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25 Cards in this Set
- Front
- Back
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Anxiety
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Is a state wherein a person feels a strong sense of dread, frequently accompanied by physical symptoms of increased heart rate, respiratory rate, elevated blood pressure (ANS responses), without having a specific source or rason for the emotions.
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Fear
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is a state wherein a person feels a strong sense of dread, with ANS responses that are focused on a specific object or event - rear of tornado, fear of surgery, fear of failing in a job.
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1872 Charles Darwin: In his book "The expression of the emotions in man and animals," what did he note to have observed?
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That fear may have two very different functions
- to increse ablility to fight - a frightened man or animal...is endowed iwth wonderful strength, and is notoriously dangerous - or to flee - Fear...soon induces...the most violent and prolonged attempts to escape from the danger. |
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Autonomic Nervous System
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Darwin emphasizes:
- responses of the ANS pg. 191. - fear behaviors are organized in the limbic system (the subcortical or primitive brain of which the hypothalamus is one part) - fear is expressed in pattersn common to many higher animals - espression of emotions can be observed by others, but the perception of emotions can only be directly studied by human resports. |
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Who is Walter Hess?
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- won nobel prize for demonstrating in animals that electrical stimulation of the hypothalamus can reproduce complez behavioral patterns closely resembling what animals actually do when they exhibit fear
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Neurobiology of Anxiety
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Think! Limbic System, Cerebral cortex, Brain stem, Hypothalamus
- cerebral cortex must be involved in the perception of fear - PET scanning- accurately measure blood flow patterns in the brain. Identify and precisely localize rapid changes in the blood flow that occur as the various mental and emotional stimuli - During a PET scan when person are made anxious: - blood flow increases both in the limbic system and in the cerebral cortex - anxiety experience (sensation of fear) has its origins in the limbic system: 1. heart rate 2. pallor 3. sweating 4. hair "standing on the end" - Neural messages are also associated with the temporal lobe and the cortical areas where sensory experiences are linked and joined to memory - processed as thoughts - Under hypothalamic stimulations release of hormonal substances; i.e ACTH and activation of ANS - resulting trigger of the ANS by the hypothalamus stimulations: 1. release cortecholamines (epinephrine) by the adrenal glands which causes increase in HR, cardian contractility - involving treatments for anxiety act on GABA - brain neutotransmitter (an imp. factor in anxiety disorder) - fear is an adaptive response - face or run - anxiety synonymous to fear, buty without a realistic source |
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Who was Soren Kierkegaard?
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Danish Theologian, taught that anxiety was inescapably part of the human condition.
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Stages of Anxiety
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In mild anxiety
- experiences day-to-day tensions and is alert, with an increase perceptions i.e: when you miss the bus In moderate anxiety - focused only on the immediate concerns, with a narrowed perceptual field i.e: when you taking an exam In severe anxiety - the person's perceptual field is greatly reduced and only focuses on a specific detail i.e: witnessing a car accident In a panic state - has feeling of dread or terror and is unable to control his behaviors; loses control i.e: when experiencing an earthquake and being unable to cope or a sunami, devastating hurricane |
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DSM: distinction between anxiety in heal vs. in illness
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In health
- all persons experience anxiety In illness - when severe anxiety interferes iwth ability to functions in daily life |
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Generalized Anxiety Disorder
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- exessive anxiety present more days
- it is "generalized" if it focuses on variety of life events - can not be solely on certain specific topic - difficult to control which causes distress or unability to function - 3 or more sypmtoms present 1. restlessness 2. fatigue 3. can't concetrate 4. irritability 5. muscle tension 6. sleeping problems - can't fit into any other diagnosis - 5% prevelent in US |
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Panic Disorder
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- discrete episodes of intense anxiety that begin abruptly and reach a peak within about 10 mins
