Psych Anxiety Disorders

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julianne.elizabeth
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296448
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Psych Anxiety Disorders
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2015-02-24 14:15:12
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lccc nursing mentalhealth
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For Cummings Exam 1
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  1. Define anxiety and when it becomes pathologic
    • Anxiety: apprehension, uneasiness, uncertainty, or dread from a real or perceived threat. Anxiety is a normal response. Normal anxiety is necessary for survival
    • Anxiety becomes pathologic when it interferes with every day life
  2. What are the physical manifestations of anxiety?
    • Increased HR and BP
    • SOB
    • Palpations, flushing, sweating
    • Sensation of choking
    • Tremors
    • N/V/D
    • Increased Urination
    • *fight or flight response
  3. What are the cognitive components of anxiety?
    • Decreased attention
    • Decreased concentration
    • Forgetfulness
    • Thought blocking
  4. What are the levels of anxiety as delineated by Peplau?
    • Anxiety rated on a level of 1-4 and exists along a continuum
    • 1. Mild Anxiety
    • 2. Moderate Anxiety
    • 3. Severe Anxiety
    • 4. Panic
  5. Describe the different levels of anxiety
    • Mild (+):
    • What is experienced in every day life
    • Person is alert
    • Sees, hearts and grasps more than usual
    • Goal oriented learning is enhances
    • Able to recognize anxiety
    • Moderate (++):
    • Perceptual field is narrowed, but person can attend to more if directed to do so
    • Selective attention
    • Mild somatic symptoms
    • Problem-solving capacity still available
    • Severe (+++):
    • Perceptual field is greatly reduced
    • Preoccupation with one detail or focus on several details at once (scattering)
    • Requires direction to change focus
    • Intese somatic symptoms present
    • Feelings of impending doom
    • Usually medicated
    • Panic (++++):
    • Attention is severely narrowed or speed of scatter is sharply increased
    • Feelings of awe, dread, terror are common; psychosis can occur
    • Rational communication and behavior disappear, fight/flight takes over
    • Exhaustion/death can occur if panic continues for prolonged period
  6. What are the s/s of a panic attack?
    • Similar to panic anxiety
    • Derealization- familiar objects become strange
    • Depersonalization- see self from a distance (out of body experience)
    • Parathesias- numbness
    • Fear of going crazy
  7. What are the DSM-5 criteria of a panic disorder?
    • Recurrent Panic Attacks (15-20 min duration)
    • At least one attack followed by persistent concern of having another, worry about losing control, significant change in behavior r/t the attacks
  8. Describe a panic disorder accompanied by agoraphobia
    • Graduation restriction of activities/travel
    • Anxiety about being in places where escape might be difficult
    • Fear of being alone in open or public places. may not leave home
  9. What interventions can be taken during a panic attack?
    • Stay with the client during panic attack
    • Maintain calm, supportive attitude
    • Offer reassurance
    • Speak using simple words, brief messages, slow delivery
    • Decrease environmental stimuli
    • Instruct to take slow, deep breaths
    • Keep expectations minimal and simple
    • Help connect feelings with attack onset
    • Health client recognize symptoms as anxiety, not as physical problem
    • Identify therapies- behavioral, medication
    • teach abdominal breathing and positive self talk
  10. What Benzodiazepines (BZDs) are commonly used for panic disorders? What are their side effects? What teaching needs to be done?
    • Alprazolam (Xanax)
    • Lorazapam (Ativan)
    • Clonazepam (Klonopin)
    • Axazepam (Serax)
    • SE: resp depression (fast acting CNS depressant)
    • Teaching: do not take with other CNS depressants. ¬†Physically and psychologically addicting. Do not stop abruptly for a risk of rebound seizures. No longer effective after 4mo if taken round the clock, must be taken PRN.
