Unit 3 Anxiety and Obsessive Compulsive Disorders Chapter 15

Question 1

What is Anxiety

Answer 1

Anxiety is a universal human experience and is among the most basic of emotions.

Anxiety is a feeling of apprehension, uneasiness, uncertainty, or dread resulting from a real or perceived threat.

Fear is a reaction to a specific danger, whereas anxiety is a vague sense of dread related to an unspecified or unknown danger.

Question 2

Mild anxiety

Answer 2

A person experiencing a mild level of anxiety sees, hears, and grasps more information, and problem solving becomes more effective.

Physical Symptoms

Physical symptoms may include slight discomfort, restlessness, irritability, or mild tension-relieving behaviors (e.g., nail biting, foot or finger tapping, fidgeting).

Question 3

Moderate Anxiety

Answer 3

As anxiety increases, the perceptual field narrows, and some details are excluded from observation. The person experienc- ing moderate anxiety sees, hears, and grasps less information and may demonstrate selective inattention, where only certain things in the environment are seen or heard unless they are pointed out. The ability to think clearly is hampered, but learning and problem solving can still take place, though not at an optimal level.

physical symptoms

The individual may experience tension, a pounding heart, increased pulse and respiratory rates, perspiration, and mild somatic symptoms (e.g., gastric discomfort, headache, uri- nary urgency). Voice tremors and shaking may be noticed.

difficulty concentrating
-selective inatenttion

Question 4

Severe Anxiety

Answer 4

A person with severe anxiety may focus on one particular detail or on many scattered details and have diffi- culty noticing what is going on in the environment, even when another person points it out. Learning and problem solving are not possible at this level, and the person may be dazed and con- fused.

Physical symptoms- IMPENDING DOOM

Behavior is automatic and aimed at reducing or relieving anxiety. Somatic symptoms (e.g., headache, nausea, dizziness,insomnia) often increase. Trembling and a pounding heart are common, and the person may experience hyperventilation and a sense of impending doom or dread.

Question 5

Panic Attack

Answer 5

Panic is the most extreme level of anxiety and results in mark- edly dysregulated behavior. Someone in a state of panic is unable to process what is going on in the environment and may lose touch with reality. The behavior that results may be manifested as pacing, running, shouting, screaming, or with- drawal.
LOSS SENSE OF REALITY

PHYSICAL SYMPTOMS

The behavior that results may be manifested as pacing, running, shouting, screaming, or with- drawal. Hallucinations, which are false sensory perceptions, such as seeing something that is not really there or hearing voices, may be experienced. Physical behavior may become erratic, uncoordinated, and impulsive.
Physical behavior may become erratic or impulsive

Question 6

• Slight discomfort
• Attention-seeking behavior
• Restlessness
• Easily startled
• Irritability or impatience
• Mild tension-relieving behavior (foot or
• finger tapping, lip chewing, fidgeting)

What category is these symptoms according to the different stages of anxiety
A. Mild
B. Moderate
C. Severe
D. Panic

Answer 6

A. Mild

Question 7

• Voice tremors
• Change in voice pitch
• Poor concentration
• Shakiness
• Somatic complaints (urinary frequency,
• headache, backache, insomnia) Increased respiration, pulse, and muscle
• tension
  More tension-relieving behavior (pacing,
  banging hands on table)

What category is these symptoms according to the different stages of anxiety
A. Mild
B. Moderate
C. Severe
D. Panic

Answer 7

B. Moderate

Question 8

• Feelings of dread
• Confusion
• Purposeless activity
• Sense of impending doom
• More intense somatic complaints
• (chest discomfort, dizziness,
• nausea, sleeplessness) Diaphoresis (sweating) Withdrawal
• Loud and rapid speech
• Threats and demands

What category is these symptoms according to the different stages of anxiety
A. Mild
B. Moderate
C. Severe
D. Panic

Answer 8

C. Severe

Question 9

• Experience of terror
• Immobility, severe hyperactivity, or flight Unintelligible communication or inability to speak Amplified or muffled sounds
• Somatic complaints increase (numbness or tingling, shortness of breath, dizziness, chest pain, nausea, trembling, chills, overheating, palpitations)
• Severe withdrawal Hallucinations or delusions Likely out of touch with reality

What category is these symptoms according to the different stages of anxiety
A. Mild
B. Moderate
C. Severe
D. Panic

Answer 9

D. Panic

Question 10

What is Separation Anxiety disorder?

Answer 10

People with Separation disorder exhibit developmentally inappropriate levels of con- cern over being away from a significant other.

Separation anxiety is a normal part of infant development that begins around 8 months of age, peaks at about 18 months, and begins to decline after that.

