Stress, Crises, Trauma, Aggression, & Abuse Flashcards
Generalized Anxiety Disorder
High GABA, low anxiety; Low GABA, high anxiety
- Persistent, generalized and excessive anxiety &
worry
- Symptoms persist at least 6 months
- Interferes with normal activities
Interventions:
- CBT (identify the relationship between the stressor and anxiety; encourage different perceptions of the stressor)
- Adaptive coping (encourage exercise, deep-breathing, relaxation, and biofeedback; decrease environmental stimuli)
- Pharmacotherapy (SSRIs, TCAs, & buspirone)
Panic Disorder
Pathophysiology:
- Recurrent, unexpected panic attacks that cause intense apprehension and feelings of impending doom
- Last 15-30 minutes; peaks at 10 minutes
Interventions:
During panic attacks
- stay with individual; be calm; offer reassurance; reduce stimuli
- Use short, clear sentences
When anxiety is mild/moderate:
- Explore possible causes of panic attacks
- Teach s/s of increasing anxiety
- Teach coping mechanisms
Pharmacotherapy:
- Benzodiazepines, SSRIs, beta blockers
Phobias
Pathophysiology:
- Intense, irrational anxiety when exposed to a specific feared object or situation
Interventions:
- Acknowledge the fear
- Systematic desensitization (exposure therapy)
- CBT (explore the perceptions of threats
- Teach appropriate coping
- Provide positive reinforcement when appropriate
Pharmacotherapy:
- Alprazolam, propranolol, SSRIs, buspirone
Obsessive-Compulsive Disorder
Pathophysiology:
- Unwanted, recurrent, and intrusive thoughts or images (obsessions) which the person tries to alleviate through repetitive behaviors or mental acts (compulsions)
Interventions:
- Initially allow time for rituals (interrupting increases anxiety)
- Encourage gradual decrease in time devoted to rituals
- Help identify causes of anxiety
- Teach effective coping immediately after ritual
Pharmacotherapy:
- SSRIs, TCAs
Post-Traumatic Stress Disorder (PTSD)
Pathophysiology:
- Trauma or stressor related disorder characterized by persistent nightmares, recurrent flashbacks, intrusive thoughts, hyper vigilance, sleep disturbance, and avoidance of reminders related to trauma
Interventions:
- Provide a nonthreatening environment
- Assess suicide/homicide risk
- CBT (encourage discussion of trauma when time, assess guilt, grief, & shame, teach appropriate coping and control of anxiety
- Group/family therapy as needed
Pharmacotherapy:
- SSRIs, TCAs, carbamazepine, beta blockers
Dissociative Amnesia
Pathophysiology:
- Inability to recall important personal information for a period of time following stressor
- Triggered by severe psychological stressor
Interventions:
- Reduce environmental stimulation to decrease anxiety
- Avoid giving too much information about past events at one time
Dissociative Fugue
Pathophysiology:
- Type of dissociative amnesia
- Inability to remember one’s identity
- Accompanied by sudden, unexpected travel from vicinity
- Can last weeks to months
Interventions:
- Reduce environmental stimulation to decrease anxiety
- Avoid giving too much information about past events at one time
Dissociative Identity Disorder
Pathophysiology:
- Two or more distinct identities or personalities that take control of one’s consciousness and behavior
- Often triggered by stress
Interventions:
- Document emergence of different personalities
- Demonstrate acceptance of the individual’s behavior during various personalities
- Encourage the individual to identify stressful situations that cause a transition from one personality to another
- Work toward integration of different personalities
Major Medications to Treat Anxiety
Anxiety Disorders:
- Benzodiazepines
- Buspirone
- Beta blockers
- SSRIs
- SNRIs
- TCAs
- MAOIs
- Antihistamines
- Anticonvulsants
Trauma/Stressor-related Disorders:
- Beta blockers
- SSRIs
- SNRIs
- TCAs
- MAOIs
Benzodiazepines
Examples: alprazolam, clonazepam, diazepam, lorazepam (ending in -pam)
Overview:
- CNS depressants
- Less tolerance and dependence than barbiturates
Indications:
- panic disorder, social anxiety disorder, alcohol withdrawal
Adverse Effects:
- anterograde amnesia
- respiratory depression
- paradoxical response (insomnia, anxiety, rage, etc.)
Nursing Considerations:
- Avoid other CNS depressants!
- Contraindicated with sleep apnea, respiratory depression, organic brain disease, breast feeding, and pregnancy
- Caution with liver/renal dysfunction and substance abuse disorder
- High abuse potential
Buspirone
Atypical anxiolytic/non-barbituate
Indications:
- panic disorder, OCD, social anxiety disorder, general anxiety disorder
Adverse Effects:
- Dizziness, nausea, headache, lightheadedness, agitation
Nursing Consideration:
- caution with older adults, liver/renal dysfunction
- may cause hypertensive crisis with MAOIs or within 14 days of stopping
- Low abuse potential
- Can take 2-6 weeks to work
- Avoid erythromycin, ketoconazole, St. John’s wort, and grapefruit juice
- Take at the same time everyday
- Take with meals
Beta blockers
Examples: atenolol, propranolol (avoid in asthma) Indications: - Stage fright Adverse Effects: - bradycardia, decreased CO, AV block, orthostatic hypotension, rebound myocardium excitation - bronchoconstriction Nursing Considerations: - Avoid beta2 blockers with asthma - Can mask hypoglycemic - Monitor HR and BP - Discontinue over 1-2 weeks
SSRIs
Examples: fluoxetine, sertraline, paroxetine
Indications:
- depression, OCD, panic disorder, GAD, social anxiety disorder, PTSD, dissociative disorder depression/anxiety
Adverse Effects:
- Sexual dysfunction
- Serotonin syndrome (confusion, difficulty concentrating, fever, agitation, anxiety, hallucinations, incoordination, hyper-reflexia, diaphoresis, tremors, tachycardia)
Nursing Considerations:
- Contraindicated with MAOIs and TCAs
- Monitor for suicidal ideation! Peak suicide risk is at 2 weeks
- Use cautiously in liver/renal dysfunction, cardiac disease, seizure disorders, ulcers, history of GI bleeding, bipolar disorder
- Can take up to 4 weeks
- Taper gradually
