Anxiety & OCD PPT

is anxiety the same as stress?

NO

define stress/stressor

an external pressure on an individual like a deadline or exam. 

define anxiety

the emotional response to the stressor. 

define fear

•a cognitive assessment of something that is a threat or danger.  Anxiety is the emotional response to the assessment.

what’s the prevalence of anxiety?

Most common disorder – over 18% of the population each year, 31% over a lifetime.  Reports show up to 80% of college students experience anxiety. 

when is anxiety “too much”?

when it interferes with daily functioning.

what are anxiety interventions aimed at?

reducing the client’s anxiety.

_________________ work best but clients must also learn coping and relaxation skills. 

Medications and therapy

where are anxiety disorders most common?

most common in US

what gender are more likely to experience anxiety?

More common in women than men

what are the comorbidities for anxiety?

another anxiety disorder, depression, and substance abuse

what are the risk factors for anxiety?

family history, childhood trauma, negative life events

what are some ways we can determine whether anxiety levels are TOO high and need to be addressed (maybe medically)?

•Regional and cultural differences

•When it affects performance:

•When anxiety response is out of proportion to the event (stops driving after seeing a wreck)

•When anxiety interferes with ADLs – working, relationships, life activities, etc. (can’t get to work because they refuse to drive)

•When it is excessive and persistent

slide 7 for anxiety scale

slide 7 for anxiety scale

define panic

sudden/unexpected overwhelming feeling of terror or impending doom with behavioral, cognitive, and physiological signs.  Are not triggered, not in relation to an event – mostly unpredictable. 

when do we usually see the onset of panic disorder?

in the 20’s

how long does a panic disorder episode last?

a few minutes, series may last a few months to years

what are the risks for panic disorders?

genetic links, negative emotions, childhood physical or sexual abuse, smoking

what is panic disorder considered?

a subtype of severe anxiety

what are the characteristics of Generalized Anxiety Disorder (GAD)?

by persistent/chronic, unrealistic,  and excessive anxiety and worry more days than not over 6 months and not from another medical cause or substance use

what does Generalized Anxiety Disorder (GAD) CAUSE?

•impairment in social, occupational, or other areas

•avoidance of stressful events or planning on how to minimize stress, procrastinates, seeks reassurance from others

when do we typically see the onset of Generalized Anxiety Disorder (GAD)?

in the 20s

what are some common symptoms seen with Generalized Anxiety Disorder (GAD)?

Depressive symptoms common with somatic complaints

what’s Generalized Anxiety Disorder (GAD) considered?

chronic, with exacerbations and fluctuations

what do you need to remember about anxiety?

it’s the emotional response to the stressor.

what are the different theories of panic and GADs?

•Psychodynamic

•Cognitive

Biological

what’s the psychodynamic theory of panic and GADs?

•use of defense mechanisms rather than coping results in poor response to anxiety

what’s the cognitive theory of panic and GADs?

•faulty, distorted, or counterproductive thinking that comes with or before maladaptive behaviors – causes an irrational assessment of the situation

what’s the biological aspects of panic and GADs?

•Genetics – twin studies 30-40% heritable, indicates risk only

•Neuroanatomical – brain structure differences

•Biochemical – elevations in blood lactate, sensitivity to increased CO2

•Neurochemical – not enough norepinephrine or GABA (deep breathing increases GABA, reduces HR) 

what does A score of 10 or greater on the GAD-7 represent?

• represents a reasonable cut point for identifying cases of GAD. 

• Cut points of 5, 10, and 15 might be interpreted as representing mild, moderate, and severe levels of anxiety on the GAD-7,

• similar to levels of depression on the PHQ-9.10. 

what’s the GAD-7 useful for?

in assessing symptom severity and monitoring change across time, although its responsiveness to change remains to be tested in treatment studies.

what should someone do if their anxiety is interfering with your daily activities?

seek assistance

what’s agoraphobia?

• Fear of being vulnerable in places or situations with questionable escape, may fear recurrence. 