Question 11

Signs and Symptoms of a patient with Separation Anxiety

Answer 11

-Gi disturbances
-Headache
-harm
-avoidance,
-worry,
-shyness,
-uncertainty,
-fatigability, and a lack of self-direction. Fear of separation is accom- panied by a significant level of discomfort and disability that impairs social and occupational functioning.

There may also be fear that something horrible will happen to the other person and that it will result in permanent separation. The anxiety is so intense that it distracts sufferers from their normal activities and causes sleep disruptions and nightmares. The separation anxiety is often manifested in physical symptoms, such as gas- trointestinal disturbances and headaches.

Question 12

Which of the following can cause separation anxiety?

A. Loss of Mother
B.Debt
C. Extreme temperatures
D.Giving birth

Answer 12

A. Loss of Mother

Environmental stresses—such as a significant loss through death of a relative or pet, separation from significant others, or a change in environment by moving or immigration—can bring about symptoms of this disorder. A physical or sexual assault may also precede symptoms. Inherited traits such as neuroticism may play a role in separation anxiety disorder.

Question 13

What is a Phobia

Answer 13

A specific phobia is 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. Specific phobias are characterized by the experience of high levels of anxiety or fear in response to certain objects or situations—for example, dogs, spiders, heights, storms, water, blood, closed spaces, tunnels, and bridges.

 High levels of anxiety or fear,
overwhelming and crippling
 Daily functioning is
compromised
 Activities are restricted

Question 14

Match each Clinical Name with each Phobia

Acrophobia Open spaces

Agoraphobia Heights

Astraphobia Electricalstorms

Claustrophobia Closed spaces

Glossophobia Talking

Hematophobia Blood

Hydrophobia Water

Monophobia Being alone

Mysophobia Germs or dirt

Nyctophobia Darkness

Pyrophobia Fire

Xenophobia Strangers

Zoophobia Animals

Answer 14

Acrophobia Heights

Agoraphobia Open spaces

Astraphobia Electrical storms

Claustrophobia Closed spaces

Glossophobia Talking

Hematophobia Blood

Hydrophobia Water

Monophobia Being alone

Mysophobia Germs or dirt

Nyctophobia Darkness

Pyrophobia Fire

Xenophobia Strangers

Zoophobia Animals

Question 15

What is Social anxiety disorder?

Answer 15

Social anxiety disorder, also called social phobia, is character- ized by severe anxiety or fear provoked by exposure to a social or a performance situation that could be evaluated negatively by others.

-fear of looking bad infront of people

Question 16

What can trigger Social Anxiety Disorder

Answer 16

Situations that trigger this distress include
*fear of say-ing something that sounds foolish in public,
*not being able to answer questions in a classroom,
*looking awkward while eating or drinking in public, and
* performing badly on stage.

Question 17

You as a pediatric nurse is caring for a 4 year old child. The child hides behind his parent when you try to introduce yourself to him. Which of the following disorders is the child displaying?

A. Panic disorder
B. Separation anxiety disorder
C. Social anxiety Disorder
D. Agoraphobia disorder

Answer 17

C. Social anxiety Disorder

Small children with this disorder may be mute and nervous and may hide behind their parents.

Question 18

Behavior of older children with Social anxiety Disorder?

Answer 18

*Older children and adoles- cents may be paralyzed by fear of speaking in class or interacting with peers.

*Worry over saying the wrong thing or being criticized immobilizes them.

*Conversely, younger people may act out to compensate for this fear, making an accurate diagnosis more difficult.

This anxiety often results in physical complaints that can help the person to avoid social situations, particularly school.

Question 19

Risk factors for social anxiety disorder

Answer 19

Risk factors for social anxiety disorder include childhood mistreatment and adverse childhood experiences. The trait of shyness is also strongly heritable. Having parents who are shy carries a double risk of genetic transmission and parental modeling.

Question 20

What is the key factor of panic disorders?

A. Impulsiveness
B. Panic attacks
C. Irritability
D. Halluciantions

Answer 20

Panic attacks are the key feature of panic disorder.

Question 21

Does Panick attacks occur suddenly Or routinely?

A. Suddenly
B. Routinely

Answer 21

A. Suddenly

People experiencing panic attacks may believe that they are losing their minds or having a heart attack. Typically, panic attacks come “out of the blue” (i.e., suddenly and not necessarily in response

Question 22

Adolescents experience with Panic attacks

Answer 22

*Unpredictability is a key aspect of panic disorder in chil- dren and adolescents. The attacks of panic seem to come out of nowhere, last about 10 minutes, and then subside.

*During the attack, the young person is less able to articulate its psychologi- cal aspects, such as fear.

*Such individuals may become avoidant of situations where help is not available, may develop feelings of hopelessness in controlling these attacks, and may become depressed. Alcohol or substance use is common among adoles- cents with this disorder.

