Psych Chapter 29 - Anxiety disorders

What are the predisposing factors of PTSD?

1. *Psychosocial* - severity and duration of stressor, extent and anticipation of event, exposure to death, number of people affected, extent of control over recurrence, location of trauma experience, coping strategies, behavior tendencies, stage of development, recovery environment 2. *Learning* - avoidance behaviors 3. *Cognitive* - experiencing trauma that cannot be comprehended, sense of helplessness and hopelessness prevail 4. *Biologica*l - experience a previous trauma, more likely to develop symptoms after another stressful life event. Opioid, glutamatergic, noradrenergic, serotonergic, and neuroendocrine pathways

What are some types of specific phobia?

1. Animal type 2. Natural environment type - darkness, water 3. Blood-injection-injury type 4. Situational type - insanity, marriage 5. Other type - loud noises, driving

What are the characteristics of Generalized anxiety disorder?

1. Characterized by chronic, unrealistic and excessive anxiety and worry 2. 6 months or longer 3. Restlessness/on edge/fatigue 4. Concentration difficulties 5. Irritability 6. Sleep disturbance Onset usually after 20

What client/family education should be given for support services of anxiety disorder?

1. Crisis hotline 2. Support groups 3. Individual psychotherapy

What should nurses do to help patients with anxiety disorders?

1. Do not leave client alone who is experiencing panic anxiety 2. Encourage 6-12 natural breaths if patient is hyperventilation 3. Provide low stimulating environment 4. help client relax 5. be calm, non-threatening, and matter of fact

What are the side effects of antianxiety agents?

1. Drowsiness/lethargy 2. Confusion 3. Tolerance 4. Potentiates effects of other CNS depressants 5. Orthostatic hypotension 6. Paradoxical excitement 7. Dry mouth 8. N/V 9. Blood dyscrasias 10. Dependence - do not stop abruptly 11. 10-14 day delayed onset of action - with buspirone

What are the characteristics of *biological aspects* that predisposing someone to panic and generalized anxiety disorders?

1. Genetics - identical twins 30% 2. Neuroanatomical - changes in structure 3. Biochemical - increase blood lactate 4. Neurochemical - increase norepinephrine, decreased serotonin, GABA 5. Medical conditions - hormonal alterations, MI, substance use, hypoglycemia, caffeine intoxication, MVP, seizures

What are types of medications given for anxiety disorders?

1. Hydroxyzine 2. Alprazolam 3. Chlordiazepoxide 4. Clonazepan 5. Clorazepate 6. Diazepam 7. Lorazepam 8. Oxazepam 9. Meprobamate 10. Buspirone

What are the symptoms of a panic attack?

1. Palpitations, 2. pounding heart/inc HR 3. sweating 4. trembling/shaking 5. SOB 6. smothering 7. feeling of choking 8. chest pain/discomfort, 9. nausea, 10. abdominal distress, 11. dizziness/unsteadiness 12. depersonalization, 13.fear of losing control/going crazy 14. fear of dying, 15. paresthesias, 16. chills/hot flashes. *Usually lasts minutes, rarely hours*

What are some nursing diagnosis used for patients with anxiety disorders?

1. Panic anxiety (panic disorder and GAD) 2. Powerlessness (panic disorder and GAD) 3. Fear (phobic disorder 4. Social isolation (phobic disorders) 5. Ineffective coping (OCD) 6. Ineffective role performance (OCD) 7. Post-trauma syndrome (PTSD) 8. Complicated grieving (PTSD)

What are predisposing factors to phobias?

1. Psychoanalytic theory - unconscious fears expressed in symbolic manner as phobia 2. Learning - conditioned response 3. Cognitive therapy - faulty cognitions, negative self-statements, irrational beliefs 4. Temperament - born with certain characteristics that dictate how a person responds to situations 5. Life experiences - early negative experiences

What are the predisposing factors to OCD?

1. Psychoanalytical theory - weak egos 2. Learning theory - conditioned response to traumatic event, active/passive avoidance 3. Neuroanatomy - brain variations 4. Physiology - similarities to depression 5. Biochemical - serotonin 6. Transactional

What are the predisposing factors of panic and generalized anxiety disorders?

1. Psychodynamic theory - ego unable to intervene between id and superego 2. Cognitive theory - faulty, distorted, counterproductive thinking 3. Transactional model of stress adaptation 4. Biologic aspects

What client/family education should be given for the management of the anxiety illness?

1. Stress management - a. Teach ways to interrupt escalate anxiety b. Teach relaxation techniques 2. Medication management a. Possible adverse effect b. Length of time to take effect c. What to expect from the medication

What are types of behavior therapy for anxiety disorders?

