Chapter 18: Anxiety, Ocd And Related Disorders

Front 1

Anxiety

Back 1

An emotional response to anticipation of danger, the source of which is largely unknown or unrecognized.

Anxiety is a necessary force for survival. It is not the same as stress.

Front 2

Maladaptive Anxiety

Back 2

When anxiety interferes with social, occupational, or other important areas of functioning

Front 3

Panic Disorder

Back 3

Fear, terror, physical symptoms: sweating, tacky, abd pain

Front 4

Generalized Anxiety Disorder

Back 4

Chronic worry

Front 5

Agoraphobia

Back 5

Fear of being in places or situations from which escape might be difficult or in which help might not be available in the event of panic-like symptoms or other incapacitating symptoms.

Front 6

Social Anxiety Disorder (Social phobia)

Back 6

Excessive fear of situations in which the affected person might do something embarrassing or be evaluated negatively by others.

Front 7

Obsessive-Compulsive Disorder (OCD)

Back 7

Recurrent obsessions or compulsions that are severe enough to be time-consuming or to cause marked distress or significant impairment

Front 8

Obsessions

Back 8

Recurrent thoughts, impulses, or images experienced as intrusive and stressful, and unable to be expunged by logic or reasoning.

Front 9

Compulsions

Back 9

Repetitive, ritualistic behavior or thoughts, the purpose of which is to prevent or reduce distress or prevent a dreaded situation.

Front 10

Body Dysmorphic Disorder

Back 10

Characterized by the exaggerated belief that the body is deformed or defective in some specific way

Front 11

Hair pulling disorder (Trichotillomania)

Back 11

The recurrent pulling out of one’s own hair that results in noticeable hair loss

Preceded by increasing tension and results in sense of release or gratification

Front 12

1. A newly admitted client, diagnosed with

obsessive-compulsive disorder (OCD), spends 1 hour packing and unpacking, folding and refolding personal belongings. What is the most likely reason for this behavior?

a) It relieves anxiety.

b) It fosters organizational skills.

c) It delays meeting unfamiliar people in the dayroom.

d) It makes the client feel good.

Back 12

Correct answer: A

OCD is characterized by recurrent thoughts or ideas (obsessions) that an individual is unable to put out of his or her mind, and actions that an individual is unable to refrain from performing (compulsions). This behavior directs the client away from the underlying anxiety and focuses the client on a repetitive activity such as packing and unpacking, folding and refolding personal belongings.

Front 13

2. For the last year, a college student continually and unrealistically worries about academic performance and love life performance. The student is irritable and suffers from severe insomnia. This behavior is associated with which diagnosis?

a) Agoraphobia

b) Generalized anxiety disorder (GAD)

c) Social phobia disorder

d) Obsessive-compulsive disorder (OCD)

Back 13

Correct answer: B

GAD may be diagnosed when excessive, unrealistic worry and anxiety become chronic and last for at least 6 months. The anxiety experienced is generalized rather than specific. The anxiety is not associated with a specific object as in phobia, or event as in PTSD.

Front 14

3. When caring for a client who is

experiencing a panic attack, which of the following nursing actions should be implemented?

a) Leave the client alone to maintain privacy.

b) Instruct the client regarding unit rules and

regulations.

c) Sit with the client in the day room to provide

comfort.

d) Communicate with simple words and brief

messages.

Back 14

Correct answer: D

When communicating with a client experiencing a panic attack, the nurse needs to use simple words and brief messages, spoken calmly and clearly. Any communication that is loud and demanding would only escalate anxiety.

Front 15

Side effects of Anxiolytics

Back 15

Drowsiness, confusion, lethargy

Tolerance; physical and psychological dependence (does not apply to buspirone)

Potentiates effects of other CNS depressants: Don’t drink

Orthostatic hypotension

Paradoxical excitement: agitation

Dry mouth; nausea and vomiting

Blood dyscrasias: changes in blood cells

10 to 14 day delayed onset of action (with buspirone)

Front 16

4. What should the nurse plan to teach a client who is taking alprazolam (Xanax) three times a day?

a) That there is a potential for dependence and tolerance.

b) The importance of discontinuing Xanax immediately if addiction is suspected.

c) That increased caffeine consumption can enhance the effectiveness of Xanax.

d) That Xanax is not habit forming.

Back 16

Correct answer: A

Xanax is a benzodiazepine and has addictive properties. It is the responsibility of the nurse to teach the client about dependence, tolerance, and other signs and symptoms of addiction.

Front 17

Benzodiazepines for Anxiety

Back 17

* Xanax/Valium/Ativan/Librium/Klonapin
* CNS depressants: anticholinergic SE, alcohol+benzos=death
* High potential for dependence, usually PRN, elderly probably should not be given these
* Used for termination of seizure, Insomnia, sleep, anxiety, muscle spasms
* Short term memory loss

Front 18

Buspar (buspirone) for Anxiety

Back 18

Non habit forming

Given more in elderly and children

Front 19

Propanol

Back 19

Beta blocker: lowers the heart rate

Good for stage fright, boards, etc...

Front 20

Posttraumatic Stress Disorder

Back 20

A reaction to an extreme trauma, which is likely to cause pervasive distress to almost anyone, such as natural or man-made disasters, combat, serious accidents, witnessing the violent

death of others, being the victim of torture,

terrorism, rape, or other crimes

Front 21

Symptoms of PTSD

Back 21

Re-experiencing the traumatic event

A sustained high level of anxiety or arousal

A general numbing of responsiveness

Intrusive recollections or nightmares

Amnesia to certain aspects of the trauma

Depression; survivor’s guilt

Substance abuse

Anger and aggression

Relationship problems

Front 22

Acute Stress Disorder (ASD)

Back 22

Similar to PTSD in terms of precipitating traumatic events and symptomatology

Symptoms are time limited: up to 1 month following the trauma

If the symptoms last longer than 1 month, the diagnosis would be PTSD

Front 23

Adjustment Disorders

Back 23

Characterized by a maladaptive reaction to an identifiable stressor or stressors that results in the development of clinically significant emotional or behavioral symptoms

Symptoms occur within 3 months of the stressor and last no longer than 6 months

Front 24

1. Two months ago, Ms. T was sexually assaulted while jogging in an isolated park. She is hospitalized for suicidal ideation at this time. She awakens in the middle of the night screaming about having nightmares of the incident. Which of the following is the most appropriate initial nursing intervention?

a) Call the doctor to report the incident

b) Stay with Ms. T until the anxiety has subsided

c) Administer prn alprazolam

d) Allow her some privacy to work through the emotions

Back 24

Correct answer: B

It is important to not leave a client who is experiencing flashbacks or nightmares alone. Clients often feel they are “going crazy” when this happens, and the presence of a trusted individual calms fears and reassures the client of her safety.

Front 25

2. Which of the following medications is

considered to be a first-line medication of choice in the treatment of PTSD?

a) Alprazolam: Benzodiazapine

b) Propranolol: Anti hypertensive-Beta blocker

c) Carbamazepine: Seizure med

d) Paroxetine: SSRI

Back 25

Correct answer: D

The SSRIs are now considered first-line treatment of choice for PTSD because of their efficacy, tolerability, and safety ratings. Paroxetine and sertraline have been approved by the FDA for this purpose.