class 4 Flashcards
what is anxiety
feelings of dread, apprehension from a real of perceived threat fear= body’s physical reaction intellectual appraisal of a fearful situation emotion response top fear=anxiety
somatic symptoms of anxiety
increased HR, stomach ache, lump throat, numb extremities
physiological conditions that can increase anxiety
cardiovascular medical conditions: arrhythmias, CHF, HTN
endocrine: thyroid dysfunction, hyperthyroid, hypoglycemia
respiratory: COPD, asthma
genetic anxiety causality
biological link: temperament and fears are inherited charcateristics
psychological anxiety causality
social support: paramount with all health-related issues
childhood dx of mental disorder
mild level of anxiety
heightened alertness of all senses
able to problem solve
physical: slight discomfort, restlessness, irritable
mannerisms: leg shaking, nail biting, fidgety
moderate level of anxiety
perception narrows
not taking in as much information- selective inattention
problem solving less effective
physical: tension, pounding pulse in ears, increased RR and HR, headache, urinary urgency,gastric upset,tremulous voice
severe level of anxiety
preception dramatically reduced
only focus on ONE specific detail: difficulty in being aware of things surrounding them
problem solving not possible
dazed and confused; pacing helps lessen anxiety
physical:trembeling, heart pounding, hyperventilate, impending doom
panic level of anxiety
noticeably disturbed behaviour
may loose touch with reality
have hallucinations
pacing helps lessen anxiety
physical: running, shouting, screaming, withdrawal
actions have no purpose and are erratic
may lead to exhaustion
‘STUDENTS’ panic s&s
S-sweating
T-trembling
U-unsteadiness
D-derealization
E-excessive HR
N-nausea
T-tingling
S-shortness of breath
s&s usually peak within 10 mins
generalized anxiety disorder (GAD)
-a syndrome of persistent,excessive, unrealistic worry about everyday things
-individuals can experience hyperarousal(restlessness, decreased concentration, sleep disturbance)
management for anxiety
Behavioural therapy
Cognitive behavioural therapy
coping strategies
education(individual & family)
imagery
relaxation techniques(journaling, yoga, massage therapy)
pharmacological
obsessive compulsive Disorder (OCD)
obsessions: unwanted, aversive cognitive experiences
compulsions: ritualistic behaviours and/or thoughts that the individual has to complete in order to reduce the anxiety and the aversive obsession
examples of obsessions
thoughts, images, or impulses that persist, reoccur and cannot be dismissed
examples of compulsions
the behaviour causes the anxiety to decrease BUT it is only temporary. therefore, the individual must repeat it again and again
the compulsion is rigid with specification
common obsessions in OCD
-loss of control
-harm
-contamination
-perfectionism
-sexual
-religious
common compulsions in OCD
-washing
-cleaning
-checking
-repeating
physical s&s of OCD
-stomach-aches
-dizziness
-racing heart
-shallow breathing
-headaches
-muscle tension
-short of breath
-feeling detached from one’s body (derealization)
emotional s&s OCD
-Guilt
-Anger/rage
-Anxiety/worry/fear
-sadness
-shame
behavioral s&s in OCD
-checking
-repeating
-doubting
-avoiding(not a compulsion but a secondary symptom)
first line drugs to treat anxiety
SSRI’s
-Fluoxetine HCL (Prozac)
-Fluvoxamine maleate (Luvox)
-sertraline HCL (Zoloft)
-Paroxetine HCL (Paxil)
-Escitalopram oxalate (Cpiralex)
-Citalopram HCL (Celexa)
Fluoxetine HCL (Prozac)
SSRI First Line
tx: OCD
Fluvoxamine maleate (Luvox)
SSRI First Line
tx: OCD and social anxiety disorder
Sertraline Hcl (Zoloft)
SSRI First Line
tx:panic disorder, social anxiety disorder, OCD, PTSD
Paroxetine HCL (Paxil)
SSRI First Line
tx: panic disorder, social anxiety disorder, OCD, PTSD
Escitalopram Oxalate (Cipralex)
SSRI first line
tx:generalized anxiety disorder
Citalopram HCL (Celexa)
SSRI first line
tx:panic disorder, social anxiety disorder, OCD, GAD, PTSD
**off label use; wasn’t originally for anxiety
Benzodiazepines
-Alprazolam (Xanax)
-Clonazepan (Rivotril)
-Diazepam (Valium)
-Lorazepam (ativan)
-Oxazepam (Serax)
Alprazolam (Xanax)
Benzodiazepine
tx: panic disorder, GAD
off label use: social anxiety disorder