- atleast 4 sets of symptoms must be present: 1. palpitations 2. sweating, 3. trembling 4. SOB 5. sensation of choking 6. chest pain 7. nausea 8. dizziness 9. fear of losing control 10. fear of dying 11. sense of altered reality 12. strong desire to run away - severe and strickingly episodic - no residual anxiety between attacks - reproducibly provoked by exposure to certain stimuli - "out of the blue" - often live in severe fear that the attacks will recur and often adjust their lives to avoid them - no other physical or psych. condition be present - Major Depressive Disorder is strongly associated - correlation with substance abuse to treat their symptoms - occur in young folks - mid 30s - genetic component - identical twins - increase in children of individuals with the condition - often do not consult professional help - made after years of suffering - linked between physical factors and panic attacks - reproduced by hyperventilation - will improve over long term follow-up - have a much higher risk of suicide than do persons with any other psych. condition, including depression - 6% prevelent in US - Treatment/therapy: Congitive-behavior therapy; tricyclics (dry mouth, low bp, urinary obstruction, sedation); SSRIs (weight change, sexual problems, arousal, akisthesia) |
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Stages of Panic Disorder
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1st stage
- attack is experienced after a variety of stressors and most often occurs during a routing task (driving a car) 2nd Stage: - begins to live in fear that he/she may have another attack and out of fear avoid events associated with prior attacks 3rd Stage: - Develop intense avoidant behaviors, refuse to participate in social events - called AGORAPHOBIA- fear of going out into public places |
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Agoraphobia
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- acute anxiety in crowds; fear of being alone; fear in any physical setting from which the individual may have trouble escaping
- still in use for a strikingly common and often severe anxiety disorder - DSM-IV-TR- persons who become feaful in any physical settings from which they might have trouble escaping or getting help in the event of an acute panic attack. - afraid to leave their homes - often results in panick attacks - rendered homebound by their fear - fear they will do somthing embarrassin in public - they typically fear each of these consequences with great intensity - they carry "things" with them to provide relief - more comfortable in dark places than in sunlight - most reliable fear-reducer is a trusted companion - the primary psych. need is to avoid panic, consequently, while stay fearfully home, but some fear to remail home alone. - comes from underlying motivation to avoid recurrent panic episodes - never seek medical or psych. treatment - most disabling and difficult to treat of all the anxiety disorders - strong linkage to panie disorder - symptoms develop gradually - 5% prevelency in US |
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Phobia
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-persisent fear of a specific object or situation, normally whenever the phobic person is brought in contact with that object
- social phobia: also referred to social anxiety disorders, maybe the most common phobia - severe anxiety when under social stress, such as speaking in public, hospitals, ER. Interventions: social skill training and exposure to social situations, assist to make their needs known for those who are intimidated or anxious - Specific phobia: fear up such things as airplane travel, heights, closed places, snakes, spiders or even seeing blood - DSM-IV-TR: criteria for specific phobia, the fear must be excessive or unreasonable by the phobic person and must result in significan social, occupational, or academic disruption - they are private - will deny the phobias - begin in early adulthood before 30 - animal phobias begin often in childhood - repeated exposures diminishes the anxiety - phobias in adolescence will be cured or much improved withing 5yrs - 10% prevelancy in the US |
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Obsessive-Cumpulsive Disorder
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- suffer from a combination of obsessions and compulsions
- obsessions are recurrent thoughts, images, or impulses that are intrusive and inappropriate that causes anxiety or distress. Common obsession fears: 1. fear of self-contamination 2. fear having to forget to do something 3. or need to have things - "it" - compulsions are repetitive behaviors or mental acts - goal of which is to prevent or reduce anxiety - often find releif from the repetive ritualistic actions or compulsions - persons with this diagnosis often recognize that their thoughts and or behaviors are unreasonable - Nursing tip: Do not take away the compulsive rituals (unless they are dangerous) until the client has some other method in place to deal with the anxiety - as common as diabetes and asthma - begin in young persons - most improve with time - very resistant to drug treatment - 2.6% prevelency |
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Post-traumatic Stress Disorder
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-anxiety disorder that typically occurs after a frightening event, most often accident, crime, or battle
