Ch. 18 Anxiety/OCD Related Disorders Flashcards

Question

Biological Aspects behind Phobias Neuroanatomical Temperament

Answer 1

- (Neuro) Specific areas in the prefrontal cortex and the amygdala play a role in storing and recalling information about threatening or potentially deadly events. Similar future events can trigger those memories, after which the amygdala triggers release of fight-or-flight hormones and the individual experiences heightened stress and fear. - (Neuro) Parental traumatic exposure creates genetic “memories” that are passed down to subsequent generations via parental gametes, which are then expressed as phobias in their offspring. - (Temp) Innate fears represent a part of the overall characteristics or tendencies with which one is born that influence how he or she responds throughout life to specific situations. - Innate fears usually do not reach phobic intensity but may have the capacity for such development if reinforced by events in later life. For example, a 4 yo is afraid of dogs. By age 5, she's overcome her fear and plays with her own dog. At 19, she is bitten by a stray dog and develops a phobia of dogs.

Answer 2

- Certain early experiences may set the stage for phobic reactions later in life. - Some researchers believe that phobias, particularly specific phobias, are symbolic of original anxiety-producing objects or situations that have been repressed. Ex A child who is punished by being locked in a closet develops a phobia of elevators or other closed places. A child who falls down a flight of stairs develops a phobia of high places. A young woman who, as a child, survived a plane crash in which both her parents were killed has a phobia of airplanes

Answer 3

- The symptoms associated with these disorders are judged to be the direct physiological consequence of another medical condition. - Medical conditions: Myocardial infarction, Congestive heart failure, and Mitral valve prolapse; Hypoglycemia, Hypo- or Hyperthyroidism, and Pheochromocytoma; COPD and Hyperventilation; Complex partial seizures, Neoplasms, and Encephalitis. - Nursing care of patients with this disorder must take into consideration the underlying cause of the anxiety. - Holistic nursing care is essential to ensure that the patient’s physiological and psychosocial needs are met.

Answer 4

- The symptoms associated with these disorders are judged to be due to the direct physiological effects of substance intoxication or withdrawal or exposure to a medication - Diagnosis made only if the anxiety symptoms are in excess of those usually associated with the intoxication or withdrawal syndrome and warrant independent clinical attention. - Withdrawal must be seen in history, physical examination, or lab findings to substantiate the diagnosis. - May be associated with use of the following substances: alcohol, amphetamines, cocaine, hallucinogen, sedatives, hypnotics, anxiolytics, caffeine, cannabis, or other substances - Nursing care of the patient with substance-induced anxiety disorder must take into consideration the nature of the substance and the context in which the symptoms occur—that is, intoxication or withdrawal.

Answer 5

The presence of obsessions or compulsions, or both, the severity of which is significant enough to cause distress or impairment in social, occupational, or other important areas of functioning. The individual recognizes that the behavior is excessive or unreasonable but, because of the feeling of relief from discomfort that it promotes, is compelled to continue the act. Common compulsions include hand washing, ordering, checking, praying, counting, and repeating words silently.

Answer 6

The disorder is equally common among men and women. It may begin in childhood but more often begins in adolescence or early adulthood. The course is usually chronic and may be complicated by depression or substance abuse. OCD is identified more frequently in single people than in married people, but this finding probably reflects the difficulty that individuals with this disorder have with maintaining interpersonal relationships

Answer 7

Obsessions are... - Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress. - The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion). Compulsions are... - Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession or according to rules that must be applied rigidly. - The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive. Note: Young children may not be able to articulate the aims of these behaviors or mental acts.

Answer 8

1. Presence of obsessions, compulsions, or both 2. The obsessions or compulsions are time consuming (e.g., take more than 1 hour a day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. 3. The obsessive-compulsive symptoms are not attributable to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition. 4. The disturbance is not better explained by the symptoms of another mental disorder Specify if: - With good or fair insight - With poor insight - With absent insight/delusional beliefs Specify if: - Tic-related

Answer 9

- Characterized by the exaggerated belief that the body is deformed or defective in some specific way. - The most common complaints involve flaws of the face or head, such as wrinkles or scars, the shape of the nose, excessive facial hair, and facial asymmetry that are slight or not observable by others. - Other complaints involve the ears, eyes, mouth, lips, or teeth. - Some clients may present with complaints involving other parts of the body, and in some instances a true defect is present. The significance of the defect is unrealistically exaggerated, however, and the person’s concern is grossly excessive. - These beliefs are differentiated from delusions in that the individual with body dysmorphic disorder is aware that his or her beliefs are exaggerated. - The person’s medical history may reflect numerous visits to plastic surgeons and dermatologists in an unrelenting drive to correct the imagined defect.

Answer 10

People with body dysmorphic disorder often have other comorbid mental disorders: - Major depressive disorder - Anxiety disorder (often OCD) - Psychotic disorder

Answer 11

1. Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others. 2. At some point during the course of the disorder, the individual has performed repetitive behaviors (e.g., mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (e.g., comparing his or her appearance with that of others) in response to the appearance concerns. 3. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. 4. The appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder. Specify if... - With muscle dysmorphia Specify if... - With good or fair insight - With poor insight - With absent insight/delusional beliefs

Answer 12

- The recurrent pulling out of one’s hair that results in hair loss. - The impulse is preceded by an increasing sense of tension and results in a sense of release or gratification from pulling out the hair. - The most common sites for hair pulling are the scalp, eyebrows, and eyelashes but may occur in any area of the body on which hair grows. - Pain is seldom reported to accompany the hair pulling, although tingling and pruritus in the area are not uncommon. - It may be accompanied by nail biting, head banging, scratching, biting, or other acts of self-mutilation.

