psych assessment 2 ch. 18

define hoarding disorder.

persistent difficulties discarding or parting with possessions, regardless of their actual value. may be specified as "with excessive acquisition," which identifies the excessive need for continual acquiring of items.

size effects of "benzodiazzzzzzzzepines"... extra z's because it makes individuals drowsy and lethargic. what would you note regarding blood pressure? can benzodiazepines aggravate depression? clients should be tapered off of _________ term use. is it okay to drink alcohol with benzodiazepines? definitely not.

the following are common side effects of anti-anxiety agents. ~ drowsiness, confusion, lethargy. ~ tolerance; physical and psychological dependence. client should be tapered off long-term use. ~ potentiates the effects of other CNS depressants. client should not take alcohol or other CNS depressants with the medication. ~ *may aggravate symptoms of depression.* ~ orthostatic hypotension. client should ride slowly from lying or sitting position. ~ paradoxical excitement. if symptoms opposite of desired effect occur, notify physician immediately. ~ dry mouth. ~ nausea and vomiting. may be taken with food or milk. ~ blood dyscrasias. symptoms of sore throat, fever, malaise, easy bruising, or unusual bleeding should be reported to the physician immediately. ~ *benzodiazepines lower blood pressure* ~ *client should be tapered off the medication at the end of therapy because withdrawal symptoms can be life threatening* ~ *helllllll no u cannot drink and take benzos*

what neurotransmitters are implicated in anxiety?

the most significant appear to be disturbances in serotonin, norepinephrine, and gamma-aminobutyric acid (GABA). ~ serotonin is thought to be decreased in anxiety disorders (based on the efficacy of SSRIs in the treatment of anxiety disorders). ~ norepinephrine is thought to be increased in anxiety disorders. ~ GABA is the major inhibitory neurotransmitter in the brain. it is thought to be decreased in anxiety disorders, allowing for increased cellular excitability.

what outcomes are important for the individual with anxiety disorders? the person is able to maintain anxiety at a __________ level; is able to ________ signs of escalating anxiety; is able to function _________ in the presence of the phobic anxiety; is able to demonstrate more adaptive coping strategies without resorting to the use of ________ behaviors. what is the first step in helping clients to interrupt escalations of anxiety? rationales: allowing the client _________ provides a measure of control and serves to increase feelings of self worth.

the person is able to maintain anxiety at a *manageable* level; is able to *recognize* signs of escalating anxiety; is able to function *adaptively* in the presence of the phobic anxiety; is able to demonstrate more adaptive coping strategies without resorting to the use of *ritualistic* behaviors. what is the first step in helping clients to interrupt escalations of anxiety? *recognition of precipitating factors* rationales: allowing the client *choices* provides a measure of control and serves to increase feelings of self worth.

Compare and contrast: body dysmorphic disorder

~ body dysmorphic disorder: the exaggerated belief that the body is deformed or defective in some specific way. examples include flaws of the face or head, such as wrinkles or scars, the shape of the nose, excessive facial hair, and facial asymmetry. the individual is aware that their beliefs are exaggerated, so it is different from delusions. social and occupational impairment may occur because of the excessive anxiety experienced by the individual in relation to the imagined defect.

what is body dysmorphic disorder? what is the difference regarding these individuals beliefs?

~ body dysmorphic disorder is characterized by the exaggerated belief that the body is deformed or defective in some specific way. only in some instances is a true defect present. ~ the significance of the defect is unrealistically exaggerated, and the person's concern is grossly excessive.

what anti-anxiety agent does not depress the CNS?

The antianxiety agent buspirone (BuSpar) is not a benzodiazepine and thus does not depress the CNS

define agoraphobia.

"fear of the marketplace." the fear of being in open shops and markets, but more specifically, it is the fear of being vulnerable and unable to get help or escape the setting, should panic symptoms occur.

what are the safety issues and nursing interventions for patients taking anti-anxiety drugs?

- Tolerance and physical dependence may develop. - Abrupt withdrawal can be life-threatening - Drowsiness, confusion, lethargy - Effect of other CNS depressants is increased. - Antianxiety agents may aggravate symptoms of depression. - Orthostatic hypotension may occur. - Paradoxical excitement (opposite from the desired effect) may occur. Especially the elderly may be at higher risk for agitation and increased anxiety. - Blood dyscrasias, although rare, can be serious or life-threatening. - Congenital malformations have been associated with use of these drugs during the first trimester of pregnancy.

BAN the BAG! use of a bag for hyperventilation is no longer recommended and can be dangerous.

...

a huge major difference between panic and GAD is __________.

A panic disorder is a recurrent panic attack and its onset is unpredictable. GAD is persistent excessive anxiety that happens more days than not and happens for at least 6 months. (cannot attribute to specific organic factors)

what neurotransmitter is affected by the anti-anxiety drugs (ex. xanax, klonopin, ativan)?

GABA

what screening tool is used for anxiety? how does it seem similar to the screening tool for depression?

