Topic 4: Anxiety/OCD/Somatic Flashcards
1
Q
what is anxiety
A
subjective emptional state, often with feelings of apprehension, uneasiness, uncertainty and dread
2
Q
normal anxiety
A
a healthy life force that is necessary for survival, normal anxiety motivates people to take action (an appropriate response)
3
Q
acute anxiety
A
is precipitated by an imminent loss ot threat (stress response)
4
Q
pathological (disordered) anxiety
A
differen from normal anxiety in terms of duration, intensity and disturbance in a persons ability to function, ecihc persists after the threat is resolved
5
Q
chronic anxiety
A
a long term issue, associated with increased risk for cardiovascular disorders (ususally begins in childhood)
6
Q
Anxiety vs. Fear
A
Fear: a reaction to a specific danger or stressor (fight-or-flight response)
Anxiety: results from a real or perceived threat or stressor whose actual source is unknown or unrecognized
7
Q
stress
A
a state produced by a change in the environment (a stressor) that is perceived as challenging, threatening, or damaging to one’s well-being
8
Q
which gender is more frequently affected by anxiety
A
women
9
Q
what are some HIGHLY co-occuring disorders that come with anxiety
A
substance abuse, major depressive disorder (MDD)
10
Q
what are FREQUENTLY co-occuring disorders that come with anxiety
A
eating disorder, bipolar disorder, dysthymia
11
Q
what are co-occuring MEDICAL conditions with anxiety
A
cancer, heart disease, hypertension, irritable bowel syndrome, renal or liver dysfunction, reduced immunity.
12
Q
when do anxiety disorders usually begin?
A
in childhood, adolescence, and early adulthood
13
Q
anxiety and genetics
A
*family ties, high concordance of panic & anxiety with monozygotic twins
14
Q
anxiety and neurobiology
A
*imbalances of serotonin, norepinephrine, and GABA; involvement of multiple brain areas
15
Q
Cultural Perspectives on Anxiety: latin americans and northern europeans
A
*panic attack symptoms: choking, smothering, fear of dying
16
Q
Cultural Perspectives on Anxiety: japanese and korean
A
*social phobia related to offensive body odors
17
Q
Cultural Perspectives on Anxiety: african Americans and asian americans
A
*least likely to seek mental health services
18
Q
Cultural Perspectives on Anxiety: other cultures
A
*panic attacks may be viewed as magic or witchcraft
19
Q
Healthy defense mechanisms
A
Altruism
Sublimation
Suppression
Humor
20
Q
intermediate defense mechanisms
A
repression, displacement, reaction formation, somatization, undoing, rationalization
21
Q
immature defense mechanisms
A
Passive aggression
Acting out
Dissociation
Devaluation
Idealization
Splitting
Projection
Denial
22
Q
altruism
A
emotional conflicts and stressors are addressed by meeting the needs of others
Sarah went through a traumatic experience when she lost her younger brother to a chronic illness. The grief was overwhelming, and she struggled with feelings of guilt and helplessness. Instead of succumbing to her sorrow, Sarah decided to channel her emotions into starting a nonprofit organization dedicated to supporting families with children suffering from the same illness. By doing so, Sarah not only found a way to cope with her grief but also created a lasting impact in her community.
23
Q
sublimation
A
directing energy from unacceptable drives into socially acceptable behavior.
A person with aggressive tendencies, instead of acting out violently, might channel that aggression into competitive sports or martial arts. Here, the aggressive impulse isn’t suppressed or denied but is expressed in a controlled, socially acceptable, and even beneficial manner. The person might become a dedicated athlete or martial artist, receiving accolades for their dedication and skills, all while healthily venting their aggressive tendencies.
