NU 125 Mental Health Nursing: Anxiety and Anxiety Disorders

Anxiety

feeling of apprehension or dread in anticipation of danger, often with an unknown source

What should be considered before diagnosing anxiety?

Rule out medical causes (thyroid, substance use)

Anxiety is the most _____ psychiatric disorder.

common

Stress Response Pathway (Mind-Stress Feedback Loop)

Body senses a threat, triggers brain response which triggers body to respond

What is the goal in treating anxiety?

Targetting the feedback loop

Neurotransmitter involved in anxiety

GABA

Anxiety vs. Anxiety Disorders

Anxiety is a normal reaction to stress triggered by a specific stressor and can be helpful while anxiety disorders interfere with day to day life and is impossible to manage

What is evaluated when recognizing anxiety?

Cognitive

Affective

Behavioral

Physiologic

Cognitive symptoms of anxiety

fear, worry, poor focus

Affective symptoms of anxiety

irritability, tension

Behavioral symptoms of anxiety

pacing, restlessness

Physiologic symptoms of anxiety

tachycardia, shortness of breath, dizziness

Generalized anxiety disorder (GAD)

excessive worry lasting over 6 months

Criteria for Generalized Anxiety Disorder

1. Excessive worry and anxiety occuring more days than not for at least 6 months about a number of events or activities

2. Difficult to control worry

3. Associated with three or more of the 6 symptoms, with at least some present for more days than not for the past 6 months.

How many items are required in children?

one

6 Symptoms according to DSM-5

Restlessness, feeling tense or on edge

Easily fatigued

Difficulty concentrating or mind going blank

Irritability

Muscle tension

Sleep disturbances

What should be ruled out before diagnosing anxiety?

Medical causes

Obsessive Compulsive Disorder (OCD)

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

Obsessions

unwanted intrusive thoughts, impulses, or images

Compulsions

repetitive actions, or ritualistic behaviors

Example of compulsion

excessive handwashing

What is the reason for this time-consuming behavior in OCD?

to decrease anxiety

With OCD, the thoughts or actions..

IMPACT social or occupational function, as behavior is excessive or unreasonable

OCD occurs in..

across the lifespan

Other OCD related disorders

Hoarding

Body Dysmorphic Disorder

Trichotillomania

Hoarding

collecting and putting things away in a guarded manner

Body Dysmorphic Disorder

a disorder characterized by the unrealistic perception of physical flaws

Trichotillomania

a disorder characterized by the repeated pulling out of one's own hair

Phobias

irrational persistent fear of an object or situation

Fear

involves intellectual appraisal of threatening situation

If anxiety is severe enough, the ___ or ___ is avoided.

situation, object, or activity

Types of Phobias

Agoraphobia

Social

Specific

Agoraphobia

fear of being in a place or situation from which escape is difficult or impossible, feeling unsafe or trapped

Social phobia

fear of social situations or performance

Specific phobia

fear of something specific, like snakes or spiders

Panic Disorder

onset occurs in early adulthood or menopause and is characterized by recurrent episodes of panic attacks

At least one of the attacks has been followed by one month of..

1. Persistent concern (of another attack)

2. Worry about consequences

3. Significant change in behavior

Panic Attack Symptoms (must have 4/5)

Sweating

Shaking

Choking

Chest pain

Nausea

Dizziness

Fear of dying or going crazy

Paresthesia

Chills

Hot flashes

Derealization

Depersonalization

Derealization

detached from reality or the situation

Depersonalization

detached from themselves

Interventions for Panic Attacks

Stay with person

Convey calm

Minimize stimuli

Encourage breathing

Offer fluids

Provide distraction

What should the nurse tell someone experiencing a panic attack?

"This will not last"

"You have experienced this before"

"You are safe"

"I will stay with you"

Goal of intervention for panic attacks

relieve immediate symptoms

Acute Stress Disorder

short-term disorder that develops after a traumatic event and stress related symptoms occur within a month of this event

How long do symptoms persist with ASD?

at least two days and cause much distress

If symptoms persist for a month of longer, diagnosis changes to..

PTSD

Post Traumatic Stress Disorder

exposure or experience of a traumatic event and severity/duration of the stressor can impact degree of distress along with timely support

Symptoms of PTSD

Recurrent nightmares

Flashbacks

Intense fear

Detached

Sleep disturbance

Hypervigilant

What can cause a re-experience of symptoms?

triggers such as images, sounds, words, etc.

Who is PTSD common in?

military personnel

Nursing interventions for PTSD

Stay calm & stay present

Encourage breathing & grounding

Reassure: 'You are safe. This will pass.

Minimize stimuli; use soft voice

Teach relaxation, mindfulness, CBT

Empower recovery through trauma-informed care

Pharmacologic Treatments for Anxiety

Benzodiazepines

Benzodiazepines

drugs that lower anxiety and reduce stress

Lorazepam (Ativan)

Benzodiazepine

Diazepam (Valium)

Benzodiazepine

Clonazepam (Klonopin)

Benzodiazepine

Benzodiazepines provide..

fast relief, short-term only

Risks of Benzodiazepines

dependence and sedation

What is the action of benzodiazepines?

increase GABA to increase relaxation and neuronal slowing

Non-benzodiazepines

Buspirone

SSRIs

Buspirone (Buspar)

slow onset, no dependence, must be scheduled not PRN

SSRIs

long-term maintenence, do not stop abruptly

Black Box Warnings for Benzodiazepines

avoid use with opiods, risk of addiction, abuse, misuse, and do not drink alcohol

Nonpharmacologic Treatments

CBT

Behavioral therapy

Breathing, mindfulness, exercise

Support groups and journaling

Cognitive Behavioral Therapy

refines maladaptive thought patterns and motivates towards adaptive actions through examining thoughts, feelings, and behaviors

Unhelpful Thinking Styles: Cognitive Distortions

Dichotomous

Personalization

Overgeneralization

Catastrophizing

Jumping to conclusions

Disqualifying the positives

Dichotomous thinking

black and white thinking (e.g. "if I don't score 100% I have no future")

Personalization thinking

"When I walk through the hospital hallway, I know everyone is looking at me."

Overgeneralization thinking

after car accident, says "I should not be on the road"

Catastrophizing

"If I fail this test, I will be a total failure"

Jumping to conclusions

Friend does not return phone, you assume he is avoiding you

Disqualifying the positives

"They are just congratulating me to be nice"

Anxiety Evaluation

Can the patient..

Recognize anxiety signs

Use coping

Maintain function and safety

Verbalize long-term plan