    • Contraindicated for pregnant or BF
  11. What non BZD medications can be used for anxiety? What is the gold standard?
    • Buspirone (Buspar): cannot be given PRN, must be given around the clock.No sedation effect (not CNS depressant), effects seratonin level
    • Propranalol (Inderal): beta blockers can be used for social anxiety PRN
    • SSRIs: the gold standard for long term anxiety management
    • -sertraline (Zoloft)
    • -Fluoxetine (Prozac)
    • -Paroxetine (Paxil)
    • -Fluvoxamine (Luvox)
    • -Citalopram (Celexa)
  12. What is generalized anxiety disorder (GAD)?
    • Excessive anxiety or worry about multiple issues which lingers six months or more can indicate generalized anxiety disorder
    • Must have 3 of the following:
    • -restless or feeling on edge
    • -easily fatigued
    • -irritability
    • -muscle tension
    • -sleep disturbances (common)
  13. What is substance-induced anxiety disorder?
    • Develop with the use of a substance of within a month of stopping use of the substance
    • Symptoms of anxiety, panic attacks, obsessions, and compulsions
  14. What is separation anxiety disorder?
    • Developmentally Inappropriate levels of concern over being away from a significant other
    • Typically diagnosed prior to age 18
    • Symptom duration of one month
    • Normal activities and sleep impaired
  15. What are healthy defense, intermediate defenses, and immature defenses against anxiety?
    • Healthy defenses:
    • -altruism
    • -sublimation
    • -humor
    • -suppression
    • Intermediate Defenses:
    • -repression
    • -displacement
    • -reaction formation
    • -somatization
    • -Rationalization
    • -undoing
    • Immature Defenses:
    • -passive aggressive
    • -acting-out
    • -projection
    • -denial
    • -dissociation
    • -splitting
  16. What is a phobia?
    • Fear cued by the presence or anticipation of a specific object or situation. Exposure invariably provokes an immediate anxiety response or panic attack even though he/she recognizes that the fear is excessive or unreasonable
    • Stimulus is avoided or endured with marked distress
  17. What is a social phobia? What are the DSM-5 criteria?
    • Marked or persistent fear of one or more social activities
    • Exposure produces anxiety
    • Person recognized fear is excessive
    • Interferes significantly with person's routine
    • Fear not related to effects of a substance
    • Fear unrelated to general medical or psychiatric condition
  18. What interventions can be done for phobias?
    • Systematic Desensitization. Either in vitro (imagery) or in vivo (live)
    • Flooding-implosion therapy
    • Group Therapy
    • Medication
    • Cognitive therapy
  19. Name the different Obsessive-Compulsive Disorders
    • OCD
    • Body dysmorphic disorder
    • Hoarding disorder
    • Hair pulling or skin picking disorders
  20. What is OCD?
    • Obsession/Thought:
    • -unfruitful attempt to ignore or suppress thoughts
    • -recognizes thoughts as product of mind
    • Compulsion/Act:
    • -Ritual acts followed according to rigid rules
    • -aimed at preventing or reducing distress or preventing some dreaded event (not done for pleasure)
    • -Compulsive act is not realistic to prevent event
    • Run-On Rituals:
    • -OCD behaviors and activities take up more than 1hr/day
  21. What are some mental health comorbidities for OCD?
    • Major Depressive disorder
    • Social phobia
    • Eating disorders
    • Substance abuse
    • Personality disorders
  22. What are some OCD manifestations that may be found upon assessment?
    • Washing: fear of contamination
    • Checking: doubt they have done something important
    • Doubters and Sinners: fear doom if not perfect
    • Counters and arrangers: magical thinking/superstition about order, symmetry or number
  23. What is the etiology of OCD?
    • Biological:neurotransmitter imbalance (Sertonin), enlarged basal gland
    • Psychoanalytic: overuse of defense mechanism "undoing", fixation at anal stage, underdeveloped egos, conflict between ego and id
    • Cognititve-behavioral: compulsion is reinforced by reduction in anxiety
  24. What are the characteristics of a hoarding disorder?
    • Difficulty discarding possessions of limited/no value with marked distress
    • Accumulation results in little to no usable personal space
    • The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functions (including safety)
  25. What are some Interventions for OCD?
    • Anticipate needs, esp for information
    • Focus on client rather than rituals
    • Monitor nutrition/sleep and encourage meals/rest
    • Avoid hurrying client
    • Do not forbid rituals, give positive reinforcement for non-ritualistic activity
  26. What therapy and medications can be used for OCD?
    • Prevent/treat self inflicted therapy
    • Cognitive therapy (stop thoughts by thinking of stop sign, snapping rubber band)