24
Q
humor
A
emphasizing the assuming or ironic aspects of the conflict or stressor through humor
25
supression
conscious denial of disturbing situation or feeling
Imagine Sarah, a medical professional, learns that a close family member has passed away right before she is about to perform a critical surgery. At that moment, Sarah decides to suppress her feelings of grief and sorrow, choosing to focus solely on her professional responsibilities. She acknowledges internally that her feelings are valid and important, but she also recognizes that it's essential for her to remain composed and attentive to perform the surgery safely.
26
repression
unconscious involuntary forgetting of unacceptable or painful thoughts, feelings, or actions
27
displacement
transfer of emotions associated with a specific person, object or situation to ANOTHER person, object, or situation that is nonthreatening
Imagine a man who had a challenging day at work because his boss criticized him in front of his colleagues. He felt humiliated and angered by his boss but couldn't express his feelings there because it might jeopardize his job. When he comes home, he finds that his dog has chewed on one of his shoes. Instead of handling it calmly, he becomes excessively angry and yells at the dog or punishes it more harshly than usual.
28
reaction formation
unacceptable feelings or behaviors are kept out of awareness by developing the oppositee behavior or emotion
Imagine a young boy in school who has developed a crush on a classmate. He might find these feelings overwhelming or unacceptable (perhaps he's been teased by friends or doesn't know how to cope with the new emotions). Instead of showing affection or trying to be near the classmate he has a crush on, he might do the opposite: tease her, be mean to her, or even claim to dislike her when talking to others.
29
somatization
occurs when represssed anxiety is demonstrated in the form of physical symptoms that have no organic cause
Imagine a woman who is under extreme stress and anxiety due to conflict in her marriage. She might not openly discuss or even acknowledge her feelings, perhaps because she's been conditioned to suppress emotional distress or doesn't have an outlet to express them. Over time, she starts experiencing frequent headaches, stomach upsets, or unexplained muscle aches. She visits various doctors and undergoes a series of tests, but they all come back normal, and no organic cause can be found for her symptoms.
30
undoing
a compulsive response that negates or reverses a previous unacceptable action
Let's say a man has an argument with his wife and says something hurtful to her out of anger. Later, he feels guilty about what he said. To try and "undo" the harm he believes he caused, he might engage in overcompensatory behaviors like buying her unexpected gifts, doing extra household chores, or being excessively affectionate. These behaviors are an attempt to cancel out or reverse the hurtful action
31
rationalization
offering a socially acceptable or logical explanation for otherwise unacceptable impulses, feelings, and behaviors
32
passive aggression
an individual dealth with emotional conflict or stressors by indirectly and unassertively expressing aggresstion toward others
33
Acting out behaviors
An individual addresses emotional conflicts or stressors by actions rather than by reflections or feelings.
Imagine a teenager named Mia who recently experienced a breakup with her first serious boyfriend. Instead of talking about her feelings, seeking support, or processing the pain of the breakup, she starts to skip school, gets involved in risky behaviors like underage drinking, and begins to hang out with peers who encourage her reckless actions.
34
dissociation
disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment
Imagine a young child who is frequently abused by a caregiver. The traumatic experience of the abuse can be too much for the child to bear. To cope, the child might use dissociation. During episodes of abuse, the child might feel as though they are floating above their body, watching the events unfold as if they were happening to someone else. This is often referred to as "derealization" or "depersonalization." Later in life, the child might not have a clear memory of the abuse due to the dissociative state they entered during those traumatic times. They might have fragmented or missing memories, and may only recall the sensation of floating or being disconnected, rather than the specific details of the abuse.
35
devaluation
occurs when emotional conflicts or stressors are handled by attributing negative qualities to self or others
Another example can involve self-devaluation. If a student gets a poor grade on a single test, instead of recognizing it as one bad day or one subject they struggled with, they might start thinking, "I'm stupid," or "I'm a failure." They attribute exaggerated negative qualities to themselves based on a single event.
