Anxiety Disorders

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Anxiety Disorders
2013-01-09 17:31:56

Mental Health
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  1. What is generalized anxiety disorder (GAD)?
    A pattern of excessive worry that starts interfering with social or occupational functioning.

    80% chance of passing to child if parent has it. Only 60% with depression. 
  2. What are some SnSs of GAD?
    • Chronic low level anxiety
    • Often physical complaints
    • Chronic worry without objective stressors
    • Medication:  reduces rumination and worry
    • Calms person to get to their words
  3. Panic Disorder
    • 4 or more of the following: (Develops fast &  peaks within 10 minutes)
    • Palpitations
    • Pounding heart or rapid heart rate
    • Sweating
    • Trembling or shaking
    • Shortness of breath or smothering
    • Feeling of choking
    • Chest pain or discomfort
    • Nausea or abdominal distress
    • Feeling dizzy
    • Unsteady, lightheaded or faint
    • Derealization (feelings of unreality)
    • Depersonalization (being detached from oneself
    • Fear of dying
    • Numbness or tingling 
  4. What Rx is used for Panic Disorders?
    • -Paxil (Paroxetine)
    • For SSRIs, reduce 25%/month until discontinued. 
  5. What is a Phobia?
    • Excessive and unreasonable fear for a specific object or situation 
    • Provokes an anxiety response (in children is expressed by crying, tantrums, freezing or clinging)
    • Person knows the fear is excessive or unreasonable 
    • Phobic situations(s) avoided or endured 
    • Interference with social/occupational functioning or ADL’s
    • Defense mechanism:  Displacement and regression

    Corrected by exposure therapy. 
  6. Nursing interventions for phobias?
    • Exposure-based procedures
    • Systematic desensitization
    • Anxiety management interventions
    • Cognitive behavioral strategies
    • Medications not as effective for phobias. 
  7. What are social phobias?
    • Social situation provokes anxiety which may be as severe as a panic attack
    • Recognizes the fear is excessive or unreasonable
    • Social or performance situations are avoided or endured (with intense anxiety or distress)
    • Interferes with social/occupational functioning or ADL’s
  8. What are some nursing interventions for a social phobia?
    • Exposure-based strategies
    • Cognitive behavioral interventions
    • Medications
    • SSRIs
    • Propranolol (Inderal) (Stage fright)
  9. OCD?
    • Obsessions- Thoughts
    • Compulsions: Repetitive behaviors
    • --Hand washing
    • --Ordering
    • --Checking
    • --Mental acts (praying, counting, repeating words silently)  
    • The person feels driven to perform

    • The behaviors or mental acts:
    • --Prevent or reduce distress
    • --Prevent some dreaded event or situation
    • --Not connected in a realistic way with what they neutralize
    • --Are excessive.
    • Time consuming (More than 1 hour a day). Purpose of the ritual is the alleviate the anxiety. Does it work? 

    Goal is to limit the ritual compulsive action. Will probably not be successful in eliminating it entirely. Medication may or may not be effective. 
  10. What are the two main defense mechanisms for OCDs?
    • Undoing 
    • Isolation
  11. Nursing interventions for OCD?
    Cognitive behavioral strategies involving exposure & ritual prevention
  12. What are some Rx to Tx OCD?
    • Luvox (Fluvoxamine) SSRI                       
    • Paxil (Paroxetine) SSRI 
    • Anafranil (Clomipramine) Tricyclic
    • Zoloft (Serraline) SSRI
    • Prozac (Floxetine) SSRI
  13. What is PTSD?
    • Impairment of social/occupational functioning or difficulties with ADLs due to Exposure to a traumatic event:  
    • Actual or threatened death or serious injury to self or others.  
    • Had intense fear
    • Helplessness
  14. PTSD traumatic events experiences in 2 or more of the following:
    • Intrusive thoughts 
    • Images
    • Thoughts or perceptions (in children, they may re-enact the trauma in repetitive play)
    • Distressing dreams- nightmares 
    • Acting or feeling as if the traumatic event were recurring 
    • Dissociative flashbacks
    • Intense psychological distress 
    • Physiological activity
  15. PTSD experiencing numbing/avoiding of 3 or more of the following:
    • Thoughts
    • Feelings
    • Conversations
    • Activities
    • Places or people
    • That lead to memories of trauma
    • Inability to recall aspects of the trauma
    • Diminished interest or participation in significant activities
    • Feelings of detachment or estrangement from others
    • Restricted affect (unable to have loving feelings)
    • Sense of foreshortened future (does not expect to have a career, marriage, children, or a normal life span)
  16. PTSD symptoms of increased arousal of 2 or more of the following:
    • Difficulty falling or staying asleep
    • Irritability
    • Anger outbursts
    • Difficulty concentrating
    • Hypervigilance

