Psych Exam 3 Anxiety

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Psych Exam 3 Anxiety
2011-04-01 16:57:02
Nursing Psych

Anxiety Disorders
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  1. What is stress?
    A pressure or force that puts strain on the system; can be either positive or negative but most often is used to mean a negative mental or physical tension or stain
  2. Define/ Discuss Stress
    • Relationship between the person and the environment
    • Appraised as exceeding the person’s resources
    • Endangering the person’s well-being.
    • Stress is NOT a disorder
    • It is a normal part of everyday life and does not have good or bad connotations
  3. Define/ Discuss Anxiety
    • Uncomfortable feeling of apprehension or dread usually rooted in fear
    • A psychological distress
    • Response to internal or external stimuli
    • Physical, emotional, cognitive, and behavioral symptoms
    • All symptoms of anxiety can be found in healthy individuals given particular circumstances
  4. List Nsg Interventions for Stress
    • Promote self-care—nutrition, exercise, sleep, leisure; practice relaxation
    • Therapeutic communication to elicit emotions & concerns
    • Support/teach effective problem solving & coping strategies
    • Assist in reducing negative coping strategies
    • Utilize/develop social support
  5. List 8 Problem-Solving Steps
    • 1.Assess the facts of the situation
    • 2.Formulate goals for resolution of the stressful
    • 3.Study the alternatives for dealing with the situation
    • 4.Determine the risks and benefits of each alternative
    • 5.Select an alternative
    • 6.Implement the alternative selected
    • 7.Evaluate the outcome of the alternative implemented
    • 8.If the first choice is ineffective, select and implement a second option.
  6. Discuss Concept of Anxiety
    • Uncomfortable feeling of apprehension or dread
    • Response to internal or external stimuli
    • Physical, emotional, cognitive, and behavioral symptoms
    • Basic, evolutionary response to impending doom— “fight or flight response”
  7. Discuss/ Define Normal Anxiety
    • Realistic intensity and duration for the situation
    • Followed by relief behaviors intended to reduce or prevent more anxiety
    • Appropriate to the situation
    • Emotional responses:
    • threat evident
    • cognitive processes
    • coping strategies/employed to resolve the threat
  8. Discuss/ Define Abnormal Anxiety
    • Factors determining whether anxiety is a symptom of a mental disorder
    • intensity of anxiety relative to the situation
    • the trigger for the anxiety
    • the particular symptom clusters that manifest the anxiety
  9. List Psychological Effects of Mild Anxiety
    tension of needs motivates behavior
  10. List Cognitive Effects of Mild Anxiety
    • attentive
    • alert
    • perceptive to a variety of stimuli
    • effective problem-solving
  11. List Emotional Effects of Mild Anxiety
    • no intense feelings
    • no threat to self-concept
    • use defense mechanisms minimal
  12. List Psychological Effects of Moderate Anxiety
    • inc heart rate
    • inc respirations
    • dec appetite
    • inc muscular tension
    • dilated pupils
    • urinary retention
    • dry mouth
    • blurred visions
    • palpitations
    • perspiration
    • gastric discomfort
  13. List Cognitive Effects of Moderate Anxiety
    • perceptual field narrows
    • responds to direction effective problem-solving with support
    • selective inattention focus on stimuli that do not add to anxiety
  14. List Emotional Effects of Moderate Anxiety
    • impatient
    • irritable
    • forgetful
    • demanding
    • crying
    • angry
    • uses defense mechanism to protect from feelings
  15. List Psychological Effects of Severe Anxiety
    increased symptoms
  16. List Cognitive Effects of Severe Anxiety
    • perceptual field greatly reduced focus on detail or many scattered details
    • cont’d selective inattention
    • learning and problem-solving ineffective
    • needs clarification and repetition
    • misinterprets
    • unable to follow directions or remember main points
    • unable to plan or make decisions
    • consciousness and lucidity threatened
  17. List Emotional Effects of Severe Anxiety
    • self-concept threatened
    • sense of helplessness
    • mood changes
    • behavior erratic or inappropriate
    • many defense mechanisms in use – disassociation and amnesia
    • disorientation, confusion
    • hallucinations and delusions
  18. List Psychological Effects of Panic Anxiety
    • may freeze
    • may be unable to function
    • may withdraw physically
    • may move to the point of exhaustion
    • needs protection
  19. List Cognitive Effects of Panic Anxiety
    • notices only object of anxiety
    • may fail to notice specific object of concern, but be
    • pre-occupied with trivial detail
  20. List Emotional Effects of Severe Anxiety
    • self-concept overwhelmed
    • defense mechanisms may be ineffective
    • behavior focused on finding relief – may be inappropriate an uncontrollable
