Anxiety and Obsessive-Compulsive Disorders

anxiety

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

fear

reaction to specific danger

known as "helpful anxiety"

mild anxiety

3 multiple choice options

mild anxiety

occurs in the normal experience of everyday living and allows an individual to perceive reality in sharp focus

symptoms of mild anxiety

restlessness, increased motivation, irritability

moderate anxiety

second level of anxiety results in selective inattention and some diminished thinking, although learning and problem solving can still occur

symptoms of moderate anxiety

- selective inattention

- diminished thinking

- beginning of sympathetic nervous system symptoms (tension, pounding heart, increased pulse and respiration rate, perspiration, gastric discomfort, headache, urinary urgency, voice tremors, and shaking)

severe anxiety

an increased level of anxiety when more primitive survival skills take over, defensive responses ensue, and cognitive skills decrease significantly

symptoms of severe anxiety

- inability to function, ritualistic behavior, unresponsive

- perceptual field greatly reduced

- difficulty concentrating on environment, inability to focus

- hyperventilation

- somatic symptoms increase (nausea, headache, dizziness)

panic level of anxiety

the most extreme level of anxiety and results in markedly dysregulated behavior

symptoms of panic level of anxiety

- distorted perception, loss of rational thought, immobility

- running, shouting, screaming, pacing

- unable to process reality

- impulsivity

defense mechanisms

automatic coping styles that protect people from anxiety and enable them to maintain their self-image by blocking feelings, conflicts, and memories

compensation

used to counterbalance perceived deficiencies by emphasizing strengths

adaptive example of compensation

a shorter-than-average man becomes assertively verbal and excels in business.

maladaptive example of compensation

a woman drinks alcohol when her self-esteem is low to temporarily ease her discomfort.

denial

escaping unpleasant, anxiety-causing thoughts, feelings, wishes, or needs by ignoring their existence.

adaptive example of denial

a man reacts to the death of a loved one by saying, "No, I don't believe you," to initially protect himself from the overwhelming news.

projection

the unconscious rejection of emotionally unacceptable features and attributing them to others.

maladaptive example of denial

a woman whose husband died 3 years earlier still keeps his clothes in the closet and talks about him in the present tense.

adaptive example of projection

no example; this is considered an immature defense mechanism.

maladaptive example of projection

a woman who has repressed an attraction toward other women refuses to socialize. she fears that another woman will come on to her.

repression

an unconscious exclusion of unpleasant or unwanted experiences, emotions, or ideas from conscious awareness.

adaptive example of repression

after a marital fight, a man forgets his spouse's birthday.

undoing

when a person makes up for a regrettable act or communication

maladaptive example of repression

a woman is unable to enjoy sex after having pushed out of awareness a traumatic sexual incident from childhood.

adaptive example of undoing

after flirting with her male secretary, a woman brings her husband tickets to a concert he wants to see.

reaction formation

when unacceptable feelings or behaviors are controlled and kept out of awareness by developing the opposite emotion or behavior

maladaptive example of undoing

a man with rigid, moralistic beliefs and repressed sexuality is driven to wash his hands to gain composure when he is around attractive women.

adaptive example of reaction formation

a recovering alcoholic constantly talks about the evils of drinking

adaptive mechanisms

healthy strategies for coping with anxiety

maladaptive example of reaction formation

a woman who has an unconscious hostility toward her daughter is overprotective and hovers over her to protect her from harm, interfering with her normal growth and development

maladaptive mechanisms

immature strategies that hinder coping with anxiety

anxiety becomes a disorder when it affects

- ability to cope

- ability to go through normal activities of daily living

- ability to interact with the world in an appropriate way

- well-being/happiness

generalized anxiety disorder (GAD)

an anxiety reaction characterized by persistent apprehension and worry greater than 6 months

generalized anxiety disorder (GAD) affects which sex more

female

1 multiple choice option

generalized anxiety disorder (GAD) leads to

avoidance that may result in lateness of absence from school or work and overall social isolation

symptoms of generalized anxiety disorder (GAD)