*People who experience these attacks begin to “fear the fear.” They become so preoccupied with the possibility of future episodes that they avoid what could be pleasurable and adaptive activities, experiences, and obligations.

Question 23

What is Agoraphobia?

A. fear of driving
B.fear of closed spaces
C. fear of open spaces
D. fear of flying

Answer 23

C. fear of open spaces

• Intense, excessive anxiety or fear
  about being in a situation in which
  escape might be difficult, or
  embarrassing ,or where help might
  not be available.

 Situation is avoided
 Debilitating and life constricting
 Stressful life events and/or adverse
childhood events often precede dx

Question 24

Your patient is expelling the fear that he has. He describes the fear as being afraid of large fields, being in the middle of the woods and ocean. Which of the following phobias is your patient describing?

A. Acrophobia
B. Agoraphobia
C. Astraphobia
D. Claustrophobia

Answer 24

B. Agoraphobia

Situations that are commonly avoided are being alone outside; being alone at home; traveling in a car, bus, or airplane; being on a bridge; and riding in an elevator.

Question 25

Which of the following therapies are anticipated for a patient with a phobia?

A. Interpersonal theory
B. Cognitive Behavioral Therapy
C. Systemic Desensitization Therapy
D. Social therapy

Answer 25

C. Systemic Desensitization Therapy

Question 26

What is Generalized Anxiety Disorder?

Answer 26

The key pathological feature of generalized anxiety disorder is excessive worry.

Question 27

What is a key term to describe Generalized Anxiety Disorder

Answer 27

WORRY DISORDER

 Excessive worry which leads to huge amounts of preparing
 Seek continual reassurance
 Putting things off or avoiding –

Key feature
 Sleep disturbances are common
 Adults – inadequacy, health, job performance
 DSM 5 criteria include physical symptoms

Question 28

What is the priority Nursing Intervention for General Anxiety Disorder

Answer 28

make sure their physiological needs are met especially eating and sleeping

Medication treatment:

SNRIs – Venlafaxine – tx of severe anxiety d/o duloxetine – Tx of GAD

Question 29

What would be an example of a person that has Generalized Anxiety Disorder?

Answer 29

” needing constant reassurance that your boyfriend loves you”

Question 30

What is Obsessive Compulsive Disorder

Answer 30

Is a long-lasting disorder in which a person experiences uncontrollable and recurring thoughts (obsessions), engages in repetitive behaviors (compulsions), or both.

Cause marked distress, often feel humiliation r/t the
compulsive behaviors

Question 31

What is the definition of Obsessions

Answer 31

Obsessions are thoughts, impulses, or images that persist and recur so that they cannot be dis- missed from the mind even though the individual attempts to do so

Question 32

What is the definition of Compulsions

Answer 32

Compulsions are ritualistic behaviors individuals feel driven to perform in an attempt to reduce anxiety or prevent an imagined calamity.
ACTION TO REDUCE ANXIETY

Question 33

What is the order of OCD cycle

Answer 33

1.Obsession
2. Anxiety
3.Compulsion
4. Relief

Question 34

What disorders are related to OCD

Answer 34

The obsessive-compulsive and related disorders include the following:
* Obsessive-compulsive disorder
* Body dysmorphic disorder
* Hoarding disorder
* Trichotillomania (hair pulling) disorder
* Excoriation (skin picking) disorder

Question 35

Examples of Obsessions following compulsions

Answer 35

Obsession
“If I don’t turn the light switch off, the room will catch on fire, and my mom will die while I am at school,” worries a 9-year-old girl.
Compulsion
Returns to her room four times before school, checks that the light is turned off, and taps the four sides of the light switch.

Question 36

What is Body Dysmorphia

Answer 36

Preoccupation with an imagined
defective body part
 Leads to obsessional thinking,
compulsive behavior and mirror
checking
 Overwhelming feelings of disgust,
shame and depression
 Suicide Risk is high
 Often have seek tx from cosmetology
or dermatology

-Self esteem is low

Question 37

Behavior of Body Dysmorphia

Answer 37

obsessional thinking and com- pulsive behavior such as mirror checking and camouflaging.

*Men tend to be concerned with body build and the appearance of their genitals.

*Women focus on the appearance of their skin, stomach, weight, breasts, buttocks, thighs, legs, hips, and toes.

Question 38

Which of the following therapies would improve Body Dysmorphic symptoms?

A. Interpersonal theory
B. Cognitive Behavioral therapy
C. Systemic Desensitization Therapy
D. Social therapy

Answer 38

B. Cognitive Behavioral therapy

Question 39

What is Hoarding Disorder

Answer 39

For individuals with hoarding disorder, it would be extremely distressing. In fact, the accumulation of belongings that may have little or no value prevents some peo- ple from leading normal lives.

