Anxiety and OCD

  1. anxiety
    • universal human experience and is the most basic of emotions 
    • apprehension ,uneasiness, uncertainty, dread resulting from a real or perceived threat
    • felt at a deep level 
    • invades personality
    • erodes self esteem
    • erodes personal self worth
  2. anxiety makes behavior
    dysfunctional as defense against it
  3. fear
    reaction to a specific danger
  4. anxiety is a vague sense of
    dread r/t an unknown danger 

    body reacts the same way in fear or anxiety
  5. normal anxiety
    • healthy reaction necessary for survival 
    • provides energy needed to carry out the tasks involved in living and striving toward goals
  6. normal anxiety examples
    • prompts constructive behavior..
    • studying for exam
    • being on time for job interview
    • preparing for a presentation
    • job promotion
  7. Hildegard Peplau identified anxiety as
    on the most important concepts and developed a model that consists of four levels: mild, moderate, severe, panic
  8. boundaries between anxiety levels are
    • NOT distinct
    • behaviors/characteristics often overlap
  9. identification of specific level of anxiety is essential because
    interventions are based on the degree of anxiety
  10. mild anxiety
    normal experience of everyday living and allows an individual to perceive reality in sharp focus

    sees, hears, and grasps more info and problem solving becomes more effective
  11. Mild anxiety symptoms
    • slight discomfort
    • restlessness
    • irritability
    • mild tension relieving behavior (nail biting, foot tapping, fidgeting)
  12. Moderate anxiety
    • sees, hears, and grasps less info and may have 
    • Selective attention: only certain things in environment are seen or heard unless they are pointed out
  13. Moderate anxiety
    • thinking clearly is hampered
    • learning and problem solving still occur but not at optimal level

    symptoms: tension, pounding heart, increased pulse and resp., perspiration, and mild somatic symptoms (gastric distress, ha, urinary urgency) voice tremors, shaking
  14. mild and moderat levels of anxiety are
    constructive: may signal that something needs attention or is dangerous
  15. severe anxiety
    focus on one particular detail or many scattered details and have difficulty noticing what is going on in environment, even when another points  it out
  16. learning and problem solving are not possible at
    severe panic level
  17. severe anxiety symptoms
    HA, nausea, dizziness insomnia, trembling, pounding HR, hyperventilation, impending doom or dread
  18. Panic anxiety
    • most extreme level of anxiety and results in marked disturbed behavior 
    • unable to process what is going on in evironment 
    • lose touch with reality
    • pacing, running, shouting, screaming, or withdrawal
  19. hallucinations may be apparent in
    panic level of anxiety
  20. acute panic may lead to
  21. who outlined defense mechanisms
    Freud and his daughter Anna
  22. Defense mechanisms
    automatic coping styles that protect people from anxiety and maintain self image by blocking feelings, conflicts, memories
  23. maladaptive use of mechanisms
    occurs when one or several are used in excess particularly in the overuse of immature defenses
  24. two healthy coping mechanisms
    • sublimation 
    • altruism
  25. chronic anxiety can lead to
    cardiovascular system related disorders
  26. Max Hamilton
    • devised a scale that is based on inventory symptoms 
    • each symptom is number rated and the total score assists in assessing whether the individual is experiencing mild, moderate, severe, panic

    *always remember to assess for medical conditions/substance/medication use
  27. compensation
    • counterbalance perceived deficiencies by emphasizing strengths 
    • Adaptive: Shorter-than-avg man becomes assertively verbal and excels in business 
    • Maladaptive: person drinks alcohol when self-esteem is low to temporarly diffuse discomfort
  28. conversion
    • unconscious transformation of anxiety into a physical symptom with no organic cause
    • Adaptive: no example, ALWAYS pathological
    • Maladaptive: Man becomes blind after seeing his wife flirt with other men
  29. denial
    • escaping unpleasant, anxiety-causing thoughts, feelings, wishes, or needs by ignoring their excistence
    • Adaptive: Man reacts to death of loved one by saying "No i don't believe you" to initially protect himself from the news
    • Maladaptive: Woman who husband died 3 years earlier still keeps his clothes in closet and talks about him in the present tense
  30. Displacement
    • transference of emotions associated with particular person, object, or situation to another nonthreatening person, object, situation
    • Adaptive: child yells at his teddy bear after being picked on by the school bully
    • Maladaptive: Child who is unable to acknowledge fear of his father becomes fearful of animals
  31. Dissociation
    • disruption in consciousness, memory, idenity, perception of the environment that results in compartmentalizing uncomfortable aspects of oneself
    • Adaptive: art student is able to mentally separate herself from noisy environment as she becomes absorbed in her work
    • Maladaptive: result of abuse childhood and need to separate from its realities, a women finds herself perpetually disconnected from reality
  32. identification
    • attributing oneself the characteristics of another person or group (con. or uncon.)