    • often easily distractible but may be unresponsive to
    • direction
  21. Define Defense Mechanisms
    Unconscious mental process or coping pattern that lessens anxiety from a situation/internal conflict & protects from mental discomfort
  22. List Defense Mechanisms
    • Acting out
    • Compensation
    • Denial
    • Devaluation
    • Identification
    • Intellectualization
    • Projection
    • Reaction Formation
    • Regression
    • Repression
    • Sublimation
    • Suppression
  23. List Adaptive Responses to Anxiety
    • problem-solving
    • talking
    • crying
    • sleeping
    • exercising
    • deep breathing
    • imagery
    • relaxation
  24. List Maladaptive Responses to Anxiety
    • obsessive-compulsive behaviors
    • aggressive acting-out
    • withdrawal
    • excessive eating, drinking, spending, gambling, spending, drug use, sexual activity
    • Blaming; negative self-talk
  25. List Nsg Interventions for Managing Anxiety
    • Monitor and reduce own anxiety
    • Assess for client’s perception of anxiety
    • Create a calm, quiet atmosphere
    • Use self to slow breathing, create focus
    • Use relaxation, deep breathing, touch (if appropriate), imagery,
    • Repeat info as necessary
    • Gather support persons
    • Realistic reassurance
    • Medicate if necessary
  26. List Theories of Anxiety Disorders
    • Neurobiologic Theories
    • Hereditary
    • Brain chemistry & developmental factors
    • Etkin and Wager studies on the role of the amygdala
    • Hippocampus
    • Psychological Theories
  27. List Basic Principles of Anxiety Disorders
    • Strong genetic predispositive
    • Symptoms often begin in childhood & early adulthood
    • Often recognizes that thoughts/behaviors are irrational & emotion is an overreaction
    • Behaviors are used to reduce/manage perception/experience of overwhelming anxiety
    • Allow continuation of behavior until other strategies are in place to manage the anxiety
  28. Define Generalized Anxiety Disorder (GAD)
    characterized by chronic and excessive worry and anxiety more days than not for at least 6 months, encompassing many aspects of the person’s life
  29. Discuss Clinical Course of GAD
    • interferes with daily life and relationships
    • onset is insidious
    • all ages
    • onset in childhood or adolescence, although onset after age 20 is also common
    • mild depressive symptoms
    • somatic
    • poor sleeping
  30. Discuss Diagnostic Criteria for GAD
    • Excessive worry most days for 6 mo
    • Little control over worry
    • 3 sx: sleep disturbance, becoming easily fatigued, restlessness, poor concentration, irritability, and muscle tension (children only have to meet one of the above symptoms)
    • Impairment of fxn
    • Not substance induced
  31. Discuss Comorbidity of GAD
    • ¾ of patients with GAD have at least one additional psychiatric diagnosis
    • The most common being major depressive disorder, social phobia, specific phobia, panic disorder, and dysthymia (mild depression)
    • Alcoholism can be a significant problem for patients with GAD
  32. List Risk Factors for GAD
    • Unresolved conflicts
    • Cognitive misinterpretations
    • Life stressors
    • Genetic predisposition
    • Behavioral inhibition: shyness, fear, or becoming withdrawn in unfamiliar situations
  33. List Assessment ? for GAD
    • 1.How do you experience anxiety symptoms?
    • 2.Are your symptoms primarily physical, psychological, or both?
    • 3.Are you aware when you are becoming anxious?
    • 4.Are you aware that anxiety induces the physical symptoms?
    • 5.What coping mechanisms do you routinely use to deal with anxiety?
    • 6.What life stressors add to these symptoms? What changes can you make to reduce these stressors?
  34. List Management of GAD
    • Diet & Nutrition: Eliminate caffeine from diet. Promote healthy eating habits
    • Sleep: Promote sleep hygiene, avoid alcohol
    • Exercise
    • Cognitive Behavioral Therapy (CBT)
    • Relaxation/meditation
    • Positive self-talk
    • Positive coping skills
  35. Discuss Medical Management of GAD
    benzodiazepines are most commonly used, but antidepressants, buspirone and beta blockers have all proven to be effective
  36. List Treatment Outcomes of GAD
    • Reducing the frequency and intensity of anxiety
    • Controlling the factors that stimulate or provoke anxiety
    • Utilizing techniques that control anxiety: relaxation, positive self-talk, and stress management
    • Reducing personal and environmental stress
  37. Define Phobia
    persistent irrational fear attached to an object or situation that objectively does not pose a significant danger
  38. Discuss Agoraphobia
    • Is a marked irrational fear of being alone or in a public place from which escape would be difficult or help would be unavailable in the event of becoming disabled
    • Most severe and persistent phobic disorder
    • In order to avoid these situations they diminish enjoyment in life/depression
    • The most common fears are being outside of the house alone, using public or mass transportation and being in a crowd.
