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Flashcards in 5 Anxiety Disorders & OCD Deck (197):
1

What is normal anxiety? (2)

1.) A normal response to the threat of injury
2.) A normal response to developmental changes

2

Who experiences anxiety?

everyone!

3

Normal anxiety is an __ __.

emotional process

4

Anxiety, which is an __ process, is a warning of __ and __ threat

adaptive

internal; external

5

What are examples of internal and external threats? (5)

1. Bodily damage/ pain
2. Possible punishment
3. Separation from loved ones
4. Threats to status or success
5. Threats to unity or wholeness

6

Anxiety prompts a person to take necessary steps to prevent __ or __ __.

threat

lessen consequences

7

Does this describe fear or anxiety?

Deal with a threat

Anxiety

8

Does this describe fear or anxiety?

More insidious (not quite clear, uneasy feeling)

Anxiety

9

Does this describe fear or anxiety?

Uncertainty to the outcome

Anxiety

10

Does this describe fear or anxiety?

More sudden

Fear

11

Does this describe fear or anxiety?

Diffuse, unpleasant vague sense of apprehension

Anxiety

12

Does this describe fear or anxiety?

An alerting signal

Anxiety

13

Does this describe fear or anxiety?

Warnings of impending danger

Anxiety

14

Does this describe fear or anxiety?

Response to a known, external, or known threat

Fear

15

Does this describe fear or anxiety?

Response to an unknown or vague threat

Anxiety

16

Is this fear or anxiety?

"Thinking about going in the battlefield"

Anxiety

17

Is this fear or anxiety?

"Bullet whizzing by your head"

Fear

18

Is this fear or anxiety?

The impending - what is going to POSSIBLY happen

Anxiety

19

Is this fear or anxiety?

IN THE MOMENT

Fear

20

What are AUTONOMIC symptoms of anxiety? (13)

1. Muscle tension
2. Headache
3. Perspiration
4. Palpitations
5. Tightness in the chest
6. Stomach discomfort
7. Restlessness
8. Uneasiness
9. Dizziness
10. SOB
11. Insomnia
12. Feeling weak in the knees
13. Loss of Appetite

21

What BEHAVIORAL symptom of anxiety does this describe?

1.) Staying awake, alert more
2.) seeing if there is danger around
3.) Got your guard up

Vigilance

22

Other general BEHAVIORAL symptoms of anxiety include __ or ___ behaviors

cautious ; avoidant

23

What are COGNITIVE symptoms of anxiety?

Changes and/or distortions in:
1.) thinking
2.) perception
3.) learning

24

What are examples of changes/distortions in thinking, perception, learning? (3)

1. Time and Space
(ex: "it felt like forever")
2. Persons and meaning of events
3. Selective attention

25

Anxiety is considered ABNORMAL or PATHOLOGICAL when: (2)

1. It is out of proportion to the situation that is creating it
2. Interferes with social, occupational, or other important areas of function

26

What differs between Normal vs. Pathologic Anxiety? (4)

1. Intensity and duration
2. Trigger
3. Emotional Response
4. Coping

27

__ __ are the most common of all psychiatric disorders

Anxiety disorders

28

1 in __ people meet diagnostic criteria for at least one anxiety disorder

4

29

Are anxiety disorders more common in women or men?
What is the ratio?

Women
2 to 1

30

50% report onset of anxiety disorder in __ or __

childhood
adolescence

31

35% of healthy people report having had a __ __ in the past year

panic attack

32

Anxiety disorders: 12-month prevalence of __%

18%

33

DSM 5 Anxiety Disorders ( 10)

1. Separation Anxiety Disorder
2. Selective Mutism
3. Specific Phobia
4. Social Anxiety Disorder (Social Phobia)
5. Panic Disorder
6. Agoraphobia
7. Generalized Anxiety Disorder
8. Substance/Medication-Induced Anxiety Disorder
9. Anxiety Disorder Due to another medical condition
10. Other specified anxiety disorder

34

Give two examples of medical conditions that can cause anxiety disorder:

1. Pheochromoctyoma
2. Hyperthyroidism

35

Neurobiology of Anxiety Disorders:
Norepinephrine -

increased
- poorly regulated noradrenergic system

36

Neurobiology of Anxiety Disorders:
Cortisol -

increased
- hypothalamic-pituitary-adrenal axis

37

Neurobiology of Anxiety Disorders:
Serotonin -

decreased
- increased turnover in prefrontal cortex, nucleus accumbent, amygdala, and later hypothalamus

38

Neurobiology of Anxiety Disorders:
Gamma Aminobutyric Acid (GABA)

decreased

39

Neurobiology of Anxiety Disorders:
Corticotropin-Releasing Hormone (CRH) -

- mediates the stress response
CRH increased activates HPA (hypothalamic-pituitary-adrenal axis) and increased release of cortisol and DHEA

40

Neuroanatomy of Anxiety:
______ is the primitive center of the brain and says "Is this a threat?"

Amygdala

41

Neuroanatomy of Anxiety :
What role does the hippocampus play?

memory related to fear responses

42

Neuroanatomy of Anxiety :
What is the role of the locus ceruleus?

Arousal

43

Neuroanatomy of Anxiety:
Role of the brainstem?

respiratory activation, heart rate

44

Neuroanatomy of Anxiety:
Role of the frontal cortex?

cognitive interpretations

45

Neuroanatomy of Anxiety:
Role of the thalamus?

integration of sensory stimuli

46

Neuroanatomy of Anxiety:
Role of the basal ganglia?

tremor

47

Neuroanatomy of Anxiety
Role of the Hypothalamic-Pituitary-Adrenal Axis (HPA) ?

increased cortisol levels

48

Panic disorder is characterized by __ __ __

recurrent panic attacks

49

What is a panic attack?

An abrupt surge of intense fear or intense discomfort that reaches a peak within minutes

50

Is the onset of a panic disorder predictable or unpredictable?

unpredictable

51

Panic disorder is manifested by __ __, __ or __

intense apprehension
fear
terror

52

Panic disorder is associated with feelings of __ __

impending doom

53

Someone with panic disorder experiences intense __ __

physical discomfort

54

Must there always be a trigger for panic disorders?

no

55

A.) Give examples of a panic response.

B.) Give an example of an emotional response

A.) Move, duck, freeze, fight back

B.) Fear

56

How many % of adults and adolescents experience a 12 month prevalence of panic disorder?

2-3%

57

Is panic disorder more common in males or females?
Ratio?

Females
2:1

58

There is a __ prevalence of panic disorder in children under 14

low

59

For panic disorder, there is a gradual __ in adolescence and __ in adulthood

increase

peaks

60

There is a __ in the prevalence of panic disorder in older adults over 64

decline

61

What is the median age for the onset of panic disorder?

20-24

62

What are the four categories of predisposing factors of panic disorder?

1. Genetics
2. Biological
3. Neurochemical
4. Psychosocial

63

Predisposing factors for Panic Disorder: Genetics

Concordance rates for identical twins is __ %

Risk for the disorder in a close relative is __-__%

30%

10-20%

64

Predisposing factors for Panic Disorder: Biological

The neuroanatomical pathological involvement are located in the:
1.
2.

there is an abnormal regulation of __ __ __

1. limbic system
2. hippocampus

brain noradrenergic systems

65

Predisposing factors for Panic Disorder: Neurochemical

Increased ___
Decreased __ and __

norepinephrine

GABA; Serotonin

66

Predisposing factors for Panic Disorder: Psychosocial

Childhood experiences of __ and __ __

___ in the months preceding their first panic attack

sexual; physical abuse

stressors

67

Comorbidities associated with Panic Disorder (9)

1. other anxiety disorders like agoraphobia
2. major depressive disorder
3. bipolar disorder
4. etoh abuse
5. cardiac arrhythmias
6. hyperthyroidism
7. asthma
8. COPD
9. irritable bowel syndrome

68

Most effective treatments for panic disorders:

pharmacotherapy and CBT

69

Treatment of Panic disorders;
Pharmacotherapy -

What are the 2 drugs approved for treatment of panic disorder by the FDA?