    • Adaptive: 8yr girl dresses up like her teacher and puts together a pretend classroom
    • Maladaptive: young boy thinks neighborhood pimp is someone to look up to
  33. Intellectualization
    • process in which events are analyzed based on remote, cold facts and without passion, rather than incorporating feeling and emotion into the process
    • Adaptive: man lost farm in tornado, he analyzes his options to lead his child to safety
    • Maladaptive: man repsonds to death of his wife by focusing on details of day care and operating household rather than processing grief with his children
  34. Projection
    • unconscious rejection of emotionally unacceptable features and attributing them to others
    • Adaptive: no example, immature defense
    • Maladaptive: women who has repressed an attraction toward other women refuses to socialize. She fears another woman will make homosexual advances towards her
  35. rationalization
    • justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations that satisfy the teller as well as the listener
    • Adaptive: an employee says "i didn't get a raise because my boss doesn't like me"
    • Maladaptive: a man who thinks his son was fathered by another man excuses his malicious treatment of the boy by saying"he is lazy and disobedient." when that is not the case
  36. reaction formation
    • unacceptable feelings or behaviors are controlled and kept out of awareness by developing the opposite behavior/emotion
    • Adaptive: recovering alcoholic constantly talks above the evils of drinking
    • Malapative: women who has an unconscious hostility toward her daughter is overprotective and hovers over her to protect her from harm, interfering with her normal growth
  37. regression
    • revering to an earlier more primitive and childlike pattern of behavior that may or may have no been previously exhibited
    • Adaptive: 4 yr old boy with a new baby brother temporarily starts sucking thumb and wanting bottle
    • Maladaptive: man who loses a promotion starts complaining to toehrs, hands in sloppy work, misses apts., comes in late
  38. repression
    • unconscious exclusion of unpleasant or unwanted experiences, emotions, or ideas from conscious awareness
    • Adaptive: man forgets wife's bday after a marital fight
    • Malaptive: women is unable to enjoy sex after having pushed out of awareness a traumatic sexaul incidne t in childhood
  39. splitting
    • inabilyt to integrate the postive and negative qulaities of oneself or others into a cohesive image
    • Adaptive: no ex, always pathological
    • Malaptive: 26 yr old woman initially values her acquitances yet invaribly becomes disillusioned when they turn out to have flaws
  40. sublimation
    • unconscious process of substituting mature and socially acceptable activity for immature and unacceptable impulses 
    • Adaptive: women woh is angry with boss writes a short story about a heroic woman
    • Malapative: always constructive!
  41. Supression
    • conscious denial of a disturbing situation or feeling 
    • Adapative: a busiessness man who is preparing to make an important speech is todl by his wife that morning she wants a divorce, although he is upset.. he puts incident aside until after speech, when he can give matter more concentration
    • Malaptive: women who feels lumps in her breast shorlty before leaving for 3 week vacation puts info in the back of her mind until after returning
  42. undoing
    • most common seen in children
    • when a person makes up for an act or communication
    • Adaptive: after flirting with her male secretary, a woman brings her husband tickets to a concert he wants to see
    • Maladaptive: a man with rigid, moralistic beliefs and repressed sexuality is driven to wash is hands to gain composure when around attractive women
  43. altruism
    • dealing with anxiety by reaching out to others
    • example: a nurse who lost a family member in a fire is a volunteer firefighter
  44. sublimination
    • dealing with unacceptable feelings or impulses by unconsciously substituting acceptable forms of expression
    • example: a person who has feelings of anger toward boss, workouts out on his lunch break
  45. suppression
    • voluntarily denying unpleasant thoughts or feelings
    • example: a person who lost his jobs states he will worry about his bills next week
  46. repression
    • putting unacceptable ideas, thoughts, and emotions out of conscious awareness
    • example: a person who has a fear of the dentist's drill continually "forgets" his dental appt
  47. separation anxiety disorder
    • developmentally inappropriate levels of concern over being away from a signficant other
    • may think something horrible will happen to them
    • diagnosed prior to 18 after about a month of symptoms
  48. panic disorder key feature
    panic attacks.. Waaalaa!
