoxetine - prozac. Paroxetine - paxil
Fluvoxamine - Luvox
Sertraline - Zoloft
Suicidality - conenr
SSNRI
Duloxetine - cybalta
Venlafaxine - effexor
need to take every day steady serum state
SSRI
common side effects
Insomnia, sedations
appetite change up or down
Nausea
Dry mouth
headache
sexual dysfunction
TCA
Cardiac, EKG done Ck Urinary retention,
dry mouth blurred vision
constipation fluids, roughage, exercise
dizziniss OHT
TCA’s - common
Amitriptyline elavil
Clomipramine anafranil
desipramine norpramin
Benzodiazepines BZO
dependency
quick onset
withdrawal
short periods only not for SUD
BZO
xanax, librium, klonopin, ativan (lorazapam)
diazepam Valium
stat PRN
sedation, ataxia,
Buspirone
Buspar
2 weeks
