Maladaptive and Mental Health

What is anxiety?

A feeling of apprehension, uneasiness, uncertanity or dread resulting from a real or perceived threat

How are stress and anxiety related?

Stress can lead to anxiety and anxiety disorders

What emotional feeling can both stress and anxiety cause?

an anxious or upset feeling

What is the relationship between stress and anxiety onset?

Stress is often the precursor to anxiety

Are stress and anxiety always harmful?

No, in small doses they are healthy reactions

What happens when stress and anxiety occur in large amounts?

They can negatively affect physical health

What is stress?

A normal physical response to demanding stimuli

What hormone is released during stress?

Adrenaline

What does adrenaline do?

Helps you make quick decisions

What effect does stress have on alertness?

It increases alertness

What happens with chronic stress?

It can damage the cardiovascular system and contribute to depression

What helps control stress?

a sense of control and positive attitude

How is anxiety different from stress?

Anxiety is more closely related to fear

What does anxiety make a person feel?

Afraid or unable to face something

Do people always know why they have anxiety?

No

How common is anxiety?

It varies and affects some people more than others

Are feelings of anxiety normal?

Yes, especially in chaotic and uncertain enviornments

When does anxiety become a problem?

When it escalates and interferes with basic needs

What is acute (state) anxiety?

A normal response to stress

Can mild anxiety improve performance

Yes it can

When does anxiety impair performance?

When it becomes excessive

What is pathological anxiety?

Chronic anxiety lasting a long time

How common are anxiety disorders in adults?

about 18%

Who is more likely to have anxiety disorders?

Women, about twice as likely as men

What are biological causes of anxiety?

Genetic predisposition

How does family history affect anxiety?

It increases the risk

what are psychological causes of anxiety?

Personality and coping styles

What are social factors from anxiety?

Learned behaviors from enviornment and family

Why is role modeling important?

Children learn coping strategies from adults

What physiological conditions can cause anxiety?

Diseases like cancer, heart disease, hypertension, IBS, kidney/liver dysfunction

What is GABA?

Gamma-aminobutyric acid, an inhibitory neurotransmitter

What do neurotransmitters do?

Facilitate communication between neurons

What are the two types of neurotransmitters?

Excitatory and inhibitory

What happens if GABA is low?

Increased anxiety

What is mild anxiety associated with?

Daily stress

What does mild anxiety do to performance?

Enhances learning and awareness

What symptoms occur with mild anxiety?

Restlessness and irritability

How do people cope with anxiety?

Sleeping, eating, exercise, laughing, crying, pacing, nail biting, talking, etc.

What happens to attention in moderate anxiety?

Reduced attention and selective inattention

What cognitive effects occur with moderate anxiety?

decreased concentration and attention span

What happens socially with moderate anxiety?

Difficulty with interpersonal relationships

What physical symptoms occur with moderate anxiety?

Increased HR, BP, RR, sweating, muscle tension, rapid speech

What are defense mechnaisms?

ways to protect from overwhelming anxiety

Are defense mechanisms conscious or unconscious?

Both

When are defense mechanisms maladaptive?

When they interfere with reality or functioning

Examples of defense mechanisms include

Rationalization, regression, repression, denial

What happens to perception with severe anxiety?

Greatly diminished

What happens to attention with severe anxiety?

Focuses on one detail or none

Can learning occur if someone is experiencing severe anxiety

No, learning cannot occur

What behaviors occur with someone experiencing severe anxiety?

Confusion, purposeless activity

Physical symptoms of severe anxiety?

Headache, palpitations, insomnia, nausea

What is panic anxiety?

the most intense level requiring intervention

What happens to reality perception with panic anxiety?

Loss of contact (hallucinations and delusions)

What behaviors occur with panic anxiety?

Disorganized thinking, irrational behavior

Emotional experience with panic anxiety?

Impending doom, terror

Physical symptoms of panic anxiety?

Dilated pupils, trembling, labored breathing, palpitations

Priority nursing interventions for panic anxiety?

Safety

Regarding nursing interventions and panic anxiety, should the patient be left alone?

No

While a patient is experiencing panic anxiety, is teaching appropriate?

No, they will not learn

What enviornment is best for a patient experiencing panic anxiety?

quiet, low stimulation

Are medications the first line of treatment for a patient experiencing panic anxiety?

No, try de-escalation first

What manual defines mental disorders?

DSM (diagnostic and statistical manual of mental disorders)

GAD (Generalized Anxiety Disorder) diagnostic timeframe?

More than 6 months

Core feature of GAD? (generalized anxiety disorder)

Excessive worry out of proportion to situation

Additional symptoms required for GAD? (general anxiety disorder)

At least 3, (restlessness, fatigue, poor concentration, irritability, muscle tension, insomnia)

Regarding somatic symptom disorder, what does somatic mean?

Body

What characterizes somatic disorders?

Physical symptoms without organic cause

Common complaints of somatic symptom disorder?

Pain, GI issues, Neurological symptoms

Why is differentiation between panic vs cardiac important?

Symptoms overlap (chest pain, SOB)

What tests help differentiate panic vs cardiac?

EKG, cardiac enzymes, labs

What tests suggests cardiac cause related to panic vs cardiac?

Elevated enzymes, response to nitro

What tests regarding panic vs cardiac, suggests panic?

Normal labs, improvement with anxiety meds

What is subjective data regarding panic anxiety?

Patient history

What should be assessed during an assessment for panic anxiety?

Triggers, coping mechanisms, support system

What is objective finding during a panic anxiety assessment?

Observable behaviors like nail biting, fidgeting and pacing

What is the nursing intervention priority for general anxiety?

Safety

communication style for general anxiety disorder?

short, simple, calm

Teaching timing for a patient with general anxiety disorder?

Only when anxiety is low

Environmental modification for a patient with general anxiety disorder?

Reduce stimulation

What is cognitive restructuring therapy?

Changing thought patterns

What are some examples of non-pharm intervention therapies for anxiety?

Relaxation, distraction, guided imagery

What is buspirone used for?

Anxiety, less sedating, low dependence risk

Examples of benzodiazepines?

Lorazepam, xanax, valium

Key teaching for benzodiazepines?

Avoid alcohol

Why avoid caffiene with benzos?

It counteracts calming effects

Can benzos be stopped abruptly?

No they cant

What do beta blockers do?

Reduce physical symptoms like palpitations

What must be monitored with beta blockers?

Orthostatic hypotension

What other medications are used with anxiety besides benzos and beta blockers?

SSRIs, MAOIs, TCAs

What is mood?

A subjective emotional state described by the patient

Why is mood considered subjective data?

Because it is based on what the patient reports

What is mood in depression?

Sustained sadness or inability to experience joy

What is affect?

The observable expression of emotion

How is affect different from mood?

Affect is objective, mood is subjective

What is blunted affect?

Reduced intensity of emotional expression

What is flat affect?

Absence of emotional expression

What is inappropriate affect?

Emotional response that does not match the situation

What is labile affect?

Rapidly changing emotions

What is full range affect?

Appropriate expression of a wide range of emotions

What is depression?

A mood disorder with sadness, despair, and pessimism