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Mental Health

Anxiety Disorders

Individuals with anxiety disorders use rigid, repetitive, and ineffective behaviors to Try to control anxiety.
Anxiety disorders tend to be persistent and often disabling
Major depression and substance abuse are frequently encountered with anxiety disorders
Anxiety disorders tend to cluster in families
Panic disorders are 2-3x more frequent in women
Generalized anxiety disorder is 2x more frequent in women
Phobias are 2x more frequent in women
Social anxiety disorder is _______in prevelance when comparing women and men. equal
OCD is _______in prevalence when comparing women and men. equal
PTSD is more likely to affect women
Abnormalities of the benzodiazepine receptors leading to the unregulated anxiety levels of a patient is what theory? GABA benzodiazepine theory
Studies suggest that a stress response of the hypothalamus-pituitary-adrenal system is abnormal in these individuals. Patients with PTSD
This person taught that anxiety resulted from the threatened breakthrough of repressed ideas or emotions from the unconscious. Freud
Freud suggested that ego defense mechanisms are used by an individual to keep anxiety at manageble levels
This person felt that anxiety experienced early in life becomes the prototype for that experienced when unpleasant events occur later in life. Sullivan
Behavioral psychologists conceptualize anxiety as a learned response that can be unlearned
Cognitive theorists take the position that anxiety disorders are caused by distortions in an individual's thinking and perceiving.
Panic attacks in Latin Americans and Northern Europeans often involve sensations of Choking, smothering, numbness, or tingling as well as fear of dying.
Blusing, eye contact or body is offensive to others in what culture? Japanese and Korean cultures
Minority groups have a much higher rates of PTSD
List the disorders that are considered anxiety disorders: Panic disorders, Phobias, OCD, GAD, PTSD, acute stress disorder, anxiety due to substance use, anxiety due to medical condition, and anxiety not otherwise specified.
The key feature of panic disorder is the panic attack
This anxiety disorder is characcterized by recurrent unexpected panic attacks, about which the individual is persistently concerned. Panid Disorder without agoraphobia
The sudden onset of extreme apprehansion or fear, usually associated with feelings of impending doom. panic attack
People experiencing _____ may believe that they are losing their minds or tare having a heart attack. panic attack
Palpitations, chest pain, breathing difficulties, nausea, feelings of choking, chills, and hot flashes are physical symptoms of panic attacks
Typically panic attacks occur _______ and not in response to stress. suddenly
Intense, excessive anxiety or fear about being in places or situations from which escape might be difficult or embarassing, or which help might not be abailable if a panic attack occured. agoraphobia
Examples of situations that are commonly avoided by clients with agoraphobia are: Being alone outside; being alone at home; traveling in a car, bus, or airplane; being on a bridge; ridign in an elevator.
Avoiding behaviors can be debilitating and life constricting.
Recurrent episodes of panic attacks, and at least one of the attacks has been followed by 1 month of either persisten concern about having the attacks, worry about aconsequences, or significant change in behavior. Panic Disorder
Irrational fear of an object or situation that persists although the person may recognize it as unreasonable. Phobia
Fear of being along in open or public places where escape might be difficult, may not leave home. agoraphobia
Fear of situations where one might be seen and embarrassed or criticized. Social phobia
Fear of a single object, activity, or situation. Specific phobia
In a person with a phobia, anxiety is severe if the object, situation or activity cannot be avoided
Preoccupation with persisten intrusive thoughts, impulses, or images or repetitive behaviors or mental acts that the person feels driven to perform in order to reduce distress or prevent a dreaded event or situation. OCD
With OCD the person knows the obsessions/compulsions are excessive and unreasonable
This anxiety disorder can caus increased distress and is timeconsuming. OCD
Excessice anxiety or worry more days than not over 6 months and an inability to control the worrying. GAD
GAD is anxiety and worry associated with three or more of the following symptoms: Restlless or keyed up;easily fatigued;difficulty concentrating, mind goes blank;irritability; muscle tension;sleep disturbance.
With this anxiety disorder, anxiety or worry or hysical symptoms cause siginificant impairment in social, occupational or other areas of important functioning. GAD
_______ without a history of panic disorder occurs only rarely, and it occurs early in the clients history. agoraphobia
Specific phobias are common and usually do not cause much difficulty because People can contrive to avoid the feared object.
A ritualistic behavior that in individual feels driven to perform in an attempt to reduce anxiety. compulsion
Common obsessions and compulsions are: Doubt, need to check; sexual imagery or ideation; need for order; violence;germs or dirt.
What are the symptoms a person with GAD may exhibit? Restlessness, fatigue, poor concentration, irritability, tension, sleep disturbance.
Examples of worries typical in GAD are: Inadequacy in interpersonal relationships, job responsibilities, finances, health of family members, household chores, and lateness for appointments.
In GAD, decision making is difficult, owing to poor concentration and dread of making a mistake.
Nurses need to teach clients with GAD that there are effective psychotherapy treatments for this disorder.
This disorder is characterized by repeated reexperiencing of a highly traumatic event that involved actual or threatened death or serious injury to self or others. PTSD
PTSD symptoms often begin _____ after the trauma. 3 months
Dissociative experiences during which the event is relived and the person behaves as though he or she is experiencing the event at that time. flashbacks
The major features of PTSD are: Persistant reexperiencing of the trauma, perisitant avoidance of stimuli associated with the trauma, experience of persistent numbness of general responsiveness, persistent symptoms of increased arousal.
Difficulty with interpersonal, social, or occupational relationships nearly always accompanies PTSD
This anxiety disorder occurs within 1 month after exposure to a highly traumatic event. Acute Stress Disorder
Acute stress disorder resolves within 4 weeks
This anxiety disorder is characterized by symptoms of anxiety, panic attacks, obsessions, and compulsions that develop with the use of a substance or within a month of stopping use of the substance. Substance-Induced Anxiety Disorder
Chronic PTSD has a duration of ________ or longer. 3 months
Acute stress disorder is no due to drug/medication or medical condition.