  49. panic attack
    sudden onset of extreme apprehension or fear, usually associated with feelings of impending doom
  50. symptoms of panic attack
    • palpitations
    • chest pain
    • breathing difficulty
    • nausea
    • feelings of choking
    • chills
    • hot flashes
  51. children with panic attacks
    • unpredicitability 
    • out of nowhere lasts 10 min
    • less able to articulate the psychological aspects, such as fear
    • avoid situations
    • hopelessness
    • depression
    • alcohol/substance abuse not uncommon
  52. panic disorder
    "fear the fear"
  53. agoraphobia
    intense, excessive anxiety or fear about being in places or situations from which escape might be difficult or embarassing or in which help might not be available
  54. common agoraphobia
    • being alone outside
    • being alone at home
    • traveling in car, bus, plane
    • being on bridge
    • riding elevator
  55. specific phobia
    persistent, irrational fear of a specific object, activity, or situation that leads to a desire for avoidance, or actual avoidance of the object, activity or situation
  56. social anxiety disorder
    • severe anxiety or fear provoked by exposure to a social or a performance situation tha tcould be evaluated negatively by others
    • *most common manifestation: public speaking
  57. generalized anxiety disorder
    • excessive worry
    • restless, irritable, muscle tension
    • decision making difficult
    • poor concentration
    • put things off 
    • avoidance
    • sleep disturbance
    • fatigue
  58. substance induced anxiety disorder
    symptoms of anxiety, panic attacks, obsessions, and compulsions with the use of substances
  59. anxiety due to medical condition
    symptoms are a direct physiological result of medical condition
  60. obsessions
    thoughts, impulses, or images that persist and recut, so that they cannot be dismissed from the mind even though the individual attempts to do so
  61. compulsions
    rituatiualistic behaviors an individual feels driven to perform in an attempt to reduce anxiety or prevent an imagined calamity
  62. OCD behavior exist along a
  63. OCD
    symptoms that occur on a daily basis and may involve issues of sexuality, violence, contamination, illness, or death
  64. questions to ask patient about their anxiety
    • "what evidence do you have?"
    • "Explain that logic to me"
    • "are you basing that conclusion on fact or feeling?"
    • "what the worst thing that could happen?"
  65. body dysmorphic disorder
    • normal appearance usually but preoccupied with an imagined defective body part results in obsessional thinking and compulsive behavior 
    • mirror checking.. camouflaging..
    • keep a secret
    • don't respond to reassurance
    • specify if muscle dysmorhia
  66. hoarding disorder
    • specify if excessive acquisition
    • women more likely
    • however men don't seek treatment
  67. trichotillomania
    • hair pulling
    • one of oldest recorded psych. problems 
    • more often in kids 
    • etiology r/t cutting..
  68. dermotillomania
    skin picking
  69. hair pulling and skin picking
    • more common in children
    • may begin as early as 1 yr old
  70. trichophagia
    • swallowing hair
    • can be fatal
    • aka Rapunzel syndrome
  71. substance induced OCD
    example: drug to treat movement in Parkinson's = obsession with gambling, urges for sex, and out of control spending
  72. OCD due to medical condition
    determine whether symptoms are due to a medical condition, CAREFUL AND COMPREHENSIVE ASSESSMENT OF MULTIPLE FACTORS
  73. nearly 3/4 of anxiety disorder will have first episode by
    21.5 years old
  74. avg onset for OCD
  75. severe cases of OCD
  76. what plays a role in anxiety?
  77. hispanic people do what when they are stressed
    tremble severely
  78. someone who has OCD
    will likely have a sibling with it too
  79. Panic attacks in Latin Americans involve
    fear of dying
  80. What would the nurse anticipate the psychiatrist to order a stat dose of for someone in a panic attack?
    short-acting benzodiazepine
  81. PTSD often involves
    • substance abuse..
    • way of coping
  82. lorazepam
    limit caffeine
  83. nursing dx for OCD
    sleep disturbance r/t excessive rituals
  84. separation anxiety disorder
    • normal from 18 mon
    • peaking at 18 mon then declines
    • symptoms: sleep problems, nightmares, GI upset, HA
  85. GAS
    • worry!! out of proportion
    • anticatory, fear the worse
    • tense, restless, irritable
    • poor concentration, fear making decision
    • wear people out, need reassurance!!
