Lecture 4 - Anxiety and Related Disorders

Question 1

What is the conclusion of Hilton et al?

Answer 1

PTSD is a significant concern for psychiatry staff. Exposure to violence and chronic stressors were found to contribute significantly to independently to explaining PTSD symptom checklist scores.

Question 2

What characterizes panic disorder? What are the signs and symptoms? How is it treated?

Answer 2

Discrete episodes of intense anxiety (impending doom, apprehension) that begin abruptly and reach a peak within minutes
Individuals may have panic attacks fearing for a panic attack to occur.

S/S: palpitations, depersonalization and derealization, trembling, SOB, chest pain, sensation of choking, going crazy, or dying.

First line treatment is CBT with goal of managing anxiety and correcting anxiety provoking thoughts

Benzodiazepines for acute, and SSRI for maintenance.

Question 3

What is a phobia? Which treatments are effective for them?

Answer 3

An irrational fear of something that leads to elevated anxiety and panic attacks, which leads to avoidance of such situations and alterations of social functioning to do so.

Psychotherapies: Systematic desensitization, exposure therapy, modelling.

Pharmacotherapy: Benzos (acute), SSRI (Maintenance)

Question 4

What is the fear of heights?

Answer 4

Acrophobia

Question 5

What is the fear of open spaces?

Answer 5

Agoraphobia

Question 6

What is the fear of bees?

Answer 6

Apiphobia

Question 7

What is the fear of of electrical storms?

Answer 7

Astraphobia

Question 8

What is the fear of public speaking?

Answer 8

Glossophobia

Question 9

What is the fear of germs or dirt?

Answer 9

Mysophobia

Question 10

What is the fear of darkness?

Answer 10

Nyctophobia

Question 11

What is the fear of the number 13?

Answer 11

Triskaidekaphobia

Question 12

How long does it take SSRIs to work? Why should they be titrated slowly? When should they be taken?

Answer 12

Full clinical response is seen by 4-6 weeks
–> feelings of overstimulation
–> Morning dosing to avoid sleep disturbances

Question 13

What nursing assessment should be done for people whom you suspect panic disorder or phobias with?

Answer 13

Mental Status:
–> Restlessness, Irritability, Decreased attention span, difficulty problem solving or helplessness
–> watch for suicidal ideations (suicide risk assessment) and catastrophic misinterpretation

Determine if there is a pattern of panic attacks
–> Might be difficult is triggers are no longer present and individual lives in fear of attack

Question 14

What to do in the acute and ongoing phase of panic disorders and phobias?

Answer 14

Emergent (Acute)
–> Benzodiazepines
–> Be present, reassure, reduce stimuli
–> Distraction (counting, pacing, rubber band)
–> Positive self talk

Allow for patient to talk about feelings post crisis

Ongoing
–>SSRIs
–>Encourage physical activity, nutritional and fluid planning
–> Relaxation and coping strategies
–> Sleep and personal hygiene
–> Psychoeducation
–> Support groups

Question 15

What is rebound anxiety?

Answer 15

A potential side effect of benzodiazepines

Question 16

What is GAD? What are the S/S?

Answer 16

Generalized Anxiety Disorder
–> Persistent exaggerated apprehension where worry is excessive, persistent, and pervasive for more days than not and for a period of 6 months. Worry becomes engrained in the person’s identity.

Fear occurs due to being incapable of controlling anxiety - impact on personal, social, and occupational functioning

S/S: Restlessness, fatigue, poor concentration, irritability, tension, sleep disturbance

Question 17

What is first line treatment for GAD?

Answer 17

–>SSRIs and SNRIs
–> CBT with the goal of addressing distorted thoughts that cause feelings of anxiety

Question 18

What nursing assessment findings align with GAD?

Answer 18

Poor concentration, irritability, overwhelming worry, rumination, difficulty making decisions and disturbed sleep patterns

Feelings of inadequacy in personal relationships, job responsibilities, finances, health of family members, household chores, lateness for appointments.

Question 19

What are somatic symptom disorders? How are they treated? Which ones are listed in this class?

Answer 19

Expressions or anxiety through physical symptoms
–> Treated through addressing underlying cause of anxiety (maybe somatic therapy or antidepressants)

In This Class:
–> Somatic Symptom disorder
–> Illness anxiety disorder
–> Conversion disorder

Question 20

What is somatic symptoms disorder? S/S?