Clonazepan (Rivotril)
Benzodiazepine
tx: GAD, social anxiety disorder
Diazepam (Valium)
Benzodiazepine
tx: panic disorder, social anxiety disorder
lorazepam (Ativan)
Benzodiazepine
tx: off label use: panic disorder, GAD, social anxiety disorder
Oxazepam (Serax)
Benzodiazepine
tx: off label use: panic disorder, GAD, social anxiety disorder
important points about benzodiazepines
-short term use ONLY
-risk for falls d/t sedation
-effective but not always curative
-not effective with alcohol or persons w/substance use disorder
treatment alternative for benzodiazepines
Buspirone (Wellbutrin) (serotonin receptor partial agonist)
-non-habit forming, no interactions, takes ~3 weeks to work, risk to increase anxiety in people
second-line drugs for anxiety disorder (TCA’s)
TCA’s
-Clomipramine HCL (Anafranil)
-Amitriptyline HCL (Elavil)
-Desipramine HCL (Norpramin)
-Imipramine HCL (Tofranil)
-Nortriptyline HCL (Aventyl)
-Doxepin HCL (Sinequan)
Clomipramine HCL (Anafranil)
TCA second-line
OCD
off label use: panic disorder, GAD, PTSD
Amitriptyline HCL (Elavil)
TCA second-line
off label use: panic disorder, GAD, PTSD
Desipramine HCL (Norpramin)
TCA second-line
off label use: panic disorder, GAD, PTSD
Imipramine HCL (Tofranil)
TCA second-line
off label use: panic disorder, GAD, PTSD
Doxepin HCL (sinequan)
TCA second-line
off label use: panic disorder, GAD, PTSD
Nortriptyline HCL (Aventyl)
TCA second-line
off label use: panic disorder, GAD, PTSD
second-line drugs for anxiety disorders (MAOIs)
Phenelzine sulphate (Nardil)
Tranylcypromine sulphate (Parnate)
Phenelzine sulphate (Nardil)
MAOI second line
off label use: panic disorder, social anxiety disorder, GAD, PTSD
*dietary restrictions & hypertensive issues
Tranylcypromine sulphate (Parnate)
MAOI second line
off label use: panic disorder, social anxiety disorder, GAD, PTSD
*dietary restrictions & hypertensive issues
anxiety in children
if a child id Dx with multiple disorders they need treatment for each one
common dx tourettes, trigatillomania
17% of ages 9-17 are dx with anxiety
screening tool available for children
ADHD in children
-difficulty with focusing, emotion regulation, and executive functioning
7.2% of children diagnosed
-more boys than girls diagnosed (d/t difference in presentation in symptoms)
-difficulty with academics
-depression, anxiety, decreased self esteem, poor sleep
-changes in frontal lobe
-genetic connection; parent 1:4 chance of kid having it
risk factors for ADHD in children
-structure and function of the brain
-genetics
other causes: lead exposure, substance use during pregnancy, premature birth, low birth weight
predominantly inattentive presentation - ADHD in children
difficulty focusing, organizing and staying on task
predominantly hyperactive/impulsive presentation - adhd in children
fidgeting with or tapping hands or feet, squirming frequently, trouble playing or engaging in leisure activities quietly, interrupting or intruding on others’ conversations or games etc
combined presentation - adhd in children
display behaviours from both inattentive and hyperactive/impulsive category
medication management - adhd in children
behavioural therapy: “parent training” therapy, goal is to strengthen positive behaviours
medications: stimulants, non-stimulants, antidepressants
medications: non-stimulants for ADHD (neurotransmitter involved)
-no controlled substances like stimulants
-work by increasing the levels of norepinephrine in your brain
-take longer to start working than stimulants
ex: Atomoxetine (Strattera)
reasons to be prescribed a non-stimulant in adhd
-stimulants arent effective
-intolerable side effects from stimulants
-pairing it with a stimulant to increase effectiveness
medications: stimulants for ADHD
dopamine + norepinephrine
formats: intermediate or extended release
child rx: careful history, cardiac workup, EKG, etc
two drug classes: Methylphenidates(ritalin, concerta)
Amphetamines: amphetamine(adderall)
paradoxical effect of ritalin
typically increases motor activity and decreases fatigue but does the opposite in people with ADHD, that’s why its used
adverse effects of stimulants
-headache, dizziness
-decreased appetite
-weight loss
-dry mouth
-irritability
-trouble sleeping
