Unit 23 Anxiety/Adjustment/Trauma Related Disorders Flashcards
What are some anxiety disorders?
General anxiety disorder Panic disorder Phobias Obsessive compulsive Post Traumatic Stress Disorder Adjustment Disorders Body Dysmorphic Disorder Trichotillomania (Hair-Pulling Disorder)
What is stress? anxiety? fear?
Stress is an external pressure that is brought to bear on the individual.
Anxiety is the subjective emotional response to that stressor.
Fear is a cognitive process whereas anxiety is emotional.
What are the common characteristics of people with Neuroses?
- Aware that they are experiencing distress
- Aware that their behaviors are maladaptive
- Unaware of any possible psychological causes of the distress
- They feel helpless to change their situation
- They experience no loss of contact with reality
- Ego-dystonic symptoms* (thoughts and behaviors that are in conflict with the ego/person’s ideal self-image.)
How are neurotransmitters affected in anxiety disorders?
Serotonin decreased
Norepinephrine increased
What can anxiety interfere with? Who is more common in and who is at risk for anxiety?
- Anxiety interferes with social, occupational, or other important areas of functioning.
- More common in women
-Minority children and children from low socioeconomic
environments at risk
-Genetic, developmental, environmental and
psychological play a role in the etiology
-Mild, moderate, severe, and panic levels
What else can produce anxiety?
Medical issues that produce those symptoms such as:
- Cardiac
- Endocrine
- Respiratory
- Neurological
Substance induced anxiety from:
- Alcohol
- Amphetamines or cocaine
- Hallucinogens
- Caffeine
- Cannabis
- Etc.
What is General Anxiety Disorder? What are manifestations of it?
Chronic, unrealistic, excessive anxiety and worry that persists at least 6 months.
General anxiety all the time
Motor tension:
Restless, easily fatigued, difficulty
concentrating, irritable, muscle tension
Autonomic hyperactivity:
sweating, palpitations, clammy hands, urinary frequency, ↑ HR
Apprehensiveness:
Worry, insomnia, ↓ concentration
Hyper-vigilance:
Scanning the environment, distractibility
What is Panic Disorder? What do symptoms include?
Severe, recurrent panic attacks, with sudden unpredictable onset and intense dread.
At least *4 of the following symptoms:
- Dyspnea
- Palpitations
- Chest discomfort
- Syncope
- Dizziness
- Diaphoresis
- Hot or cold flashes
- Trembling
- Tingling hands or feet
- Fear of losing control
- Feelings of unreality going crazy, dying
What is Panic Disorder with Agoraphobia?
-Characterized by same symptoms characteristic of
panic disorder
-In addition, fear of
being in places where escape might be difficult (or embarrassing) or in which help might not be available in the event that a panic attack
happens
What is the basic nursing care for individuals with Panic Disorder of General Anxiety Disorder?
-Relief of acute panic symptoms.
-Assisting patient to take control of
his/her own life situations and accept those
situations over which he/she has no
control.
-one instruction at a time, (face to face, stay with them)
What are Phobias?
Irrational fear of an object or situation, although the person may recognize it as unreasonable.
Examples:
- Agoraphobia
(open spaces) - Social phobia
- Specific phobia
-Anxiety is severe if the object, situation, or activity
cannot be avoided.
-Defense mechanism used is “Displacement.”
What is the nursing care for phobias?
Intervention aimed at decreasing fear and increasing ability to function in presence of the phobic stimulus.
What is Obsessive Compulsive Disorder? what happens if compulsions are resisted?
Preoccupation with persistent intrusive thoughts (obsessions) and repeated performance of rituals
(compulsions).
-Time consuming and impair normal functioning.
-Anxiety occurs if obsessions or compulsions
are resisted.
What are interventions for escalating anxiety?
-Stay and offer safety
-Maintain calm, non-threatening approach
-Use simple words and brief messages
-Slow breathing
-Low stimuli
-Helping the client learn to function in the presence of the phobic object without experiencing panic anxiety
-Administer medication
-When level of anxiety reduced, explore reasons
for occurrence
-Teach s&s, ways to interrupt progression
What are treatments for anxiety disorders?