Xanax (Alprazolam) and
Paxil (Paroxetine)

70

Treatment of Panic disorders;
Pharmacotherapy -

All ___ are effective for panic disorder

SSRI's

71

Treatment of Panic disorders;
Pharmacotherapy -

You want to use __ until SSRI is effective
Then, taper __ slowly over __-__ weeks

Have pt on SSRI for __-__ months

Provide _____

benzodiazepines

benzo
4-10 weeks

6-12 months

psychoeducation

72

Prolonged use of benzodiazepines can cause pt to __ __ and cause __/__

develop tolerance

addiction/dependency

73

Name 7 nursing interventions for someone with panic disorder:

1. Stay with client to offer reassurance
2. Calm non-threatening directive approach
3. Low stimuli
4. Administer medication as ordered
5. When anxiety is reduced, begin to explore etiology
6. Teach signs and symptoms of escalating anxiety
7. Teach coping mechanisms (deep breathing)

74

A fear cued by the presence or anticipation of a specific object or situation is

phobia

75

What are 3 phobic disorders ?

1. Agoraphobia - a condition in which people avoid ordinary places and activities for fear of a panic attack
2. Social Anxiety Disorder (Social Phobia)
3. Specific phobia

76

Prevalence of Specific Phobia
1. 12-month prevalence __-__%
2. __% in children
3. __% in 13-17 y/o's
4. Older individuals __-__%
5. Females to male ratio:

1. 7-9%
2. 5%
3. 16%
4. 3-5%
5. 2:1

77

Course of Specific Phobia
1. Develops following...
2. Usually develops in...
3. Children may express fear by...

1. a traumatic event
2. early childhood prior to age 10
3. crying, tantrums, freezing, or clinging

78

Excessive fears are common in children but are usually __ and only __ __

temporary

mildly impairing

79

Specific phobia is characterized by ...

fear of specific objects or situations that could conceivably cause harm

80

The reaction of specific phobia is __, __, and __

excessive
unreasonable
inappropriate

81

Specific phobia must interfere or restrict:

activities of daily living

82

In specific phobia, fear or anxiety is circumscribed to the presence of a particular __ or __

situation
object

83

In specific phobia, the individual ___ avoids the situation or object

actively

84

What are the treatments for specific phobia? (5)

1. behavior therapy
2. psychotherapy
3. hypnosis
4. supportive therapy
5. family therapy

85

Treatment for specific therapy: Behavior therapy
What specific type of therapy is used here?

Exposure therapy - which consists of systematic desensitivation and flooding

86

Treatment for specific therapy: Psychotherapy

What specific type of therapy is used here?

insight oriented therapy

87

Name this disorder.
Characterized by an excessive fear or situations in which a person might do something embarrassing or be evaluated negatively by others.

social anxiety disorder (social phobia)

88

In social anxiety disorder (social phobia), fear may be defined such as __ __

performance anxiety

89

In social anxiety disorder (social phobia), person has marked intense fear of __ __

social situations

90

Prevalence of social anxiety disorder:
1. 12 month prevalence __% in adults and children
2. Prevalence __ with age
3. Higher in __

1. 7%
2. decreases
3. Females

91

Course of social anxiety disorder:
1. Median age of onset __
2. Onset may follow a __ __ such as __.
3. Onset in adulthood is __

1. 13
2. stressful event; bullying
3. rare

92

Psychotherapy and pharmacotherapy treatment for social phobia:
(4)

1. SSRI's
2. Benzodiazepines
3. SNRI (Effexor, Venlafaxine)
4. Buspar (Bupspirone)

93

Treatment for social phobia associated with performance (2)

1. Beta blockers Inderal (Propanolol), Tenormin (Atenolol)
2. Ativan (Lorazepam) or Xanax (Alprazolam)

94

Name this disorder.
Characterized by fear of being in places or situations from which escape might be difficult.

