W4: anxiety disorders Flashcards

Question

discuss the use of antidepressants in anxiety treatment

Answer 1

- Antidepressant medication (typically SSRI category) are preferred medication in anxiety treatment = works by changing the level of the neurotransmitter, serotonin in the brain. - Serotonin is thought to have an important effect on mood and anxiety. Low seretonin= low levels of mood and anxiety SSIR= increase uptake of serotonin in the brain and thus increase mood. Benifits - They are well tolerated by most people - Not addictive Side effects include; - feeling agitated - anxious - feeling or being sick - diarrhoea - headache - problems sleeping - drowsiness - sexual problems (most will diminish). Most people start to feel better within 2-4 weeks SSRI’s commonly prescribed for anxiety include sertraline, citalopram, fluoxetine, fluvoxamine,paroxetine

Answer 2

= Benzodiazepines suppress the CNS and enhance the effects of GABA. - GABA is a inhibitory neurotransmitter making the neurons less responsive to excitatory neurotransmitters of norepinephrine, serotonin, and dopamine therefore reduce symptoms of anxiety. - also known as anxiolytics - anti anxiety medications. Benifits - rapid onset of action Risks - risk of dependence, sedation and tolerance. - NOT first line of treatment. Symptoms of anxiety; - increased heart rate - fearfulness - sense of dread - relaxing muscles - severe agitation

Answer 3

Physical responses: palpitations, tachycardia, dry mouth, chest pain, sweating, shortness of breath, GI upset, hot flashes, insomnia, trembling. Psychological or affective responses: feeling on edge, extreme or irrational fear, hypervigilance, tense, nervous, scared, fearful, impaired concentration. Behavioural responses: isolation, avoidance, aggression, increasing consumption of substances.

Answer 4

Biological: - Drugs; nicotine, caffeine, prescription drugs, amphetamines, marijuana, and cocaine - Drug withdrawal - Inadequate nutrition - Endocrine (thyroid or adrenal) - Chronic illness - Menopause - Cardiac - Eating disorders - Other mental illnesses Psychological: - Coping strategies - Personality traits - Self-talk or thinking processes Social: - Life events, e.g. divorce or financial difficulties, changing jobs or schools, natural disaster, school exams - Bullying/ Punishment - Childhood experiences and associations, e.g. role modelling, unsafe early childhood, parenting (rewards and punishment)

Answer 5

Ilicits a fight, flight or fright/freeze - Increase heart rate/ strength of beat - Redistribution of blood from areas that are not vital to those that are (ever notice your hands going cold when you're nervous?) - Increase in rate and depth of breathing - Increased sweating - Pupils dilating - Decreased activity of the digestive system - Muscle tension.

Answer 6

- To establish a good therapeutic relationship - To consider differential diagnoses and establish a primary diagnosis (only psychiatrists and psychologists can give official diagnoses. As nurses we can still make a provisional diagnosis) - To identify comorbid disorders and risks that may affect treatment and outcome - To assist treatment planning - To assess psychosocial and lifestyle factors that could predispose and perpetuate the anxiety disorder - To assess the capacity of the individual to benefit from self-help material independent of the nurse.

Answer 7

The nature, severity and duration of symptoms - Nature (ask the client to talk about where in their body they experience the anxiety. What does it feel like?) - Severity (Get the client to rate this from 0 no anxiety to 10 worst anxiety they have ever experienced) - Duration (How long does the anxiety remain? minutes, hours, half a day, whole day, weeks, months) - The underlying cognitions - Behavioural and cognitive responses to anxiety (e.g. avoidance, worry, reassurance-seeking, safety behaviours) - Precipitants for anxiety - The degree of distress and functional impairment - The presence of any comorbid mood disorders or anxiety disorders, substance use disorders, personality disorders or medical conditions - The presence of suicidal ideation - Experience with previous treatment for the disorder, including therapeutic response and adverse effects - Personal and family history of mental disorders - Social life and circumstances (e.g. quality of interpersonal relationships, social media presence, living conditions, employment, immigration status) - Factors that could be maintaining the disorder or preventing the individual from recovering