Acute stress disorder occurs within _____ of the traumatic event. 4 weeks
In this anxiety disorder, the individual's symptoms of anxiety are a direct physiological result of a medical condition, such as hyperthyroidism, pulmonary embolism, or cardiac dysrhythmias. Anxiety due to medical condition
This anxiety disorder is a diagnosis used for disorders in which anxiety or phobic aboidance predominates but the symptoms do not meet full diagnostic criteria for a specific anxiety disorder. Anxiety Disorder Not Otherwise Specified
People with anxiety disorders rarely need ______ unless they are suicidal or have compulsions causing injury. hospitalization
The main symptoms of anxiety disorders are: panic attacks, excessive anxiety, severe reactions to stress or trauma, phobias, obsessions, and compulsions.
What defense is used by a patient who has a phobia? displacement
What defense is used by a patient who has a compulsion? undoing
What defenses are used by a patient who has an obsession? reaction-formation and intellectualization
What defenses are used by a patient who has PTSD? Isolation and repression
Basic level psychiatric mental health nurses use ________ to assist clients with anxiety disorders to reduce anxiety, enhance coping and communication skills, and intervene in crises. counseling
Advanced nurses use treatment approaches that include: Cognitive or cognitive behavioral therapy, relaxation training, and the behavioral techniques of modeling, systematic desensitization, flooding, and response prevention.
If a patient with anxiety does have to be hospitalized, what features of atherapeutic mileu can be especcially helpful to the patient? Structure of the daily routine, providing daily activities to promote sharing and cooperation, provide therapeutic interactions, including client in decisions about his or her own care.
What self-care activities are most likely to be affected with an anxiety disorder? Nutrition and fluid intake, personal hygiene and grooming, elimination, and sleep.
Weighing anxiety disorder clients frequently is a useful tool for assessing nutrition
Why might maintenanc of skin integrity become a problem for a client with an anxiety disorder? Excessive washing of the skin.
Patients with GAD, PTSD, and acute stress disorder often experience sleep disturbances from nightmares
These intervention include the use of simple relaxation exercises and administration of medications. Psychobiological Interventions
What medications are the first line treatment for anxiety disorders? SSRI's (antidepressants)
Why are SSRI's preferable to the tricyclic antidepressants (TCA's)? Because they have a more rapid onset of action and fewer problematic side effects.
Why are MAOI's reserved for treatment-resistant conditions? Because of the risk of life-threatening hypertensive crisis if the client does not gollow dietary restrictions (tyramine).
Antidepressants have the secondary benefit of treating comorvid depressive disorders in clients
When antidepressant therapy is started, why is it important to start with low doses of SSRI's? Because of the activating effect, which temporarily increases anxiety symptoms.
What may use of an antidepressant do in a client with co-occuring bipolar disorder? It may cause a manic episode which will require the addition of mood stabilizers or even antipsychotic agents.
Use of MAOI's is contraindicated clients with comorbid substance abuse because There is a risk of hypertensive crisis with the use of stimulant drugs.
These drugs are often used to treat the somatic and psychological symptoms of anxiety disorders. anxiolytic drugs
Why are benzodiazepines the most common form of anxiolytic drugs used? Because they have a quick onset of action.
What are the side effects of benzodiazepine? Sedation, ataxia, and decreased cognitive function,.
An alternative anxiolytic drug that does not cause dependence is Buspirone
How long does it take for Buspirone to reach its full effects? 2-4 weeks
What anxiolyic drug would be used for long term treatment? Buspirone
Aside from antidepressants and anyiolytics what are the other classes of medications that may be used to treat anxiety disorders? Beta blockers, antihistamines, and anticonvulsants.
_______ have shown some benefit in management of GAD, SAD, and comorbid depression with SAD or panic disorder. anticonvulsants
Because benzodiazepine is discouraged for patients with comorbid substance dependence, _____ are a safe nonaddictive alternative. antihistamines
Problems that can occur with the use of psychotropic herbs include: Toxic side effects and herb drug interactions
Inhibition of GABA may cause increased anxiety
Among the suggested effective treatments for panic disorder is participation in ______ ______ therapy to gain mastery over panic episodes. cognitive-behavioral
Assisting a client to increase his or her personal judgment of self-worth. self esteem enhancement
The age of onset of most anxiety disorders is before 40 years
Studies of clients with posttraumatic stress disorder suggest that the stress response of what is considered abnormal? Hypothalamus-pituitary-adrenal system
A recurrent, persistent thought or impulse. obsession
Fear and impending doom is a symptom associated with panic attacks
Working with a client to help the client view an occurrence in a more positive light is called cognitive restructuring
The primary purpose of performing a physical examination before beginning treatment for any anxiety disorder is to determine if the anxiety is of primary or secondary origin
The treatment for secondary anxiety is treatment of the underlying cause.
Inability to leave one's home because of avoidance of severe anxiety suggests the anxiety disorder of panic attacks with agoraphobia
Panic attacks in Latin American individuals often involve fear of dying
The nurse caring for a client with a panic attack might anticipate that the psychiatrist would order a stat dose of a short-acting benzodiazepine
The physician orders lorazepam 1 mg po qid for 1 week for a client with generalized anxiety disorder. What should the nurse caution the patient to limit intake of? caffeine
Anxiety disorders often interfere with the usual _________ of clients role performance
Sleep disturbances is a potential problem that should be investigated for a client with severe obsessive-compulsive disorder
What therapeutic intervention can the nurse independently use with a client with anxiety disorder? modeling
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