(Exam 3) Anxiety, OCD, and Related Disorders

anxiety

feelings of apprehension, uneasiness, uncertainty, or dread from a real or perceived threat

- EMOTIONAL response

- normal healthy reaction ; necessary for survival

fear

reaction to a specific danger

- COGNITIVE response

what are our anxiety disorders (5)

- generalized anxiety disorder (GAD)

- panic disorder

- social anxiety disorder (social phobia)

- specific phobias

- seperation anxiety disorder

what is mild anxiety

not usually a problem; comes from day-to-day living

- sharpens senses, motivates action

- increases the perceptual field

what is moderate anxiety

anxiety increases; it diminishes the perceptual field

- less alert to events in environment

- more direction to problem-solving

- increased restlessness & muscle tension

what is severe anxiety

overwhelming anxiety; difficulty completing simple tasks

- physical: HA, palpitations, insomnia

- emotional: dread and horror

what is panic

most intense state of anxiety; terror and physical sx feel life-threatening

- may lose contact with reality

- marked dysregulated behavior

what are the defenses against anxiety

adaptive use of defense mechanisms: helps lower anxiety and achieve goals

maladaptive use of defense mechanisms: when one or several are used in excess, particularly immature defenses

seperation anxiety disorder

developmentally inappropriate levels of concern over being away from a significant other

- fear that something horrible will happen

- distracts from activities, causes sleep disturbances

what are the sx of seperation anxiety

physical sx; GI disturbances and HA

when is separation anxiety a normal part of infant development

peak: 8 months - 18 months

- declines after 18 months

phobia

persistent, irrational fear of a specific object, activity, or situation

- leads to the avoidance of things

specific phobia (and example of agoraphobia)

excessive or unreasonable fear when in the presence of, or anticipation of, a specific object or situation

- agoraphobia: fear of being in places or situations from which escape might be difficult, or help might not be available

social anxiety disorder

aka social phobia: anxiety or fear provoked by exposure to a social or performance situation

- people avoid such situations

- if they are unable to avoid them: clients endure the situation w/ anxiety and emotional distress

social anxiety disorder sx in small children and adolescents

small children: mute or nervous

adolescents: paralyzed by fear of speaking in class or interacting with peers

panic disorder

client experiences panic attacks: sudden onset of extreme apprehension or fear, associated w/ feelings of impending doom

- functioning is suspended

- may believe they are losing their minds or having a heart attack

what else might someone with panic disorder experience

preoccupied with the possibility of future episodes; they avoid pleasurable and adaptive activities, experiences, and obligations

generalized anxiety disorder

characterized by excessive anxiety and worry

- anxiety/worry or physical sx cause clinically significant distress or impairment in social, occupational, or other areas of functioning

what are the general symptoms of GAD (4)

- difficult to control the worry

- restlessness, feelings on edge

- difficulty concentrating

- sleep disturbances, easily fatigued

what is big about anxiety's general assessment in nursing

determine whether anxiety is the PRIMARY problem (like anxiety disorder) or SECONDARY to another cause (like a medical condition or substance use)

what are nursing dx for anxiety related disorders

- anxiety (moderate, severe, panic)

- impaired coping

what do nurses want to do with anxiety-related disorders (4)

- evaluates the effective use of coping mechanisms in the past

- uses relaxation exercises to initiate a relaxation response

- applies new behaviors to manage anxiety

- considers alternatives and activities that may relieve feelings of inner tension

what are outcomes related to anxiety (nursing dx)

reduced anxiety

- monitor intensity of anxiety

- use relaxation techniques

- decreases environmental stimuli as needed

- controls anxiety response

- maintains role performance

what are outcomes related with impaired coping (nursing dx)

improved coping

- identifies ineffective coping patterns

- asks for assistance

- seeks information about illness and tx

- identifies multiple coping strategies

- modifies lifestyle as needed

what are specific nursing interventions for anxiety (8)

- provide calm presence

- teach coping strategies & assist w/ problem-solving

- intervene in unhealthy defense mechanisms

- cognitive restructuring

- teach relaxation techniques

- health teach (reducing caffeine!!)

- provide physical outlets

- pharmacotherapy

what are specific nursing interventions with panic attacks (6)

PSYCHIATRIC EMERGENCIES

- do not leave client alone

- remain calm, stay w/ patient

- clear, concise instructions, speak calmly

- administer medications (as ordered!)

