CH 18: anxiety, obsessive-compulsive and related disorders

anxiety

a feeling of discomfort, apprehension, or dread related to anticipation of danger, the source is nonspecific or unknown

what is anxiety necessary for?

survival; its not the same as stress

if anxiety is left untreated, what can it cause?

serious health problems

what are 3 comorbidities of anxiety disorders?

• another anxiety disorder

• depression

• substance abuse

what is a stressor?

an external pressure that is brought to bear on the individual

what is a subjective emotional response to a stressor?

anxiety

how are anxiety and fear distinguished from one another?

anxiety is an emotional process, whereas fear is cognitive

who is anxiety more common in?

women

what are the most common of all psychiatric illnesses?

anxiety disorders

what predisposition may exist in someone with anxiety?

familial predisposition

what puts a pt at risk for anxiety disorders?

childhood trauma and negative life events

How much anxiety is TOO much?

• when anxiety is out of proportion to the situation that is creating it

• when anxiety interferes with social, occupational, or other important areas of functioning

  • interferes with ADLs

what can high levels of anxiety interfere with?

perception and environment

what can high levels of anxiety affect?

• memory

• judgment

• motor responses

what may or may not a panic disorder be accompanied by?

agoraphobia

during a panic attack, the pt may feel like they’re having a what?

heart attack

how is a panic attack characterized?

by recurrent panic attacks, the onset of which are unpredictable and manifested by intense apprehension, fear, or terror

what feelings may a person have during a panic attack?

feeling of impending doom accompanied by intense physical discomfort

if a person is stressed for a long period of time, what may happen?

the body keeps record in form of a panic attack later

what are some symptoms of a panic attack?

• sweating, trembling shaking

• SOB, chest pain, or discomfort

• palpitations, pounding heart rate

• dizziness, chills, hot flashes

• numbers or tingling sensations

• derealization or depersonalization

• fear of losing control or “going crazy”

• fear of dying

according to the DSM, how many symptoms need to be present for a panic disorder ?

4 symptoms

how long can a panic attack last?

10-15 minutes or up to an hour

what is generalized anxiety disorder characterized by?

chronic, unrealistic and excessive anxiety and worry

how long/frequent must symptoms last to be dx with GAD

AT LEAST 6 months AND more days of anxiety than not

what are some other causes of anxiety?

anxiety and hyperthyroidism

what are some s/s of GAD

• muscle tension

• on edge

• social/occupational impairment

• effects ADLs

• avoiding events

• spend time and prepare for the activity

• procrastination in behavior and decision making

• will repeatedly seek reassurance

what are some biological aspects of panic and GADs?

• genetics

  • family history of the disorder and hospitalizations

• neuroanatomical

  • anatomy of the nervous system

• biochemical

• neurochemical

what biochemical are DECREASED during panic and GADs?

• serotonin

• GABA

what is agoraphobia?

fear of being in places or situations from which escape might be difficult or in which help might not be available in the event of panic-like symptoms or other incapacitating symptoms, fear can be of an object, activity, or situation

what are some examples of agoraphobia

• traveling in public transportation

• being in OPEN spaces

• being in shops, theaters, or cinemas

• standing in line or being in a crowd

• being outside of the home alone in other situations

what is an extreme case of agoraphobia ?

patient won’t be able to leave the home

what may some with social anxiety disorder have a fear of?

• public speaking

• eating in public

• using public restroom

• answering questions in public

what is social anxiety disorder?

excessive fear of situations in which the affected person might do something embarrassing or be evaluated negatively by others

during specific phobia, exposure to the phobic object may produce what?

• overwhelming symptoms of panic

• palpitations

• sweating

• dizziness

• difficulty breathing

what is specific phobia?

a fear of SPECIFIC OBJECTS or situations that could conceivably cause harm, but the persons reaction to them is excessive and irrational

what are some specifiers of specific phobia?

• animals

• heights

• needles

• dirt

• germs

• darkness

• snakes/spiders

• natural environment type

• blood injection injury type

• situationa type

• other type

what are some medical conditions that may produce anxiety symptoms?

• cardiac (MI, CHF, mitral valve prolapse, regurgitation)

• endocrine (hypoglycemia, hyperglycemia, hypothyroidism, hyperthyroidism_

• respiratory (COPD, hyperventilating)

• neurological (seizures)

in substance or medication induced anxiety disorder, the pt should use substitutes like…

mocktails instead of cocktails because anxiety meds and alcohol do not mix; do decaffeinated coffee instead of caffeinated

teaching for someone taking anxiolytics

• don’t stop suddenly, can cause rebound anxiety

• taper off, don’t stop suddenly, can make anxiety worse

substance or medication induced anxiety disorder may be associated with intoxication or withdrawal from substances like…

• alcohol

• sedatives

• hypnotics

• anxiolytics

• amphetamines

• cocaine

• caffeine

• cannabis

what are some examples of OCD?

• hand washing

• ordering

• checking

• praying

• counting

• repeating words

what is obsessive compulsive disorder (OCD)?

