NUR 3105-002: Anxiety Disorders Lecture

Mild Anxiety

- Adaptive

- Reality in sharp focus

Motivated to salve problems effectively

How may Mild Anxiety be displayed?

Displayed a slight tension-relieving behaviors

- Fidgeting

Moderate Anxiety

- Constructive Anxiety

- Person does not percieve all details of a situation; learning decreased

How is Moderate Anxiety displayed?

- Fine Tremors

Severe Anxiety

- Harmful

- Person only focus on relieveing SNS symptoms

How is Severe Anxiety Displayed?

Display an increased heart rate and breathing

- Non-pharmalogical relaxation techniques are effective

Panic

- Terror-Stricken

- Person unable to process information. Non-adherent to calming tactics

How can Panic be treated?

- Wait for person to become exhausted

- Offer medication that regulates SNS

Denial

Escapin unpleasent thoughts, feelings, or needs by ignoring their existence

Projection

Maintaining self-esteem by attributing one's shortcoming onto others.

- When someone does not accept responsibility onto others

Splitting

Difficulty viewing both the positives and negatives into a cohesive view of oneself, others, or life situations

What is Obsessive-Compulsive Disorder (OCD)?

OCD involves obsessions and/or compulsions that cause significant distress or interfere with daily life.

- The person recognizes the behavior is excessive but is compelled to continue

Obsessive-Compulsive Disorder: Obsession

Repetitive, intrusive and unwanted images, thoughts. or urges

Recognized as irrational but can't be ignored

Obsessive-Compulsive Disorder: Distress

You feel like the thoughts must be significant, and they bother you

Obsessive-Compulsive Disorder: Compulsions

Repetitive ritualistic behaviors or mental acts that the individual feels drive to perform.

- Are intended to reduce the anxiety associated with obssesive thoughts

Common Compulsions

• Handwashing

• Checking

• Ordering

• Praying

• Counting

• Repeating words

Obsessive-Compulsive Disorder: Temporary Relief

The compulsions only make you feel better for a little while

Nursing Interventions for OCD:

- Structured Schedule

- Teach distraction, thought stopping, exercise and relaxation

- Encourage expression of feeling

- Positive Reinforcement

Do NOT Interrupt Compulsions

- Encourage client to engage in Exposure and Response Prevention with a trained provider

Anxiety Medication: Benzodiazepines (Action)

Increases the affinity of the GABAa receptor for GABA

Anxiety Medication: SSRIs (Action)

Block reuptake of serotonin into the presynaptic nerve terminal, increasing the synaptic concentration of serotonin

Anxiety Medication: SNRIs (Action)

Inhibit reuptake of neuronal serotonin and norepinephrine, and mild reuptake of dopamine

Anxiety Medication: Noradrenergic Agents

Propranolol and Clonidine

Noradrenergic Agents: Propranolol (Action)

Nonadrenergic

Blocks beta-adrenergic receptor activity

Noradrenergic Agents: Clonidine (Action)

Noradrenergic

Stimulates alpha-adrenergic receptors

Anxiety Medications: Buspirone MOA

Partial agonist of 5-HT 1A Receptor

Which SSRI is used to treat Social Anxiety?

Sertraline (Zoloft)

Which SNRI is used to treat Social Anxiety

Venlafaxine (Effexor)

Noradrenergic Agents used to treat Social Anxiety

Propanolol

What SSRIs are used to treat Panic Disorder?

Sertraline (Zoloft)

Fluoxetine (Prozac)

Which SNRI is used to treat Panic Disorder?

Venlafaxine (Effexor)

Which Benzodiazepines are used to treat Panic Disorder

Alprazolam (Xanax)

Clonazepam (Klonopin)

What SSRIs are used to treat GAD?

Escitalopram (Lexapro)

Which SNRIs are used to treat GAD?

Venlafaxine (Effexor)

Duloxetine (Cymbalta)

Which Benzodiazepines are used to treat GAD?

Alprazolam (Xanax)

Lorazepam (Ativan)

What Anxiolytic Agent is used to treat GAD?

Buspirone (Buspar)

Which SSRIs are used to treat OCD?

Sertraline (Zoloft)

Fluoxetine (Prozac)

What TCA is used to treat OCD?

Clomipramine (Anafranil)

Benzodiazepines: Alprazolam (Xanax) Schedule

IV Controlled Substance

Benzodiazepines: Alprazolam (Xanax) Onset

Fast Acting

- 5mins IV

- 15mins IM

- 30mins PO

Benzodiazepines: Alprazolam (Xanax) Adverse Effects

Physical and Psychological Dependence

Benzodiazepines: Alprazolam (Xanax) Nursing Implications

- Client should avoid alcohol and CNS depressants with the medication

- Use caution in elderly clients due to increased fall risk

- Client should not drive when impaired by the medication

- Risk of withdrawal if the scheduled medication is stopped

- Monitor for signs of misuse, such as double dosing

- Client should avoid stimulants like caffeine and nicotine, which can reduce the desired effects of the medication

- This medication is not recommended if pregnant

SNRI: Venlafaxine (Effexor) Onset

Typically takes 2-4 weeks for symptom improvement to begin

Takes 6-8 weeks to achieve Maximum Therapeutic Effect

SNRI: Venlafaxine (Effexor) Side Effects

Gastrointestinal Upset

- Better to take with Food

Why do most clients stop taking Venlafaxine (Effexor)?

Sexual side effects

Cession of SNRI Venlafaxine (Effexor)

Taper off the medication if going to stop the treatment to avoid serotonin discontinuation syndrome.

SNRI: Venlafaxine (Effexor) Adverse Effects

Serotonin Syndrome

Increased Suicidality (children, adolescents, and young adults)

Atypical Anxiolytic - Busiprone (Buspar)

Atypical Anxiolytic for long-term treatment of GAD

Serotonin receptor partial agonist

Atypical Anxiolytic - Buspirone (Buspar) Onset

2-4 weeks for symptom improvement. Is not not effective for acute anxiety.

Lacks the dependency risk of benzodiazepines.

Atypical Anxiolytic - Buspirone (Buspar) Side Effects

-Nausea, headache, dizziness

Atypical Anxiolytic - Buspirone (Buspar) Nursing Implications

- Client should avoid alcohol and CNS depressants with the medication

- Like SSRIs and SNRIs, must be taken consistently for full symptom improvement

- Should be used with caution in clients with renal and hepatic impairment

TCA - Clomipramine (Anafranil)

Tricyclic Antidepressant (TCA)

Obsessive-Compulsive Disorder (OCD) for those 10 years or older

TCA - Clomipramine (Anafranil) MOA

It is unknown exactly how increasing serotonin and norepinephrine in the brain reduces obsessions and compulsions.

TCAs also antagonize several other receptors

TCA - Clomipramine (Anafranil) Side Effects

-Histamine H1 receptors → sedation, weight gain

-Muscarinic cholinergic receptors → dry mouth, constipation, urinary retention, blurred vision.

-Alpha-1 adrenergic receptors → orthostatic hypotension, dizziness.

TCA - Clomipramine (Anafranil) Adverse Effects

- Risk of death from heart arrhythmia (prolonged QT interval) if taken at high doses (overdose).

TCA - Clomipramine (Anafranil) Nursing Implications

- Should be used with caution in older clients due to the high likelihood of side effects.

- Clients at risk of suicide are usually given a limited supply of pills. Check for cheeking.