Describe the clinical manifestations of each anxiety disorder.
Clinical manifestations of anxiety:
Dry mouth
Sweating
Irritable
Fearful
Urinary
frequency
Nausea
("butterflies")
Suspicious
Forgetful
Short attention
span
Pacing, figiting
Sad
Withdrawal
OCD: At the more severe end of the continuum are obsessive-compulsi
Propose realistic outcomes for patients with each anxiety disorder.
PTSD:
Patient and others (e.g., family, friends) will remain safe.
�Patient will receive treatment for co-occurring conditions, which is always part of active treatment (e.g., alcohol/drug addiction, depression, anxiety disorders, specifically panic attac
Identify nursing interventions for each anxiety disorder.
General interventions for severe/Panic level of anxiety:
1. Maintain a calm manner.
1. Anxiety is communicated interpersonally. The quiet calm of the nurse can serve to calm the patient. The presence of anxiety can escalate anxiety in the patient.
2. Alwa
Discuss three classes of medications that have demonstrated evidenced-based
effectiveness in treating anxiety disorders
1.Benzodiazepines: Prescribed for short-term treatment only; not recommended for use by patients with substance dependence problems
2.Buspirone: Management of anxiety disorders or short-term relief of anxiety symptoms, especially GAD
3.SSRIs: First-line t
Compare and contrast the essential characteristics of Somatic Symptom Disorder
versus those of Dissociative Disorders.
The individual with a somatic sympton disorder usually has a long history of physician visits for complaints of multiple somatic symptoms. Much time and energy is spent on preoccupation with this health concern. The most frequent symptoms are pain (head,
Identify psychosocial interventions for a patient with somatic complaints that have
no medical cause.
Psychotherapy and psychodynamic techniques such as psychoeducation, "talking through", traumatic re-enactment, safety planning, and journaling.
Communication Guidelines
Generally for patients with somatic symptom disorders, nursing interventions take plac
Describe three key components in the assessment of a patient with a dissociative
disorder.
1. Assess for a history of a similar episode in the past with benign outcomes.
2. Establish whether the person suffered abuse, trauma, or loss as a child.
3. Identify relevant psychosocial distress issues by performing a basic psychosocial assessment. (Se
Compare and contrast dissociative amnesia and dissociative fugue.
Dissociative Amnesia:
Psychologically induced memory loss of an autobiographical nature is called dissociative amnesia and is marked by the inability to recall important personal information. The amnesia is reported to occur after a severe physical or psy
Identify internal and external factors that contribute to mood disorders.
BOX 15-1 PRIMARY RISK FACTORS FOR DEPRESSION
� History of prior episodes of depression
� Family history of depressive disorder, especially in first-degree relatives
� History of suicide attempts or family history of suicide
� Female gender
� Age 40 years
Recognize unstable affective states in clients and the need for further assessment in
emergency situations.
In particular, nurses must be able to recognize unstable affective states known as affective instability. Signs of affective instability, such as crying, rage, euphoria, and blunting(absence/ diminished reactions to stimuli), indicate the need for further
Formulate multiple nursing diagnoses that are applicable to clients based on
assessment.
Signs & symptoms:
Previous suicidal attempts, putting affairs in order, giving away prized possessions, suicidal ideation (has plan, ability to carry it out), overt or covert statements regarding killing self, feelings of worthlessness, hopelessness, help
Develop a holistic plan of care in accordance with the Psychiatric-Mental Health
Nursing Scope and Standards of Practice
Planning:
Outcomes should include goals for safety. Even if the patient is not having self-destructive thoughts, one goal should be to name a person who the patient will contact if such thoughts arise. Goals for the outcomes of vegetative or physical sign
Identify evidence-based interventions for providing care to clients with mental
illness (SLO 1.2), specifically mood disorders.
1. When a patient is mute, use the technique of making observations: "There are many new pictures on the wall" or "You are wearing your new shoes."
1. When a patient is not ready to talk, direct questions can raise the patient's anxiety level and frustrat
Develop an intervention plan for the nursing diagnosis, Risk for Suicide.
Assessment:
1. Always evaluate the patient's risk of harm to self or others. Overt hostility is highly correlated with suicide (see Chapter 23).
2. A thorough medical and neurological examination helps determine if the depression is primary or secondary t
Assess personal feelings, values, and attitudes towards clients with mood disorders
that may provide challenges to professional practice.
