TOPIC 2 - anxiety and somatic disorders Flashcards
brainstem is composed of
medulla, pons, midbrain
cerebellum is responsible for
motor control and cognitive processing
the amygdala processes
fear and anxiety
hyperactive vs hypoactive amygdala
hyper - trauma, may underlie in schizophrenia
hypo - respons to antidepressants
what do antianxiety drugs do to the limbic system
slow
why do drugs that affect brain function stimulate resp depression
basal ganglia controls movement of the diaphragm that is essential for breathing and the basal ganglia is slowed with antipsychotic drugs
what part of the brain is associated with schizophrenia
thalamus and prefrontal cortex
what system is disrupted in depression, anxiety, insomnia, substance use disorder, and alzheimers
how CRH stimulates the cortex to secrete cortisol
first line drug for treating ADHD
sympathomimetics
common side effects of stimulants
decreased appetite and weight loss
CT scans
can detect lesions, abrasions, areas of infarct, aneurysm
MRI and fMRI
used to exclude neurological disorders in those presenting with mental illness
MRI and fMRI
used to exclude neurological disorders in those presenting with mental illness
can detect edema, ischemia, infection, neoplasm, trauma
detect blood flow to functionally active brain regions
PET scan
detect oxygen utilization, glucose metabolism, blood flow, and NE receptor interaction
dopamine
important neurotransmitter involved in cognition, motivation, and movement
stimulate hypothalamus to release hormones
ACH
plays a role in skeletal muscle movement, arousal, memory, and sleep-wake cycle
NE
mood, attention, arousal, stimulate fight or flight
serotonin
mood, sleep regulation, hunger, pain perception, aggression, libido, hormonal activity
histamine
alertness
inflammatory response
GI secretion
GABA
reduce anxiety, excitation, aggression
muscle relaxing
how do SSRIs work in the body
inhibit the re uptake, making it stay longer in the synapse
SSRIs are commonly used to treat …
panic disorder, GAD, OCD, PTSD, social phobia
what does buspirone do
reduce anxiety without causing immediate sedative and mildly euphoric effects of benzodiazepines
action of benzos
promote the activity of GABA
physiological response of anxiety
associated with muscle tension and vigilance in preparation for future danger with cautious or avoidant behaviors
difference between fear and anxiety
anxiety - no known cause
fear - known cause
why is normal anxiety beneficial
provides energy needed to carry out the tasks involved in striving toward goals
acute anxiety
imminent, real, or potential loss that threatens an individuals sense of security
triggered by an acute stressor
pathological anxiety
- intensity is our of proportion to the threat
- emotional response persists after the threat is resolved
- emotional response becomes generalized to benign situations
physical symptoms of mild anxiety
restless, irritable, tension relieving behaviors such as nail biting or finger tapping
physical symptoms of moderate anxiety
tension, pounding heart, increased pulse and resp, voice tremors
what do patients have a sense of with severe anxiety
impending doom
symptoms related to panic level anxiety
confusion, shouting, screaming, extreme withdrawal, hallucinations
what levels are affected with panic level anxiety
perceptual field
ability to concentrate and learn
physical manifestations
what should you do as a nurse when a patient is experiencing mild to moderate anxiety
remain calm, recognize patient distress, be willing to listen
what should you do as a nurse when a patient is experiencing severe to panic level anxiety
firm, short statements to be better understood
speak slower
wait longer for responses
repeat comments
what determines if a defense mechanism is adaptive or maladaptive
adaptive - healthy
maladaptive - unhealthy
frequency, intensity, and duration determines
healthy defenses
altruism, sublimation, humor, suppression
intermediate defenses
repression, displacement, reaction formation, somatization, undoing, rationalization
immature defenses
passive aggression, acting out behaviors, dissociation, devaluation, idealization, splitting, projection, denial
altruism
emotional conflicts and stressorts are addressed by meeting the needs of others which in turn gives them gratification
sublimation
unconsciously substituting constructive and socially acceptable activity for strong impulses that are not usually considered acceptable
ex: man with strong hostile feeling participates in contact sports
humor
emphasizing amusing or ironic aspects of the conflict
suppression
conscious denial of a disturbing situation or feeling
repression
excluding unpleasant or unwanted experiences or ideas from conscious awareness
first line of psychological defense against anxiety
displacement
transfer of emotions associated with a specific person, object, or situation to another person that is not as threatening
ex: dad yells at mom, mom yells at kid
reaction formation
unacceptable feelings are kept out of awareness by developing the opposite behavior or emotion
somatization
repressed anxiety is demonstrated in the form of physical symptoms that have no organic cause
undoing
performing an action to make up for previous behavior
rationalization
justifying illogical or unreasonable ideas, actions, or feelings by developing explanations for the behavior
ex: everybody cheats, why wouldn’t I?