-nausea, vomiting
serious side effects of stimulants
-slowed growth
-chest pain
-shortness of breath
-cold or numb fingers
-fainting
-increased violence/violent thoughts
-auditory hallucinations
-painful erections
-addiction
warnings for stimulants
-controlled substances
-need to taper to avoid withdrawal
-high misuse potential
-increased risk for suicide ideation under age 25
warnings for SSRI’s
FDA and Health Canada has issued “black box warning” for SSRI’s
“start low and go slow” start lowest dose and slowly increase to therapeutic dose needed
-Fluoxetine(prozac) citalopram(celexa) sertraline(zoloft)
ADHD in adults
-symptoms start in childhood and continue to adulthood
-sometimes ADHD may not be recognized or diagnosed until the person is an adult
-hyperactivity may decrease
s&s of adhd in adults
impulsiveness, disorganization and problems prioritizing, poor time management skills, problems focusing on a task, coping with stress etc
treatment for ADHD in adults
medications, psychotherapy, treatment of concurrent mental health conditions
-similar to treatment of childhood adhd
conduct disorder
a condition characterized by hostile & sometimes physically violent behaviour and general disregard for others
behaviours associated with conduct disorder
-exhibit cruelty
-push, hit, bite, progress to relentless bullying
-hurt animals
-pick fights
-lying
-theft
-arson
associated risks with developing conduct disorder
-first degree relative
-family history
-parental abuse/neglect
-exposure to violence
-conflict with the judicial system
management of conduct disorder
-psychotherapy
-behavioural therapy
-parental training
autism spectrum disorder
1:66 canadians ages 1-16
26% of females also diagnosed with a seizure disorder
-condition related to brain development
-impacts how a person perceives and socializes with others, causing problems in social interaction and communication
-includes limited and repetitive behaviour
symptoms of autism spectrum disorder
sandifer’s syndrome: sign in children, head,neck,back spasm associated with reflux
problems with social interaction and communication skills(i.e. rather play alone, resists hugs, poor eye contact)
limited, repetitive patterns of behaviour, interests or activities(i.e performs activities that could cause self-harm. develops specific routines/rituals & becomes disturbed with change)
treatment for autism spectrum disorder
behavioural analysis
parent management training
speech language & occupational therapy
social skills training
medications for concurrent issues
characteristics of cluster C personality disorders
intense fearfulness, insecurity, & perfectionism
avoidant personality disorder
-pattern of inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation and disapproval
-shy,timid,socially inept,avoid social situations
-low/poor self esteem
-use fantasy for gratification of needs, confidence, and conflict resolution
-nurses must be self aware of their approach to assessment and interaction (d/t struggle w socialization)
-slow development of therapeutic relationship
dependent personality disorder
-pervasive and excessive need to be taken care of, leads to clinging behaviour, fear of separation/being alone
-passive, submissive, tolerate abusive situations
-difficulty making own decisions
-affects interpersonal relationships
-nursing assess: feelings of self worth, interpersonal relationships, and social behaviour
-meds may be used
-assertiveness training
obsessive compulsive personality disorder
-pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control
-may hoard resources
-high expectations of selves and others
-rigid thoughts and behaviours; difficulty w/affection
-less demonstration of obsession and compulsions
-psychotherapy helpful
-short term pharmacotherapy may used
-note physical symptoms, interpersonal relationships, and social problems
-NOT OBSESSIVE COMPULSIVE DISORDER
cause of obsessive compulsive personality disorder
genetics, trauma, temperament, culture
treatments fo obsessive compulsive personality disorder
therapeutic relationships: develops slowly
psychotherapy: individual, family, group, CBT, DBT, psychoanalytic, psychoeducational
medication: to treat s&s of concurrent mental health dx
