Psych - Anxiety

Question 1

stress (stress is biological)

Answer 1

Stress: biological reaction to the physical, mental or emotional stimuli that tends to disturb the homeostasis of an organism. cortisol.

Question 2

anxiety - reaction to what?

Answer 2

feeling of apprehension, uneasiness, uncertainty or dread resulting from a real or perceived threat. It is a reaction to stress. Symptoms can be physical or emotional.

Question 3

fear (my fear is specific)

Answer 3

is a reaction to a specific danger (spiders) whereas anxiety is a vague sense of dread r/t an unspecified danger.

Question 4

normal anxiety

Answer 4

is a healthy life force that is necessary for survival

Question 5

acute anxiety

Answer 5

(situational) is precipitated by an imminent loss or change that threatens an individual’s sense of security. lost a loved one, or divorce. usually resolves after situation is resolved. benzos, short-term ssris. therapy.c

Question 6

chronic anxiety is a what?

Answer 6

is a trait. is anxiety that the person has lived with for a long time, from childhood or adolescence. longterm SSRI. CBT.

Question 7

mild anxiety

Answer 7

occurs in the normal experience of everyday living (studying for test, late for work)

Question 8

mild anxiety - features (think test)

Answer 8

Helps one deal constructively with stress
Heightened ability to take in sensory stimuli
Learning is easier, pt is more receptive to new learning
VS WNL or mildly elevated, tense or executed feelings
Nail biting, foot or finger tapping, fidgeting
e.g. studying the morning of a big test

Question 9

moderate anxiety - focus

Answer 9

can only focus on one thing at a time
Perceptual field narrows (can’t notice the big picture)

Question 10

s/sx of anxiety

Answer 10

Tension, ↑P, ↑R, perspiration
Mild somatic: gastric discomfort, HA, urinary urgency, muscles tense

Question 11

severe anxiety (severely in fight or flight)

Answer 11

threatened, disorganized
“Fight or Flight” response or freeze

Question 12

what to do for pt w/ severe anxiety

Answer 12

Need to ↓ stimuli, needs assistance with basic needs
Ask if they need anything to meet basic needs, no problem solving
e.g. a pt is in the ER crying, feeling like she can’t breathe well after she just found out her mom died - on the VERGE of a panic attack, but not there yet.
DEEP BREATHING - use their name, get eye contact, get their attention, give them instructions.

Question 13

panic attack - behavior

Answer 13

terrified, helpless
Logical thinking is impossible
May become angry and combative or may run or may cry, totally withdraw
Losing control, losing touch of reality. Dissociation may occur.
May act impulsively

Question 14

helping pt with Mild to Moderate Anxiety

Answer 14

Mild to Moderate Anxiety
Open-ended questions
Giving broad openings
Exploring & seeking clarification
Deep breathing and guided imagery

Question 15

helping pt with Severe Anxiety to Panic - think Maslow

Answer 15

Concern with pt safety & safety of others
Address physical needs (fluids, rest, etc.)
The use of medication may be used
Use firm, short & simple statements
DEEP BREATHING

Question 16

Etiology of Anxiety - and which is the most inheritable?

Answer 16

Biologic, psychosocial and genetic factors all play a role.
panic disorder the most inheritable

Question 17

anxiety - Neurotransmitters: 3 of them (anxiety nags me)

Answer 17

GABA (decreased activity) – BZDs increase GABA
serotonin (decreased activity)
norepinephrine (increased activity) - this is why SNRI aren’t as effective - they increase norepinephrine

Question 18

Medical conditions associated with the sxs of anxiety include:

Answer 18

excessive caffeine intake, substance abuse (marijuana, stimulants, withdrawals), nutrients - anemia, Vit B12 deficiency, hyperthyroidism, hypoglycemia, etc.

Question 19

Anxiety is a symptom as well as a

Answer 19

disorader**

Question 20

anxiety disorders - common?

Answer 20

very

Question 21

anxiety disorders - more women or men?