passive aggression
indirectly and unassertively expressing aggression toward others
masks covert resistance, resentment, and hostility
acting out behaviors
by lashing out at others, an individual can transfer the focus from personal doubts and insecurities to another person or object
dissociation
disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment
devaluation
occurs when emotional conflicts or stressors are handled by attributing negative qualities to self or others
idealization
emotional conflicts or stressors are addressed by attributing exaggerated positive qualities to others
splitting
inability to integrate the positive and negative qualities of oneself or others into a cohesive image
projection
unconsciously rejecting emotionally unacceptable personal features in one’s self and attributes those unacceptable traits to other people, objects, or situations
denial
escaping unpleasant realities by ignoring their existence
co-occurring conditions with anxiety
cancer, IBS, kidney and liver dysfunction, reduced immunity, cardiovascular morbidity and mortality
prescription meds that onset acute anxiety
asthma meds, bp meds, hormones, amphetamines, steroids, thyroid meds, phenytoin, antidepressants
nonprescription meds that may cause anxiety
caffeine, decongestants, illegal drugs
parts of the brain involved in anxiety
frontal cortex: cognitive interpretations
hypothalamus: activate stress response
hippocampus: memory related to fear
amygdala: fear
neurotransmitters involved in anxiety responses
serotonin, NE, GABA
behavioral theory on anxiety
anxiety is a learned responses that can be unlearned
cognitive theory on anxiety
belief that anxiety disorders are a results of cognitive distortions in an individuals thinking and understanding
which cultural group is least likely to seek mental health services
african americans and asian americans
what is an important criterion for the diagnosis of panic disorder
anticipatory anxiety (low level constant anxiousness of having another attack)
treatments for panic disorders
benzos (short term)
antidepressants/SSRIs
CBT
phobia
irrational fear that leads to a desire for avoidance or actual avoidance
how does propranolol work on anxiety
reduce physiological symptoms of anxiety, but not the cognitive worry symptoms
more pervasive social anxiety may respond better to what med
SSRIs
agoraphobia
intense, excessive anxiety about fear of being in places where help may not be available and escape might be difficult or embarrassing
symptoms of GAD
restless, fatigue, poor concentration, irritable, muscle tension, sleep disturbance
drugs effective to GAD
buspirone and SSRIs
conditions associated with anxiety
respiratory, cardiovascular, endocrine, neurological, metabolic
selective mutism
complex childhood anxiety disorder characterized by a child’s inability to speak and communicate effectively in social settings
obsession vs compulsion
obsession : thoughts, impulses or images that persist and recur so that they are not dismissed from the mind
compulsions : ritualistic behaviors that individuals feels driven to perform in an attempt to reduce anxiety
pharmacological agents for treating people with BDD
SSRI antidepressants and clomipramine, a TCA
hoarding
excessively collecting of items that may or may not have value and the persistent difficulty in discarding or parting with these obsessions
screening tools to monitor symptoms changes in anxiety
clinically useful anxiety outcome scale
GAD-7
hamilton rating scale for anxiety
how to assess for anxiety
- ensure a complete neurological and physical exam
- assess potential for self harm
- perform a psychosocial assessment
- assess cultural beliefs and background
goals of health teaching, health promotion, and psychoeducation
-provide info
-support treatment adherence through med teaching
-teach ways to promote sleep
-access to info and continue learning the tools to help reduce symptoms
mileu therapy techniques
structure daily routine, provide info about daily routine, provide daily activities to promote sharing and cooperation, provide therapeutic interactions such as one on one care, include patient in decisions
cognitive restructuring
identify the distortion, challenge the distortion, replace the distortion with a more realistic interpretation
meditation vs mindfulness
meditation: relaxed or restful alertness
mindfulness: become more aware of present moment
aversion therapy
undesirable behavior associated with unpleasant stimulus
flooding
uses prolonged exposure to a feared object
systematic desensitization
gradually exposing a person to a feared object or situation until the person is free of incapacitating anxiety
exposure and response prevention
systematically desensitize people to their fears by repeatedly facing fears
modeling
imitate another person
thought stopping
get rid of unwanted thoughts
identify thought, focus exclusively on thought, actively interrupt the thought by performing a behavior such as saying “stop”
types of relaxation techniques
deep breathing, guided imagery, progressive relaxation, autogenic training, self hypnosis, biofeedback assisted relaxation
most effective treatment strategy
combination of psychopharmacology with other therapies such as CBT
antidepressants
most widely prescribed for long term anxiety and OCD
taper off !!