- restlessness

- muscle tension

- avoidance of stressful activities or events

- increased time and effort required to prepare for stressful activities or events

- procrastination in decision making

- sleep disturbance

separation anxiety

excessive fear or anxiety when separated from an individual to which the client is emotionally attached

age range for children with separation anxiety

8-24 months; peak = 18 months

symptoms of separation anxiety in children

- sleep disruption

- nightmares

- GI issues

- headaches

separation anxiety in adults is a

common comorbidity of other disorders

symptoms of separation anxiety in adults

- worry

- shyness

- uncertainty

- fatigability

- lack of self-direction

selective mutism

a condition where children do not speak owing to fears of negative responses or evaluations

substance-induced anxiety

characterized by symptoms of anxiety, panic attacks, obsessions, and compulsions that develop with the use of a substance (e.g., alcohol, cocaine, heroin, hallucinogens)

anxiety due to a medical condition

symptoms of anxiety are a direct physiological result of a medical condition

panic attack

an intense, sudden, and overwhelming fear or feeling of anxiety that produces terror and immediate physiologic changes that result in paralyzed immobility or senseless, hysteric behavior

panic disorder

psychological disorder that is characterized by recurrent attacks of anxiety or terror and usually results in the development of one or more phobias

"fear the fear" leading to avoidance characterizes which anxiety disorder

panic disorder

3 multiple choice options

symptoms of panic disorder

- palpitations

- shortness of breath, hyperventilation (respiratory alkalosis)

- choking or smothering sensation

- chest pain

- nausea

- feelings of depersonalization

- fear of dying or insanity

- chills or hot flashes

comorbid conditions of panic disorder

- depression

- OCD

- phobias

- hyperthyroidism

- dizziness

- cardiac arrhythmias

- asthma

- COPD

phobias

irrational fear causing avoidance of specific situations

agoraphobia

intense excessive anxiety or fear about being in places or situations from which escape might be difficult or embarrassing or where help might not be available

agoraphobia affects which sex more

females

1 multiple choice option

obsessive-compulsive disorder (OCD)

an anxiety disorder characterized by recurrent and persistent thoughts, ideas, and feelings or repetitive acts sufficiently severe to cause marked distress, consume considerable time, or significantly interfere with the patient's occupational, social, or interpersonal functioning

obsessions

thoughts, impulses, or images that persist and recur so that they cannot be dismissed from the mind even though the individual attempts to do so

compulsions

ritualistic behaviors individuals feel driven to perform in an attempt to reduce anxiety or prevent an imagined calamity

daily symptoms of obsessive-compulsive disorder (OCD) may involve

issues of contamination, illness, etc

defense mechanism associated with obsessive-compulsive disorder (OCD)

undoing

3 multiple choice options

body dysmorphic disorder

an obsessive-compulsive disorder that involves preoccupation with an imagined defective body part, resulting in obsessional thinking and compulsive behavior.

hoarding

an obsessive accumulation of belongings that may have little or no value and that prevents people from leading normal lives

trichotillomania

compulsive hair pulling often leading to hair loss.

excoriation disorder

compulsive skin picking leading to skin damage.

risk factors for anxiety disorders

- genetics

- neurobiological (too little of GABA)

- traumatic events

- learned behaviors

- distortion of thoughts

assessment for anxiety disorders

- interview room should be safe, quiet, non-stimulating, structured, and simple​

- full physical and neurological exam​ (nonverbal and body posture​)

- determine source of anxiety​

- determine current level of anxiety​

- assess for potential self-harm​ (ask patient about causes they can identify [triggers])

