Anxiety & Anxiety Disorders

Mental Health Exam 2

What are the major components that define anxiety disorders?

Anxiety disorders are characterized by excessive anxiety that leads to behavioral changes impacting daily functioning.

Describe mild anxiety and its behavioral changes.

healthy response, teaching can be effective; sharpened senses, irritability, restlessness, fidgeting.

What is the difference between primary gain and secondary gain in anxiety?

Primary gain refers to relief from anxiety through specific behaviors, while secondary gain refers to external benefits received due to being sick.

What are effective interventions for Generalized Anxiety Disorder (GAD)?

CBT, adaptive coping (exercise, deep breathing, relaxation, biofeedback, decreased environmental stimuli), meds (SSRIs, TCAs, Buspirone)

What characterizes Panic Disorder?

discrete episodes of panic attacks; 15-30min of rapid, intense, anxiety w/4 or more manifestations: palpitations, SOB, choking or smothering sensation, chest pain, nausea, chills/hot flashes, fear of dying or insanity, depersonalization

What risk factors are associated with anxiety disorders?

Female gender, genetic predisposition, medical conditions, trauma, and lifestyle choices like poor diet and substance use.

What is agoraphobia?

fearing and avoiding places or situations that might cause panic and feelings of being trapped, helpless, or embarrassed; can occur w/ or w/o panic attacks.

What are the primary nursing care strategies for patients with anxiety disorders?

trauma-informed care, assess for comorbid substance use, perform suicide risk assessments, facilitate relaxation techniques, identify defense mechanisms, postpone health teaching until after acute anxiety subsides, ID counseling/group therapy/community resources.

What types of cognitive-behavioral therapy can be used for anxiety?

positive reframing, decatastrophizing, assertiveness training

When is panic disorder diagnosed?

when pt has recurrent, unexpected panic attacks followed by at least 1 month of persistent worry about future attacks, their meaning, or significant behavioral changes r/t them.

What is the recommended intervention for phobias?

systematic desensitization (exposure therapy), CBT, appropriate coping strategies, positive reinforcement, acknowledging fear.

When do phobias usually occur?

childhood or adolescence

What is generalized anxiety disorder?

uncontrollable, excessive worry at least 50% of time for 6 months or more causing significant impairment in 1 or more areas of functioning.

What manifestations are seen w/Generalized Anxiety Disorder?

3 or more sx: restlessness, muscle tension, avoidance of stressful activities/events, procrastination, sleep disturbance, fatigue, difficulty thinking.

What is systematic desensitization?

behavioral therapy where pt is gradually exposed to anxiety-producing object, event, or place while engaged in type of relaxation at same time

What is flooding?

behavioral therapy that exposes pt to greatest fear for prolonged period until brain and body eventually calm down

What is response prevention?

behavioral therapy that encourages pt to face fears and let obsessive thoughts occur w/o putting them right or neutralizing them w/compulsions

What is thought stopping?

behavioral therapy that helps pt identify unwanted or intrusive thoughts and take action by pushing it away

What mental health conditions are benzodiazepines used to treat?

short term for GAD & panic disorder/social anxiety disorder; alcohol withdrawal; insomnia; prior to surgery/procedures

What are some examples of benzodiazepines used in tx of anxiety?

alprazolam, lorazepam, diazepam, oxazepam, clonazepam, chlordiazepoxide, clorazepate

What is the action of a benzodiazepine?

enhances inhibitory effects of GABA in CNS; anxiety relief occurs rapidly after admin

What are the adverse effects of benzodiazepines?

respiratory depression from acute toxicity and CNS depression (sedation, lighthead, decreased cognition)

What are some precautions/contraindications of benzodiazepines?

avoid other CNS depressants and breastfeeding (teratogenic); caution w/hx of substance misuse disorder.

What is the pt education for benzodiazepines?

significant tolerance can develop; high potential for abuse; taper over 6 weeks to avoid withdrawal sx (rebound anxiety, insomnia, agitation, hallucinations, etc.)

How is Buspirone classified and used?

atypical/non-barbiturate anxiolytic; GAD

What is the action of Buspirone?

unknown; binds to serotonin and dopamine receptors to reduce anxiety symptoms.

What are the 2 distinctive advantages of Buspirone over benzodiazepines?

no abuse potential and doesn’t intensify effects of CNS depressants

What are some adverse effects of Buspirone?

dizzy, lighthead, HA, nausea, agitation

What are some precautions/contraindications of Buspirone?

teratogenic; not recommended while breastfeeding; avoid grapefruit juice (increases effects)

What is the pt education for Buspirone?

tolerance, dependence, withdrawal, or sedation not an issue; can take 1-4 weeks to take full affects.

What are some common SSRIs used to treat anxiety?

paroxetine, fluoxetine, sertraline, citalopram, escitalopram, fluvoxamine

What is generally the first line treatment for anxiety disorders, specifically panic disorders and trauma/stressor related disorders?

SSRIs

What is the action of SSRIs?

selectively inhibits the reuptake of serotonin allowing more at neurons junction.

What are the uses of SSRIs?

GAD, panic disorder, social anxiety disorder, PTSD, depressive disorders, adjustment disorders, associated manifestations of dissociative disorders.

What are the adverse effects after the first few weeks of taking an SSRI?

nausea, diaphoresis, tremor, fatigue, and drowsy

What are the adverse effects after 5=6 weeks of taking an SSRI?

sexual dysfunction, weight loss or gain, HA, increase of suicidal ideations

How long does it take serotonin syndrome to manifest?

2-72 hrs after starting tx

What are the precautions/contraindications for SSRIs?

cautiously w/seizure disorders, bipolar disorder (risk for mania), hx of GI bleed; hypernatremia can occur esp. w/pts taking diuretic

What is the pt education for SSRIs?

taper gradually (start low and go slow); take in AM due to potential sleep disturbance; can take up to 4 weeks for effect.

What is serotonin syndrome?

potentially life threatening drug reaction resulting from too much serotonin in body; symptoms can be mild or severe.

What is the mnemonic for serotonin syndrome?

SHIVERS: shivering, hyperreflexia/myoclonus, increased body temp, V/S instability (increased RR/HR, variable BP), encephalopathy (altered LOC), restlessness, sweating

Describe moderate anxiety and its behavioral changes.

disturbing feeling, can still process info, selectively attentive narrowed to immediate tasks; muscle tension, sweating, HA, GI upset; nurse must speakk in short & simple sentences and make sure pt is following what nurse is saying.

Describe severe anxiety and its behavioral changes.

trouble thinking & reasoning, can’t complete tasks/problem solve, feels dread, cries, N/V, trembling, vertigo, tachycardia, chest pain; pt no longer able to pay attention or take in info; goal is to lower pt’s anxiety level.

Describe panic and its behavioral changes.

loss of rational thought, can’t communicate verbally, delusions, may be suicidal, may run or not able to move, dilated pupils, increased BP; pt safety is primary concern; pt can’t perceive potential harm or have rational thought; recommend to go to small, quiet, non-stimulating environment.

What is the genetic theory of the etiology of anxiety?

research shows there may be inheritability with first degree relatives.