36
idealization
emotional conflicts or stressors are addressed by attributing exaggerated positive qualities to others
Consider a young woman named Lisa who has had a series of negative relationships in the past. She meets Michael, who shows her some kindness and attention. Instead of seeing Michael as a multi-dimensional person with both strengths and flaws, Lisa might immediately elevate him to a pedestal, viewing him as the "perfect" partner. She believes he can do no wrong, and attributes to him qualities he might not actually possess, such as extreme intelligence, unparalleled compassion, or unmatched skills. When Michael shows any signs of human flaw or makes a mistake, Lisa might dismiss it or make excuses for him, preserving her idealized image of him. This can be a coping mechanism for Lisa, as she might be trying to protect herself from another negative relationship experience by believing she's found the "perfect" partner.
37
splitting
is the inability to integrate the positive and negative qualities of oneself or others into a cohesive image
Anna has a close friend named Beth. When things are going well in their relationship, Anna sees Beth as the best friend anyone could ever have — generous, caring, and simply perfect. However, if there's a disagreement or if Beth does something that Anna doesn't like, Anna's view can rapidly shift. Suddenly, Beth becomes the "worst" friend, someone who never truly cared, who is entirely selfish, and who cannot be trusted at all. Instead of recognizing that Beth, like everyone, has both strengths and weaknesses, and that sometimes disagreements or misunderstandings can occur, Anna switches between viewing Beth as all-good or all-bad. It becomes difficult for Anna to maintain stable relationships, as she can swing between over-attachment and complete detachment.
38
projection
attributing our own thoughts or impulses to another person
Let's say Mark is having feelings of attraction towards a co-worker named Jane, even though he's in a committed relationship. Instead of acknowledging his feelings and dealing with them responsibly, he becomes convinced that Jane is the one who is attracted to him and is trying to seduce him. He might even complain to friends that Jane is "clearly" interested in him and is being inappropriate, even if she has done nothing of the sort.
39
denial
avoidance of disagreeable (uncomfortable) reality by ignoring or refusing to recognize it
Let's say Jenny's father has been a heavy drinker for years. Every time family members express concern about his drinking habits, Jenny dismisses their worries, saying, "He just likes to have a drink after work, it's not a big deal." Even when her father starts missing work, getting into altercations, or neglecting his responsibilities due to his drinking, Jenny maintains that he doesn't have an alcohol problem and that people are overreacting.
40
compensation
putting forth extra effort to achieve in area of real (or imagined) deficiency
Growing up, Sam always felt physically weak. He was smaller than his peers and often got teased for his stature. As he got older, Sam felt that he had to compensate for his perceived physical inadequacy. So, instead of focusing on physical prowess, he dedicated himself to academics with immense vigor. Sam believed that if he could be the top student, garner academic awards, and achieve professional success, it would offset his feelings of physical inferiority. Over time, Sam becomes an esteemed scholar and is recognized for his academic achievements. This success provides him with a sense of worth and self-esteem that he felt he lacked due to his physical size
41
Regression
returning to an earlier level of emotional development
7-year-old boy named Jake who has always been independent and hasn't wet the bed since he was a toddler. However, after the birth of his baby sister, he starts wetting the bed again. Additionally, he begins to act more baby-like, wanting to be held and asking for a bottle instead of a cup. In this scenario, Jake is experiencing feelings of insecurity and perhaps jealousy with the arrival of the new baby, who is getting a significant amount of attention. As a result, he regresses to earlier behaviors that once garnered him more care and attention from his parents. By acting like a baby, Jake might be trying to recapture some of the attentio
42
mild anxiety
is experienced during everyday life events, and is normal.
43
possible signs of mild anxiety
Mild tension-relieving behaviors (e.g., tapping, fidgeting, chewing)
44
possible symptoms of mild anxiety
· Slight discomfort
· Restlessness
· Irritability
· Impatience
· Enhanced problem-solving ability
Enhanced ability to focus on & work toward goals
45
Moderate anxiety
the person's ability to think clearly is affected, but they can still solve problems, they can be selective to what they pay attention to.