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

what are obsessions?

recurrent thoughts, impulses, or images experienced as intrusive and stressful, and unable to be expunged by logic or reasoning

what are compulsions?

repetitive ritualistic behavior or thoughts

what is the purpose of compulsions ?

to prevent or reduce distress or to prevent some dreaded event or situation

what are some symptoms of body dysmorphic disorder?

depression and obsessive compulsive personality

how is body dysmorphic disorder characterized?

by an exaggerated belief that the body is deformed or defective in some specific way; if true defect is present, the persons concern is unrealistically exaggerated and grossly excessive

examples of body dysmorphic disorder?

• wrinkles

• scars

• facial asymmetry

who is hair pulling disorder more common in?

women

what are some comorbidities of hair pulling disorder?

• mood disorder

• eating disorder

• anxiety disorder

• substance use

• personality disorders

what is hair pulling disorder (trichotillomania)?

the recurrent pulling out of ones own hair that results in noticeable hair loss

what is hair pulling disorder preceded by?

increasing tension and results in sense of release or gratification

who is most likely to develop a hoarding disorder?

men

what is hoarding disorder?

• the persistent difficulty discarding possessions regardless of their value

• there can be a need for excessive acquiring of items (purchasing or other means)

A newly admitted client diagnosed with obsessive-compulsive disorder, spends 1 hour packing and unpacking, folding and refolding personal belongings. What is the most likely reason for this behavior?

it relieves anxiety

.For the last year, a college student continually and unrealistically worries about academic performance and love life performance. The student is irritable and suffers from severe insomnia. This behavior is associated with which diagnosis?

Generalized anxiety disorder (GAD)

how should nurses approach a situation of anxiety(panic)?

• maintain calm, nonthreatening approach

• keep the immediate surrounding lows in stimuli

• teach the client signs of escalating anxiety

• dont leave them alone!!

• use simple words and brief messages

s/s of anxiety (panic)

• pale

• hypertensive

• poor hand eye coordination

• muscle pain

• decreased in hearing

• dizziness

• SOB (have pt deep breathe)

• may last 30 minutes or less

nurse planning/implementation for someone with fear

• include the client making decisions

• encourage the client to explore underlying feelings

nurse planning/implementation for someone with ineffective coping

• initially meet the clients dependency needs

• provide a structures schedule of activities

nurse planning/implementation of a patient with disturbed body image

• help client see their body image is distorted

• involve client in activities that reinforce positive sense of self

• make referrals to support groups

nurse planning/implementation for someone with ineffective impulse control

• convey a nonjudgmental attitude

• practice stress management techniques

• offer support and encouragement

• offer better ways to cope with stress

• habit reversal training

• support pt when setbacks occur

When caring for a client who is experiencing a panic attack, which of the following nursing actions should be implemented?

communicate with simple words and brief messages

medication management client/family education

• possible adverse effects of the medication

• length of time to take effect (immediate relief to weeks)

• what to expect from the medication

stress management client/family education

• teach ways to interrupt escalating anxiety

• teach relaxation techniques

• therapy

what are some support services of client/family

• crisis hotlines

• support groups

• individual psychotherapy

treatment modalities for anxiety

• individual psychotherapy

• cognitive therapy

• behavior therapy

cognitive therapy of anxiety

• helps to alter cognitive distortion the patient has

• brief and time limited (5-20 sessions)

  • we want the pt to be self sufficient and be able to cope on their own

behavior therapy of anxiety

• systemic desensitization

• implosion therapy

• other nonpharmacolgical treatments

• habit reversal therapy

• deep breathing

• muscle relaxation

• imagery

• mindfulness

• meditation

• exercise

systemic desensitization

patient is gradually exposed to the phobia they have, real or imagined

implosion therapy

flooding the client with information concerning situations that trigger anxiety

habit reversal therapy

pt becomes aware and identifies triggers and substitute with more adaptive coping strategies

examples of anti anxiety agents

• hydroxyzine (vistaril)

• chlordiazepoxide (Librium)

• clonazepam (klonopin)

• chlorazepate (tranxene)

• diazepam (valium)

• lorazepam (Ativan)

what are some medications for panic and generalized anxiety disorder (GAD)?

• anxiolytics

• antidepressants

• antihypertensive agents

what are some medications for phobic disorders?

• anxiolytics

• antidepressants

• antihypertensive agents

what medications are used for obsessive compulsive disorder and body dysmorphic disorder?

antidepressants

what medications are used for hair pulling disorder?

• chlorpromazine

• amitriptyline

• lithium carbonate

• SSRI and pimozide

• olanzipine

What should the nurse plan to teach a client who is taking alprazolam (Xanax) three times a day?

there is a potential for dependence and tolerance

what drug should be taken for generalized anxiety disorder?

buspirone

what is decreased during anxiety?

serotonin and GABA

what is increased during panic ?

norepinephrine

what drug can be used for anxiety and is FDA approved?

hydroxyzine

what meds are used for social anxiety?

• paroxetine and sertraline

• beta blockers such as propranolol and atenolol can alleviate sweaty palms, trembling hands, and memory loss

what meds do u used for body dysmorphic disorder?

clomipramine and fluoxetine