Self-awareness is a positive trait and a competent and effective interviewer needs to possess a high degree of psychological, emotional, and social/cultural self-awareness to perform optimally We all have personal biases and "off days" (i.e., days we feel
Primary prevention
calmness, promoting safety, self and community effectualness, social connectedness, and optimism�may alleviate the untoward psychologic distress of anxiety and prevent the development of trauma-related anxiety disorders such as posttraumatic stress disord
Secondary prevention
The Revised Children's Manifest Anxiety Scale (RCMAS) is a 73-item yes and no answer tool used to evaluate anxiety in children in grades 1 through 12. There are several tools used to screen various types of anxiety in adults. The Acute Panic Inventory (AP
defense mechanisms
Healthy defense mechanisms:
Altruism:
emotional conflicts and stressors are addressed by meeting the needs of others. Unlike in self-sacrificing behavior, in altruism the person receives gratification either vicariously or from the response of others--Six
functions of the brain
�Frontal cortex: cognitive interpretations (e.g., potential threat)
�Hypothalamus: activation of the stress response (fight-or-flight response; refer to Chapter 10)
�Hippocampus: associated with memory related to fear responses
�Amygdala: fear, especially
GAD Diagnostic criteria
Screening tools - Compare the GAD-7 scale to
the diagnostic criteria
Generalized Anxiety Disorder 7 (GAD-7) is a self-reported questionnaire for screening and severity measuring of generalized anxiety disorder (GAD).[1] GAD-7 has seven items, which measure severity of various signs of GAD according to reported response cat
Differentiation from other anxiety disorders
Is it psychogenic or biologically mediated?
different anxiety disorders see #1
GAD: This disorder is thought to be primarily due to psychogenic causes that lead to a conditioned response of fear and anxiety. The disorder is chronic, although it responds well to cognitive behavioral therapy (CBT) an
Why are more women diagnosed with an anxiety disorder?
Women are reported to be more frequently affected than men. Despite the high prevalence of these disorders, they often are unrecognized and untreated.
Anxiety disorders are highly comorbid/co-occurring with each other, with major depressive disorders, and
What is a barrier for some cultural groups seeking health care for an anxiety disorder?
Reliable data on the incidence of anxiety disorders among cultures are sparse, but sociocultural variation in symptoms of anxiety disorders has been noted. In some cultures, individuals express anxiety through somatic symptoms, whereas in other cultures c
EPINEPHRINE (INCREASED
NOREPINEPHRINE (INCREASED)
SEROTONIN (DECREASED)
GABA ( DECREASED)
During a manic episode, patients with bipolar disorder demonstrate significantly higher plasma levels of norepinephrine and epinephrine, and people with depression have decreased levels of epinephrine and norepinephrine.
1. Anxiolytics (Anti-Anxiety Drugs)
2. Antidepressants
3. Buspirone (Buspar)
4. CAM (Kava-Kava and Valerian)
1. Anxiolytics (Anti-Anxiety Drugs):
Anxiolytic effects result from depressing neurotransmission in the limbic system and cortical areas. Useful for short-term treatment of anxiety; dependence and tolerance develop. These drugs are NOT indicated as a prim
2. Antidepressants
First-line agents:
� Cyclic antidepressants (e.g., TCAs): The tricyclic antidepressants (TCAs) inhibit the reuptake of norepinephrine and serotonin by the presynaptic neurons in the CNS. Therefore the amount of time that norepinephrine and serotonin are a
SSRIs
Selective serotonin reuptake inhibitors (SSRIs) may cause sexual dysfunction or lack of sex drive. Inform nurse or physician.
� SSRIs may cause insomnia, anxiety, and nervousness. Inform nurse or physician.
� SSRIs may interact with other medications. Be
What is Serotonin Syndrome?
One rare and life-threatening event associated with the SSRIs is serotonin syndrome. This is thought to be related to overactivation of the central serotonin receptors, caused either by too high a dose or by interaction with other drugs. Symptoms include
* la belle indifference
* secondary gain
* munchausen syndrome
la bellle: inappropriate lack of emotion or concern for the perceptions by others of one's disability, usually seen in persons with conversion hysteria.
Munchausen syndrome is a factitious disorder, a mental disorder in which a person repeatedly and delib
Cognitive
restructure thinking, correct
distortions, challenge core beliefs
Behavioral
teach and physical practice of
activities to decrease behaviors:
Systematic desensitization
Thought stopping
What category of antidepressant medication is
used most commonly for these disorders?
A. Tricyclics
B. SSRIs
C. MAOIs
D. SSNRIs
What is true about GAD symptoms?
A. They are usually so severe that the client will
refuse to leave the house.
B. They are always associated with depression or
phobic symptoms.
C. They include excessive tearfulness, guilt, and
suicidal thoughts.
D. They can cause considerable distress an
A nurse is teaching abut how
benzodiazepines work.