- self-assessment​ (severity measures for GAD​, Yale-Brown OCD scale, hoarding scale)

outcome identification: risk for injury d/t anxiety

- self-monitors

- uses reduction techniques

- maintains role performance

- recognizes triggers for anxiety

outcome identification: ineffective coping

- identifies effective and ineffective patterns

- asks for assistance and information

- modifies as needed

outcome identification: chronic low-self esteem

- verbalizes acceptance

- increased confidence

outcome identification: self-mutilation

- identified predictive feelings

- practices self-restraint

planning care for patients with anxiety disorders

- usually doesn't require inpatient admission

- encourage active participation to increase positive outcomes

- patient experiencing severe levels of anxiety may not be able to participate

guidelines for basic nursing interventions

- keep the patient safe

- use simple language and calm manner when speaking or providing instructions

- slow, deep breathing exercises with progressive muscle relaxation

- identify community resources and support groups

priority nursing interventions for acute anxiety or panic attacks

- assist with reduction of anxiety

- calm

- brief, direct communication

- eye contact (focus)

- breathing

- explaining you are there to help

self-care activities for clients with anxiety

- nutrition and fluid intake

- personal hygiene and grooming

- elimination

- sleep

first line of treatment for anxiety and obsessive-compulsive disorders

SSRIs

3 multiple choice options

onset of long-term anxiolytic

2-4 weeks

Paxil, Prozac, Lexapro, Zoloft

SSRIs

3 multiple choice options

Effexor, Cymbalta

SNRIs

3 multiple choice options

short-term, PRN medications for anxiety

benzodiazepines

3 multiple choice options

Ativan, Valium, Xanax, Klonopin

benzodiazepines

3 multiple choice options

benzodiazepines work on which neurotransmitter

GABA

3 multiple choice options

benzodiazepines have a potential for

dependence

benzodiazepines should be cautiously used in

elderly patients

3 multiple choice options

what should be avoided while taking SSRIs, SNRIs, benzodiazepines

alcohol

3 multiple choice options

long-term anti-anxiety medication that has no dependence

buspirone/Buspar

cognitive restructuring

process of changing an individual's perceptions of stress by reassessing a situation and replacing irrational beliefs

components of cognitive restructuring

- identification

- exploration

- realistic evaluation

- replacement of negative self-talk

behavioral therapy

psychotherapy that attempts to modify observable maladjusted patterns of behavior by substituting a new response or set of responses to a given stimulus

relaxation training

a therapeutic technique in which a person acquires the ability to relax the muscles of the body in almost any circumstance

modeling

therapist or significant other acts as a role model to demonstrate appropriate behavior in a feared situation, and then the patient imitates it

systematic desensitization

patient is gradually introduced to a feared object or experience through a series of steps, from the least frightening to the most frightening (graduated exposure); the patient is taught to use a relaxation technique at each step when the anxiety becomes overwhelming

flooding

involves exposing the client to a great deal of an undesirable stimulus in an attempt to turn off the anxiety response

effective behavioral therapies for patients with phobias

systematic desensitization and flooding

response prevention

focuses on preventing the client from performing a compulsive behavior with the intent that anxiety will diminish

thought stopping

teaches a client to say "stop" when negative thoughts or compulsive behaviors arise, and substitute a positive thought

cognitive-behavioral therapy (CBT)

evidence-based therapeutic modality for children, adolescents, and adults that seeks to identify negative and irrational patterns of thought and challenge them based on rational evidence and thoughts

evaluation of effective in clients with anxiety

- is the patient experiencing a reduced level of anxiety?​

- does the patient recognize symptoms as anxiety-related?​

- does the patient continue to display signs and symptoms such as obsessions, compulsions, phobias, worrying, or other symptoms of anxiety disorders? ​(if still present, are they more or less frequent? more or less intense?​)

- is the patient able to use newly learned behaviors to manage anxiety?​

- does the patient adequately perform self-care activities?​

- can the patient maintain satisfying interpersonal relations?​

- is the patient able to assume usual roles?

what do we hope your level of anxiety is on the day of a nursing exam?

mild

3 multiple choice options