Answer 8

General appearance and behaviour - psychomotor agitation (they be may restless) or have difficulty sitting still - sweats, shaking or have muscle tension - GI upset or complain of feeling sick - hyperventilation Speech - increased rate - hesitant or shaky Mood - low - related in insomnia, loack of sleep or Gi upset/distrubances Thought content - constant worry of issues and events - worry out of proportion - catastrophising - engaging in unhelpful thinking patterns and negative self talk Cognition - difficulty concentrating - easily distracted - difficult making decisions - memory impairment e.g. forgetting daily commitments that they wouldn't usually forget Insight - understand their fear/anxiety is unwarranted but have limited ability or are unable to control it and feel overwhelmed

Answer 9

- Convey calmness and confidence, assist in containing their anxiety - Reduce the immediate demands on the person, where possible move the person to a quieter environment - Respond to their immediate needs - Avoid medical terminology and jargon that will impede the therapeutic relationship - Utilise diversion activities when the person displays signs of escalating anxiety levels - Give the person regular feedback and ownership of successes - Assist the person to explore and mutually identify any events / factors that may have precipitated their distress - Assist the person to identify adaptive coping mechanisms that were previously trialled and successful

Answer 10

- Establish therapeutic rapport - Remain person centred and responsive to the person’s immediate needs using active listening skills, being supportive and providing reassurance - Encourage the person to discuss their feelings and share their thoughts and associated experiences – acknowledge, validate, clarify and empathise - Covey a shared understanding of the person’s situation and accept the person’s feelings - Be mindful that people with anxiety disorders will be sensitive to any indication that they are being judged and will fear perceived rejection - Be mindful of our own anxieties – this can further exacerbate the client’s anxiety

Answer 11

- break the cycle of anxiety by distracting them away from worry. - decrease body physiological response

Answer 12

Physical exercise - implement/encourage physical exercise e.g. running, pelvic floor as more decent option Mental exercises - e.g. count backwards by 7s Sensory modulation: Using targeted sensory input can lead to reduced anxiety and produces calmer states in people with mental illness. There are various ways that you could do this in a ward setting for example vestibular input through a rocking chair, deep pressure touch through encouraging the client to engage in self-massage or use of weighted blankets, auditory input through use of the application of aromas through scented hand-creams. Look for the sensory room or sensory box when you are on placement. Mindful - focusing on the present moment and becoming less focused on unhelpful things - lead a mediation breathing exercises - increase rate and depth of breathing to overcome physiological changes caused by anxiety - something mindful breathing

Answer 13

Some questions to guide this process are: 1. What is the evidence? What evidence do you have to support the thoughts? What evidence do you have against them? 2. What alternative views are there? How would someone else view this situation? What evidence do you have to back these alternatives? 3. What is the worst that could happen? Could you live through it? What is the best that could happen? What is the most realistic outcome? 4. What is the effect of thinking the way you do? Does it help you, or hinder you from getting what you want? How? What would be the effect of looking at things less negatively? What would you tell a friend if they were in the same situation? Am I blaming myself for something that is not my fault? Am I taking something personally which has little or nothing to do with me? Am I expecting myself to be perfect? Am I using a double standard- how would I view someone else in my situation? Am I overestimating the changes of disaster? Am I exaggerating the importance of events? Am I fretting about the way things ought to be instead of accepting and dealing with them as they come? Am I assuming I can do nothing to change my situation? Am I predicting the future instead of experimenting with it? 5. What action can I take? What can I do to change my situation? Am I overlooking solutions to problems on the assumption they won't work? What can I do to test out the validity of my rational answers?

Answer 14

- People who are experiencing anxiety may report feel like they are ‘out of control.’ - Education on anxiety and strategies to decrease unpleasant symptoms will give the client hope and a sense of control over their life. - Education is an important strategy when working within a recovery-orientated framework as it helps to build a culture of hope, it promotes autonomy and self-determination, and it fosters collaboration and meaningful engagement.

Answer 15

- What anxiety is, including the body’s physiological response - The relationship between increased stress and anxiety - Lifestyle interventions (sleep hygiene, decreasing caffeine, decreasing drug and alcohol use, getting adequate exercise). A helpful strategy here is to teach your client to reflect on the acronym PLEASE. Have I.... - Treated PhysicaL illness? - Balanced Eating? - Avoided mood-Altering substances? - Balanced Sleep? - Exercised? (Linehan, 2015, p249) - The relationship between unhelpful thinking styles and anxiety and how to challenge these thoughts - How relaxation and distraction can help with anxiety How to identify triggers for escalating anxiety