    • sleep disturbance, fatigue!
  86. body dysmorphic
    • described over a century ago
    • may see them in psych facility, plastic surgery
    • thoughts may be secretive
  87. OCD r/t medical condition
    • physiological
    • postencephalatic syndrome
    • postanoxic event
    • traumatic brain injury
    • Huntingtons
    • seizures
    • cerebral infarctions
  88. anxiety coexists with
    • depression..
    • anxiety symptoms comes first
    • genetics/neurobio role
  89. amygdala
    stores memories with emotional significance and have been implicated in phobic responses such as fears/snacks/heights
  90. limbic system
    • anxiety-related responses
    • regulate anxiety: E, NE, dopamine,serotonin, and GABA
  91. GABA
    • puts break on excitatory neurotransmitters
    • common focus pharmacologically for anxiety
    • benzodiazepine facilitates its action
  92. Pediatric acute-onset neuropsychiatric syndrome
    • children develop OCD after strep infection
    • *compulsive behavior and eating disorder have been known to develop after suffering from this bacterial infection
  93. psychodynamic theroies
    development of anxiety disorders suggest that unconscious childhood conflicts are the basis for future symptom development
  94. Freud believed anxiety results when threatening repressed ideas/emotions are close to breaking through from the
    unconscious mind into the conscious mind
  95. Harry Stack Sullivan believed anxiety is linked to emotional distress caused
    • when early needs go unmet or disapproval is experienced (interpersonal theory)
    • thinks its contagious
    • felt early in life
  96. behavorial theories
    suggest that anxiety is a learned response to specific environmental stimuli (classical conditioning)
  97. example of classical conditioning
    boy who is anxious in the presence of his abusive mother, he then generalizes this anxiety as a response to all women
  98. cognitive theorists
    anxiety disorders are caused by distortions in an individual's thoughts and perceptions.
  99. Latin americans and Northern Europeans panic attacks
    choking, smothering, numbness, tingling, fear of dying
  100. other cultural groups with panic attacks
    fear of magic/witchcraft
  101. Social anxiety in Japanese/ Korean
    individual's blushing, eye contact, or body odor is offensive to others
  102. popular tool for measuring anxiety
    Hamilton Rating Scale  for Anxiety waalaa!
  103. stage outcomes in
    small, attainable steps
  104. Hamilton Rating Scale Anxiety
    • Mild: 14-17
    • Moderate: 18-24
    • Severe: 25-30
  105. Assessing Anxiety/OCD
    • 1. primary or secondary?
    • 2. what level?
    • 3. asses for self-harm 
    • 4. perform psychosocial assessment
  106. Severe anxiety
    • can't solve problems
    • use firm, short, simple statements
  107. are there any FDA approved medications for kids with anxiety disorders?
  108. SNRIs
    • Duloxetine (Cymbalta):GAD
    • Venlafaxine (Effexor): several anxiety disorders
  109. Benzos
    • quick onset of action
    • short periods, until meds/treatment reduce symptoms
    • s.e.: sedation, ataxia, decrease cognitive
    • don't give to: substance abusers, pregnant, breastfeeding
  110. Anti anxiety med teaching
    • no alcohol, caffeine (decreases effects)
    • unsafe to handle machinery
    • take with or shortly after meals to reduce GI upset
  111. Drug interactions with anti-anxiety meds
    • antacids: delay absorption
    • Cirmetidine: interferes with benzo metabolism, increased sedation
    • alcohol/barbiturates: increase sedation
    • serum phenytonin: may build up because of decreased metabolism
  112. BuSpar
    • doesn't cause dependence
    • 2-4 weeks for required effect
    • may be used longterm
  113. D-cycloserine
    • antibiotic used to treat TB
    • helps patients unlearn fear responses
  114. kava
    • south american plant used as sedative with antianxiety effects
    • liver damage risk**
    • especially with alcohol or other CNS depressants
  115. cognitive restructuring
    • identify automatic negative beliefs that cause anxiety
    • explore the basis for these thoughts 
    • reevaluate the situation realistically 
    • replace negative self-talk with supportive ideas
Card Set
Anxiety and OCD