One of the most widely used clinician-administered scales is the Hamilton Anxiety Rating Scale (HAM-A), which is used in both clinical and research settings. The scale consists of 14 items and measures both psychic and somatic anxiety symptoms (psychological distress and physical complaints associated with anxiety).

the first line treatment(s) for social anxiety is/are __________.

SSRIs have become the first-line treatment of choice for social anxiety disorder.

what drugs are first line for anxiety?

SSRIs, SNRIs, and buspirone are the first line drugs for anxiety.

what is habit reversal training?

a type of behavior therapy in which the individual develops awareness of unhealthy habits and learns to substitute more adaptive coping strategies in an effort to extinguish unwanted behaviors.

phobias: the most common are ________ and _________.

agoraphobia and social phobia (social anxiety disorder).

benzodiazepines are much like _________ in their effects on GABA receptors, which explains why benzodiazepine's may be used for the management of alcohol withdrawal.

alcohol

anxiety is described as being the result of exaggerated, __________ thinking.

anxiety is described as being the result of exaggerated, automatic thinking.

regarding trichotillomania, what suggestions are made to the client to prevent behaviors?

behavior modifications have been used to treat trichotillomania, using techniques including covert desensitization and habit reversal training. these include a system of positive and negative reinforcements in an effort to modify the hair-pulling behaviors. an aspect of HRT is substituting an incompatible behavior to help extinguish the undesirable behavior. for example, when a pt experiences a hair-pulling urge, suggest that the individual ball up his/her hands into fists, tightening arm muscles, and "locking" his/her arms so as to make hair pulling impossible at that moment. once the pt has become aware of hair-pulling times, suggest that the pt hold something in his/her hand at times when hair pulling is anticipated.

_________ are addictive and are used for short-term intervention.

benzodiazepines are addictive and used for short-term intervention.

__________ is an anti-anxiety agent effective in 60-80% of clients with GAD.

busprione is effective in about 60-80% of clients with GAD.

peds! review how children are affected by fears as part of their development.

children experience fears as a part of normal development.

what is the purpose of cognitive therapy?

cognitive therapy strives to assist the individual to reduce anxiety responses by altering cognitive distortions.

how does cognitive therapy assist the individual to reduce anxiety?

cognitive therapy strives to assist the individual to reduce anxiety responses by altering cognitive distortions. the therapist uses questions to encourage the client to correct his or her anxiety-producing thoughts. the client is encouraged to become aware of the thoughts, examine them for cognitive distortions, substitute more balanced thoughts, and eventually develop new patterns of thinking.

hair pulling is a result of _______ anxiety.

obsessive-compulsive related anxiety

what is the difference between GAD and ^?

~ GAD is characterized by persistent, unrealistic, and excessive anxiety and worry, which have occurred more days than not for at least 6 months and cannot be attributed to specific organic factors, such as caffeine intoxication or hyperthyroidism. the anxiety and worry are associated with muscle tension, restlessness, or feeling keyed up or on edge. onset is not uncommon after age 20. depressive symptoms are common. tends to be chronic, with frequent stress-related exacerbations and fluctuations in the course of the illness. * unlike the typical experience of anxiety, the symptoms in GAD are intense enough to cause clinically significant impairment in social, occupational, of other important areas of functioning.

compare and contrast: GAD

~ GAD: characterized by persistent, unrealistic, and excessive anxiety and worry, which have occurred more days than not for at least 6 months and cannot be attributed to specific organic factors. the anxiety and worry are associated with muscle tension, restlessness, or feeling keyed up or on edge. symptoms are intense enough to cause clinically significant impairment in social, occupational, or other important areas of functioning.

Compare and contrast: OCD

~ OCD: the presence of obsessions, compulsions, or both in which the severity is significant enough to cause distress or impairment in social, occupational, or other important areas of functioning. the individual recognizes that the behavior is excessive or unreasonable but, because of the feeling of relief from discomfort that it promotes, is compelled to continue the act.

Compare and contrast: agoraphobia

~ agoraphobia: "fear of the marketplace." the fear of being in open shops or markets; the fear of being vulnerable and unable to get help or escape the setting should panic symptoms occur. the person may become totally confined to his/her home.

epidemiology of generalized anxiety disorder (GAD)

~ anxiety disorders are the most common of all mental illnesses in the US, affecting 18.1% of the population each year. ~ most stats agree that anxiety disorders are more common in women than in men by at least 2:1. ~ lifetimes prevalence for any anxiety disorder is ~ 31.1% for adults and ~31.9% for children 13-18. ~ common comorbidities include another anxiety disorder, depression, or substance abuse. ~ studies suggest that a familiar predisposition to anxiety disorders probably exists.

what nursing diagnoses are commonly associated with anxiety disorders? list interventions to consider.

