chapter 18 Anxiety, obsessive compulsive and Related Disorders

Anxiety

• This is an emotional response to anticipation of danger, UNCERTAINTY, the source of which is largely unknown or unrecognized.

•This is a necessary force for survival. It is not the same as stress.

serotonin

What neurotransmitter is implicated in the development of obsessive-compulsive disorder?

emotional, cognitive

anxiety is a ________ process, meanwhile fear is a ___________ process

panic disorder

An anxiety disorder marked by unpredictable minutes-long episodes of intense dread in which a person experiences terror and accompanying chest pain, choking, and fear of dying

accompanied

panic disorder could be __________ by agoraphobia

20 minutes, 1 hour

panic disorders peak at ____________________ and usually lasts 30 minutes to _ _______

concerned, change, 1

in order to be officially diagnosed with panic disorder, one must be ________ about having an attack again or coming up with significant _______ to adapt to that fear, following ___ month after.

DSM-5 Criteria for Panic Disorder

Recurrent unexpected panic attacks

At least 1 month of concern about the possibility of more attacks, worry about the consequences of an attack, or maladaptive behavioral changes because of the attacks

General Anxiety Disorder

an anxiety disorder in which a person is continually tense, apprehensive, and in a state of CHRONIC, unrealistic and excessive anxiety and worry.

6 months

in order to be diagnosed with GAD excessive anxiety and worry must be present for most days for at least ______________

Buspar

long term anxiety medication that is great for GAD

psychodynamic theory

•Ego unable to intervene between id and superego

•Overuse or ineffective use of ego defense mechanisms results in maladaptive responses to anxiety

sodium lactate

can cause increase in anxiety

Norepinephrine

with little of this neurochemical, patients could have GAD

Cognitive Theory

According to this theory, our thoughts shape our attitudes, beliefs, and behaviors.

- altered thought processes (faulty, distorted, or counterproductive thinking patterns) lead to anxiety

agoraphobia

fear or avoidance of situations, such as crowds or wide open places, where one has felt loss of control and panic

•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

DSM5 criteria of Agoraphobia

intense fear/ anxiety about 2 or more situations (using transportation, being in open/closed spaces etc.) due to concern of difficulty escaping or obtaining help in case of panic or other humiliating

- typically lasting 6 months or more

social anxiety disorder

an anxiety disorder involving the extreme and irrational fear of being embarrassed, judged, or scrutinized by others in social situations.

- typically lasting 6 months or more

predisposing factors to phobias

- Psychoanalytical theory

- Learning theory

- Cognitive theory

- Biological aspects

- Life experiences

learning theory

Fears are conditioned responses and thus are learned by imposing reinforcements for certain behaviors

psychoanalytical theory

Unconscious fears may be expressed in a symbolic manner as phobia

drugs, caffeine

Before patient is officially labeled as having medical condition that produces anxiety you need to rule out _______ like ________

obsessive-compulsive disorder (OCD)

an anxiety disorder characterized by unwanted repetitive thoughts (obsessions) and/or actions (compulsions)

- must take an hour out of their day

- help patient by making them wean off from their disorder when ready

an hour

to be diagnosed with OCD it must take __ _____ out of their day.

obsessions

repetitive, intrusive thoughts

- somatic obsessions

compulsions

repetitive behaviors

- constantly checking

active avoidance

a response a subject has learned to avoid an aversive stimulus

body dysmorphic disorder

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

- can be linked to OCD and depression

- remind patient that they look normal

Trichotillomania

hair pulling disorder

hoarding disorder

Persistent difficulty discarding or parting with possessions, regardless of their actual value

- more men than women are diagnosed with this disorder

Nursing Diagnosis for anxiety OCD and related disorders

•Panic anxiety (panic disorder and GAD)

•Powerlessness (panic disorder and GAD)

•Fear (phobias)

•Social isolation (agoraphobia)

anxiety interventions

•Maintain calm, nonthreatening approach.

•Keep the immediate surroundings low in stimuli.

•Teach the client signs of escalating anxiety.

phobia interventions

•Include the client in making decisions.

•Encourage the client to explore underlying feelings.

ineffective coping interventions

•Initially meet the client's dependency needs.

•Provide a structured schedule of activities.

disturbed body image interventions

•Help client see his or her body image is distorted.

•Involve client in activities that reinforce positive sense of self.

•Make referrals to support groups.

journaling

Cognitive therapy homework assignment:

implosion therapy

A behavioral therapeutic technique that exposes a client to anxiety-provoking stimuli, in an attempt to extinguish the anxiety associated with the stimuli. usually for anxiety or ptsd

- basically, shove anxiety down throat

systemic desensitization

A type of exposure therapy that associates a pleasant relaxed state with gradually increasing anxiety-triggering stimuli. Commonly used to treat phobias.

- step by step approach

Diazepam (Valium) and Lorazepam (Ativan

are benzodiazepines used to treat anxiety disorders.

• Drowsiness, confusion, lethargy

• Tolerance, physical & psychological dependence

ocd medications

are medications such as selective serotonin reuptake inhibitors (SSRIs) and clomipramine that help reduce the symptoms of obsessive-compulsive disorder by altering serotonin levels in the brain.