NURS 312 final part 3 (Anxiety and obsessive compulsive disorder)

what are the three parts of adaptive anxiety?

physiological arousal, cognitive appraisal, and coping strategies

what is an important nursing consideration when the patient is overwhelmed with emotion?

no learning can occur! Make sure to ground yourself before trying to regulate another person's anxiety

what is GAD?

Generalized anxiety disorder

characterized by unwarranted enduring anxiety across life situations, especially when individual feels a lack of control

what is social anxiety?

a marked/intense fear of social situations in which the individual feels scrutinized and negatively evaluated by others

What is generalized social phobia versus specific s? (category of social anxiety)

fear related to most social situations VERSUS fear related to only one or two social situations

What is a panic disorder?

characterized by repeated episodes of panic; abrupt surges of intense fear/discomfort

this could be triggered or appear out of the blue

What is a phobia?

a persistent and unreasonable fear of a particular object, activity, or situation

what is obsessive compulsive disorder?

OCD. characterized by severe obsessions, compulsions or the both

What is an obsession?

unwarranted, intrusive and persistent impulses or images that are incongruent with a person's ususal thought patterns and causes significant anxiety/distress

what is a compulsion?

behaviours performed repeatedly in a ritualistic fashion with the goal of preventing or relieving the anxiety caused by their obsessions

what is the KEY link between obsessions and compulsions?

Obsessions CAUSE anxiety, and compulsions attempt to RELIEVE that anxiety

When does OCD specifically become a psych disorder?

not until they are severe and interfere with an individual's reality testing/judgment to the degree that the person spends most of their day performing actions to minimize severe anxiety

What is hoarding?

excessive aquiration or inability or unwillingness to discard material possessions (chronic pogressive disorder)

what are some etiologic theories to try and explain anxiety?

genetic theories, neurobiology of anxiety, neurotransmitters/neuropeptides, neuroimaging and psychodynamic theories

What is the diathesis stress model?

genetic and environmental factors interact to heighten an individual's vulnerability to an anxiety disorder

What is fear conditioning?

conditioned to associate a neutral stimulus with an adverse stimulus (automatic emotional response over time, where the patient learns to respond with fear)

what is extinction related to fear conditioning?

if a fear can be learned, it can also be unlearned (through repeated exposure)

What are some neurotransmitters potentially involved in anxiety?

serotonin, norepinepherine, GABA, and neuropeptides like corticotropin-releasing hormone (controls the fight/flight/freeze response)

How does neuroimaging help us explain anxiety?

gives us insight into the interactions between the brain, neural network circuits and the physiology of anxiety- specifically prefrontal cortex and the amygdala.

Different types of anxiety will exhibit a hyper/hypoactivity of the amygdala and frontal cortex

how do psychodynamic theories explain anxiety?

they focus on the psychological influences on human behaviour, feeling, and emotion in the context of early life experiences

in other words, the MIND/BRAIN/BODY connection

What assessments should you conduct for the biologic domain in anxiety?

- rule out life threatening causes

- assess environmental triggers/stressors

- detailed history of previous/similar experiences

- substance use

- pain and sleep patterns

What assessments should you conduct for the psychological domain in anxiety?

- determine patterns

- MSE

- suicidal tendancies

- cognitive thought patterns

- any avoidance behaviours

what assessments should you conduct for the social/occupational domain?

- assess individual's understanding of how anxiety and avoidance have impacted social and vocational life

What assessments should you conduct for the spiritual domain?

- assess individual's spiritual sense of purpose

- sense of meaning

what's the deal with panic? how is it related to anxiety?

Panic can be a normal but extreme and overwhelming form of anxiety

it is often initiated when an individual is placed in a real/perceived life threatening situation

What is agoraphobia?

extreme or irrational fear of crowded spaces or enclosed public places.

What is a specific/simple phobia?

a disorder marked by an irrational fear of a specific object/situation that the person realizes is unreasonable

Mild stage of anxiety

special attention; increased sensory stimulation; motivational

Mild stage of anxiety: what should nurses do?

Learning is possible!

RN assists the patient to use the energy anxiety provides to encourage growth and learning

Moderate stage of anxiety

zoning in on the situation, and not much else. Some of the symptoms of moderate anxiety include stomach pains, racing heartbeat, sweating or dry mouth.