Answer 21

women 2:1

Question 22

DSM-5 Classifications and Prevalence of Anxiety Disorders

Answer 22

Panic Disorder (3-5%)
Phobias (15-25%)
Social Anxiety Disorder (7-13%)
Obsessive Compulsive Disorder (OCD) (1-3%)
Generalized Anxiety Disorder (GAD) (3-5%)

Question 23

Panic attack

Answer 23

Panic attack: involves the sudden onset of extreme apprehension or fear, usually associated with feelings of impending doom, feeling of terror

Question 24

s/sx of panic attack - women vs. men

Answer 24

women have more air hunger, males have more chest pain

Question 25

panic attack - age of onset

Answer 25

age of onset - mid 20s, can start in adolescence, 80% inheritable, it is genetic, usually need meds.

Question 26

physical s/sx of panic attack - and time it takes to escalate

Answer 26

(sudden onset, increase in intensity over 10 mins, last about 30 mins) Palpitations Chest pain Breathing difficulties Nausea Feelings of choking Chills Hot flashes

Question 27

tx for panic attack (and what type of therapy)

Answer 27

Keep expectations minimal & simple Teach deep, slow, abdominal breathing. keep hand on chest and belly, and focus on breathing. Med teaching ( BZDs, esp Xanax for acute tx, SSRIs for maintenance) Systematic desensitization and cognitive therapy

Question 28

GAD (generalized anxiety disorder) - how long does it last?

Answer 28

Characterized by excessive anxiety or worrying that lasts for 6 months or longer. Sxs of anxiety are unrelated to a specific person or situation. Pt’s worry is out of proportion to the true impact of the event of situation about which the pt is worried.

Question 29

GAD - s/sx (anxiety in the FR PITS)

Answer 29

(at least 3 of the following) Restlessness Fatigue Poor concentration Irritability Tension Sleep disturbance

Question 30

treatment for GAD

Answer 30

SSRIs, SNRIs, BZDs (used in the beginning), Buspar (not the most effective), Effexor, Doxepin, beta blockers (propralol) Cognitive and behavior therapy Identify effective coping mechanisms used in the past and teach new ones Have pt write assessment of strengths Reframe situation in ways that are positive (“cognitive reframing”)

Question 31

phobia

Answer 31

a persistent, irrational fear of a specific object, activity, or situation that leads to a desire for avoidance, or actual avoidance of the object, activity or situation

Question 32

specific phobia

Answer 32

high levels of anxiety or fear provoked by a specific object or situation (e.g. arachnophobia, xenophobia)

Question 33

social anxiety disorder

Answer 33

(aka Social Phobia): severe anxiety or fear provoked by exposure to a social situation or a performance situation (e.g. fear of public speaking)

Question 34

agoraphobia

Answer 34

intense, excessive anxiety or fear about going in places or situations from which escape might be difficult or embarrassing or in which help might not be available of a panic attack occurs Being alone outside Being alone at home Traveling in a car, bus or airplane (public transport is a big one) Being on a bridge Riding in an elevator

Question 35

tx for phobias - and what meds?

Answer 35

Teach relaxation techniques (deep breathing, progressive muscle relaxation, guided imagery) meditation*** Model unafraid behavior in phobic situation & discuss with pt - hold hand out for dog Systematic desensitization, flooding (exposure in fast period, sink or swim), hypnosis, psychotherapy Short-term BZDs, and beta-blockers to control autonomic sxs Antidepressants, esp SSRIs

Question 36

obsessions

Answer 36

Obsessions: thoughts, impulses, or images that persist & recur so that they cannot be dismissed from the mind

Question 37

compulsions

Answer 37

ritualistic behaviors that an individual feels driving to perform in an attempt to reduce anxiety

Question 38

OCD

Answer 38

Most common: hand-washing, checking (e.g. “did I forget to turn the oven off?”), counting, putting things in order can be a need for constant reassurance, it’s rigid very heritable - 70-80%

Question 39

OCD treatment - what types of therapy (2)

Answer 39

behavior therapy (e.g. systematic desensitization, flooding), also exposure therapy SSRIs (high doses) and

Question 40

Body Dysmorphic Disorder

Answer 40

Body Dysmorphic Disorder: the exaggerated belief that the body is deformed or defective in some way, big among ppl who get plastic surgery. stood in front of the mirror for hours - face melting. difficult to treat.

Question 41

Hoarding Disorder: - common among who?

Answer 41

Hoarding Disorder: persistent difficulties parting with or discarding possessions, regardless of their actual value; 3X common in older people. difficult to treat.