46
possible signs of moderate anxiety
· Vocal tremors
· Change in voice pitch
· Increased respiratory rate, pulse rate
· Shakiness
· Repetitive questioning
· Increased muscle tension
Moderate tension-relieving behaviors (e.g.,pacing, banging hands on table)
47
possible symptoms of moderate anxiety
· Narrow perceptual field (grasps less of what is occurring around them)
· Selective inattention (will benefit from guidance)
· Able to solve problems, though not at optimal ability
· Somatic complaints
Difficulty concentrating
48
Severe anxiety
Greatly reduced, can focus only on specific details, scattered attention, completely self-absorbed, blocking out the environment
49
possible signs of severe anxiety
· Hyperventilation
· Tachycardia
· Loud and rapid speech
· May make threats and demands
Purposeless activity
50
possible symptoms of sever anxiety
· Greatly reduced perceptual field (can focus on one detail at a time)
· Scattered attention
· May not be able to recognize events occurring in the environment (even when pointed out by others - "tunnel vision")
· Feelings of dread, impending doom
· Confusion
· Ineffective general functioning
· More intense somatic complaints
· Distorted perception of events
Unable to problem-solve
51
Panic level anxiety
Extremely narrow. Unable to focus, may lose touch with reality
52
possible signs of Panic level anxiety
· Dilated pupils
· Severe shakiness
· Sleeplessness
· May be mute or may have unintelligible speech
· Severe hyperactivity response or may be immobile (fight or flight response)
Severe social withdrawal
53
possible symptoms of panic level anxiety
· Unable to focus on environment at all
· Focused only on relieving the panic
· Experience of terror
· May feel they will die
· Hallucinations, delusions are possible (out of touch with reality)
Irrational thought process
54
priority interventions for mild anxiety
· Assess level of anxiety
· Encourage client to talk about any concerns
Encourage problem-solving
55
priority interventions for moderate anxiety
· Assess level of anxiety
· Encourage safe tension-relieving behaviors
· Assess previous effective coping strategies
Encourage client to discuss concerns
56
priority interventions for severe anxiety
· Assess level of anxiety
· Assess for client safety
· Do not leave the client alone (for safety)
· Allow for safe physical release of tension if possible and appropriate (based on assessment and environment)
· Assess vital signs
· Minimize stimulation in environment if possible
Assess need for medication
57
what is the most important intervention for severe/panic anxiety
*DO NOT LEAVE THE CLIENT ALONE
58
priority interventions for panic anxiety
· Do not leave client alone (for safety)
· Assess level of anxiety
· Assess for client safety
· Lower the client's anxiety level prior to attempting other interventions that require focus and problem-solving (client will be unable at this level), provide a quiet room/environment
Assess need for medication
59
effective communication for mild anxiety
· Remain calm
· Body language to engage client in communication (open, relaxed, attentive)
· Active listening
Keep focus on the client
60
effective communication for moderate anxiety
· Remain calm
· Active listening
· Keep the focus on the client
· Engaging nonverbals (as in "mild")
Clarify when needed (client may lose focus occasionally or require repeated answers/ statements)
61
effective communication for severe anxiety
· Remain calm (vocal & nonverbal)
· Speak slowly and clearly
· Firm, brief statements and directives
· May need to repeat multiple times
62
effective communication for panic anxiety
· Remain calm (vocal & nonverbal)
· Speak slowly and clearly
· Firm, brief statements and directives
· May need to repeat multiple times
Reinforce reality if client expresses perceptual disturbances (hallucinations, delusions)
63
what are some non-pharm interventions and coping strategies
*Breathing exercises, guided imagery, meditation
*Journaling, writing
*Art activities
*Listening to music
*Progressive muscle relaxation
*Recreational activities, exercise
*Crying
*Laughing
*Sleeping
*Diet and fluid intake
*Time management
64
Separation Anxiety Disorder
A developmentally inappropriate fear of separation from the person to whom the child is most attached (often parents)
65
When is separation anxiety normal?
