Anxiety & Anxiety Related Disorders
Q: What is anxiety?
A: A vague feeling of dread or apprehension in response to internal or external stimuli.
Q: How does anxiety differ from fear?
A: Fear is a reaction to a specific identifiable threat, while anxiety is a response to a perceived or vague stressor.
Q: When does anxiety become considered a disorder?
A: When it is chronic, excessive, and significantly impairs daily routines and functioning.
Q: Who developed the General Adaptation Syndrome theory of stress?
A: Hans Selye.
Q: What are the three stages of General Adaptation Syndrome?
A: Alarm reaction, resistance stage, and exhaustion stage.
Q: What occurs during the alarm reaction stage of stress?
A: The hypothalamus stimulates the adrenal glands to release adrenaline and norepinephrine to prepare the body for fight, flight, or freeze.
Q: What physiological changes occur during the alarm reaction stage?
A: Dilated pupils, increased oxygen intake, and blood being shunted to vital organs.
Q: What happens during the resistance stage of stress?
A: The body remains at a heightened level of functioning to adapt to the stressor.
Q: What happens if adaptation is successful during the resistance stage?
A: The parasympathetic nervous system returns the body to normal.
Q: What occurs during the exhaustion stage of stress?
A: The body's energy stores are depleted, leading to emotional distress and possible physical illness.
Q: What are examples of illnesses that may occur during the exhaustion stage?
A: Tension headaches, eating disorders, and worsening of medical conditions like hypertension.
Q: What are the four levels of anxiety?
A: Mild, moderate, severe, and panic.
Q: What characterizes mild anxiety?
A: Widened perceptual field, increased motivation, and improved learning.
Q: What characterizes moderate anxiety?
A: Narrowed perception, nervousness, but the person can still be redirected.
Q: What characterizes severe anxiety?
A: Greatly reduced perceptual field, ineffective reasoning, and activation of fight or flight response.
Q: What characterizes panic level anxiety?
A: The individual focuses only on self-defense, has distorted perceptions, and cannot process stimuli.
Q: Is there a single cause for anxiety disorders and OCD?
A: No, they result from a combination of biological, psychological, and environmental factors.
Q: What do biologic or genetic theories suggest about anxiety disorders?
A: There is moderate genetic heritability for panic disorder, phobias, and GAD, and a strong genetic component for OCD.
Q: Which neurotransmitter is an inhibitory neurotransmitter involved in anxiety disorders?
A: GABA.
Q: What is the role of GABA in the brain?
A: It reduces neuronal excitability and helps calm the nervous system.
Q: How is norepinephrine related to anxiety disorders?
A: Increased norepinephrine levels are associated with heightened anxiety.
Q: Which neurotransmitter dysregulation is strongly associated with OCD and anxiety disorders?
A: Serotonin, especially the 5-HT1A subtype.
Q: What did Freud’s psychodynamic theory suggest about anxiety?
A: Anxiety results from overuse of unconscious defense mechanisms to control internal conflicts.
Q: What is a major limitation of overusing defense mechanisms according to Freud?
A: It inhibits emotional growth and problem-solving abilities.
Q: What do interpersonal theories by Sullivan and Peplau suggest about anxiety?
A: Anxiety originates from interpersonal relationship problems and can be transmitted from caregivers to children.
Q: What do behavioral theories say about anxiety disorders?
A: Anxiety is a learned response that develops from negative experiences.
Q: What is the implication of behavioral theories for treatment?
A: Maladaptive behaviors can be unlearned through therapy.
Q: What do cognitive models suggest about the development of OCD?
A: OCD stems from perfectionism, inflated responsibility, and the belief that thinking something makes it more likely to happen.
Q: What is panic disorder?
A: An anxiety disorder characterized by recurrent, unexpected panic attacks.
Q: How long do panic attacks typically last?
A: About 15 to 30 minutes.
Q: What are common symptoms of panic attacks?
A: Palpitations, sweating, shortness of breath, chest pain, and fear of impending doom.
Q: What are phobias?
A: Illogical, intense, and persistent fears of specific objects or situations.
Q: What is anticipatory anxiety?
A: Anxiety experienced when thinking about or anticipating exposure to a feared object or situation.
Q: What behavior commonly results from phobias?
A: Severe avoidance behaviors.
Q: What is agoraphobia?
A: Fear of open or public spaces where escape may be difficult.
Q: What disorder commonly occurs with agoraphobia?
A: Panic disorder.
Q: What is generalized anxiety disorder (GAD)?
A: Excessive worry and anxiety occurring more days than not for at least six months.
Q: What symptoms accompany generalized anxiety disorder?
A: Muscle tension, fatigue, sleep disturbances, and persistent uneasiness.
Q: What is obsessive-compulsive disorder (OCD)?
A: A disorder involving intrusive obsessions and repetitive compulsions.
Q: What are obsessions?
A: Recurrent, intrusive, and unwanted thoughts that cause distress.
Q: What are compulsions?
A: Repetitive behaviors performed to reduce anxiety caused by obsessions.
Q: What is excoriation disorder?
A: Compulsive skin picking.
Q: What is trichotillomania?
A: Compulsive hair pulling.
Q: What is hoarding disorder?
A: Persistent difficulty discarding possessions regardless of value.
Q: What is onychophagia?
A: Compulsive nail biting.
Q: What is kleptomania?
A: Compulsive stealing.
Q: What is oniomania?
A: Compulsive buying.
Q: What is body dysmorphic disorder (BDD)?
A: A disorder involving obsessive concern over perceived physical flaws.