1. Systematic desensitization 2. Implosion therapy

What client/family education should be given for the nature of the anxiety illness?

1. What is anxiety 2. What might it be related to 3. What is OCD 4. What is PTSD 5. Symptoms of anxiety disorder

What medication class should be given for panic, GAD, and phobias?

1. anxiolytics 2. Antidepressants 3. Antihypertensive agents

What medication class should be given for PTSD?

1. anxiolytics 2. Antidepressants 3. Antihypertensive agents 4. Others

What are the characteristic symptoms of PTSD?

1. re-experiencing the traumatic event 2. a sustained high level of anxiety or arousal 3. a general numbing of responsiveness 4. Intrusive recollections or nightmares of the event are common 5. Symptoms for >1 month and cause significant interference with life *Depression common, amnesia, painful guilt feelings about surviving, substance abuse common*

What medication class should be given for OCD?

Antidepressants

What is the difference between anxiety and fear?

Anxiety is an emotional process and fear is cognitive

What is panic disorder with agoraphobia?

Characterized by same symptoms of panic disorder. Additionally the individual experiences a fear of being in places or situations from which escape might be difficult/embarrassing or in which help might not be available in the event of a panic attack. May become completely housebound

What are the characteristics of specific phobia?

Marked persistent and excessive or unreasonable fear when in the presence of or when anticipating an encounter with a specific object or situation

What are some nursing interventions for patients with OCD?

Nurse will... 1. Help client learn new, more adaptive coping strategies without resorting to obsessive compulsive behaviors 2. Help client gain independence and greater control over life situations 3. Provide Systematic desentitization or implosion therapy 4. Support self-esteem - positive reinforcement 1 week - decrease participation in ritualistic behavior by half.

What are some nursing interventions for patients with PTSD?

Nurse will... 1. Integrate the trauma into the client's persona 2. Renew significant relationships 3. Establish meaningful goals for the future 4. Progress through the grief process 5. Develop a sense of optimism and hope for the future

What are some nursing interventions for patients with anxiety disorders?

Nurse will... 1. Maintain anxiety at manageable level 2. Problem-solve to increase client's level of personal control 3. Help the client learn to function in the presence of the phobic object without experiencing panic anxiety 4. Assist the client to overcome fear of leaving home alone.

What are some client outcomes for patients with anxiety disorder?

The client will... 1. Be able to recognize signs of escalating anxiety and intervene before reaching panic level (panic and GAD) 2. Be able to maintain anxiety at manageable level and make independent decisions about life situation (panic and GAD) 3. Function adaptively in the presence of the phobic object or situation without experiencing panic anxiety (phobic) 4. Verbalizes a future plan of action for responding in the presence of the phobic object or situation without developing panic anxiety (phobic) 5. Be able to maintain anxiety at a manageable level without resorting to the use of ritualistic behavior (OCD) 6. Demonstrates more adaptive coping strategies for dealing with anxiety than ritualistic behaviors (OCD) 7. Experience fewer flashbacks, intrusive recollections and nightmares (PTSD) 8. Demonstrate adaptive coping strategies and verbalizes desire to put the trauma in the past and progress with his or her life (PTSD)

What is a panic disorder?

characterized by recurrent panic attacks, the onset of which are unpredictable and manifested by intense apprehension, fear, or terror, often intense apprehension, fear or terror, often associated with feelings of impending doom and accompanied by intense physical discomfort.

What is PTSD?

development of characteristic symptoms following exposure to an extreme traumatic stressor involving a personal threat to physical integrity or to the physical integrity of others

What is social phobia?

excessive fear of situation in which the affected person might do something embarrassing or evaluated negatively by others. Begins late childhood/early adolescence.

What is Agoraphobia without history of panic disorder?

fear of being in places or situations from which escape might be difficult or in which help might not be available if a limited-symptoms attack or panic like symptoms should occur. 20s-30s, more in women

What are the characteristics of Substance induced anxiety disorder?

prominent anxiety symptoms that are judged to be due to the direct physiological effects a substance

What is OCD?

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

What are the characteristics of anxiety due to a general medical condition?

symptoms are judged to be the direct physiological consequence of a general medical condition. Endocrine, CV, Respiratory, Metabolic, Neurological

What are the characteristics of *Compulsions* in Obsessive compulsive disorder?

unwanted *repetitive behavior patterns* or mental acts that are intended to reduce anxiety, not to provide pleasure or gratification. Ex - *Counting, cleaning, checking, washing, repeating actions*

What are the characteristics of *obsession* in Obsessive compulsive disorder?

unwanted, *intrusive, persistent*, ideas, *thoughts,* impulses or images that cause marked anxiety or distress. Ex - *Theft, contamination, burning*