symptoms are considered normal up to 1 year of age
66
what are the symptoms of the separation anxiety disorder
-Fear of injury or death of important people
-Fear of being lost or kidnapped
-Refusal to stay away from home
-Sleeps near or with parent(s)
-Nightmares
67
what are the somatic symptoms of separation anxiety disorder
*Stomach distress (often in anticipation of separation)
*Temporary loss of bowel or bladder control
68
what assessment tools are used for separation anxiety disorders
*Questions & observation
*Spence Children's Anxiety Scale, or Hamilton Anxiety Scale
69
wht therapies are used for separation anxiety disorder
*Supportive therapy, cognitive behavioral therapy (CBT), family therapy; relaxation and guided imagery; BIBLIOTHERAPY (children's books addressing separation anxiety)
70
medications for separation anxiety disorder
SSRI antidepressants, beta blockers, or antihistamines
71
social anxiety disorder
Severe anxiety due to exposure to a social situation or performance
(Based on a fear of being judged or rejected by others and/or being publicly embarrassed)
72
medication treatment for social anxiety disorder
*Propranolol (beta blocker)
*Other anxiolytic or antidepressant medications
73
why are beta blockers prescribed for social anxiety disorder
Beta blocker will lower the heart rate (these meds may be PRN)
74
generalized anxiety disorder
Characterized by excessive, persistent, and uncontrollable anxiety and worry and develops *slowly overtime
75
how long must an individual experience anxiety in order to be diagnosed with GAD
6 months
76
what are the commpn physical symptoms of GAD
*Restlessness
*Fatigue
*Headaches
*Muscle tension, muscle aches
*Perceived difficulty swallowing
*Trembling, twitching
*Irritability
*Sweating
*Nausea
*Lightheadedness
*Having to go to the bathroom frequently
*Shortness of breath
*Hot flashes
77
treatment for GAD
CBT and anxiolytic medications
78
agoraphobia
fear or avoidance of situations, such as crowds or wide open places, where one has felt loss of control and panic
79
panic disorder
Frequent panic attacks that impede the person's ability to function in daily life as desired.
80
Panic Disorder with Agoraphobia
*Intense, excessive anxiety about, or fear and avoidance of situations or places where escape might be difficult, or where help might not be available if they have a panic attack
81
Panic Disorder with Agoraphobia treatment
CBT and SSRI
82
CBT
cognitive behavioral therapy; skills-focused treatment aimed at altering maladaptive emotional responses by changing the client's thoughts, behaviors, or both
83
Cognitive restructuring
a process in which the negative thinking patterns that contribute to anxiety are challenged, replacing them with more positive, realistic thoughts
84
what are the three steps of cognitive restructuring
-identifying negative thoughts
-challenging negative thoughts
-replacing negative thoughts with realistic thoughts
85
phobias
Intense, irrational fears about specific places, situations, or things (sometimes referred to as 'triggers')
86
How do people with a phobia typically react?
-physically: increased heart rate, sweating, trembling, feeling faint, nausea, feeling of choking, and/or increased blood pressure.
-Avoidance is the most common reaction
87
obsession
An unwanted and intrusive thought, persistent idea, impulse, or image that causes significant anxiety or distress
88
compulsion
An unwanted, repetitive behavior pattern or mental act intended to reduce anxiety, which does not provide pleasure or gratification
89
obsessive-compulsive disorder (OCD)
an anxiety disorder characterized by unwanted repetitive thoughts (obsessions) and/or actions (compulsions)
90
OCD treatments
CBT
Interpersonal therapy
Exposure therapy (systematic desensitization)
91
Exposure therapy
exposes the client to the situations or objects feared
92
why are benzodiazepines indicated for short term use
carry a risk for dependence, tolerance, and potential abuse
93
what are some examples of benzodiazepines
lorazepam
alprazolam
diazepam
clonazepam
94
what are the side effects of benzodiazepines
dizziness, drowsiness, amnesia, sedation
95
what is the mechanism of action for benzodiazepines
GABA is an inhibitory neurotransmitter in the brain. The release of GABA slows neural transmission, which has a calming effect.