Agoraphobia

95

In agoraphobia, there is marked anxiety or fear of the following situations:
(6)

1. using public transportation
2. being in open spaces
3. being in closed spaces
4. standing in line or being in a crowd
5. being outside of the home alone
6. fear or not having control

96

Prevalence of Agoraphobia
1. 12 month prevalence is __ % in adolescents and adults
2. 2 to 1 ratio of __ to __

1. 1.7%
2. females to males

97

Course of Agoraphobia
1. Onset of symptoms usually in the __ -__'s
2. Course typically __ and __
3. Impairment can be __

1. 20-30's
2. persistent; chronic
3. severe

98

Name this Disorder.
Characterized by persistent unrealistic and excessive chronic free-floating worry and anxiety

Generalized anxiety disorder (GAD)

99

GAD occurs...

more days than not for at least 6 months

100

GAD is not attributable to __ __ __

specific organic factors

101

Symptoms of GAD cause clinically significant __ or __ in __, __, or other important areas of functioning.

distress; impairment
social; occupational

102

Anxiety in Generalized Anxiety Disorder is associated with: (6)

1. restlessness or feeling keyed up or on edge
2. being easily fatigued
3. difficulty concentrating or mind going blank
4. irritability
5. muscle tension
6. sleep disturbance

103

12 month Prevalence of GAD
1. __% among adolescents
2. __% among adults
3. Lifetime prevalence is __

1. 0.9%
2. 2.9%
3. 9.0%

104

Prevalence of GAD:
Females are __ as likely to develop

twice

105

Prevalence of GAD:
peaks in __ __

middle age

106

GAD course:
1. __ symptoms are common
2. ___ complaints
3. often __
4. Frequent __ related exacerbations

1. depressive
2. somatic
3. chronic
4. stress

107

"Period prevalence" is the proportion of a population that...

Which people are included in this period?

has the condition at some time during a given period (ex: 12-month prevalence)

People who already have the condition at the start of the study period as well as those who acquire it during that period.

108

What are the treatments of GAD?

A.) Psychotherapy which includes:
1. CBT
2. Supportive
3. Insight oriented psychotherapy

B.) Pharmacotherapy

109

What are the drug classes used to treat GAD?

1. SSRI's
2. Benzodiazepines
3. Buspar (Buspirone) - anti-anxiety medication

110

Which SSRI's are used to treat GAD?

1. Paxil (Paroxetine)
2. Lexapro (Escitalopram)
3. Cymbalta (Duloxetine)
4. Effexor (Venlafaxine)

FDA Approved

111

Which benzodiazepines are used to treat GAD?

1. Xanax (Alprazolam)
2. Ativan (Lorazepam)
3. Klonipin (Clonazepam)

112

In substance/medication-induced anxiety disorder, anxiety or panic are a direct result of the physiological consequences of:
(4)

1. intoxication
2. withdrawal
3. exposure to a medication
4. substance

113

The involved substance in substance/ medication-induced anxiety disorder has to be capable of __ __

producing symptoms

114

List the associated substances involved in substance/medication-induced anxiety disorder
(10)

1. alcohol
2. caffeine
3. cannabis
4. phencyclidine
5. other hallucinogen
6. opioid
7. sedative, hypnotic or anxiolytic
8. amphetamine (or other stimulant)
9. cocaine
10. other (or unknown) substance

115

These associated substances are substances in the ...

DSM 5 that carry codes for the disorder

116

In Anxiety Disorder Due to Another Medical Condition, what are the predominant clinical symptoms?

panic or anxiety

117

In Anxiety Disorder Due to Another Medical Condition, symptoms (of anxiety) are best explained the...

associated physical condition

118

In Anxiety Disorder Due to Another Medical Condition, the __ __ precedes __

medical condition

anxiety

119

What medical conditions are known to include anxiety? (5)

1. Endocrine disease
2. Cardiovascular Disorders
3. Respiratory Illness
4. Metabolic disturbances
5. Neurologic disorders

120

During your assessment of anxiety disorders it is important to distinguish between what two things?

anxiety disorders and a medical condition

121

During the assessment of anxiety disorders, what are your disease differentials? (6)

1. Cardiovascular
2. Pulmonary
3. Neurological
4. Endocrine
5. Drug Intoxications/Drug Withdrawal
6. Other conditions

122

Name 6 anxiety screening tools

1. Generalized Anxiety Disorders Scale (GAD-7)
2. Beck Anxiety Inventory (BAI)
3. Hamilton Anxiety Rating Scale (HAM-A)
4. Burns Anxiety Inventory (BAI)
5. Zung Self-Rating Anxiety Scale
6. State-Trate Anxiety Inventory (STAI)

