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62 Cards in this Set
- Front
- Back
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Incidence of Anxiety Disorders
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Anxiety disorders are the most diagnosed disorder in the U.S.
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Prued's Psychoanalytic Theory
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Unconscious unacceptable thoughts attempt to emerge into consciousness resulting in anxiety.
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Sullivan/Peplau Psychoanalytic Theory
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Dysfunctional relationships witin the environment result in anxiety disorders
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Psychoanalytic Theories in general
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We react to our environment with anxiety and this alters our perception of our environment.
This is what leads to an anxiety disorder. |
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Behavioral/Learning Theory
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All behaviors including anxiety are learned.
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Cognitive Theory
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Anxiety is the result of distorted or faulty thinking patterns
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Dysregulation in Anxiety D/O
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* GABA
- Release of GABA from post-synaptic sites = anxiety - Benzo theory * Serotonin - Dysregulation of 5HT system = increased levels of 5HT subtype = Anxiety |
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Norepinephrine (NE) in Anxiety D/O
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- malfunctioning NE system has decreased threshold for arousal
- Increase in HR, lactate levels and oxygen use causes and increase in the release of NE - Increased levels of NE are excitatory and cause anxiety - In a erson who has an anxiety d/o, a small alteration in NE can cause a larger stress response |
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Therapeutic Management for Anxiety D/O: Assessment and General Screening
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* Screening involves the ability to concentrate and focus
* Assessment of anxiety symptoms * Physical & neurological exam - a lot of anxiety will be due to caffeine intoxication or mitrovalve d/o - this will usually be discovered when people enter a hospital for help with their anxiety * Suicide Assessment - about 20% of people with anxiety d/o have suicidal thoughts * Psychosocial screening |
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Physical Effects of Anxiety D/O
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- chest pain
- Dizziness - Decreased sex drive - Irritability - Rapid breathing - Heart palpitations - Increased BP - Nausea or diarrhea - Difficulty swallowing |
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Therapeutic Management: Behavioral Therapies
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- Systematic Desensitization (gradual exposure)
- Flooding (implosion) - Aversion Therapy - Though Stopping - Structure and routine - Relaxation training - Modeling techniques - Positive reinforcement |
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Systematic Desensitization
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- Training the body to behave in a certain way
- Ex) fear of elevators |
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Flooding
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Exposing the person to as much of what they're afraid of at once.
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Aversion
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- Using some noxious stimulus that when the person thinks of the thing that scares them, the noxious stimulus is implements
- Ex) Inott says that this is like punishment |
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Thought Stopping
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- Use of image, distraction, etc
- Ex) When I begin to panic, I'm going to make a list of all the states in the US |
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Structure and Routine
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Stops anxiety
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Modeling techniques
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Learning how to react wi/o anxiety to a response
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Therapeutic Management: Relaxation Techniques
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- Meditation
- Guided imagery - Breathing exercises - Progressive muscle relax |
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Therapeutic Management: Cognitive Approaches
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* Journal keeping
* Priority restructuring - adding something to your daily/weekly schedule that is a pleasurable activity * Cognitive reframing * Assertiveness training * Cognitive-Behavioral Therapies - Address automatic thoughts and assumptions |
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Therapeutic Managment: Lifestyle (Self-Care)
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- Nutrition and fluid intake
- Hygiene and grooming - Elimination - Sleep & Exercise |
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Nursing Diagnosis for Anxiety D/O
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* Decreased intake
- r/t rituals; specific phobias * Decreased skin integrity - r/t excessive rituals, indecisiveness * Altered elimination patterns - r/t suppressed urge or increased urgency * Decreased ability to sleep - r/t anxious feelings, rituals, nightmares |
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Pharmacological Interventions for Anxiety D/O
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- Benzodiazepines
- TCA's - SSRI's - Buspirone - Other |
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Benzodiazepines in Tx of Anxiety D/O
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* Advantages
- rapid, little cardiac, generic forms * Disadvantages - side effects, abuse potential |
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TCA's in Tx of Anxiety D/O
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* Advantages
- Single dosing, antidepressant * Disadvantages - Delayed onset, antichol + cardiac |
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SSRIS's in Tx of Anxiety D/O
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* Advantages
- Single dosing, antidepressant * Disadvantages - Delayed onset, insomnia, irritability |
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Buspirone in Tx of Anxiety D/O
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* Advantages
- Few side effects, slow onset, No sedation * Disadvantages - Cost |
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DSM-IV-TR Criteria for all Anxiety D/O
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* Prominent: anxiety, panic attacks, or obsessions/compulsions
* Not directly due to a medical condition * Not exclusive to delirium episode * Not better accounted for by another mental disorder * Significant distress or impairment |
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Panic Disorder: General Info
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* 1/2 develop panic d/o before age 24
* 2 times as many women as men * comorbidity with depression and substance abuse - 30% abuse ETOH - 17% abuse cocaine, marijuana and others * 1/3 develop agoraphobia - a fear of being in spaces where it would be difficult to get help quickly * Amygdala/Caudate area in the brain is involved - limbic and basal ganglia * Decreased activity in the frontal lobe |
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Panic Disorder: psychosocial and biological findings
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* Psychosocial
- disoriented thinking patterns * Biological - malfunctioning NE systmens * always in fear of having another panic attack after one has happened * Think "over arousal" - fight or flight * During an attack, judgment is suspended and is none - this happens even when a person has a good understanding of why the attacks occur |
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Criteria Specific to Panic Disorder
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* Recurrent, unexpected panic attacks
* At least 1 of the attacks has been followed by a month of one of the following: - persistent concern about having additional attacks - worry about the implications of the attack or its consequences - ex) losing control, having a heart attack, going crazy |
