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What is the difference between anxiety and anxiety disorders?
Anxiety disorders are chronic and impair the following-- Daily routines,Social functioning, Occupational functioning
Symptoms of a panic attack
- Shortness of breath
- Chest pain
- Racing heart
- Abdominal distress
- Chills n“Hot flashes”
- “Going crazy”
- Losing control
What is a panic attack?
Recurrent, unexpected, intense periods of extreme apprehension and terror without a clear precipitant
Adverse effects of panic disorder
- Limits social activities
- Interferes with work and social relationships
What is a panic disorder?
- When panic attacks are unexpected and recurrent
- After at least one attack the client has concerns about more attacks in the future, worries about the implications of future attacks, and has a change in behavior.
What is agoraphobia?
“fear of the marketplace” where fear focuses on being in places or situations where there is no escape or leaving would be difficult or embarrassing
Panic disorder without agoraphobia?
recurrent, unexpected panic attacks followed by at least one month of persistent concern about having another panic attack and how this would adversely impact their life.
Panic disorder with agoraphobia?
recurrent, unexpected panic attacks along with social withdrawal and isolation related to the fear of having future attacks (50% experience this)
What is Primary gain?
relief of anxiety by performing certain behaviors (such as staying at home).
What is secondary gain?
attention received from others due to behaviors ( such as relief from daily responsibilities).
What are some Treatments of panic disorder?
- Cognitive-behavioral techniques—reframe catastrophic thinking and self-awareness issues
- Deep-breathing and relaxation
- Medications such as anxiolytics, antidepressants, and alpha adrenergic agonists.
What is the nursing process for panic disorder?
- Assessment—signs and symptoms
- Nursing diagnoses—Risk for injury, Anxiety, Fear, Social isolation, Disturbed Sleep, Altered Nutrition
- Goals—Injury prevention, Improved coping, Adequate sleep and nutrition
What are the Nursing interventions for patients with panic disorder?
- safe environment
- Decrease stimuli
- Remain with the client
- Display a calm demeanor
- Therapeutic communication
- Mutual problem-solving
What are some coping techniques for patient with panic disorder?
- Relaxation techniques
Client and family teaching-Avoid secondary gain behaviors
- Review breathing control and relaxation techniques
- Discuss positive coping strategies
- Medication and follow-up
- Time management and goal-directed activities
- Participation at the community level in support groups, family therapy, etc.
What are phobias?
Persistent, excessive, irrational fear of a particular object or situation that can lead to avoiding the feared object or situation.
What are some types of phobia?
- Agoraphobia—”fear of the marketplace”...where one may avoid public places and in extreme cases may never leave home
- Specific phobias
- Social phobias
What is the definition of Specific phobias?
- Irrational fear of an object or situation for at least 6 months in persons older than 18 years of age
- Broad categories of specific phobias:Natural environment, Blood-injection, Situational, Animal, Other
How the DSM-IV defines “specific phobia”
- Client has marked, persistent, excessive, or unreasonable fear. Presence of the object/situation or “anticipation” can provoke fear.
- Exposure causes marked anxiety
- Client recognizes their fear is irrational
- Attempts to avoid or endure=distress and disability to usual activities
Examples of specific phobias
- Acrophobia—fear of heights
- Astrophobia—of thunderstorms
- Claustrophobia—when confined
- Glossophobia—of talking
- Hematophobia—of blood
- Hydrophobia—of water
What is Social phobia?
The client experiences severe anxiety, possibly panic when confronted with situations involving people such as—Making a presentation, Eating out, Meeting new people, Being the “center of attention”
Diagnosis or seriousness of phobias
- Diagnosis based on how phobic behavior affects the client’s lives
- Is there marked distress?
- Does it present difficulties with interpersonal relationships or interfere with the client’s occupation?
What are some Treatments of phobias?
- Psychopharmacology—anxiolytics, SSRI antidepressants, beta blockers (cardiac)
- Behavioral therapies such as desensitization, exposure treatment, flooding, and cognitive re-structuring
What is Systemic desensitization?
- The therapist progressively exposes the client to their phobic object in a safe setting and teaches relaxation strategies
- The complexity and intensity of the exposure is gradually increased
- Once the client’s anxiety is manageable, they are encouraged to confront the source of their phobia
What is flooding?
- The therapist “floods” the patient with information that causes anxiety.
- There is a sort of “give and take” communication pattern
- The therapy is considered successful once the client doesn’t react adversely to the information
What is Obsessive-compulsive disorder (OCD)?
Client has intrusive thoughts of unrealistic obsessions and in an effort to control these thoughts---they engage in Compulsive behaviors
What are some Common types of obsessions?
Repeated thoughts about: Contamination,Doubts,Order ,Aggression or horrific impulse, Sexual imagery
What are some Clinical examples of compulsions?
- Checking rituals—Is the door locked? Is the coffee pot off?Counting rituals—ceiling tiles, steps
- taken, desks in class.
- Praying or chanting
- Touching, rubbing, or tapping
- Ordering—vacuuming in one direction
- Rigid performance—only dress in one way
- Aggressive urges—to harm one’s spouse or child
What are some Statistics about OCD?
- Onset as young as childhood, commonly seen in the “20’s”
- Equal sex distributionnGradual onset and may be exacerbated by stress
- Manageable in 80% of cases
- With 15% of cases, see progressive deterioration
What are some treatments of OCD?
