Anxiety & Anxiety Related Disorders

What is anxiety?

A vague feeling of dread or apprehension in response to internal or external stimuli.

How does anxiety differ from fear?

Fear is a reaction to a specific identifiable threat, while anxiety is a response to a perceived or vague stressor.

When does anxiety become considered a disorder?

When it is chronic, excessive, and significantly impairs daily routines and functioning.

Who developed the General Adaptation Syndrome theory of stress?

Hans Selye.

What are the three stages of General Adaptation Syndrome?

Alarm reaction, resistance stage, and exhaustion stage.

What occurs during the alarm reaction stage of stress?

The hypothalamus stimulates the adrenal glands to release adrenaline and norepinephrine to prepare the body for fight, flight, or freeze.

What physiological changes occur during the alarm reaction stage?

Dilated pupils, increased oxygen intake, and blood being shunted to vital organs.

What happens during the resistance stage of stress?

The body remains at a heightened level of functioning to adapt to the stressor.

What happens if adaptation is successful during the resistance stage?

The parasympathetic nervous system returns the body to normal.

What occurs during the exhaustion stage of stress?

The body's energy stores are depleted, leading to emotional distress and possible physical illness.

What are examples of illnesses that may occur during the exhaustion stage?

Tension headaches, eating disorders, and worsening of medical conditions like hypertension.

What are the four levels of anxiety?

Mild, moderate, severe, and panic.

What characterizes mild anxiety?

Widened perceptual field, increased motivation, and improved learning.

What characterizes moderate anxiety?

Narrowed perception, nervousness, but the person can still be redirected.

What characterizes severe anxiety?

Greatly reduced perceptual field, ineffective reasoning, and activation of fight or flight response.

What characterizes panic level anxiety?

The individual focuses only on self-defense, has distorted perceptions, and cannot process stimuli.

Is there a single cause for anxiety disorders and OCD?

No, they result from a combination of biological, psychological, and environmental factors.

What do biologic or genetic theories suggest about anxiety disorders?

There is moderate genetic heritability for panic disorder, phobias, and GAD, and a strong genetic component for OCD.

Which neurotransmitter is an inhibitory neurotransmitter involved in anxiety disorders?

GABA.

What is the role of GABA in the brain?

It reduces neuronal excitability and helps calm the nervous system.

How is norepinephrine related to anxiety disorders?

Increased norepinephrine levels are associated with heightened anxiety.

Which neurotransmitter dysregulation is strongly associated with OCD and anxiety disorders?

Serotonin, especially the 5-HT1A subtype.

What did Freud’s psychodynamic theory suggest about anxiety?

Anxiety results from overuse of unconscious defense mechanisms to control internal conflicts.

What is a major limitation of overusing defense mechanisms according to Freud?

It inhibits emotional growth and problem-solving abilities.

What do interpersonal theories by Sullivan and Peplau suggest about anxiety?

Anxiety originates from interpersonal relationship problems and can be transmitted from caregivers to children.

What do behavioral theories say about anxiety disorders?

Anxiety is a learned response that develops from negative experiences.

What is the implication of behavioral theories for treatment?

Maladaptive behaviors can be unlearned through therapy.

What do cognitive models suggest about the development of OCD?

OCD stems from perfectionism, inflated responsibility, and the belief that thinking something makes it more likely to happen.

What is panic disorder?

An anxiety disorder characterized by recurrent, unexpected panic attacks.

How long do panic attacks typically last?

About 15 to 30 minutes.

What are common symptoms of panic attacks?

Palpitations, sweating, shortness of breath, chest pain, and fear of impending doom.

What are phobias?

Illogical, intense, and persistent fears of specific objects or situations.

What is anticipatory anxiety?

Anxiety experienced when thinking about or anticipating exposure to a feared object or situation.

What behavior commonly results from phobias?

Severe avoidance behaviors.

What is agoraphobia?

Fear of open or public spaces where escape may be difficult.

What disorder commonly occurs with agoraphobia?

Panic disorder.

What is generalized anxiety disorder (GAD)?

Excessive worry and anxiety occurring more days than not for at least six months.

What symptoms accompany generalized anxiety disorder?

Muscle tension, fatigue, sleep disturbances, and persistent uneasiness.

What is obsessive-compulsive disorder (OCD)?

A disorder involving intrusive obsessions and repetitive compulsions.

What are obsessions?

Recurrent, intrusive, and unwanted thoughts that cause distress.

What are compulsions?

Repetitive behaviors performed to reduce anxiety caused by obsessions.

What is excoriation disorder?

Compulsive skin picking.

What is trichotillomania?

Compulsive hair pulling.

What is hoarding disorder?

Persistent difficulty discarding possessions regardless of value.

What is onychophagia?

Compulsive nail biting.

What is kleptomania?

Compulsive stealing.

What is oniomania?

Compulsive buying.