123

GAD-__ subscale (+) go on to GAD-7

Score of __ or more on the GAD-7 or __ or more on the GAD-__ warrant further assessment

2

8
3

2

124

Anti-anxiety agents are considered __ treatments, or treatments in addition to the primary treatment

adjunctive

125

Anti-anxiety agents are usually given in __ situation with use until __ takes effect

acute

SSRI

126

Do anti-anxiety agents have a rapid or slow onset of action?

rapdi

127

Benzodiazepines enhance ___

GABA

128

What are two other types of anti-anxiety agents besides benzodiazepines?

1. Antihistamines Vistaril (Hydroxyzine)
2. Buspar (Buspirone) onset of action delayed

129

Name 7 Benzodiazepines

1. Chloridiazepoxide (Librium)
2. Clonazepam (Klonipin)
3. Clorazepate (Tranxene)
4. Diazepam (Valium)
5. Lorazepam (Ativan)
6. Oxazepam (Serax)
7. Xanax (Alprazolam)

130

Benzos must be...

tapered slowly and cautiously

131

Withdrawal from benzos can be ___-______

life-threatening

132

Benzodiazepine caution in the __

elderly

133

Extreme caution/contraindicated in individuals with __ __ __

substance abuse histories

134

What are benzodiazepine side effects? (9)

1. Confusion
2. Drowsiness
3. Lethargy
4. May aggravate symptoms of depression
5. Orthostatic hypotension
6. Paradoxical excitement
7. Potentiates side effects of other CNS depressants (ETOH)
8. Psychological and physical dependence
9. Tolerance

135

Name 6 different SSRI's

1. Paxil (Paroxetine/Paroxetine CR)
2. Prozac (Fluoxetine)
3. Zoloft (Sertraline)
4. Celexa (Citalopram)
5. Lexapro (Escitalopram)
5. Luvox (Fluvoxamine)

136

SSRI's are first line agents for __ __ __

chronic anxiety disorders

137

SSRI's act on the __ system and indirectly on __

serotonin
GABA

138

SSRI's take __-__ __ to reach symptom control

3-4 weeks

139

SSRI's work best when combined with ___

psychotherapy

140

What are 5 common side effects to SSRI's ?

1. Initial activation, anxiety, insomnia
2. GI: Nausea, diarrhea
3. Sleepiness
4. Emotional Flattening
5. Sexual side effects: decreased libido and difficulty reaching orgasm

141

SNRI's are ...

dual serotonin and norepinephrine reuptake inhibitors

142

name 2 examples of SNRI's

1. Effexor (Venlafaxine)
2. Cymbalta (Duloxetine)

143

4 common side effects to SNRI's

1. sexual dysfunction
2. weight gain
3. sedation
4. increased BP (Venalfaxine)

144

8 nursing interventions for anxiety disorders

1. stay with the client
2. offer reassurance of safety and security
3. maintain a calm directive approach to talk about symptoms
4. simple words, brief messages spoken calmly and clearly to explain hospital experiences
5. teach diaphragmatic breathing
6. low stimuli
7. administer PRN meds as ordered, assess for effectiveness and side effects
8. teach relaxation techniques

145

Obsessive-Compulsive disorder is characterized by the presence of __, __ or both the severity of which is significant enough to cause __ or __

obsession
compulsions

distress; impairment

146

In OCD, individual ____ that the behavior is excessive or unreasonable

recognizes

147

What are common compulsions? (5)

1. hand washing
2. ordering
3. counting
4. praying
5. repeating words (silently)

148

Define obsession

a recurrent and intrusive thought, feeling, idea, or sensation

149

Define compulsion

a conscious standardized, recurrent behavior

Ego-dystonic-unwanted, appears irrational

150

12 month prevalence of OCD

1.2%

151

Does OCD occur more frequently in males or females?

equally common in men and women

152

what is the mean age of onset for OCD?

19.5 y/o

153

How many % of cases of OCD start by age 14?