- Individual psychotherapy
- Cognitive therapy
- Behavior therapy
- Desensitization therapy and Implosion therapy (Phobia)
- Relaxation
- Physical Exercise
- Nutrition ;↓ caffeine, take additional vitamins B and C
- Group therapy
- Psychopharmacology- Anxiolytics, antidepressants
Describe the action of anti-anxiety agents used in Anxiety Disorders.
- Depress levels of the CNS
- Potentiates the inhibitory effects of GABA
Exception: Buspirone
-Buspirone does NOT depress the CNS
-It’s thought to effect serotonin, dopamine, and other
neurotransmitter receptors
What are the anti-anxiety (Anxiolytic) medications used?
[Benzodiazepines:]
all the “zepam” Rx’s
[-buspirone (BuSpar)]
[Antihistamines:]
hydroxyzine (Vistaril)
diphenhydramine (Benadryl)
[B-Blockers]
Propranolol (Inderal)
What are side effects of antianxiety(Anxiolytic) agents?
- Drowsiness, confusion, lethargy
- Enhances effects of other CNS depressants
- Orthostatic hypotension
- Paradoxical excitement
- Dry mouth; nausea and vomiting
- Blood dyscrasias (body part suffers abnormal blood supply)
-10 to 14 day delayed onset of action (with
buspirone)
-Tolerance; physical and psychological dependence
(does not apply to buspirone)
What are the medications for the specific disorders OCD and PTSD?
OCD:
-Antidepressants (Luvox-SSRI)
PTSD:
Antidepressants - Tricyclics, SSRI’s,Trazadone
Anxiolytics - Xanax, Buspirone
Antihypertensives - Propranolol
Anticonvulsant - Tegretal, Depakote, Lithium
What should the nurse plan to teach a client who is taking alprazolam (Xanax) three times a day?
That there is a potential for dependence and
tolerance.
What are nursing interventions for OCD?
- Helping the client learn new, more adaptive coping strategies without resorting to obsessive-compulsive behaviors
- Helping the client gain independence and greater control over life situations
What are nursing interventions for PTSD aimed at?
- Integration of the trauma into his or her persona
- Renewing significant relationships
- Establishing meaningful goals for the future
- Progressing through the grief process
- Developing a sense of optimism and hope for the future
What is Body Dysmorphic Disorder?
- Characterized by the exaggerated belief that the body is deformed or defective in some specific way
- If true defect is present, the person’s concern is unrealistically exaggerated and grossly excessive
- Symptoms of depression and obsessive-compulsive personality are common
What is Hair-Pulling Disorder (Trichotillomania)?
- The recurrent pulling out of one’s own hair that results in noticeable hair loss
- Preceded by increasing tension and results in sense of release or gratification
- More common in women
What are psychosocial influences related to trichotillomania?
Stressful situations
Disturbances in mother-child relationship
Fear of abandonment
Recent object loss
Possible childhood abuse or emotional neglect
What is Posttraumatic Stress Disorder?
A reaction to an extreme trauma, likely to cause pervasive distress to almost anyone, such as natural or man-made disasters, combat, serious accidents, witnessing the violent death of others, being the victim of torture, terrorism, rape, or other crimes.
- Symptoms may begin within the first 3 months after the trauma, or there may be a delay of several months or even years
- More common in women
What are the characteristics of Posttraumatic Stress Disorder?
- Re-experiencing the traumatic event
- A sustained high level of anxiety or arousal
- A general numbing of responsiveness
- Intrusive recollections or nightmares
- Amnesia to certain aspects of the trauma
- Depression; survivor’s guilt
- Substance abuse
- Anger and aggression
- Relationship problems
What is Acute Stress Disorder?
- Similar to PTSD in terms of precipitating traumatic events and symptomatology
- Symptoms are time limited: up to 1 month following the trauma
- If the symptoms last longer than 1 month, the diagnosis would be PTSD
What is Adjustment Disorder?
-Maladaptive reaction to an identifiable stressor or stressors, results in significant emotional or behavioral symptoms
-Symptoms occur within 3 months of the
stressor and last no longer than 6 months
Which of the following medications is
considered to be a first-line medication of
choice in the treatment of PTSD?
SSRI paroxetine