Q: What treatment approach is most effective for anxiety disorders?
A: A combination of medication and psychotherapy.
Q: What psychotherapy is highly effective for anxiety disorders?
A: Cognitive Behavioral Therapy (CBT).
Q: What technique involves challenging catastrophic thinking?
A: Decatastrophizing.
Q: What technique involves stopping intrusive thoughts?
A: Thought-stopping.
Q: What is assertiveness training?
A: A CBT technique that teaches individuals to communicate needs effectively.
Q: What therapy is commonly used to treat phobias through gradual exposure?
A: Systematic desensitization.
Q: What therapy involves rapid exposure to the feared stimulus?
A: Flooding.
Q: What medications are commonly used for short-term treatment of anxiety?
A: Benzodiazepines.
Q: Give examples of benzodiazepines used for anxiety.
A: Alprazolam and diazepam.
Q: Why should benzodiazepines be used for short durations only?
A: They have a high risk of dependence.
Q: What is the recommended maximum duration for benzodiazepine use in anxiety?
A: About 4 to 6 weeks.
Q: What medications are preferred for long-term treatment of anxiety disorders?
A: SSRIs.
Q: Give examples of SSRIs used for anxiety.
A: Paroxetine and fluoxetine.
Q: What is buspirone?
A: A non-benzodiazepine anxiolytic used for anxiety.
Q: What antihypertensive medication may be used to reduce physical symptoms of anxiety?
A: Clonidine.
Q: What is the gold standard therapy for OCD?
A: Exposure and Response Prevention (ERP).
Q: What occurs during Exposure and Response Prevention therapy?
A: The client confronts anxiety-provoking stimuli and avoids performing the compulsive ritual.
Q: What medications are first-line treatments for OCD?
A: SSRIs.
Q: Give examples of SSRIs used for OCD.
A: Fluvoxamine and sertraline.
Q: What medications may be used for treatment-resistant OCD?
A: Second-generation antipsychotics.
Q: Give examples of antipsychotics used for resistant OCD.
A: Risperidone and aripiprazole.
Q: What somatic therapies may be used for severe OCD cases?
A: Deep brain stimulation or targeted neurosurgery.
Q: What tool is commonly used to assess anxiety severity?
A: Hamilton Rating Scale for Anxiety.
Q: What behaviors should nurses observe when assessing anxiety?
A: Motor behavior such as pacing or wringing hands.
Q: What physiological symptoms should be assessed in anxiety?
A: Increased heart rate, sweating, and respiratory changes.
Q: What are common nursing diagnoses for anxiety disorders?
A: Anxiety, ineffective coping, risk for injury, powerlessness, and disturbed sleep pattern.
Q: What is the priority intervention during severe or panic anxiety?
A: Ensuring the client's safety.
Q: What should the nurse do when a client is experiencing panic anxiety?
A: Stay with the client and remain calm.
Q: What environment should be provided for a client experiencing severe anxiety?
A: A quiet, low-stimulation environment.
Q: How should a nurse communicate with a client experiencing severe anxiety?
A: Using short, simple sentences in a calm voice.
Q: Should clients experiencing panic be forced to make decisions?
A: No.
Q: Should nurses immediately stop OCD rituals?
A: No, because it increases anxiety.
Q: What is the initial approach to OCD rituals in nursing care?
A: Allow time for the ritual.
Q: How should OCD rituals be managed over time?
A: Gradually limit the time allowed for the ritual.
Q: What coping techniques should be encouraged for OCD clients?
A: Deep breathing, CBT strategies, and stress reduction.
Q: Why do nurses often encounter anxiety disorders in community settings?
A: Many clients receive outpatient or community-based care rather than inpatient care.
Q: What is an important health promotion message about anxiety?
A: Mild anxiety is normal and can motivate positive change.
Q: What lifestyle habits help manage anxiety?
A: Regular exercise, balanced nutrition, and adequate sleep.
Q: What substances should be limited to reduce anxiety symptoms?
A: Caffeine and alcohol.
Q: What important medication teaching should be given about benzodiazepines in older adults?
A: They increase the risk of falls due to sedation.
Q: What should clients avoid while taking anti-anxiety medications?
A: Alcohol and other CNS depressants.
Q: Why are community resources important for anxiety clients?
A: They reduce isolation and provide ongoing support.
Q: What resources can help clients manage anxiety disorders?
A: Mental health providers, psychiatrists, and support groups.
Q: What is required for effective long-term management of OCD?
A: Consistent practice of exposure and response prevention techniques.
Q: What modern tools may enhance CBT for OCD?
A: Technology-assisted CBT and bibliotherapy.
Q: Why is self-evaluation important for nurses treating anxiety disorders?
A: Anxiety can be transmitted interpersonally.
Q: How can a nurse's behavior affect an anxious client?
A: If the nurse appears anxious or frustrated, the client’s anxiety may increase.
Q: What emotional stance should nurses maintain when caring for anxious clients?
A: Calm, centered, and controlled.
Q: What is cultural humility in mental health care?
A: Recognizing and respecting different cultural expressions of distress.
Q: How might some cultures express psychological distress?
A: Through somatic symptoms or supernatural explanations.
Q: What should nurses avoid when providing culturally sensitive care?
A: Stereotyping.
Q: Why is empathy especially important when caring for clients with OCD?
A: Clients often know their behaviors are irrational but feel powerless to stop them.
Q: Why is telling an OCD client to "just stop" their ritual harmful?
A: It invalidates their experience and increases distress.
Q: What is the appropriate approach to treating OCD behaviors?
A: Empathy, patience, and structured behavioral therapy.