week 4 mood disorders- anxiety and ptsd Flashcards
anxiety disorders types
- Specific phobia (9.1%)
- Panic Disorder (6%)
- Social anxiety disorder (2.7%)
- Agoraphobia (0.9%)
- Generalized anxiety disorder (2.2%)
- Separation anxiety disorder (4%)
anxiety disorder neurobiology
-genes
-psychosocial adversity in childhood
-ongoing or recent psychosocial stress
-norephinehrine
-serotonin
-dopamine
Anxiety Disorders: Pharmacotherapeutic Interventions: Antidepressants & Anxiolytics
Increase activity of neurotransmitters in the brain which help to lessen the symptoms of anxiety
* Dopamine
* Norepinephrine * Seratonin
* Work best when combined with psychotherapy, social support and self care
Specific Phobia: Diagnostic Criteria (DSM-5, APA)
❑ Extreme anxiety experienced when anticipating exposure or being exposed to a feared stimulus
❑ Five categories of specific phobias:
❑ Animal type (spiders, snakes, dogs)
❑ Natural environment type (tornadoes, heights, water, fire)
❑ Blood injection type (needles, medical procedures)
❑ Situational type (flying on an airplane, enclosed spaces)
❑ Other type (phobias that do not fit into the previous four categories)
Panic Disorder: Diagnostic Criteria
❑ Extreme surge of fear and discomfort due to a perceived loss of control ❑ Physical symptoms may signal the presence of a panic attack including:
❑ Dizziness
❑ Nausea
❑ Racing heart
❑ Shaking
❑ Trembling
❑ Sweating
❑ Chills
❑ Unsteadiness
❑ Shortness of breath ❑ Sensation of choking ❑ Chest pain
❑ Abdominal pain
❑ Fear of losing control ❑ Fear of dying
Social Anxiety Disorder: Diagnostic Criteria
❑ Extreme fear of social situations
❑ Extreme fear of criticism or scrutiny by others in social interactions ❑ Intense fear often leads to avoidance of the social situation \
❑ Intense fear can cause impairments in school, work or relationships
Obsessive Compulsive Disorders
Obsessions
* Recurrent Persistent Intrusive un-wanted THOUGHTS
Compulsions
* Repetitive behaviours or mental acts that the person is driven to perform in response to the obesessive thought
=
OCD
* Body Dsymorphic D/O
* Hoarding D/O
* Trichotillomania * Excoriation D/O
Obsessive Compulsive Disorder: Diagnostic Criteria
❑ Behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation, however these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive
❑ The obsessions or compulsions are time-consuming or cause clinically significant distress or impairment in social, occupational or other important areas of functioning
❑ The obsessive compulsive symptoms are not attributable to the physiological effects of a substance
❑ Recurrent and persistent thoughts, urges or images that are experienced, at some time during the disturbance as intrusive and unwanted and that in most individuals cause marked anxiety or distress
❑ The individual attempts to ignore or suppress such thoughts urges or images or to neutralize them with some thought or action
❑ Repetitive behaviors (hand washing, ordering, checking) or mental acts (praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly
Benzodiazepines- side effects
-Common side effects include drowsiness, sedation, dizziness and loss of balance
* Effects are more serious when combined with alcohol or with other sedative medications
Clonazepam (Rivotril)
Alprazolam (Xanax)
Lorazepam (Ativan)
Anxiety Disorders: Non-Pharmacological
Interventions: Cognitive Behavior Therapy+.benefits/drawbacks
- CBT is the evidence-based treatment) of choice for people living with anxiety disorders
- The aim of CBT is to help the client to become aware of inaccurate or negative thinking so that they can view challenging situations more clearly and respond to them in a more effective way
- CBT can be helpful either alone or in combination with other therapies
BENEFITS
* Helps individuals with illness self- management
* Has a role in preventing relapse of symptoms of anxiety
DRAWBACKS
* Individuals may feel emotionally uncomfortable at times when they are exploring painful feelings, emotions and experiences
* Individuals may feel physically drained, cry, get upset or feel angry during challenging sessions
46
Anxiety Disorders: Non-Pharmacological Interventions
Exposure & Response Prevention + benefits and drawbacks
- An evidence-based treatment for people living with obsessive compulsive disorder, panic disorder and agoraphobia
- Exposure consists of habituating the client degree by degree to the feared situations in imagination and then in vivo
- The aim is to obtain a habituation of emotional responses and the extinction of avoidance behaviors which are reinforced by anxiety
- Exposure treatment is most effective when used in combination with antidepressants
BENEFITS
* Exposure to feared
situations in imagination before being exposed to them in vivo reduces anxiety responses
DRAWBACKS
* Completion of homework exercises between sessions is important to optimize treatment benefits
* Services may not be available through publicly funded health care system
Mood Disorders: Non-Pharmacological Interventions
Cognitive Restructuring
- An evidence-based therapy for anxiety disorders
- Therapy has four key components:
- Breathing retraining to help to control the physiological sensations resulting in panic attacks
- Teaching abdominal breathing (Valsalva technique) to control tachycardia
- Cognitive restructuring to modify misinterpretations of bodily sensations and challenge the “danger” cognitive schemata
- Graded exposure through behavioral experiments to modify agoraphobia
- Treatment typically includes 15 to 20 sessions
BENEFITS - Brief intervention is effective in reducing anxiety
48
DRAWBACKS - Services may not be available through publicly funded health care system
Anxiety Disorders: Nursing Interventions
Psychoeducation
Skill Teaching- illness self- management
Supportive Counselling
Family support & education
Delivering brief structured treatments
Resource matching & referral
Individual & system level advocacy
Crisis prevention & intervention
Monitoring Service Delivery
Medication monitoring, management & Administration
Risk factors for trauma-related disorders include:
Experiencing dangerous events and trauma in the past
* Having a history of mental health or substance use problems
* Feeling helplessness or extreme fear
* Having a small support system after the traumatic event
* Feeling guilt shame or responsibility for the event or its outcome
* Experiencing additional stress after the event
Post-Traumatic Stress Disorder: Diagnostic Criteria (DSM-5, APA)
❑ Reexperiencing a traumatic event over and over having recurring nightmares
❑ Experiencing unwanted, disturbing memories of the event
❑ Acting or feeling as if the event is happening again
❑ Feeling upset when reminded of the event
❑ Staying away from activities, places or people that are reminders of the traumatic experience
❑ Avoiding friends and family
❑ Losing interest in activities that used to be enjoyable
❑ Being unable to feel pleasure
❑ Experiencing difficulty having loving feelings
❑ Constantly worrying
❑ Having a hard time concentrating
❑ Getting angry easily
❑ Having trouble falling asleep or staying asleep
❑ Fearing harm from others
❑ Experiencing sudden attacks or dizziness, fast heartbeat or shortness of breath
❑ Having fears of dying