~ anxiety: palpitations, tremblings, sweating, chest pain, shortness of breath, fear of going crazy, fear of dying, excessive worry, difficulty concentrating, sleep disturbance ~ powerlessness: verbal expressions of having no control over life situation, nonparticipation in decision making related o own care or life situation, expressions of doubt regarding role performance ~ fear: behavior directed toward avoidance of a feared object or situation (phobic disorder) ~ social isolation: stays at home alone, afraid to venture out alone ~ ineffective coping: ritualistic behavior, obsessive thoughts, inability to meet basic needs, severe level of anxiety (OCD) ~ ineffective role performance: inability to fulfill usual patterns of responsibility because of need to perform rituals (OCD) ~ disturbed body image: preoccupation with imagine effect, verbalizations that are out of proportion to any actual physical abnormality that may exist, numerous visits to plastic surgeons or dermatologists seeking relief (body dysmorphic disorder) ~ ineffective impulse control: repetitive and impulsive pulling out of one's hair (trichotillomania)

regarding treatment modalities, differentiate between behavior therapy

~ behavior therapy: has been used to treat trichotillomania. techniques include covert desensitization and habit reversal training. may include a system of positive and negative reinforcements in an effort to modify the behaviors. with HRT, in an attempt to extinguish the unwanted behavior, the individual learns to become more aware of the hair pulling, identifies times of occurrence, and substitutes a more adaptive coping strategy. other forms of behavior include systematic desensitization and implosion therapy (flooding); these are commonly used to treat clients with phobic disorders and to modify the stereotyped behavior of clients with OCD.

regarding treatment modalities, differentiate between cognitive vs. behavior vs. systematic desensitization vs. implosion therapy.

~ cognitive therapy: relates how individuals respond in stressful situations to their subjective cognitive appraisal of the event. strives to assist the individual to reduce anxiety responses by altering cognitive distortions. cognitive therapy is structured and orderly, the focus is on solving current problems. *together, the client and therapist work to identify and correct maladaptive thoughts and behaviors that maintain a problem and block its solution.*

define compulsions

~ compulsions: repetitive ritualistic behaviors or mental acts that the individual feels driven to perform, which are intended to reduce the anxiety associated with obsessive thoughts.

Compare and contrast: hoarding disorder

~ hoarding disorder: persistent difficulties discarding or parting with possessions, regardless of their actual value. individuals collect items until virtually all surfaces within the home are covered.

regarding treatment modalities, differentiate between implosion therapy

~ implosion therapy: a therapeutic process in which the client, for a prolonged period, must imagine situations or participate in real-life situations that he or she finds extremely frightening. the therapist "floods" the client with information concerning situations that trigger the client's anxiety by describing anxiety-provoking situations in vivid detail. the more anxiety is provoked, the more expedient the therapeutic behavior. this tactic is continued for as long as it arouses anxiety in the client.

define obsessions

~ obsessions: intrusive thoughts that are recurrent and stressful. although they are recognized by the individual as irrational, they continue to be repetitive and cannot be ignored.

what is the difference between panic attacks?

~ panic attacks are manifested by intense apprehension, fear, or terror, often associated with feelings of impending doom and accompanied by intense physical discomfort. the physical sensations can be so intense that the individual believes he or she is having a heart attack or other critical illness.

what is the difference between panic disorder and ^?

~ panic disorder is characterized by recurrent panic attacks, the onset of which are unpredictable. may last for weeks-months-years.

define phobias. give an example.

~ phobia: a persistent, intensely felt, and irrational fear of a specific object, activity, or situation that results in a compelling desire to avoid the feared stimulus. responses typically include anxiety or panic attacks. examples. ~ acrophobia: fear of heights. ~ aquaphobia: fear of water. ~ cynophobia: fear of dogs. ~ homophobia: fear of homosexuality. ~ nyctophobia: fear of darkness. ~ zoophobia: fear of animals.

Compare and contrast: social anxiety disorder

~ social anxiety disorder: AKA social phobia. an excessive fear of situations in which a person might do something embarrassing or be evaluated negatively by others. the individual has extreme concerns about being exposed to possible scrutiny by others and fears social or performance situations in which embarrassment may occur. fear may be defined or may involve general social situations. exposure of the phobic situation usually results in feelings of panic anxiety with sweating, tachycardia, and dyspnea. impairment interferes with social or occupational functioning and causes marked distress.

regarding treatment modalities, differentiate between systematic desensitization

~ systematic desensitization: the client is gradually exposed to the phobic stimulus, in either a real or an imagined situation.

is body dysmorphic disorder delusional? would you expect them to have multiple visits to the plastic surgeon or dermatologist?

~ these beliefs are differentiated from delusions in that the individual is aware that his/her beliefs are exaggerated. ~ the person's medical history may reflect numerous visits to plastic surgeons and dermatologists in an unrelenting drive to correct the imagined effect. they also may forego unnecessary surgical procedures toward this effort.

Compare and contrast: trichotillomania

~ trichotillomania: AKA hair-pulling disorder. the recurrent pulling out of one's hair that results in hair loss. the impulse is preceded by an increasing sense of tension and results in a sense of release or gratification from pulling out the hair. areas of hair loss are often found on the opposite side of the body from the dominant hand. usually begins in childhood.