Question 42

Hair-Pulling Disorder (trichotillomania) and Skin-Picking Disorder (dermotillomania)

Answer 42

Hair-Pulling Disorder (trichotillomania) and Skin-Picking Disorder (dermotillomania): like OCD, feels involuntary to the person. difficult to treat. acute stress disorder is not PTSD because it lasts less than 1 month***but it can turn into PTSD

Question 43

adjustment disorder -and timeline

Answer 43

not really trauma related. an emotional or behavioral reaction to a stressful event or change in a person's life. The reaction is considered an unhealthy or excessive response to the event or change within three months of it happening

Question 44

PTSD

Answer 44

characterized by repeated re-experiencing of a highly traumatic event that involved actual or threatened death or serious injury to self or others to which the individual responded with intense fear, hopelessness, or horrorc

Question 45

causes of PTSD

Answer 45

Military combat Prisoner of war, victim of terrorist attack Natural disaster: floods, tornadoes & earthquakes Rape, assault

Question 46

s/sx of PTSD - and how long do they last?

Answer 46

(include both hyperarousal and withdrawal, last more than one month) Recurrent intrusive recollections of the event Nightmares Flashbacks Social withdrawal Guilt over being a survivor (e.g. sole survivor of a car crash) Persistent numbing of general responsiveness as evidenced by: Feeling detached or estranged from others Feeling empty inside Feeling turned off to others

Question 47

PTSD - Persistent of ↑ (hyper) arousal as evidenced by: (Tu)

Answer 47

Irritability Difficulty sleeping Difficulty concentrating Hypervigilance Exaggerated startle responses

Question 48

PTSD - meds

Answer 48

(no treatment for PTSD, but hyperarousal responds well to medication) Meds: Sometimes SSRIs, SNRIs and beta-blockers are helpful. Anticonvulsants (e.g. Depakote for flashbacks and nightmares) can be used for flashbacks and nightmares. MDMA (ecstasy) really helpful.

Question 49

nursing assessment - anxiety

Answer 49

Level of anxiety Coping style: “How do you usually cope? How have you dealt with problems effectively in the past?” Stressors: what stressors do you have right now? Type of anxiety Trait: (family hx?) State: (recent crisis, traumatic event?) Self esteem Assess DTS/DTO (pts with anxiety d/o are often at risk for self destructive & suicidal behavior)

Question 50

nursing - planning

Answer 50

Pt will identify triggers to anxiety (“Describe what you were doing right before you started to feel anxious”)

Question 51

nursing interventions - and what type of therapy?

Answer 51

Teach coping skills and make referrals to community resources for skill development Assist pt to identify stressors Have pt develop a plan if triggers occurs (important for pt to set goals & daily planning) Encourage expression of feelings, esp in mild to moderate anxiety Cognitive therapy: focus on the here and now Cognitive restructuring

Question 52

nursing interventions

Answer 52

Behavioral therapy: modeling, systematic desensitization, flooding, response prevention, thought-stopping Relaxation training: breathing exercises, guided imagery, head to toe relaxations Exercise Yoga Meditation Teach about good sleep habits Use of support system Meds support systems

Question 53

Somatic Symptom Disorders:

Answer 53

characterized by physical sxs without a sufficient organic cause. The pt is NOT faking, not delusional, but truly believes that he/she has a physical problem. High comorbidity w/ depression and anxiety d/o.

Question 54

Somatic Symptom Disorder - how long?

Answer 54

a hx of multiple somatic c/os over many years, most of which cannot be explained medically. not faking it, usually have depression and anxiety. ie fibromyalgia

Question 55

conversion disorder - are they bothered by it?

Answer 55

(formerly called “hysteria”) abrupt, dramatic loss of motor (e.g. paralysis, seizures) or sensory function (e.g. hearing, vision), often w/ an obvious or symbolic significance. The pt appears is often strangely unconcerned about the problem (“la belle indifference”) ie woman who sees her kid get run over by a car and suddenly becomes blind

Question 56

Illness Anxiety Disorder (formerly known as “hypochondriasis”): - how long does it last? (hypochondria times 6)

Answer 56

exaggerated concern w/ health and illness over > 6 months despite medical evaluation and reassurance by an MD

Question 57

tx for somatic disorders (somatic stressors)

Answer 57

identify stressors (sxs are often stress-related) decrease secondary gain (i.e. getting attention from others or avoiding responsibility) associated w/ the sxs evaluate pt’s support system individual and group therapy, hypnosis, behavioral and relaxation therapy

Question 58

Factitious Disorder (Munchausen Syndrome) - are they aware of it?