Answer 20

Distress or alterations to the Quality of Life, disproportionately to the seriousness of physical health concerns

S/S: Chest pain, fatigue, dizziness, headache, swelling, back pain, SOB, insomnia, abd pain, numbness

Question 21

What is illness anxiety disorder?

Answer 21

Anxiety secondary to believing one has a serious illness or death in imminent - they might have physical symptoms to support their feelings such as cramps of increased HR.

Question 22

What is conversion disorder?

Answer 22

Neurological symptoms in the absence of a neurological disorder
–> Deficits of voluntary motor or sensory functions, paralysis, blindness, gait disorder, numbness, paresthesia burning sensations, seizures.
–> Patient lacks emotional response to the symptoms

Organic causes must be ruled out before such a diagnosis can be made.

Question 23

What might be seen in a nursing assessment of someone with SSD? What are potential nursing interventions?

Answer 23

Mental status: monitor frequency and severity of somatic symptoms, secondary gains met by illness, perceptual disturbances, constructed affect.
–> Role changes for family members or loved ones

Interventions
–> Help develop socially acceptable coping techniques for anxiety instead of medical attention for symptoms of physical illness, stress reduction techniques and assertive communication.
–> Teach acceptance and support for feelings of anxiety
–> Care plan should be structured so requests are directed to assigned professional

Question 24

What are dissociative disorders?

Answer 24

Disorders precipitated by trauma where there is come disconnection between body and mind

Dissociation is thought to be a defense mechanism of the mind to protect against trauma, however it might interfere with socio-professional functioning.

Question 25

What is pathological dissociation?

Answer 25

Involuntary fragmented flashbacks/images of traumatic events.

Some incapacity to link certain smells, memories, and persons with traumatic events which cause intense anxiety - inability to identify the reason for experiencing emotions related to trauma.

Question 26

What dissociative disorders are talked about in this class?

Answer 26

–> Depersonalization/Derealization disorder
–> Dissociative amnesia
–> DID

Question 27

What is depersonalization/derealization disorder?

Answer 27

Depersonalization: person feels detaches from their body or parts of their body
Derealization: Person feels as though their surroundings are unreal

DDD often occurs in episodes, often triggered by stress.

Question 28

What is dissociative amnesia?

Answer 28

The inability to recall autobiographical information - may be accessible with retrieval cues.

Question 29

What is the difference between localized and selective dissociative amnesia?

Answer 29

Localized: unable to remember all events in a certain period

Selective: Able to recall some but not all events from a certain period

Question 30

What is a dissociative fugue?

Answer 30

Characterized by sudden travel away from customary locale and loss of ability to recall one’s identity and information about some or all of the past.

Question 31

What is DID?

Answer 31

The presence of two or more personality states with their own memories, patterns or perceiving, etc.

Associated with an alternate who has blocked access and response to traumatic memories so as to function daily, and a state fixed on traumatic memories.

Question 32

What kinds of interventions might be helpful to a person with a dissociative disorder?

Answer 32

Simple structured routine to encourage predictability.

Encourage autonomy and reorient to person, place, time.

Support families if patient does not remember loved-ones.

Question 33

What is PTSD? How soon after a traumatic experience do symptoms appear?

Answer 33

Acute emotional response (re-experiencing traumatic event) which results is fear, helplessness and horror.

May appear within 3 months, but may be years.

Question 34

How is PTSD treated?

Answer 34

Psychotherapy
–> Desensitization, CBT

Pharmacotherapy:
–>Antidepressant, anxiolytics, anticonvulsants

Question 35

What psychosocial factors should be included in a PTSD assessment?

Answer 35

Assess for sleep pattern, use of substances, and safety of family, suicide risk.

Question 36

What are obsessions?

Answer 36

Unwanted, intrusive and persistent thoughts, impulses, or images that cause anxiety and distress

Question 37

What are compulsions?

Answer 37

Behaviours that are performed repetitively and in a ritualistic fashion, with the goal of preventing or relieving anxiety and distress caused by obsessions.

Question 38

When is OCD usually diagnosed?

Answer 38

Early 20s-30s

Question 39

What are treatment options for OCD?

Answer 39

CBT involving exposure and ritual prevention

SSRIs, clomipramine, deep brain stimulation

Question 40

What are some nursing interventions for OCD?

Answer 40

–> Keep a consistent care plan
–> teach coping mechanisms, thought stopping, and relaxation techniques

Facilitate relationship development and assist with developing structured routine or schedule.