    • Treatment includes the use of SSRI’s, antidepressants, benzodiazepines, and CBT/exposure therapy
  39. Discuss Social Phobia
    • A persistent irrational fear of and compelling desire to avoid situations in which people may be exposed to strangers or to scrutiny from others
    • Fear embarrassment and being judged
    • The most common fears are public speaking, fear of meeting strangers, eating in public, writing in public, using public restrooms, and being stared at or being the center of attention.
    • SSRI’s and Benzodiazepines are used to treat social phobia
  40. Discuss Specific Phobia
    • Is a persistent irrational fear of and compelling desire to avoid circumstance or thing other than those specific to agoraphobia or social phobia
    • Medications have not proven successful.
    • The treatment of choice is exposure therapy
  41. Define Panic
    normal but extreme, overwhelming form of anxiety often experienced when an individual is placed in a real or perceived life-threatening situation
  42. Discuss Panic Attacks
    • Sudden, discrete periods of intense apprehension or terror without any real danger that are accompanied by significant physical and cognitive symptoms (at least 4 of the 13 physical symptoms)
    • People experiencing a panic attacks incorrectly perceive their circumstances to be life-threatening
    • Attacks usually last for 5-20 minutes but can last as long as one hour
    • They may develop anticipatory anxiety about when the next panic attack will happen
  43. List Sx of a Panic Attack
    • Palpitations, pounding heart, or accelerated heart rate
    • Swearing
    • Trembling or shaking
    • Smothering or sob
    • Feeling of choking
    • Chest pain or discomfort
    • Abdominal distress or nausea
    • Feeling dizzy, unsteady, light-headed or faint
    • *Derealization or depersonalization
    • Fear of losing control or going crazy
    • Fear of dying
    • Paresthesias (numbness or tingling)
    • Chills or hot flashes
  44. Discuss Panic Disorder
    • Panic disorder is a chronic condition that has several exacerbations and remissions during the course of the disease
    • Characterized by panic attacks that often lead to other symptoms, such as phobias
    • Recurrent, unexpected, worry persistently about recurrences ,consequence of occurrence, or change in behavior for at least 1 month
    • Can occur with or without agoraphobia (fear of open spaces—or ability to get out of situations)
  45. Discuss Epidemiology of Panic Disorder
    Highly associated with depression, medical conditions including hypertension, and cigarette smoking, recently associated with marijuana use
  46. List Comorbidity of Panic Disorder
    • May experience more than one anxiety disorder
    • Depression
    • Eating disorders, substance use or abuse
    • Schizophrenia
    • *Cardiac disease
    • *Gastrointestinal disorders
    • *Asthma
  47. Discuss Assessment of Panic Disorder
    • Since physical symptoms tend to be the impetus for people seeking medical care, medical causes of symptoms must first be ruled out
    • Assess for substance abuse including caffeine and tobacco
    • Assess sleep patterns, panic attacks can occur during sleep
    • Assess physical activity
  48. Discuss Assessment ? for Panic Disorder
    • 1.What did you experience preceding and during the panic episode, including physical symptoms, feelings and thoughts?
    • 2.When did you begin to feel that way? How long did it last?
    • 3.What is it that caused you to feel and think that way?
    • 4.Have you experienced these symptoms in the past? If so, under what circumstances?
    • 5. Has anyone in your family ever had similar experiences?
    • 6.What do you do when you have these experiences that help you to feel safe?
    • 7.Have these feelings and sensations ever gone away on their own?