25%

154

__ have an earlier onset of OCD than ___

males
females

155

Is the onset of OCD usually rapid or gradual?

gradual

156

If left untreated, OCD can become __

chronic

157

OCD is often complicated by __ or __ __

depression
substance abuse

158

Name 6 DSM 5 Obsessive-Compulsive Disorders

1. Hoarding disorder
2. Excoriation (Skin Picking) Disorder
3. Substance/Medication Induced Obsessive-Compulsive and Related Disorder
4. Obsessive-Compulsive and Related Disorder Due to Another Medical Condition
5. Other Specified Obsessive-Compulsive and Related Disorder
6. Unspecified Obsessive-Compulsive and Related Disorder

159

What are 4 types of OCD treatments?

1. Pharmacotherapy
2. Behavior therapy
3. Family therapy particularly in childhood
4. group

160

Name 2 Pharmacotherapy treatments for OCD

1. SSRI
2. Anafranil (Clomiprimine)

161

Name 4 behavior therapy treatment for OCD

1. Desensitization
2. thought stopping
3. flooding
4. aversive conditioning

162

If treatment resistant, what 4 other options are there to treat OCD?

1. ECT
2. Cingulotomy
3. Capsulotomy
4. Deep brain stimulation

163

__ dosing may need to be higher in the treatment of OCD

SSRI

164

For someone with OCD, person is __ by whatever they are doing

disturbed

165

Name this disorder:
Exaggerated belief that the body is deformed or defective in some specific way

Body Dysmorphic Disorder (BDD)

166

BDD is/ is not observable to others ?

is not

167

In BDD, individual performs repetitive behaviors __ __, __ __, __ __

mirror checking
excessive grooming
reassurance seeking

168

In BDD, __ causes clinically significant distress and impairment

preoccupation

169

Muscle dysmorphia is mostly common in __

males

170

Prevalence of BDD in females

2.5%

171

Prevalence of BDD in males

2.2%

172

Prevalence of BDD in dermatology patients

9-15%

173

Prevalence of BDD in cosmetic surgery (US)

7-8%

174

Prevalence of BDD in international cosmetic surgery

3-16%

175

Prevalence of BDD in adult orthodontia patients

8%

176

Prevalence of patients presenting for maxillofacial surgery

10%

177

mean age of onset of BDD

16-17

178

subclinical symptoms of BDD being on average at age

12-13

179

course of BDD is acute/or chronic?

chronic

180

rates of __ __ and __ are high in both children/adolescents and adults with BDD

suicidal ideation
attempts

181

Name this Disorder.
Characterized by the recurrent pulling out of one's hair

Tricotillomania or Hair-Pulling disorder

182

In Tricotillomania, patient has had __ __ to stop

repeated attempts

183

Tricotillomania causes clinically significant __ or __

distress; impairment

184

12 month prevalcne for trichotillomania in adults and adolescents

1-2%

185

Are males or females more affected by trichotillomania?
ratio?

females
ratio : 10:1

186

Onset of trichotillomania is usually

puberty

187

usual course of trichotillomania is __

chronic

188

pharmacotherapy for BDD

1. Anafranil (Clomiprimine)
2. Prozac (Fluoxetine)

189

pharmacotherapy for trichotillomania

1. SSRI's augmented with pimozide
2. Olanzapine

190

Name this disorder.
excessively saving items that others may view as worthless

Having persistent difficulty getting rid of or parting with possessions

leads to clutter that disrupts their ability to use their living or work spaces

hoarding disorder

191

prevalence of hoarding disorder

2-5% of the population

192

In hoarding disorder, patient has impaired __, __, and other important areas of functioning

social
occupational

193

Potential consequences of hoarding disorder include:

health and safety concerns
fire hazards
tripping hazards
health code violations

194

hoarding disorder is associated with

family strain and conflicts
isolation
loneliness

195

in hoarding disorder, patient is unwilling to have anyone else ...

enter the home

196

in hoarding disorder, patient is not able to perform ...

daily tasks such as cooking and bathing in the home

197

8 nursing diagnoses associated with anxiety and OCDs

1. panic anxiety
2. powerlessness
3. fear
4. social isolation
5. ineffective coping
6. ineffective role performance
7. disturbed body image
8. ineffective impulse control