What is body dysmorphic disorder (BDD)?

A disorder involving obsessive concern over perceived physical flaws.

What treatment approach is most effective for anxiety disorders?

A combination of medication and psychotherapy.

What psychotherapy is highly effective for anxiety disorders?

Cognitive Behavioral Therapy (CBT).

What technique involves challenging catastrophic thinking?

Decatastrophizing.

What technique involves stopping intrusive thoughts?

Thought-stopping.

What is assertiveness training?

A CBT technique that teaches individuals to communicate needs effectively.

What therapy is commonly used to treat phobias through gradual exposure?

Systematic desensitization.

What therapy involves rapid exposure to the feared stimulus?

Flooding.

What medications are commonly used for short-term treatment of anxiety?

Benzodiazepines.

Give examples of benzodiazepines used for anxiety.

Alprazolam and diazepam.

Why should benzodiazepines be used for short durations only?

They have a high risk of dependence.

What is the recommended maximum duration for benzodiazepine use in anxiety?

About 4 to 6 weeks.

What medications are preferred for long-term treatment of anxiety disorders?

SSRIs.

Give examples of SSRIs used for anxiety.

Paroxetine and fluoxetine.

What is buspirone?

A non-benzodiazepine anxiolytic used for anxiety.

What antihypertensive medication may be used to reduce physical symptoms of anxiety?

Clonidine.

What is the gold standard therapy for OCD?

Exposure and Response Prevention (ERP).

What occurs during Exposure and Response Prevention therapy?

The client confronts anxiety-provoking stimuli and avoids performing the compulsive ritual.

What medications are first-line treatments for OCD?

SSRIs.

Give examples of SSRIs used for OCD.

Fluvoxamine and sertraline.

What medications may be used for treatment-resistant OCD?

Second-generation antipsychotics.

Give examples of antipsychotics used for resistant OCD.

Risperidone and aripiprazole.

What somatic therapies may be used for severe OCD cases?

Deep brain stimulation or targeted neurosurgery.

What tool is commonly used to assess anxiety severity?

Hamilton Rating Scale for Anxiety.

What behaviors should nurses observe when assessing anxiety?

Motor behavior such as pacing or wringing hands.

What physiological symptoms should be assessed in anxiety?

Increased heart rate, sweating, and respiratory changes.

What are common nursing diagnoses for anxiety disorders?

Anxiety, ineffective coping, risk for injury, powerlessness, and disturbed sleep pattern.

What is the priority intervention during severe or panic anxiety?

Ensuring the client's safety.

What should the nurse do when a client is experiencing panic anxiety?

Stay with the client and remain calm.

What environment should be provided for a client experiencing severe anxiety?

A quiet, low-stimulation environment.

How should a nurse communicate with a client experiencing severe anxiety?

Using short, simple sentences in a calm voice.

Should clients experiencing panic be forced to make decisions?

No.

Should nurses immediately stop OCD rituals?

No, because it increases anxiety.

What is the initial approach to OCD rituals in nursing care?

Allow time for the ritual.

How should OCD rituals be managed over time?

Gradually limit the time allowed for the ritual.

What coping techniques should be encouraged for OCD clients?

Deep breathing, CBT strategies, and stress reduction.

Why do nurses often encounter anxiety disorders in community settings?

Many clients receive outpatient or community-based care rather than inpatient care.

What is an important health promotion message about anxiety?

Mild anxiety is normal and can motivate positive change.

What lifestyle habits help manage anxiety?

Regular exercise, balanced nutrition, and adequate sleep.

What substances should be limited to reduce anxiety symptoms?

Caffeine and alcohol.

What important medication teaching should be given about benzodiazepines in older adults?

They increase the risk of falls due to sedation.

What should clients avoid while taking anti-anxiety medications?

Alcohol and other CNS depressants.

Why are community resources important for anxiety clients?

They reduce isolation and provide ongoing support.

What resources can help clients manage anxiety disorders?

Mental health providers, psychiatrists, and support groups.

What is required for effective long-term management of OCD?

Consistent practice of exposure and response prevention techniques.

What modern tools may enhance CBT for OCD?

Technology-assisted CBT and bibliotherapy.

Why is self-evaluation important for nurses treating anxiety disorders?

Anxiety can be transmitted interpersonally.

How can a nurse's behavior affect an anxious client?

If the nurse appears anxious or frustrated, the client’s anxiety may increase.

What emotional stance should nurses maintain when caring for anxious clients?

Calm, centered, and controlled.

What is cultural humility in mental health care?

Recognizing and respecting different cultural expressions of distress.

How might some cultures express psychological distress?

Through somatic symptoms or supernatural explanations.

What should nurses avoid when providing culturally sensitive care?

Stereotyping.

Why is empathy especially important when caring for clients with OCD?

Clients often know their behaviors are irrational but feel powerless to stop them.