What brain chemical is targeted?
A. Acetylcholine
B. Gamma aminobutyric acid (GABA)
C. Norepinephrine
D. Dopamine
What is an advantage of using
benzodiazepines other than efficacy?
A. There is no abuse potential.
B. It is useful for treating anxiety long-term.
C. Its onset of action is rapid.
D. There are no agonist reactions with other
CNS depressants.
What Medication used for performance anxiety?
Propranolol (Inderal) & Atenolol(Tenormin)
Used to relieve physical symptoms of anxiety, as in performance anxiety (stage fright). Act by attaching to sensors that direct arousal messages.
What is the hallmark feature of panic disorder?
Severe and panic levels prevent problem solving and discovery of effective solutions. Unproductive relief behaviors are implemented, thus perpetuating a vicious cycle.
The panic attack is the key feature of panic disorders (PDs). A panic attack is the sud
When does a panic attack typically occur?
Typically, panic attacks occur suddenly (not necessarily in response to stress), are extremely intense, last 1 or 2 minutes (occasionally lasting up to 30 minutes), and then subside. Panic attacks can happen at any time during the day or can occur while s
How is agoraphobia related to panic disorder?
Typically develops in adolescence or early adulthood; about one in three people with panic disorder develops agoraphobia. At times, people with panic disorder may also have agoraphobia. If agoraphobia is present, it is noted as a specifier on a DSM-5 diag
What is the best intervention for a
client who is having a panic attack?
A. Teach the client S & S of a panic attack.
B. Provide the client with privacy and leave for
30-60 seconds.
C. Distract the client with involvement in fine
motor activities.
D. Remain with the client.
What types of events have individuals with PTSD
experienced?
...
How long after the event do the
symptoms of PTSD manifest?
...
What are the clinical manifestations of PTSD?
...
What evidence-based treatments are available for PTSD?
...
What would the nurse do when
caring for a client with PTSD?
A. Avoid discussion of the traumatic event
B. Encourage verbalization of thoughts
C. Help the client use distraction to cope
D. Advise the client to forget the past
What are common compulsive behaviors and
what purpose do they serve?
What defense mechanisms are used?
What pharmacological treatment is best?
Clomipramine (tca)
What are frequent complaints of persons
diagnosed with Somatic Symptom Disorder?
Is there voluntary control of the symptoms?
How is this disorder differentiated from a
factitious disorder and malingering?
Give an example of a secondary gain.
What differen
...
What does the nurse want to focus
on to help a client with somatic S &S ?
a.The physical symptoms
b.Suppression of thoughts of inferiority
c.The client's feelings
d.Use of medications
In the assessment of a client with a
Conversion Disorder
what would the nurse anticipate that the
health assessment would reveal?
a. High serum calcium levels
b. Sensory loss along affected nerve tracks
c. No organic cause to the problem displayed
d. Motor loss to body parts along the nerves
Differentiate between dissociative amnesia
and dissociative fugue
What is the trigger for these two dissociations
disorders? What defense mechanism is used?
Is there any psychosis present?
Are all dissociation experiences pathological?
What predisposes an
...
Suicide:
High risk populations
What and how do we assess?
What do we know when energy levels
increase as a result of treatment?
Interventions for Risk for Suicide
Risk populations:
16.5% OF ADULTS.
WOMEN ARE 70% MORE LIKELY TO EXPERIENCE A DEPRESSIVE EPISODE THAN MEN.
OFTEN SECONDARY TO A MEDICAL CONDITION.
OFTEN UNDIAGNOSED IN TEENS. ASSOCIATED WITH SUBSTANCE ABUSE AND ANTISOCIAL BEHAVIOR.
DEPRESSION IN OLDER ADUL
Bipolar I
Bipolar II
Cyclothymia
Bipolar D.O. Unspecified
Bipolar I: at least one episode of mania
Bipolar II: major depressive and hypomanic episodes
Cyclothymia: less severe form of bipolar
Bipolar D.O. Unspecified: only hypomania
Lithium used to treat
therapies for bipolar disorder
1. ECT
2. Psychotherapy
3. Interpersonal and
Social Rhythm
Therapy
4. Family Focused
Therapy
5. Support Groups
What group has the highest incidence of suicide?
What are some contributing factors for suicide?
What are some protective factors?
contributing factors:
90% of people who attempt suicide have a psychiatric condition.
Alcohol and drugs are contributing factors, along with being a veteran, T.B.I. and physical illness. Can you name others?
Medications for anxiety disorders
ABLE 11-10 ACCEPTED TREATMENTS FOR SELECTED ANXIETY DISORDERS page 188 varcarolis