Question 40

Is treatment easy for patients with Hoarding Disorder?

A. Yes
B. No

Answer 40

B. No

Accumulation of items with little to no value
 Prevents some from leading normal lives
 Purging gives individual extreme anxiety
 Belongings literally fill every surface and area
 Prevent people from visiting
 May become uninhabitable due to danger and or extreme sanitation risks
 75% experience depression and/or
anxiety
 Tx is more difficult for those who don’t
see hoarding as an issue

Question 41

Is it common for family to visit a person who’s a hoarder?

A. Yes
B. No

Answer 41

A. Yes

 Prevent people from visiting

Usually, family and other guests can (or will) no longer visit. The problem may progress to the point where the home is nearly uninhabitable owing to unsafe and/or unsanitary conditions.

Question 42

Which of the following terms is associated with the pulling hair disorders?

A. Acrophobia
B. Trichotillomania
C. Astraphobia
D. Claustrophobia

Answer 42

B. Trichotillomania

Either of these activities is irresistible to the individual, who typically tries to hide it. These disorders have been linked to symptoms of OCD. They occur more often in chil- dren than in adults and may begin as early as 1 year of age.

Question 43

Which of the following terms is associated with the skin pealing disorder?
A. Acrophobia
B. Trichotillomania
C. excoriation
D. Claustrophobia

Answer 43

C. excoriation

Question 44

What is a common phrase that a person may say that’s related to v when they’re stressed?

Answer 44

The phrase “I was so annoyed that I wanted to pull my hair out” attests to the anxiety-related com- ponent of the disorder.

Question 45

Is the hair being pulled from Trichotillomania only on the head ?

A.Yes
B. No

Answer 45

B. No

Typically it is the hair of the head, but it may be hair anywhere on the body, including eyebrows, eyelashes, pubic areas, axillae, and limbs.

from small patches to completely naked skin. For some, the pain brought on by hair pulling reduces their anxiety, as is the case of those who engage in cutting. Most individuals may be unaware of their behavior until they notice a wad of hair close by.

Question 46

What is the swallowing hair disorder?

A. Trichophagia
B. Trichotillomania
C. Excoriation
D. Claustrophobia

Answer 46

Trichophagia – secretly swallowing hair

This may lead to hair masses, or trichobe- zoars, in the gastrointestinal system. The masses can be fatal if they progress to abdominal obstruction or perforation. You may be interested to know that this last condition is also referred to as the Rapunzel syndrome.

Question 47

What is the biggest complication of escoriation?

Answer 47

Infection-

Complications include pain, sores, scars, and infections.

Question 48

Action Of Excoriation

Answer 48

The skin-picking of excoriation (ex·co·ri·ay·shun) disorder is typically confined to the face, although other areas of the body may be targeted. As with hair pulling, the individual may engage in skin picking as a way to deal with stress and relieve anxiety, whereas others may engage in this activity without thinking about it. Most people occasionally pick at their skin, nails, and scabs. However, people with skin-picking disorder damage their skin. Fingers and fingernails are the usual implements, but nail cutters, tweezers, and the person’s teeth may also be used. The most common areas of focus are the face, head, cuticles, back, arms and legs, and hands and feet.

Question 49

Cultural Considerations of Anxiety

Answer 49

 Some cultures express anxiety through somatic symptoms
 Panic attacks in Latin Americans and Norther Europeans often involve sensations of
choking, smothering, numbness or tingling and fear of dying
 Panic attacks involve fear of magic or witchcraft in some cultures
 Social anxiety in Japan – beliefs that individual’s blushing, eye contact or body odor is
offensive to others

Question 50

Therapy Interventions for Anxiety Disorders

Answer 50

 Cognitive Therapy
 Identify Negative Thoughts, explore, reevaluate and replace negative self-talk

 Behavioral Therapy
 Modeling
 Systematic Desensitization
 Flooding
 Response prevention
 Thought Stopping

 Cognitive-Behavioral Therapy
 Combination

Question 51

Flooding

Answer 51

Flooding involves exposing the client to a great deal of an undesirable stimulus in an attempt to turn off the anxiety response. This therapy is useful for clients who have phobias.

Question 52

Thought Stopping

Answer 52

Thought stopping teaches a client to say “stop” when negative thoughts or compulsive behaviors arise, and substitute a positive thought. The goal of therapy is that with time, the client uses the command silently.

Question 53

Systematic desensitization

Answer 53

Systematic desensitization begins with mastering
of relaxation techniques. Then, a client is exposed to increasing levels of an anxiety-producing stimulus (either imagined or real) and uses relaxation to overcome the resulting anxiety. The goal of therapy is that the client is able to tolerate a greater and greater level of the stimulus until anxiety no longer interferes with functioning. This form of therapy is especially effective for clients who have phobias.