- may follow natural disasters - event that threatened ones's physical integrity or causes death - response is fear or helplessness, and teh event needs to be persistently reexperiences through recurrent recollections, dreams, or hallucinatory-like flashbacks - impaired social functioning - hospital memories can act as stimuli to true PTSD - great interest in adult post-traumatic stress due to unrecalled childhood trauma, most commonly sexual abuse - commonly seen in military situtions - persons who are very close witnesses to violence may be more likely to be affected than those who observe violence at a distance. - unexpected events i.e. pregnancy loss - witness violence of domestic violence perpetrated by a parent or caretaker - large scale trauma that may extend inthe general population - the degree of anxiety felt and the duration of symptoms depends on what was mental state prior and subsequent social support - 3-58% prevelence for persons exposed to serious danger |
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Causes of anxiety disorders
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Psycoanalytic Theories
- origin of anxiety as being infantile conflicts involing sexual development - mental processes are unconsicious and, as a result, only dimly accessible to personal understanding, most often through dreams - impossible to validate b/c info. is very subjective and private "Commonsense" Theories (two highly individual factors) - adversity: is a measure of how strong given stimulus for anxiety: big earthquake - Trait anxiety: based on the everyday observation taht some quite normal persons appear to experience more anxiety than do others. 1. based adversity, person appraises an event 2. you get aroused: may lead to flight or fight symptoms - attempt to reduce the anxiety i.e. deep breathing or stimulus-reducing activities - coping methodscan be either "emotion focused coping" or "reality-focused coping" - problem with this theory is that it does not seem to offer any deep explanation of why some peope are more anxious than others. - neither has biological explanantion provided any substantial explanation for the mystery of anxiety |
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Treatment of anxiety:\
Psychotherapy |
- helping individuals achieve insight into why they feel anxiety
- those that emphasize behavioral means of controlling the anxiety |
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Insight Based Treatments
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- for highly motivated individuals whose symptoms are not disabling
- psychoanalysis best known therapies use to assist persons with anxiety |
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Behaviorally Based treatments
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- cognitive- behavior therapy assumes clients can learn to identify the common stimuli that give rise to their anxiety, develop plans to respond to those stimuli with nonanxious responses, and problem solve when unanticipated anxiety-provoking situations arise - practical commonsense problem solving
- Its educational; better than placebo in treating phobic disorders, OCD, GAD - brief course of therapy - may need med. and psych. follow up to ensure satisfactory improvement |
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Emergency Treatments for Acute Stress
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to help persons cope and prevent posttraumatic stress
- aims to reframe their cognitive appraisal so they no longer feel helpless. - concluded that single-session "debriefing" after a traumatic event is not helpful and my result in paradoxically higher incidence of post traumatic symptoms. |
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Antidepressants
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- Effective in many forms of anxiety disorders
TRICYCLICS (GAD, PD) - dry mouth, lbp, urinary obstruction, sedation - clomipramine (primarily OCD) SSRIs (GAD, PD, OCD, SP) - weight change, sexual dysfunction arousal, akisthesia NEWER ANTIDEPRESSANTS - drowsiness, drymouth, weight - venlafaxine (extended release) OTHER DRUGS - Buspirone (NOT AN ANTIDEPRESSANT) (GAD) - Anticonvulsant/mood stabilizers (GABA-modulating agents) - Monoamine oxidase inhibitors(SP) - phenelzine - drug-drug and drug-diet interactions - Beta blocker (PA, performance anxiety- shaking hands or loss of voice control during public presentations) - propranylol fatigue, low bp |
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Benzodiazepines
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- short-term effectiveness in the control of anxiety symptoms
- treatment of choice for acute episodes of anxiety: medical procedures such as colonoscopy - Diazepam (Valium): 6-12mos - GAD w/ addl. counseling - partially relieve the symptoms of anxiety - withdrawal- moderate to sever symptoms of insomnia, anxiety, seizures - controlled substances - significant physical dependence |
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Nursing theory and Clients
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1st- Provide patience, trust, and intuition, and
2nd- fully understand the nature of the clients anxiety and sense of being overpowered by the emotions Modeling and rolemodeling - build trust and model the client's world - supportive presence first |
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making assessments
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begin with observable, physical cognitive signs of anxiety:
- Increased pulse, blood pressure, resp. rate, startled response and "gut symptoms," sense of disorientation, difficulty concentrations, fear of losing control |