    • The above are evidenced by:
    • Isolation
    • High risk behaviors
    • Survivor guilt
    • Avoids crowds and open places
    • Exaggerated startle response 
  17. Theoretical framework for PTSD?
  18. Nursing Interventions for PTSD?
    • Cognitive restructuring
    • Critical incident debriefing
    • Discuss risk taking behavior
    • Anger management 
    • Counseling & therapy 
    • --EMDR (eye movement desensitization reprogramming)
    • --Cognitive-behavioral strategies
    • --EFT (emotional freedom technique). 
    • Stress management
    • Anger management
    • Sleep hygiene Ch 16 Stuart (p. 253)
    • Teach coping skills
    • Administer medications: 
    • (SSRI, Tricyclics and MAOI)
    • --Propranolol (Inderal), Fluoxitine (Prozac)
    • --Buspirone (Buspar),
    • --Fluvoxamine (Luvox)
    • --Trazodone for sleep
  19. What are Somataform Disorders?
    • Somatization Disorder: Somatization 
    • Somatization 
    • Conversion Disorder: Conversion 
    • Conversion
    • Hypochondriasis
    • Body Dysmorphic Disorder

    No physical cause or actual disorder, but will feel pain.
  20. SnSs of somatization disorders
    • History of many physical complaints
    • Begins before age 30
    • Results in seeking treatment
    • Social/occupational impairment or interference in ADLs.
    • Somatization defense mechanism
    • Describe complaints in colorful, exaggerated terms, lacking in factual information
    • Inconsistent historians  
    • Seek treatment from several physicians at once
    • May lead to complicated and hazardous treatment combinations
    • Anxiety and depression common.  (Reason seen in a mental health setting)
    • May have impulsive behavior
    • May have suicide threats and attempts and marital discord
    • Lives often chaotic and complicated.
    • [Source:  APA DSM IV-TR]
  21. Nursing interventions for somatization disorders
    • Help know when experiencing anxiety as needed
    • Help deal constructively with the anxiety
    • Set limits on somatic complaints
    • Address secondary gain
    • Cognitive behavioral strategies & Group therapy
    • Administer Antidepressants for comorbid depression
  22. Conversion Disorder
    • Affects the voluntary motor or sensory functions (suggest a neurological or general medical condition and is not)
    • Symptoms:
    • preceded by conflicts or other stressors.
    • not intentionally produced or feigned.
    • not fully explained after appropriate investigation.
    • Interference in social/occupational functioning or ADLs.
  23. Nursing interventions for conversion disorders
    • Help label and deal with feelings
    • Cognitive restructuring
    • Learn new coping strategies
    • Intervene in unhealthy defense mechanisms
    • Problem-solving
    • Discuss precipitants to anxiety
    • Group therapy
    • Have a healing ceremony. People with conversion disorders are highly suggestible 
  24. What are some nursing interventions for hypochondriasis
    • Set limits on somatic complaints
    • Reward interaction that is not focused on symptoms
    • Withdrawal attention when making physical complaints
    • Cognitive behavioral strategies
    • Help them get a life.
  25. Hypochondriasis
    • Preoccupation with fears of having a serious disease 
    • Preoccupation persists despite appropriate medical evaluation and reassurance
    • Causes significant interference with social/occupational functioning or interferes with ADLs
  26. What are Malingering vs. Munchhousen
    • Malingering: Faking an illness
    • Malingering by proxy: Faking illness for someone else

    • Munchhausen: making self sick
    • Munchhausen by proxy-making someone else sick
  27. What are some interventions for Malingering/munchhousen
    Diagnostics and confrontation, possible legal implications.
  28. What are body dysmorphic disorders?
    • Preoccupation with imagined defect in appearance.  
    • Excessive concern if slight physical anomaly
    • Preoccupation causes impairment in social/occupational functioning or ADLs.
  29. What are nursing interventions for body dysmorphic disorders?
    • Work on body image
    • Cognitive behavioral and restructuring techniques
    • Group therapy
  30. What are dissociative disorders? 
    • Dissociative Amnesia
    • Dissociative Fatigue
  31. What is Dissociative amnesia? 
    • Inability to recall important personal information
    • Traumatic or stressful nature
    • Too extensive to be ordinary forgetfulness.
    • Can occur with other disorders
  32. What is dissociative fugue?
    • Unexpected travel away from home or work place
    • Inability to recall one's past
    • Confusion about personal identity
    • Assumption of a new identity
  33. What is dissociative personality disorder?
    • Presence of  2 or more distinct identities or personalities (each with its own pattern of perceiving, relating to and thinking about the environment and self)
    • At least 2 personalities take control of the person’s behavior
    • Inability to recall important personal information--too extensive to be explained by forgetfulness
    • Defense mechanism:  Dissociation
  34. Nursing interventions for dissociative disorders?
    • Talk to them through the main alter
    • Cognitive behavioral strategies and restructuring 
    • Bodywork for body memories. Be sensitive to psychosocial Hx, especially when doing invasive stuff like caths on pt who has been sexually abused. 
    • Count backwards into a safe place
    • Takes extensive work with a therapist