Answer 58

In contrast to pts w/ somatoform disorder (who really believe that they are ill), pts w/ factitious disorder know that they are pretending to have a mental or physical illness to obtain medical attention. In factitious disorder by proxy, an adult (usually a parent) feigns or induces illness in a child to obtain medical attention.

Question 59

Malingering

Answer 59

the conscious simulation of exaggeration of physical or mental illness for financial or obvious gains (e.g. avoiding work or incarceration)

Question 60

Dissociative Disorders:

Answer 60

characterized by sudden but temporary loss of memory or identity or by feelings of detachment b/c of emotional (traumatic) factors

Question 61

Dissociative Amnesia: (dissaciate from yourself)

Answer 61

inability to recall important data about oneself - usually temporary

Question 62

Dissociative Fugue: (fugue is rogue)

Answer 62

sudden inability to remember pertinent personal information coupled w/ leaving home, moving away and taking on a new identity. The pt is usually not aware that he/she has assumed a new identity.

Question 63

Dissociative Identity Disorder:

Answer 63

characterized by at least two separate personalities, or “alters”, within one individual. Very controversial. Pts are often victims of incest.

Question 64

Depersonalization disorder and derealization:

Answer 64

characterized by recurrent and persistent feelings of detachment from the self (depersonalization), social situation or environment (derealization)

Question 65

fear is what type of process

Answer 65

cognitive

Question 66

anxiety is what type of process

Answer 66

emotional

Question 67

anxiety and fear - physiological symptoms

Answer 67

The physiologic manifestations of anxiety are similar to those of fear (i.e. shakiness, palpitations, GI disturbances, dizziness, diaphoresis, etc.)

Question 68

moderate anxiety - attention and focus

Answer 68

Selective inattention: only certain things in the environment are seen or heard unless they are brought to that attention Can refocus with direction you want to bring them down to mild anxiety. moderate is not good

Question 69

moderate anxiety - physical - can you learn during this phase?

Answer 69

peeing more often, tense muscles, teeth grinding. Not as receptive to teaching. Needs to be brought to mild level for ↑ teaching e.g. a nursing student who is doing oral presentation on SI paper

Question 70

severe anxiety - perception

Answer 70

Sensory perception greatly reduced (difficulty hearing, tunnel vision) disorganized, difficulty hearing. vision narrows. Difficulty problem solving

Question 71

difference between moderate and severe is

Answer 71

severe is severe can’t refocus***

Question 72

severe anxiety - nursing

Answer 72

focus on basic needs for severe.

Question 73

severe anxiety - physical symptoms

Answer 73

Autonomic nervous system activated: HA, nausea, dizziness, diarrhea, tachypnea, muscles rigid, dilated pupils, dry mouth, elevated BP, HR

Question 74

panic attack - nursing protocol

Answer 74

anticipate and protect client Reduce stimuli, meet basic needs Sxs: confusion, shouting, screaming or withdrawal, distorted sensory perceptions may dissociate, may act impulsively keep them safe, reduce stimuli

Question 75

how long do panic attacks last?

Answer 75

can last from 5 - 30 minutes

Question 76

clomipramine (tricyclic) - for what?

Answer 76

OCD

Question 77

PTSD - therapy

Answer 77

Psychotherapy, especially EMDR (eye movement desensitization reprocessing) watch finger move back and forth and talk about event. eye movements quiet amagdlya - and decreases vividness of stress while increasing access to memories. Support groups

Question 78

state anxiety

Answer 78

is just acute anxiety

Question 79

learn better - what type of anxiety?

Answer 79

mild

Question 80

how to give OCD meds- and what 3 meds (OCD pros clomp the flu)

Answer 80

high doses - clompiramine, fluvoxetine, prozac

Question 81

acute stress disorder (PTSD is a cutie)

Answer 81

s/sx of PTSD but it's less than 1 month. This can also turn into PTSD.