- provide structure, ensure safety

- decrease environmental stimuli

what are the treatment modalities for anxiety (4)

- pharmacotherapy

- antidepressants/antianxiety/other classes

- psychological therapies

- behavioral therapy/cognitive-behavioral therapy

antidepressants drugs

SSRIs; 1st line tx for most anxiety-related disorders

- paroxetine, fluoxetine, escitalopram, sertraline

- teaching: 6 weeks for anxiety to work, sexual dysfunction

SNRI; another 1st line tx

- venlafaxine

- teaching: dose-dependent HTN

anti-anxiety drugs (1/2)

benzodiazepines; potentiate the inhibitory effects of GABA

- rapid onset of action

- risk dependence & withdrawal; used for short periods of time

- SE: sedation, ataxia, decreased cognitive function

not recommended in pt w/ comorbid substance abuse

anti-anxiety drugs (2/2)

buspirone; serotonin 5 HT partial agonist

- does NOT cause dependence

- takes 2-4 weeks for effects

- not recommended w/ impaired hepatic or renal function

- SE: dizziness, nausea, HA

other medications for anxiety (4)

antihistamines (hydroxyzine, diphenhydramine): non-addictive alternatives to benzos; used in clients with substance use problems

beta-blockers: reduce physical sx by slowing HR & reducing blushing in social anxiety disorder

anticonvulsants (gabapentin, pregabalin): some benefit in GAD and social anxiety disorder

antipsychotic: used to tx severe sx of anxiety disorders

what are psychological therapies for anxiety (4)

- modeling

- systematic desensitization

- flooding

- cognitive-behavioral therapy

what is modeling

therapist acts as a role model, demonstrating appropriate behavior in a feared situation

what is systematic desensitization

client is gradually introduced to a feared object or experience through a series of steps, from least frightening to most frightening

what is flooding

method exposes the client to a large amount of an undesirable stimulus to extinguish the anxiety responses

what is cognitive-behavioral therapy

includes cognitive restructuring, psychoeducation, muscle relaxation, self-monitoring for sx, vivo (real-life) exposure to feared objects or situations

what are our obsessive-compulsive disorders (5)

- obsessive compulsive disorder (OCD)

- body dysmorphic disorder (BDD)

- hoarding disorder

- trichotillomania

- excoriation disorder

obsessive-compulsive disorder

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

- obsessions

- compulsions

what are obsessions

excessive, unwanted, intrusive, and persistent thoughts, impulses, or images causing anxiety and distress --> unable to be expunged by logic

what are compulsions

repeatedly performed behaviors in a ritualistic fashion

- attempt to prevent or relieve anxiety & distress caused by obsessions

what are some examples of obsessions and compulsions (5)

- concerns w/ dirt, germ exposure, fears of illness = cleaning rituals

- fears of harm befalling self or others = checking

- need for symmetry, order, exactness = repeating behaviors

- need to save or hoard = ordering or arranging

- excessive moral, religious, or sexual concerns

body dysmprphic disorder

characterized by the exaggerated belief that the body is deformed or defective in some specific way

- if true defect is present, the person's concern is unrealistically exaggerated and grossly excessive

what else is there about body dysmorphic disorder (2)

- beliefs are NOT delusions; individual is aware that their beliefs are exaggerated

- preoccupated w/ imagined defective body part; leads to obsessive thinking and compulsive behavior

hording disorder

persistent difficulty discarding possessions; accumulate belongings that may have little or no value

- prevents people from leading a normal life

what else is there to hording disorder (2)

- problem can progress to the point where the home is uninhabitable, unsafe or unsanitary conditions

- individuals who hoard may or may not be aware of the problem and how it has consumed their lives

trichotillomania (4)

recurrent pulling out of one's hair

- results in noticable hair loss (small patches to completely naked skin)

- most unaware of the behavior

- pain of hair pulling = reducing stress/anxiety

- common sites: scalp, eyebrows & eyelashes

excoriation disorder (2)

compulsive skin-picking disorder; can be used to deal with stress and relieve anxiety, or others can engage without thinking about it

- typically confined to face; but can be skin/nails/scabs

- complications: pain, sores, scars, infections

what is tx modalities for OCD (3)

- pharmacotherapy

- brain-based therapies

- psychological therapies

pharmacotherapy for OCD

SSRIs: fluoxetine, fluvoxamine, paroxetine, sertraline

TCAs: clomipramine

- EBP w/OCD --> cardiotoxic w/ OD

brain-based therapies for OCD

deep brain stimulation as a adjunct to medications in treatment resistant OCD

psychological therapies for OCD (2)

exposure & response prevention: client learns to lengthen the time between rituals until urge fades away

flooding: method exposes client to undesirable stimulus to extinguish the responde