SSRI - first line treatment, rapid onset
SNRI - venlafaxine = PD, GAD, social anxiety, OCD / duloxetine = GAD, PD, OCD
benzos
anxiolytics for short term use
tolerance requires higher dosages to achieve the same calming effect
increases risk of falls, development of dementia, and increased mortality
antihistamines
provide quick, periodic anxiety relief
most effective for short term uses and are useful for those with substance use problems because they are not addicting
buspirone
nonaddictive med used in the management of long term relief
most effective for GAD
anticonvulsants
valproic acid, gabapentin, pregabalin
treat GAD, social anxiety, panic attacks
antipsychotics
may be used as calming agents for acute anxiety in certain situations
CAMS
kava kava, valerian, lavender oil, st johns wort
symptoms of somatic disorders diagnosis
presence of physical symptoms but also how to patient interprets them
symptoms are not intentional or under conscious control
relate to body more than the mind
cognitive theorists beliefs on somatization
somatic disorders are the result or negative, distorted, catastrophic thoughts and reinforcement of these thoughts
focus on body sensations, misinterpret their meaning and respond with excessive alarm
effect of adverse childhood experiences
shown to contribute more negative health outcomes in adulthood, including somatic symptoms
somatic symptoms disorder
medical findings are lacking or less than expected to magnitude of complaint
patient may have histories of multiple treatments, substance abuse, marital difficulties, suicidal ideation, chronic pain, and impaired work and life function
functional neurological disorder
chronic or brief symptoms of altered voluntary motor or sensory function that cause substantial distress or psychosocial impairment
freuds beliefs on FND
unbearable effect of stressors is converted into physical symptoms that provide an escape from an unpleasant conflict
Type A vs D personalities
A- increased survival, more goal oriented
D- extreme difficulty approaching other people and have an avoiding coping style
factitious disorder imposed on self
faking symptoms in order to assume sick role with no obvious external benefits
malingering
intentionally faking or exaggerating symptoms for an obvious benefit
is a behavior, not a psychiatric disorder
factitious disorder imposed on another
deliberate fabrication of symptoms or injury is imposed upon another person
assessment of somatic disorders
collect data about the nature, location, onset, character, and duration of symptoms
assess patients ability to meet their own needs
nutrition, fluid balance, and elimination
altered sexual desires
history of childhood trauma
altered respiratory and heart rate
altered safety, security, rest, hygiene, ADLs
if patients cannot identify their anxiety and emotionally coach themselves…
the stage is set to believe only a medical problem could be the cause
dependence on medication
somatic complaints are likely to have dependence on meds and experience “rebound anxiety” when the dosage wears off, exacerbating the anxiety problem over time
goal of somatic symptoms care
meet needs without resorting to somatization,
increase quality of life and independence
assertive training
teach a direct means of meeting needs and thereby decreases the need for somatic symptoms
teaches people to stand up for themselves
use “I” statements
feeding and eating disorders in adolescence
pica - eating nonfood substances
rumination disorder - eating regurgitated food
avoidant food intake - persistent failure to meet nutritional needs
elimination disorders in adolescence
enuresis - repeated voiding of urine
encopresis - repeated passage of feces
disruptive, impulse control, and conduct disorders in adolescence
oppositional defiant disorder - beyond normal limit testing, displays symptoms with at least one person who is not a sibling (at least four of: temper, annoyed, angry, argues with authority, defies rules, deliberately annoy others, blames others for mistakes)
conduct disorder - more severe than ODD, at least 3 of the following: bullies, initiates fights, used a weapon, physically cruel, stolen, raped, sets fires, destruction of property, broken into places, lies, stay out at night against rules, have run away at least twice
trichotillomania
recurrent twisting or pulling off of ones hair
anxiety and trauma/stressor related disorders
reactive attachment disorder - consistent pattern of inhibited, emotionally withdrawn behaviors
separation anxiety - developmentally inappropriate fear of separation from a person they are attached to
selective mutism - failure to speak when speaking is an expectation
when is anxiety normal vs not normal
anxiety is a universal human experience and is normal until is lasts well beyond a specific stressful event or when it interferes with a persons day to day ability
acute anxiety
This level of anxiety is precipitated by an imminent loss or change that threatens one’s sense of security. For example, the sudden death of a loved one precipitates an acute state of anxiety.
chronic anxiety
This level of anxiety is one that usually develops over time, often starting in childhood. The adult who experiences chronic anxiety may display that anxiety in physical symptoms, such as fatigue and frequent headaches.
pathological anxiety
differs from normal anxiety in duration, intensity, and impact on functioning
stress vs anxiety vs fear
stress : a state produced by a change in the environment that is perceived as challenging, threatening, or damaging to ones well being
anxiety : a subjective emotional state, often with feelings of apprehension, uneasiness, uncertainty, dread - results from a real or perceived threat or stressor whose actual source is unknown
fear : a reaction to a specific danger or stressor
what symptoms are people likely to seek help for when they experience anxiety
physical symptoms
contributing factors to anxiety
family history
NE, GABA, serotonin imbalance
co occurring medical or mental health diagnoses (Substance use disorders, Disordered sleep, Mood disorders, Eating disorders, Heart disease, Irritable bowel syndromes, Reduced immune response)
cultural approach
where is the criteria for diagnosis found
DSM-5
how to assess and analyze anxiety
consider cognitive ability, literacy level, and primary language
consider that fear or shame may prevent a client from disclosing anxiety
assess : physical signs, affective symptoms, cognitive symptoms, social symptoms, and spiritual symptoms
non benzos and benzos
NON BENZOS
beta block - propranolol
antihistamine - hydroxyzine, diphenhydramine
alternative anxiolytic - busprione
SSRIs
anticonvulsant - pregabalin, gabapentin
BENZOS
lorazepam, alprazolam, donazepam
