Anxiety, OCD

Anxiety

one anticipates a threat or has just experienced a stressful situation = causes fear, nervousness, worry

→ adapts individual from danger

based on experience

anxiety cycle

trigger → anxious thoughts → feelings → physiological response → behavior response → trigger

physiological changes

increased blood to the heart, muscles, and brain, which increases the person’s ability to function, think, and perform

inability to function → panic

Seyle’s general adaptation syndrome

alarm: fight-flight = cortisol → more energy = higher acuitity

resistance: starts to downregulate without getting out of heighten alert

• if stressor resolved → baseline

if not resolved = depleted energy = unable to self regulate

Peplau’s Theory of Interpersonal Relations

orientation, identification, exploitation, and resolution

empathic linkages = ability to identify with and experience pt feelings

mild anxiety

visible s/s = restless, voicing concern

heighten function

moderate anxiety

s/s continue but more frustrated, on edge, restlessness

unable to think, difficulty concentrating, worry

can’t sleep due to job loss

severe anxiety

overwhelmed and coping mechanism does not work

does not respond to others, cannot complete simple tasks, and has an intense feeling of dread or doom

sudden loss of child

panic

overwhelmed with terror → exhaustion

anxiety becomes disorder when

• feelings of anxiety occur at inappropriate times or situations.

• the frequency of anxiety increases.​​​​​​​​​​

• the intensity of anxiety affects a person’s ability to function.

• the duration of anxiety becomes increasingly prolonged.

OCD

obsessions = intrusive thoughts

compulsions - to release anxiety

know it does not make sense but are unable to stop

takes 1hr of more of day + daily living disruption

diathesis- stress model

vulnerabilities: genetic, biological, physiological, cognitive, and personality + environmental stress = inc risk of mental illness

anxiety disorder s/s

disruptions in sleep, changes in concentration, fatigue, and changes in arousal

anxiety pathophysiology

amygdala-centered circuit = fear → amygdala + hypothalamus → hypothalamic-pituitary-adrenal axis (HPA) = fight hormone

worry = cortico-striato-thalamo-cortical circuit (CSTC) affected when ruminates, obsesses about something, or has a delusion

• serotonin, GABA, dopamine, glutamine, and norepinephrine

anxiety prevalence

most common mental illness = combination of heredity and learned response to stress.

lack of healthy coping strategies, increased use of alcohol, and rise in suicide rates, by Covid-19

more likely in women

anxiety transdiagnostic s/s

OCD, panic, trauma-stressor related, depressive, SUD, somatic s/s, sleep-wake, ED, PTSD

PE, stroke, MI, cancer, spesis, asthma, emphysema, chronic pain, IBS, delirium

anxiety/ OCD risk factors

childhood trauma (ACEs) , cigarette, personality trait/ temperament (shyness, avoidance), family hx, hx of illness (thyroid, cardiac), genetic predisposition, lifestyle

genetic = MAOA gene

OCD transdiagnostic

mood disorder = major depressive/ bipolar

tic

ADHD

oppositional defiant disorder

schizophrenic spectrum

eating disorder

SUD

ACE/ PCES

positive childhood experience (PCES) = give some s/s protection

anxiety disorder

when interferes with daily life and relationships

avoids anxiety cause

separation anxiety

reluctant to leave who they are attached too

nightmare

physical s/s of distress

selective mutism

failure to speak in situations which it is expected to speak

• during school even when spoken to → affect socially and academically

phobias

experienced marked fear during specific object or situation

social anxiety

fear of being embarrassed, humiliated, rejected, offending others

interactions include:

• meet new people

• being observed when eating/drinking

• performing to others

panic disorder

unexpected extreme periods of hyperarousal

• avoidance of situations, people, events

• worried another attack will occur

time limited with peak of intensity of fear or anxiety

can occur from calm or anxious state

s/s include 4 or more

• palpitation

• sweating

• trembling/ shaking

• sensation of SOB and smothering, choking

• chest pain

• nausea, abdominal distress

• chill, heat sensation

• derealization, depersonalization

• fear of dying or losing control

agoraphobia

fear upon exposures associated with travel or location

• closed/open spaces

• leaving home alone

not being able to escape

→ avoids situation or requires others to navigate them

GAD

excessive anxiety over numerous situations

6 months or more

• work, school, relationship, performing in front of others

→ affect daily life

SUD/ or medical condition induced

OCD and related

have specific compulsive or repetitive behaviors

body dysmorphic

with perceived flaws of one’s appearance

behaviors:

• mirror checking, excessive grooming, skin picking, seeking reassurance about looks

thoughts:

• comparing to others, belief body type is insufficient

• possible eating disorder

hoarding disorder

inability to discard of possessions

excessive accumulation of clutter

trichotillomania

ritualized behavior of pulling one’s hair

trigger: boredom, anxiety → reduce tension, pleasure

excoriation disorder

picking one’s skin = lesions

in multiple body sites, like pimple, scabs,

extensive time spent picking

attempts to cover with clothing or makeup

universal trauma percautions

trauma-informed care

provide safety, respect, trust

unconditional positive regard

sense of unqualified acceptance and good will for potential shame or stigma

recovery care model

focus on developing meaningful life

types of therapy:

• psychotherapy: talk therapy focused on pt’s specific anxiety

• CBT: directed on pt thinks, behaves due to cause of anxiety

• cognitive: eliminated distorted thoughts

• exposure therapy

• support groups

• complementary-integrative approaches: relaxation techniques, hypnosis, massage therapy

• lifestyle management:

pharmacology

BZ, SSRI, SNRI = alprazolam, paroxetine, and venlafaxine.

buspirone = non BZ

SSRI/SNRI = OCD

types of anxiety scale

GAD-7 = GAD

Hamilton (HAM-A) = anxiety disorder

Screen for Child Anxiety Related Disorders (SCARED)= anxiety disorder, childhood

Leibowitz Social Anxiety Scale (LSAS)

Hospital Anxiety and Depression Scale (HADS)

Penn State Worry Questionnaire (PSWQ)= GAD

Yale-Brown Obsessive Compulsive Scale (Y-BOCS)

Brief Obsessive-Compulsive Scale (BOCS)