Exam 3 - Anxiety, Obsessive-Compulsive, and Related Disorders & Trauma and Stressor-Related Disorders

Medication teaching for benzodiazepines, including which neurotransmitter it affects

Benzodiazepines

Neurotransmitter affected: GABA (gamma-aminobutyric acid) — enhances its effect to produce a calming effect.

Teaching:

Short-term use only (risk of dependence)

Avoid alcohol and CNS depressants

Do not stop abruptly (risk of withdrawal)

May cause drowsiness, dizziness, confusion

Identify the 4 levels of anxiety,

o   describe what occurs in each stage and

o   interventions effective at each stage

Mild: special attention; increased sensory stimulation; motivational - Encourage learning, problem-solving

Moderate: feeling something is definitely wrong; nervousness/agitation; difficulty concentrating; able to be redirected - Use calm communication, help focus

Severe: trouble thinking and reasoning; tightened muscles; increased vital signs; restless, irritable, angry - Stay with client, use simple directions

Panic: fight, flight, or freeze response; increased vital signs; enlarged pupils; cognitive processes focusing on defense - Ensure safety, stay calm, reduce stimuli

Role of defense mechanisms in anxiety

Purpose: Unconscious strategies to reduce anxiety.

Examples:

Denial: Refusing to accept reality

Repression: Unconsciously blocking out painful or anxiety-provoking thoughts, memories, or feelings.

Regression: Reverting to behaviors characteristic of an earlier developmental stage when faced with stress or anxiety.

Sublimination: Channeling unacceptable impulses or desires into socially acceptable or constructive activities.

Example: Someone with aggressive urges becomes a professional boxer or takes up intense exercise.

Projection: Attributing one’s feelings to others

Displacement: Redirecting emotions to a safer target

Rationalization: Justifying behaviors with logical reasons

Best combination of treatment modalities for anxiety

Medication with therapy

Cognitive techniques:  identifying and facing anxiety-producing situations

correct thoughts, substitute more balanced thoughts

Homework assignments

Behavioral therapy: Systematic desensitization

Medication:

SSRIS: GAD, Panic, Phobia, OCD, BDD, Trichotillomania

SNRIS: GAD, Panic

Buspirone: GAD

Hydroxyzine: as needed for: GAD exacerbation, anxiety attack, panic attack

Clonidine: Management/prevention of anxiety

Benzodiazepine: Extreme anxiety/panic as needed, Risk for addiction/dependence

• Combination of:

  • Cognitive Behavioral Therapy (CBT)

  • Medication (SSRIs, SNRIs, benzodiazepines short-term)

    • Relaxation techniques (breathing, mindfulness)

Therapy for anxiety

CBT: Most effective (identify and change negative thought patterns and behaviors)

Exposure therapy: Especially for phobias

Treatments for phobias

Systematic desensitization (pairing relaxation techniques with gradual exposure to the feared object or situation)

Flooding (less common – exposure to greatest fear all at once)

CBT

Homework

Be able to identify and differentiate obsessions from compulsions

OBSESSION = THOUGHTS

COMPULSION = BEHAVIORS

Characteristics of OCD, including preferred treatment settings (hospital inpatient or clinic outpatient/group therapy)

Obsessions/Compulsions

Thoughts or behaviors that interfere with personal, social, and/or occupational functioning

The person realizes that their thoughts/behaviors are unreasonable, but they cannot stop/control them

OCD relieves anxiety when situations producing anxiety cannot be avoided

Mild to Moderate OCD:

✅ Outpatient therapy is preferred

✅ Group therapy can be helpful for support and shared strategies

✅ CBT with Exposure and Response Prevention (ERP) is the gold standard

Severe OCD or when safety is a concern:

✅ Inpatient hospitalization may be necessary

Especially if the person is unable to function, is suicidal, or has co-occurring disorders

Etiology of OCD

Biological Factors:

Neurotransmitter imbalance, especially low serotonin levels.

Abnormal activity in brain circuits involving the orbitofrontal cortex, anterior cingulate cortex, and basal ganglia.

Genetic predisposition: Higher risk if a first-degree relative has OCD.

Psychological Factors:

Cognitive distortions (e.g., overestimating threats, perfectionism).

Learned behaviors reinforced by anxiety relief (e.g., compulsions reduce distress temporarily).

Environmental Factors:

Childhood trauma or abuse, Stressful life events.

In rare cases, infections (e.g., PANDAS in children).

Goals/Outcomes of OCD treatment

The primary goals are to reduce the frequency, intensity, and distress caused by obsessions and compulsions, and to improve daily functioning.

Identify characteristics of body dysmorphic disorder (BDD)

Exaggerated belief body is deformed or defective

Person aware beliefs are exaggerated

Usually have another mental disorder (depression common)

Visit plastic surgeons and dermatologists

Definition and characteristics of post-traumatic stress disorder (when does it occur in relation to “event” that caused it, what behaviors are typical?)

Disturbing pattern of behavior demonstrated by someone who has experienced, witnessed, or been

confronted with traumatic event. Event posted actual or threatened death or serious injury.

Responses

o Intense fear

o Helplessness

o Terror

Present for at least 1 month

Interferes with life functions

May occur years later·        Differentiate acute stress disorder from PTSD

Differentiate acute stress disorder from PTSD

Acute stress disorder occurs 3 days to 4 weeks after trauma

Acute stress disorder resolves by 4 weeks

How to respond to a patient experiencing a flashback

Focus the client in the present, grounding techniques

Teaching for family members of survivors of trauma (promoting self-esteem)

It may take years for the patient to reach their goals

Validate their feelings: “It’s okay to feel this way.” Avoid judgment or pressure: Don’t say “You should be over this by now.” Celebrate small victories: Acknowledge progress, no matter how small.