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XIO > Psych - Anxiety > Flashcards

Psych - Anxiety Flashcards

1
Q

stress (stress is biological)

A

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

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2
Q

anxiety - reaction to what?

A

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.

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3
Q

fear (my fear is specific)

A

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

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4
Q

normal anxiety

A

is a healthy life force that is necessary for survival

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5
Q

acute anxiety

A

(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

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6
Q

chronic anxiety is a what?

A

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

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7
Q

mild anxiety

A

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

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8
Q

mild anxiety - features (think test)

A

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

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9
Q

moderate anxiety - focus

A

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

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10
Q

s/sx of anxiety

A

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

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11
Q

severe anxiety (severely in fight or flight)

A

threatened, disorganized
“Fight or Flight” response or freeze

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12
Q

what to do for pt w/ severe anxiety

A

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.

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13
Q

panic attack - behavior

A

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

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14
Q

helping pt with Mild to Moderate Anxiety

A

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

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15
Q

helping pt with Severe Anxiety to Panic - think Maslow

A

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

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16
Q

Etiology of Anxiety - and which is the most inheritable?

A

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

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17
Q

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

A

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

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18
Q

Medical conditions associated with the sxs of anxiety include:

A

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

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19
Q

Anxiety is a symptom as well as a

A

disorader**

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20
Q

anxiety disorders - common?

A

very

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21
Q

anxiety disorders - more women or men?

A

women 2:1

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22
Q

DSM-5 Classifications and Prevalence of Anxiety Disorders

A

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

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23
Q

Panic attack

A

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

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24
Q

s/sx of panic attack - women vs. men

A

women have more air hunger, males have more chest pain

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25
Q

panic attack - age of onset

A

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

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26
Q

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

A

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

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27
Q

tx for panic attack (and what type of therapy)

A

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

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28
Q

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

A

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.

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29
Q

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

A

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

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30
Q

treatment for GAD

A

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”)

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31
Q

phobia

A

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

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32
Q

specific phobia

A

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

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33
Q

social anxiety disorder

A

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

34
Q

agoraphobia

A

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

35
Q

tx for phobias - and what meds?

A

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

36
Q

obsessions

A

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

37
Q

compulsions

A

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

38
Q

OCD

A

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%

39
Q

OCD treatment - what types of therapy (2)

A

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

40
Q

Body Dysmorphic Disorder

A

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.

41
Q

Hoarding Disorder: - common among who?

A

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

42
Q

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

A

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

43
Q

adjustment disorder -and timeline

A

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

44
Q

PTSD

A

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

45
Q

causes of PTSD

A

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

46
Q

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

A

(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

47
Q

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

A

Irritability
Difficulty sleeping
Difficulty concentrating
Hypervigilance
Exaggerated startle responses

48
Q

PTSD - meds

A

(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.

49
Q

nursing assessment - anxiety

A

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)

50
Q

nursing - planning

A

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

51
Q

nursing interventions - and what type of therapy?

A

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

52
Q

nursing interventions

A

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

53
Q

Somatic Symptom Disorders:

A

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.

54
Q

Somatic Symptom Disorder - how long?

A

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

55
Q

conversion disorder - are they bothered by it?

A

(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

56
Q

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

A

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

57
Q

tx for somatic disorders (somatic stressors)

A

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

58
Q

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

A

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.

59
Q

Malingering

A

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

60
Q

Dissociative Disorders:

A

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

61
Q

Dissociative Amnesia: (dissaciate from yourself)

A

inability to recall important data about oneself - usually temporary

62
Q

Dissociative Fugue: (fugue is rogue)

A

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.

63
Q

Dissociative Identity Disorder:

A

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

64
Q

Depersonalization disorder and derealization:

A

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

65
Q

fear is what type of process

A

cognitive

66
Q

anxiety is what type of process

A

emotional

67
Q

anxiety and fear - physiological symptoms

A

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

68
Q

moderate anxiety - attention and focus

A

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

69
Q

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

A

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

70
Q

severe anxiety - perception

A

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

71
Q

difference between moderate and severe is

A

severe is severe can’t refocus***

72
Q

severe anxiety - nursing

A

focus on basic needs for severe.

73
Q

severe anxiety - physical symptoms

A

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

74
Q

panic attack - nursing protocol

A

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

75
Q

how long do panic attacks last?

A

can last from 5 - 30 minutes

76
Q

clomipramine (tricyclic) - for what?

A

OCD

77
Q

PTSD - therapy

A

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

78
Q

state anxiety

A

is just acute anxiety

79
Q

learn better - what type of anxiety?

A

mild

80
Q

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

A

high doses - clompiramine, fluvoxetine, prozac

81
Q

acute stress disorder (PTSD is a cutie)

A

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

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