96
what must patients taking benzodiazepines avoid
Must avoid all other CNS depressants (including alcohol and herbs/CAMs)
97
what is an example of a beta blocker that is used for anxiety
propranolol
98
what is an example of a antihistamine that is used for anxiety
hydroxyzine
99
what is an example of an alternative anxiolytic used for anxiety
buspirone (serotonin-dopamine agonist)
100
what is important to know about buspirone
Need to steadily take buspirone at the same time each day, requires 2 to 4 weeks for effectiveness
101
what is an anticonvulsant used to treat GAD (especially in somatic symptoms are also present)
pregabalin
102
what class of medication is used for longer term treatment of anxiety
nonbenzodiazepines
103
what class of medication is used for short term treatment of anxiety
benzodiazepines
104
why are Beta-blockers prescribed for panic and social anxiety disorders?
they have a calming effect on the CNS.
105
SSRIs:
*citalopram (Celexa)
*escitalopram (Lexapro) (Not effective for social anxiety disorder or panic disorder)
*fluoxetine (Prozac)
*fluvoxamine (Luvox)
*paroxetine HCl (Paxil)
*sertraline (Zoloft)
106
CAMs and alternative therapies for anxiety
kava, valerian root, lavender oil
107
somatization
psychological distress results in physical symptoms
108
somatic symptom disorder
psychological disorder in which the symptoms take a somatic (bodily) form without apparent physical cause
(People seek relief from their somatic symptoms, yet medical tests repeatedly reveal no medical basis.)
109
what is the key point for somatic symptom disorder
these clients are not faking; they believe they are sick.
110
Somatic Symptom Disorder is associated with:
*Increased health care use and costs
*Functional impairment
*Provider dissatisfaction (can lead to "doctor shopping")
*Failed treatment response (attempted treatments logically fail, because there is no true medical cause for the symptoms)
111
To be diagnosed with SSD, the individual must...
be persistently symptomatic (typically at least for 6 months).
112
illness anxiety disorder
(Hypochondriasis)
-Constant worry about having or getting an illness (≥ 6 months)
-Alarmed by body sensations/changes
-May or may not seek medical help for symptoms
113
conversion disorder
a condition in which symptoms affect a person's perception, sensation or movement with no evidence of a physical cause. A person may have numbness, blindness or trouble walking
114
treatment for conversion disorder
*CBT, clinical hypnosis (No medications for conversion disorder)
*Identification of the underlying trauma or anxiety is key to resolving conversion disorder
115
nursing interventions for conversion disorder
*Supportive interventions for real symptoms
*Goal is to foster independence in the client, not enable more somatic symptoms
116
factitious disorder imposed on self
Deliberate symptom fabrication or self-injury without any obvious potential reward (other than attention)
117
malingering
faking illness or injury for obvious gain (usually monetary)
118
factitious disorder imposed on another
*Perpetrator is usually a parent or caregiver (most often the mother); and the victim is dependent on the caregiver (usually—but not exclusively—a child)
119
Factitious disorder signs and symptoms
*Extensive knowledge of medical terms and diseases
*Vague or inconsistent symptoms
*Conditions that get worse for no apparent reason
*Conditions that don't respond as expected to standard therapies
*Seeking treatment from many different doctors or hospitals, which may include using a fake name
*Reluctance to allow doctors to talk to family or friends or to other health care professionals
*Frequent stays in the hospital
*Eagerness to have frequent testing or risky operations
*Many surgical scars or evidence of numerous procedures
*Having few visitors when hospitalized
*Arguing with doctors and staff