- Combined behavior therapy and medication
- Medications include: SSRI antidepressants, Fluvozamine (Luvox),Clomipramine (Anafranil),Buspirone (BuSpar), Clonazepam (Klonipin)
What are some Behavior therapies for OCD?
- Exposure—to confront the situations they have been deliberately avoiding
- Response prevention—delaying or avoiding their rituals
- *Empowerment of the client to recognize that the anxiety will recede and they do not need to engage in their ritualistic behaviors
What is the Yale-Brown Obsessive-Compulsive Scale?
- Extensive assessment tool using 14 criteria
- Examples include-- qHow much time do you spend having obsessive thoughts or performing compulsive behaviors? Range from none to greater than 8 hours a day
What is the Nursing process for OCD ?
- Diagnoses—Ineffective coping, Fatigue, Social isolation
- Goals—Client will follow a daily routine, Spend less time on rituals, and/or Exhibit an improved communication pattern
What are some Nursing interventions for OCD?
- Convey “acceptance” for the client
- Establish trust by: Allowing time for rituals, Mutual goal-setting—set limits, Active listening—therapeutic communication, Identify “triggers”—”Exposure Response Prevention” programs,
- Teach coping mechanisms such as journaling, relaxation techniques,Follow a daily routine, and Medication compliance and education issues
What are some things we can educate the family regarding OCD?
- Supportive role of family
- Open communication
- Family therapy
- Medication and therapy compliance
- Prognosis is good with early recognition and therapeutic intervention
What is Generalized Anxiety Disorder?
- Client has worries or feels anxious 50% of the time for at least 6 months
- Exhibits at least 3 of the following symptoms:Uneasy, Irritable, Muscle tension, Fatigue, Difficulty thinking, Sleep disturbances
- Often seen by non-psychiatrist providers
- Tends to diminish client’s quality of life and that is the rationale for treatment
- Medications often include SSRI’s or Buspar
- Cognitive therapy improves the results and outcomes of pharmacology treatment
What is the definition of Dissociative Disorders?
A subconscious effort to regain control over a traumatic situation—allowing the mind to remove the painful event from its memory.
What are some Underlying causes of dissociative disorders?
- Trauma—person may separate themselves from the memory
- Abuse—especially during childhood
- Effect of early abuse—may cause poor neurodevelopment (limbic, left brain)
- Gender—3-9 times more common among women
What are some Symptoms of Dissociative Disorders?
- May occur both during and after the event
- Onset may be sudden or gradual, transient or chronic
- Rare in the general population
What are some types of dissociative disorders?
Amnesia, Fugue, Identity disorder, Depersonalization
What is amnesia?
cannot remember important personal information
What is Fugue?
leaves their current setting of home or work and relocates elsewhere unable to remember past identity
What is the definition of an identity disorder?
displays 2 or more distinct identities—yet, doesn’t know important personal information—”Multiple Personality Disorder” formerly described this disorder
What is the definitions of depersonalization?
"detached” from their body or mental processes yet in touch with reality
What are some types of amnesia?
local and selective, general amnesia, continuous amnesia, and systemized amnesia.
What is Local and selective amnesia?
cannot recall details about a traumatic event for a certain amount of time—such as after a MVA
What is general amneisa?
has no recollection of their former life
What is continuous amnesia?
cannot recall events that occurred before a certain time
What is systemized amnesia?
categorical or specific to a certain person or place
What is dissociation?
- Broad categories: Amnesia, Fugue, Identity
- disorder, Depersonalization
- Sub-types of amnesia: Local and selective, General, Continuous-up to a certain time, and Systemized-categorical and specific to a certain situation or location
What is Post-traumatic stress disorder?
- A disturbing pattern of coping demonstrated by an individual who has experienced a traumatic event, combat, a natural disaster, assault, etc.
- Cardinal symptoms—Hyperarousal,Recurrent nightmares, Flashbacks
What are some Symptoms of PTSD?
- Reliving the event
- Avoiding reminders of the event
- Being on guard or experiencing hyperarousal
- Cues in the environment remind the brain of the original trauma
- The cues result in fight or flight responses
What are some treatments for PTSD?
- Cognitive behavioral therapy: Targeting thoughts, feeling and behavior of trauma victims, Putting
- conscious back together with dissociative disorders
- Encourage patient to talk about the event and use a system of gradual re-exposure
- May use inpatient setting and/or medications such as anxiolytics and/or antidepressants
What are some interventions that we can use for clients with PTSD?
Safety, Grounding, and change positions
Providing safety for those with PTSD will do what?
Client management while promoting self-care. Use of a “safe haven” when self-destructive thoughts or impulses are present
Grounding-"In the present" means what for those with PTSD?
Focus on the “here and now” using nursing techniques that are calm and reassuring
What does changing positions mean for those with PTSD?
Encourage the client to move out of a fetal position into one of increased control such as walking or standing
What are some Techniques that assist with coping for those with PTSD?
- Use of deep breathing, relaxation, focus on the present, or similar methods
- Distractions such as physical activity, music, conversation, hobbies, etc.
- Assess for and discourage the use of drugs and/or alcohol as coping techniques
- Journaling to identify “triggers”
What is the difference between acute stress disorder vs PTSD?
- Acute stress disorder: Symptoms occur within first month after traumatic event but do not persist longer than 4 weeks
- PTSD: Symptoms occur more than 3 months after the traumatic event, 50% of persons with PTSD have complete recovery within 3 months