  49. List Tx of Panic Disorder
    • Safe and therapeutic environment
    • Medication: antidepressants, antianxiety and MAO
    • Cognitive-behavioral Therapy
    • Individual psychotherapy
    • Distraction, positive self-talk, exposure therapy, relaxation
  50. Discuss Tx Outcomes for Panic Disorder
    • Patients encouraged to keep a daily log to monitor the severity, frequency and duration of the panic episode
    • Although it is considered a chronic, long-term condition patients can learn to effectively manage their symptoms
  51. Discuss Emergency Care
    • Rule out life threatening illness—especially cardiac event
    • Stay with the patient
    • Reassure him/her that you will not leave
    • Give clear directions
    • Assist patient to an environment with minimal stimulation
    • Walk with the patient
    • Administer PRN antianxiety medications
  52. Define Obsessive Compulsive Disorder
    psychiatric disorder characterized by severe obsessions or compulsions that interfere with normal daily life
  53. Define/ Discuss Obsessions (OCD)
    • Unwanted, intrusive, and persistent thoughts, impulses, or images that cause anxiety and distress
    • Obsessions are ego-dystonic (the thoughts and compulsions experienced or expressed are often not consistent with the individual's self-perception, causing extreme distress) because they are not under the patient’s control and are incongruent with the patient’s usual thought patterns
    • Examples: fear of contamination, need for symmetry, thoughts of hurting someone
  54. Define/ Discuss Compulsions (OCD)
    • Behaviors that are performed repeatedly, in a ritualistic fashion, with the goal of preventing or relieving anxiety and distress caused by obsessions
    • Examples: hand washing
  55. List Diagnostic Criteria of OCD
    • Presence of obsessions or compulsions
    • Unreasonable or excessive
    • Taking longer than 1 hour a day to complete
    • Not Axis 1
    • Not substance or medical condition
  56. List Comorbidity of OCD
    • Tourette’s syndrome
    • Major depressive disorder
    • Social phobia
    • Specific phobia
    • Panic disorder
    • Mood disorders
    • Eating disorders
    • Alcoholism/substance abuse
    • Personality disorders; most common dependent personality disorder
  57. Discuss Children and OCD
    • OCD affects between 1% and 2.3% or more of children and adolescents
    • *Obsessive and ritualistic behaviors may go unnoticed
    • Parents typically notice when child’s grade fall as a result of decreased concentration and more time spent performing rituals
  58. Discuss Elderly and OCD
    • Can be a lifelong illness, lasting more than 30 years
    • Predictors of poor outcomes during lifelong treatment include initial symptom onset during childhood, low social functioning, and the presence of both obsessions and compulsions
  59. Discuss Epidemiology of OCD
    • Rates are similar among women and men
    • First-degree relatives of people with OCD have a higher prevalence rate than the general population
    • Early-onset OCD increases the chances of OCD in relatives and predicts poorer treatment outcomes
  60. List Risk Factors for OCD
    • Link between infection with β-hemolytic streptococci and OCD
    • Young, divorced or separated, and unemployed
    • OCD appears to be less common among African Americans than among non-Hispanic Caucasians
  61. List Special Assessment Considerations for OCD
    • Multiple physical symptoms
    • Dermatologic lesions secondary to repetitive hand washing, excessive cleaning with caustic agents or bathing
    • Osteoarthritic joint damage secondary to cleaning rituals
  62. List Tx for OCD
    • Obsessions and compulsions consistently interfere with treatment
    • Nurses must control their own anxiety
    • Medications: SSRI’s and TCA’s
    • ECT
    • Psychosurgery
    • Relaxation techniques
    • Response Prevention
    • Thought Stopping
    • Cue cards: tool to help restructure thought pattern
    • Psychoeducation
  63. Discuss OCD vs. Obsessive-Compulsive Personality Disorder
    • Obsessive-Compulsive Disorder has no connection to Obsessive-Compulsive Personality Disorder.
    • People with Obsessive-Compulsive Personality Disorder do not have actual obsessions and compulsions and they do not experience symptoms as uncomfortable, distressful or bothersome
  64. Discuss Types of Stress Disorders
    • They are similar in that they result from exposure to a severe or extraordinary stressor however they differ in terms of timing, duration, and degree of impairment
    • Acute stress disorder (ASD)
    • Acute PTSD
    • Chronic PTSD
    • Delayed PTSD
  65. Discuss/ Define Acute Stress Disorder (ASD) (no sx)
    • Occurs within the first month of exposure to extreme trauma; combat, rape, physical assault, near-death experience or witnessing a murder.
    • Symptoms begin during the event or shortly following.