• Onset from 20-30s, more women, may be unable to leave home. 

what’s the lifetime prevalence of agoraphobia?

1.3%

what’s the lifetime prevalence of social anxiety disorder?

7%

what’s social anxiety disorder (“social phobia”)?

Excessive fear of possible embarrassing situations, performance anxiety (like speaking in public), results in panic anxiety with sweating, tachycardia, and SOB, may last a lifetime

define specific phobia?

fear of specific object or condition that restricts activities or interferes with daily living, not anxious until exposed to the object

what are the characteristics of specific phobia?

•person recognizes that the fear is excessive

•Almost any age, may grow out of them

•Cause is unknown

what are the different theories for phobias?

•Psychoanalytical

•Learning

•Cognitive

•Biological

Life experiences

what’s the psychoanalytical theory of phobias?

unconscious or repressed fears

what’s the learning theory of phobias?

conditioned fear response

what’s the cognitive theory of phobias?

negative self statements or irrational beliefs

what’s the biological theory of phobias?

recalling information triggers fight or flight response, innate fears, situational

what’s the life experience “theory” of phobias?

experiences create response later in life

what are different examples of behavior therapy performed for phobias (by the therapist)?

systematic desensitization & flooding/implosion

what systematic desensitization?

• Behavior therapy for phobias (by therapist)

• •gradual exposure at increasing intervals (talk about it, see picture, see it from a distance, see it closer, touch it or do it, etc…

what’s flooding/implosion for phobias?

• Behavior therapy for phobias (by therapist)

• immersion in the triggering experience that is continued until it does not trigger anxiety

define Anxiety Disorder- Attributable to Another Medical Condition

Direct physiological effect of another medical condition or with intoxication or withdrawal from substance abuse

what are some conditions related to Anxiety Disorder- Attributable to Another Medical Condition?

•Cardiac

•Endocrine

•Respiratory

•Neurological

what will resolve Anxiety Disorder- Attributable to Another Medical Condition?

determine and then treat the underlying cause and it will resolve

define obsessions in OCD?

•recurrent, repetitive, and intrusive thoughts that even though they are irrational, they cannot be dismissed

define compulsions in OCD?

•repetitive and ritualistic behaviors that the person is compelled to perform to reduce their anxiety

what would you see in your assessment for OCD?

presence of one or both (obsession and/or compulsions) which causes distress or impairment in daily living

what are the presentations characteristics for OCD?

•Equal in men and women

•Begins in childhood, adolescence or early adulthood

define body dysmorphic disorder

• the exaggerated belief that the body is deformed or defective in some specific way -

• Mostly of the face (can be other parts)  but the significance of the defect is overexaggerated and the person understands this

what do we see in the event of body dysmorphic disorder?

High percentage also have MDD and/or anxiety

define Hair-pulling disorder (Trichotillomania)?

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

what are the characteristics of Hair-pulling disorder (Trichotillomania)?

•Comorbid mood and anxiety common

•Begins in childhood

•More common in women

•About 4% of the population

define hoarding

•Persistent problems discarding items regardless of their value

•May have excessive acquisition

•Collect items until all surfaces of the home are covered

Results in unsanitary conditions, especially if hoarding animals

who do we commonly see hoarding in?

•More men than women

•More in older adults

•High association with personality disorders

•May be related to unresolved grief

how do we manage hoarding?

•Symptoms become more severe over time

•Change is slow and relapse is high

what are the psychoanalytic theories that predispose people to OCD and related disorders?

(Freud) regressed to earlier phase in life, poor parent-child bond

what are the learning theories that predispose people to OCD and related disorders?

response to traumatic event; prevents anxiety by avoiding or behaviors that bring comfort

what are the psychosocial influences that predispose people to OCD and related disorders?

(related to trichotillomania) – stressful situations, issues in mother-child relationship, fear of abandonment

what are the biological aspects that predispose people to OCD and related disorders?

possible hereditary links, brain structure changes, low serotonin (50% of new hoarders have hoarder in the family)

what are the common nursing diagnoses associated w anxiety, OCD, and related disorder

•Panic anxiety (panic disorder and GAD)

•Powerlessness (panic disorder and GAD)

•Fear (phobias)

Social isolation (agoraphobia)

what are some additional problems seen with relation to anxiety?