Moderate stage of anxiety: what should nurses do?

nurse needs to check their own anxiety so the patient doesnt empathize with it

enourage the patient to talk: focus on one experience, describe it fully, then formulate the patients generalizations about the experience

Severe degree of anxiety

increased heart rate, feelings of panic and social withdrawal. These symptoms can result in loss of work and increased health care costs

Severe stage of anxiety: what should nurses do?

learning is still possible

allow relief behaviours to be used but do not ask about them

enourage patient to ventilate their random ideas to decrease anxiety to moderate

Panic degree of anxiety

extreme fear, rapid breathing and heart palpitations. Panic attacks typically last about 10 minutes and can be triggered by various things

Panic stage of anxiety: what should nurses do?

learning is impossible

RN needs to STAY with the patient

allow pacing and walk with the patient

pick up on what the patient says and provide direct and short phrases

Do not touch the patient, because they distort all intentions as invasions of their personal space

match current attention span to decrease anxiety in a helpful way

What are some biologic interventions for anxiety?

breathing control, balanced eating patterns, decreased intake of caffiene and food additives, encourage routine exercise, administer medications and monitor side effects

Medications for anxiety

Anxiolytics: drugs that reduce anxiety

Benzodiazepines

Valium

Xanax

Ativan

Antidepressants

Tricyclics

Selective Serotonin Reuptake Inhibitors (SSRIs)

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

What are some psychological interventions for anxiety?

Stay with the patient during acute panic, perform behavioural analysis to identify antecedent events, progressive muscle relaxation, use distraction behaviours, address myths and misconceptions

What are some social interventions for anxiety?

assist with lifestyle restructuring, time management, decrease lifestyle stress, review childbearing practices, refer to family therapy if needed, and encourage use of support groups

What are some spiritual interventions for anxiety?

address feelings of alienation/estrangement, confront and reconcile fear of death, support hope, and support spiritual practices

What is fear?

emotional response to a specific and proximal threat to life or integrity

what is anxiety?

An emotion characterized by the apprehension/dread of a potentially threatening or uncertain outcome

(FUTURE ORIENTED)

What is worry?

thoughts and images centreing on adverse outcomes that engender negative affect and are relatively uncontrollable (this is a symptoms of fear and anxiety)

What is emotion?

A transient response to a specific stimulus that produces an arousal reaction characterized by changes in subjective feelings/behaviour

What is allostasis?

An adaptive process that maintains homeostasis through production of various brain and peripheral stress-related chemicals

This process promotes adaption to stress

DSM-5 diagnostic criteria for panic disorders: the symptoms of recurrent unexepted attacks (and how many of these symptoms must be present?)

4+ of the following symptoms:

palpitations, sweating, trembling, SOB, chest pain, nausea, dizziness, chills, paresthesias, derealization, depersonalization, fear of losing control/going crazy, and fear of dying

DSM-5 diagnostic criteria for panic disorders: what are the three other criteria needed to diagnose a panic disorder?

1. the disturbance is not attributable to the effects of a substance/other medical condition

2. at least one of the attacks has been followed by 1+ month of one or both of: persistent concern/worry about additional panic attakcs/their consequences OR maladaptive change in behaviour related to the attacks

3. The disturbance is not better explained by another mental disorder (ie. phobia)

What is paresthesias?

numbness and tingling

What is derealization?

experiences of unreality or detachment with respect to surroundings

What is depersonalization?

disturbance in the perception of oneself

What is the first line pharmacotherapy for anxiety?

SSRIs

What are the structures in the brain involved in fear condition

hippocampus (memory storage), and the amygdala (stores fearful memories)

what is CRH?

Corticotropin-releasing hormone

neuropeptide that activates the HPA axis in the brain, which ouputs cortisol

increases during panic attacks

CCK neuropeptide also induces panic attacks

What is emotional processing?

associated with regions in the prefrontal cortex; learning that a stressor can be coped with, is under control, or no longer requires attention

CPD/phobias have decreased activity in the prefrontal cortex and disinhibits the amygdala

GAD/social anxiety has increased prefrontal cortex activity

What are CBT strategies?

pyschoeducation, self monitoring, cognitive restructuring, somatic exercises

the R's: Relabel, reattribute, refocus, and re-evaluate