    • The person continually re-experiences the event, avoids situations that remind him/her of the event and has increased anxiety and excitation that negatively affects lifestyle
  66. List/ Discuss Sx of Acute Stress Disorder
  67. The person must have at least three of the following dissociative symptoms:
    • numbing
    • detachment
    • reduction of awareness to one’s surroundings
    • derealization
    • depersonalization
    • dissociative amnesia
    • ASD usually resolves within 2-28 days following exposure to the trauma
    • If the symptoms continue beyond one month, the diagnosis is changed to PTSD
  68. Define Acute PTSD
    When symptoms of Acute Stress Disorder continue for more than one month and are accompanied by functional impairment or stress, the diagnosis changes to PTSD; re-experience thru flashbacks, nightmares, distressing images; extreme stress on exposure; avoidance; trouble sleeping; startle response; poor concentration; irritability
  69. Define Chronic PTSD
    When the symptoms of acute PTSD persist beyond three months the disorder is referred to as Chronic PTSD
  70. Define Delayed PTSD
    Occurs when people develop symptoms at least six months after exposure to the trauma
  71. Discuss Tx for PTSD
    • Sertraline (Zoloft) is approved for treatment of PTSD
    • Minipress (Prazosin) an antihypertensive agent, has been found to decrease recurrent nightmares
    • CBT/Exposure Therapy
    • EMDR (eye movement desensitization and reprocessing)
    • Group Therapy
    • Family Therapy
  72. Define Dissociative Identity Disorder (DID)
    psychiatric disorder characterized by the existence of two or more distinct identities with unique personality characteristics and the inability to recall important information about oneself or events
  73. List Types of DID
    • Dissociative amnesia: inability to recall
    • Dissociative fugue: unexpected travel away from home
    • Depersonalization disorder: being detached from one’s body
    • Dissociative identity disorder (multiple personality disorder)
    • Dissociative disorder not otherwise specified
  74. List Comorbidity in DID
    • Substance abuse
    • Anxiety
    • Eating disorders
    • Mood disorders
    • Personality disorders
    • PTSD
  75. List Tx for DID
    • Psychopharmacology is not a primary treatment however antidepressants and antidepressants may be used
    • Individual Therapy
    • Hypnotherapy
    • CBT
    • Group Therapy
    • Art Therapy
  76. Discuss Cognitive Behavioral Therapy (CBT)
    • Goal is to gain insight into what is causing the anxiety and to learn new responses to irrational thinking.
    • It includes education and problem solving strategies but primarily focuses on learning to identify and change faulty thinking that can lead to emotional distress
  77. List Selective Serotonin Reuptake Inhibitors (SSRIs)
    • Fluoxetine (Prozac)
    • Citalopram (Celexa)
    • Escitalopram oxalate (Lexapro)
    • Sertraline (Zoloft)
    • Paroxetine (Paxil)
    • Fluvoxamine (Luvox)
  78. Discuss MOA of SSRIs
    SSRIs inhibit the reuptake of serotonin by blocking its transport into the presynaptic neuron, increasing the concentration of synaptic serotonin
  79. List SE of SSRIs
    • Headache
    • Anxiety
    • Insomnia
    • Transient nausea
    • Vomiting
    • Diarrhea
    • Sedation
    • Sexual dysfunction
    • Diastolic hypertension
    • Increased perspiration
  80. List Antianxiety and Sedative-Hypnotic Meds Benzodiazepines
    • clonazepam (Klonopin)
    • alprazolam (Xanax)
    • lorazepam (Ativan)
    • diazepam (Valium)
    • chlordiazepoxide (Librium)
    • flurazepam (Dalmane)
    • triazolam (Halcion)
    • oxazepam (Serax)
  81. Discuss Benzos
    • The most commonly used medications for panic disorder even though SSRIs are recommended for first-line treatment.
    • Therapeutic onset is much faster (hours, not weeks) than that of antidepressants.
    • Useful in treating intensely distressed patients.
    • Used for short-term relief of anxiety or anxiety associated with depression
  82. List SE of Benzos
    • Drowsiness, intellectual impairment, memory impairment, ataxia, reduced motor coordination, sedation, “hangover” effects
    • Tolerance develops
    • Alcohol potentiates the CNS depression
    • Tolerance and psychological dependence are common
    • Abrupt discontinuation may result in a recurrence of the target symptoms (rebound insomnia or anxiety)
  83. List Guidelines for Benzos
    • Lowest dose necessary
    • Monitor Effects
    • Do not stop abruptly
  84. List SE of W/d from Benzos
    • Hallucinations
    • Abnormal behavior
    • Severe confusion
    • Suicidal thoughts
    • Daytime drowsiness
    • Dizziness
    • Ataxia
    • Double vision or other vision problems
    • Agitation
    • Vivid or abnormal dreams
  85. Discuss Buspirone (BuSpar)
    • Nonbenzodiazepines
    • Effective for treating anxiety disorders without the CNS depressant effects or the potential for abuse and withdrawal syndromes
  86. List SE of Buspirone (BuSpar)
    • Dizziness
    • Drowsiness
    • Nausea
    • Excitement
    • Headache
  87. List Methods of Achieving Relaxation
    • Deep breathing exercises
    • Physical exercise
    • Progressive relaxation
    • Mental imagery
    • Meditation
    • Biofeedback