    • Benzodiazepines
    • SSRI
    • Tricyclic Antidepressent Clompramine (Anafril) works great. S/E are cardiac
  27. What is body dysmorphic disorder?
    • Exaggerated belief that body is flawed/deformed/defective in some way
    • Social and occupational impairment occurs r/t excessive anxiety
    • Numerous visits to plastic surgeons and dermatologists
  28. Name the somatoform disorders? What are they?
    • 1. Conversion disorder
    • 2. Illness Anxiety disorder (hypochrondriasis)
    • 3. Factitious disorders
    • History of many physical complaints over a series of years, s/s cannot be medically explained and are they intentionally produced or feigned
    • Results in tx being sought, significant impairment in functioning
  29. What is the etiology and outcome for somatic symptom disorder?
    • Etiology: children learn to gain affection, care attention through illness, family systems unable to deal with conflict- child becomes ill and received focus
    • Outcome: client will demonstrate ability t cope with stress by means other than preoccupation with physical symptoms
  30. What is conversion disorder?
    • Loss or change in body function
    • Physical symptoms (such as paralysis, blindness, deafness, dysphasia) cannot be medically explained
    • Primary gain: s/s prevent internal conflict/painful issues from attaining awareness
    • Secondary gain: enables client to avoid difficult situation or obtain support that might otherwise not be forthcoming
    • Goal: client demonstrates more adaptive coping strategies for dealing with stress
  31. What is Hypochondriasis?
    • Misinterpretation of physical sensations
    • Over-concerned for health and preoccupied with symptoms leading to extreme worry and fear
    • Course of illness is chronic and relapsing
  32. What are factitious disorders?
    • Munchausen Syndrome: deliberate/conscious sickening of self for attention
    • Munchausen By Proxy: sickening another for attention
    • Malingering: physical complaint for financial gain
  33. What is adjustment disorder?
    • precipitated by a stressful event
    • debilitating cognitive, emotional, and behavioral symptoms that negatively impact normal functioning
    • May include combo of depression, anxiety, and conduct disturbances
    • Milder form of PTSD
  34. What is PTSD? What 3 cluters of s/s are associated with it? What are some common causes?
    • Re-experiencing of the trauma
    • Avoidance of stimuli associated with trauma
    • Increased physical arousal and alt in mood
    • Common causes include war, terrorism, natural disasters, violence/abuse, accidents/injury
  35. What interventions can be used for PTSD? What medications?
    • Remain with clients during flashbacks
    • Allow client to talk at own pace
    • Acknowledge themes and feelings
    • Debrief immediately following experience
    • Grief and loss therapy
    • Beta blockers: decreased ANS hyperarousal by inhibiting NOR (Inderal)
    • Benzo: increases inhib effect of GABA (use PRN, highly addictive)
    • Mood Stabilizer: stabilize CNS
    • Antidepressents: increases serotonin
  36. What are dissociative disorders? Name three types
    • Occur after signif trauma
    • Respond with severe interruption of consciousness, unconscious defense mechanisms
    • This protects the individual against overwhelming anxiety through emotional separation
    • Dissociative amnesia: inability to integrate memories
    • Dissociative fugue: sudden travel away from home
    • Dissociative Identity Disorder: multiple personality disorder, almost always a result of childhood abuse. Integration therapy is the treatment
  37. What is the difference between anger and aggression? What can anger co-exist with in adults and children?
    • Anger is an emotion, aggression is an action
    • Adults: Depression, PTSD, Mania, psychosis, Alzheimer
    • Children: ADHD, oppositional defiance, impulsivity
  38. What are Mileu's characteristics conducive to violence? Who is most at risk?
    • Overcrowding
    • Inexperienced staff
    • Provocative or controlling staff
    • Poor limit setting
    • *history of violence is the best predictor of future violence
    • Most at risk:
    • substance abusers
    • cognitive defects
    • those who feel ignored
    • those with unreal expectations
    • those who feel threatened or frightened
  39. What are some warning signs or precursors to violence?
    • restlessness/hyperactivity
    • Signs of anxiety or tension
    • Profanity, argumentativeness
    • Loud voice or stony silence
    • Intense glaring or eye contact
    • Intoxication
    • Carrying a dangerous object
    • Recent acts of violence
    • Challenging and threatening- verbal, written, or gestures
  40. What are some de-escalating techniques for aggressive/violent clients/situations?
    • Maintain a client's dignity and self-esteem
    • Stay calm
    • Assess the situation; identify stressors and what client sees as need
    • Use calm voice, non threatening body language
    • Be empathetic, genuine, honest
    • Maintain large personal space
    • Don't argue
    • Give clear options
    • Assess for own personal safety

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