•Ineffective coping (OCD)

•Ineffective role performance (OCD)

•Disturbed body image (body dysmorphic disorder)

•Ineffective impulse control (hair-pulling disorder)

what are the desired outcomes for the pt w anxiety?

•The client will:

•recognize signs of escalating anxiety and intervene before reaching panic level (panic and GAD)

•maintain anxiety at manageable level and make independent decisions about life situation (panic and GAD)

•function adaptively in the presence of the phobic object or situation without experiencing panic anxiety (phobic disorder)

•verbalize a future plan of action for responding in the presence of the phobic object or situation without developing panic anxiety (phobic disorder)

•maintain anxiety at a manageable level without resorting to the use of ritualistic behavior (OCD)

•demonstrate more adaptive coping strategies for dealing with anxiety than ritualistic behaviors (OCD)

•verbalize a realistic perception of his or her appearance and expresses feelings that reflect a positive body image (body dysmorphic disorder)

•verbalize and demonstrate more adaptive strategies for coping with stressful situations (hair-pulling disorder)

what is the purpose of the interventions for GAD?

•Relief of acute panic symptoms and helping the client to take control

what are the specific nursing actions for intervening on GAD or panic disorder?

•Stay with person

•Reassure them they are safe, if not, get them to safety

•Be extra calm – anxiety can be contagious

•Speak clearly in simple sentences or phrases

•Slow their breathing (if hyperventilating/lightheaded/dizzy breathe in paper bag)

•Reduce stimuli (visual, auditory, activity)

•Administer PRN medications if ordered and available

•After event, explore possible precipitating event

•Teach to reduce anxiety at earlier stage if possible

what are the BIG things you should do for GAD or panic disorder?

Stay with person

•Reassure them they are safe, if not, get them to safety

•Be extra calm – anxiety can be contagious

what is the purpose for interventions in OCD?

help client maintain anxiety at a manageable level and  develop more adaptive methods of coping with anxiety

what are the specific nursing actions for intervening on OCD?

•Reassure them they are safe, if not, get them to safety

•Allow time for rituals (more at the beginning and help them adapt)

•Be nonjudgmental

•Explore the threat (phobic object causing anxiety)

•Allow the person to make decisions/choices

•Assist with reinforcing therapy goals

•Encourage self-reflection

•Give positive reinforcement

•Encourage thought stopping or other coping measures

what is the big nursing action to do with OCD?

•Allow time for rituals (more at the beginning and help them adapt)

what is the purpose for interventions in phobias?

decreasing fear and increasing the ability to function in the presence of the phobic stimulus

what are the specific nursing actions for intervening on phobias?

•Reassure them they are safe, if not, get them to safety

•Explore the threatening object

•Present reality if irrational

•Discuss what can be changed about the situation

•Teach alternate coping methods

•Encourage goals of therapy (desensitization for example)

•Encourage emotional expression

what is the purpose for interventions in body dysmorphia?

recognize the distorted body image and develop a positive sense of self not based on appearance

what are the specific nursing actions for intervening on dysmorphic disorder?

•Assess client’s self perception

•Identify distorted thinking (with therapist)

•Encourage emotional expression

•Teach to use alternate coping methods

•Reinforce positive self image

Encourage use of support groups

what is the purpose for interventions in body hair-pulling disorder (Trichotillomania)?

•Assisting with habit reversal training and using more adaptive stress management techniques

what are the specific nursing actions for intervening on body hair-pulling disorder (Trichotillomania)?

•Reinforce that stopping the behavior is possible

•Be nonjudgmental

•Help client become aware of habit (with therapist)

•Help client substitute with another behavior

•Offer positive feedback/make an observation

•Help client anticipate likely times of behavior and offer substitute

•Teach and practice alternate coping methods