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Treatment of Choice for Panic D/O
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* #1 is safety
* Cognitive-behavioral - systematic desensitization - Thought stopping * Anxiety decreasing - Relaxation, etc * First drug choice - TCA (possibly with short acting Benzo combo) - SSRI's (have fewer side effects) * Third drug choice - MAOI's |
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Phobias: General Info
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- Twice as likelyin women as men
- Higher proportion of men seek help - Onset in childhood and adolescence - rarely after age 25 - Comorbid with depression (up to 25%), substance abuse - Usually conditioned to something that was experienced in the past |
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Phobia: psychosocial and biological findings
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* Psychosocial: conditioned response
* Biological: predominant GABA |
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Common Types of Specific Phobias
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* animals (includes insects)
* Natural environment - ex) heights, storms, water * Blood-infection-injury * Situational - ex) airplanes, elevators, closed places |
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Social phobias
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- Speaking in public
- Eating in front of others - Using a public lavatory - Writing in front of others - Answering questions |
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Specific Phobia - Criteria
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- A marked and persistnet fear that is excessive or unreasonable, that is cued by a specific object or situation
- Exposure to the phobic stimulus almost invariable provokes immediate anxiety response - The object or situation is avoided or endured with intense anxiety |
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Treatments specific to phobias
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* In addition to basic anxiety reducing interventions:
- Systematic desensitization - Flooiding |
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Pharmacological interventions for phobias
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- PRN: benzo's
- PRN: beta-blockers (specific to social phobias) - SSRI's |
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OCD - Epidemiology
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* 10-30% of population
* Mean and Women effected equally * One of the Top 10 leading causes of disability in established market economics worldwide * Up to 67% have comorbid depression |
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OCD psychosocial and biological findings
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* Psychosocial
- Conditioned - Distorted thoughts * Biological - Primary: 5HT - Decrease size of caudate - Basal ganglia and limbic system |
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OCD and Tourette's
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- Tourette's Syndrome has many OCD components to it.
- The person will need to move a certain way and say a particular word and until they do, their anxiety will increase |
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Essential features to OCD
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- recurring obsessive thoughts and/or compulsive behaviors that are time consuming and produce impairment
- either obsession and/or compulsions |
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OCD Cycle
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Obsessions to
Anxiety to Compulsions to Relief and back to Obsessions |
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Most Common Obsessions
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- Double checking
- Order - Counting - Illness - Violence |
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Most Common Compulsions
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- Touching
- Cleaning - Avoidance - Doing/undoing - Symmetry |
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OCD Therapies
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Behavioral
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Pharm for OCD
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* Luvox
- possible other SSRI's - Specifically for OCD * TCA's - Anafrinil? - Imipramine? |
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Generalize Anxiety D/O (GAD): General Info
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- Chronic anxiety
- Only 1/3 seek treatment |
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GAD: Psycosocial and Biological findings
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* Psychosocial: Distorted thought patterns
* Biological: lidely 5HT system |
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Criteria specific to GAD
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* Excessive anxiety (worry) for at least six months about a number of events or activites
* The person finds it difficult to control the worry * Three or more of the following symptoms - Restlessness/feeling keyed up - on edge - Easily fatigues - Difficulty concentrating (mind going blank) - Irritability - Muscle tension - Sleep disturbance |
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GAD treatment: non pharm
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- cognitive/behavioral
- cognitive reframing - stress management - lifestyle modification - support groups |
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GAD treatment: pharm
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- Buspar (Buspirone)
- Valium (Diazepam) - TCA's (impipramine) - SSRI's |
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Post-Traumatic Stress Disorder (PTSD): General Info
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* more likely in women
* can develop in childhood * 30% of combat veterans * Persons subject to - natural and man-made disasters, violence, terrorism * Comorbid diagnoses - depression, substance abuse, other anxiety d/o's |
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PTSD: Psychosocial Theories and/or components
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- distorted appraisal
- Shattered assumption theory - Conditioning and sensitization |
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PTSD: biological findings
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- chronic dyregulation of multiple neurobiological systems
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PTSD risk factors
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- very young/elderly
- assault/witness to assault - history of abuse - substance abuse (or other poor coping) - pre-existing emotional/behavioral difficulties |
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PTSD time line
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* Traumatic event:
- actual or threatened death or serious injury - outside the range or usual experience * Initial response: - intense fear or horror * Prevention - crisis intervention - Can be prevented in that intervention can occur in the hopes that the person won't even develop PTSD |
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PTSD: Diagnostic Indicators and Symptoms
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* Persistent
- re-experiencing of trauma - avoidance - numbing of responsiveness - symptoms of increased arousal |
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PTSD: Associated difficulties
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- substance use/abuse
- domestic abuse/violence - lack of intimacy - difficulties: interpersonal, social, occupational |
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PTSD: long-term interventions
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* In addition to basic anxiety decreasing techniques:
- grief therapy - support groups - Cognitive and behavioral therapy - TCA's and MAOI's are most helpful - SSRI's used as a last resport - Benzos are not recommended |
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PTSD: therapeutic management/general areas of focus
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- anxiety reduction
- relaxation (simple) - improving coping - enhancing self-esteem - instillation of hope |
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Common Nursing Diagnoses (All anxiety d/o)
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- anxiety (panic)
- fear - Ineffective individual coping - powerlessness - social isolation - self-care deficit - risk for self-harm |