Answer 13

- Comorbid psychiatric disorders are common with hair-pulling disorder. The most common are mood and other anxiety disorders. - The disorder usually begins in childhood and is seven times more prevalent in children than adults - This phenomenon occurs more often in women than in men.

Answer 14

- “Persistent difficulties discarding or parting with possessions, regardless of their actual value” - Additionally, the diagnosis may be specified as “with excessive acquisition,” which identifies the excessive need for continual acquiring of items (either by buying them or by other means). - Associated symptoms include perfectionism, indecisiveness, anxiety, depression, distractibility, and difficulty planning and organizing tasks

Answer 15

- More men than women are diagnosed with the disorder, and it is almost three times more prevalent in older adults (ages 55–94) than in younger adults - The symptoms, regardless of when they begin, appear to become more severe with each decade of life. - In addition to OCD, hoarding is associated with high comorbidity for dependent, avoidant, schizotypal, and paranoid personality disorders

Answer 16

- Individuals with OCD have weak, underdeveloped egos (for any of a variety of reasons: unsatisfactory parent-child relationship, conditional love, or provisional gratification) - Views clients with OCD as having regressed to earlier developmental stages of the infantile superego—the harsh, exacting, punitive characteristics that now reappear as part of the psychopathology. - Regression and use of defense mechanisms (isolation, undoing, displacement, reaction formation) produce the clinical symptoms of obsessions and compulsions

Answer 17

- Explain obsessive-compulsive behavior as a conditioned response to a traumatic event. - The traumatic event produces anxiety and discomfort, and the individual learns to prevent the anxiety and discomfort by avoiding the situation with which they are associated. (passive avoidance) - When passive avoidance is not possible, the individual learns to engage in behaviors that provide relief from the anxiety and discomfort associated with the traumatic situation. (active avoidance) - According to this classic conditioning interpretation, a traumatic event should mark the beginning of the obsessive-compulsive behaviors. However, in a significant number of cases, the onset of the behavior is gradual.

Answer 18

- The onset of trichotillomania can be related to stressful situations in more than one quarter of cases. - Additional factors that have been implicated include disturbances in mother-child relationship, fear of abandonment, and recent object loss. - Trichotillomania has at times been connected to childhood trauma - Hoarding disorder has been associated with unmanaged stress following the sudden loss of a loved one, divorce, or other significant life stressors

Answer 19

- Twin studies and family studies support a genetic susceptibility for OCD, especially in childhood onset OCD - Trichotillomania has commonly been associated with OCDs among first-degree relatives, leading researchers to conclude that the disorder has a possible hereditary or familial predisposition. - Structural abnormalities in various areas of the brain, as well as alterations in the serotonin and endogenous opioid systems, have also been noted. - Genetics also may play a role in the development of hoarding disorder. Family and twin studies indicate that approximately 50% of individuals who hoard report having a relative who also hoards

Answer 20

- Abnormalities in various regions of the brain have been implicated in the neurobiology of OCD. - Neuroimaging and neurocognitive assessment have identified impairment in motor inhibition responses (the ability to stop an action once initiated) in patients with OCD and trichotillomania - In individuals with hoarding disorder, neuroimaging studies have indicated less activity in the cingulate cortex, the area of the brain that connects the emotional part of the brain with the parts that control higher-level thinking - Animal models and brain imaging studies of patients with trichotillomania suggest abnormalities in neural regions involved in cognition (frontal cortex), affect regulation (amygdala-hippocampal formation), and habit learning (putamen). One study suggests that [trichotillomania] may be associated with altered reward processing within the CNS

Answer 21

- Electrophysiological studies, sleep electroencephalogram studies, and neuroendocrine studies have suggested that there are commonalities between depressive disorders and OCD. - Neuroendocrine commonalities were suggested in studies in which about one-third of OCD clients show nonsuppression on the dexamethasone-suppression test and decreased growth hormone secretion with clonidine infusions.

Answer 22

- A number of studies have implicated the neurotransmitter serotonin as influential in the etiology of obsessive-compulsive behaviors - The serotonergic system may also be a factor in the etiology of body dysmorphic disorder. This can be reflected in a high incidence of comorbidity with major mood disorder and anxiety disorder and the positive responsiveness of the condition to the serotonin-specific drugs.

Answer 23

Palpitations, trembling, sweating, chest pain, shortness of breath, fear of going crazy, fear of dying (panic disorder); excessive worry, difficulty concentrating, sleep disturbance (generalized anxiety disorder)

Answer 24

Verbal expressions of having no control over life situation; nonparticipation in decision making related to own care or life situation; expressions of doubt regarding role performance (panic and generalized anxiety disorders)

Answer 25

Behavior directed toward avoidance of a feared object or situation (phobic disorder)

Answer 26

Stays at home alone, afraid to venture out alone (agoraphobia)

Answer 27

Ritualistic behavior; obsessive thoughts, inability to meet basic needs; severe level of anxiety (OCD)

Answer 28

Inability to fulfill usual patterns of responsibility because of need to perform rituals (OCD)

Answer 29

Preoccupation with imagined defect; verbalizations that are out of proportion to any actual physical abnormality that may exist; numerous visits to plastic surgeons or dermatologists seeking relief (body dysmorphic disorder)

Answer 30

Repetitive and impulsive pulling out of one’s hair (trichotillomania)

Answer 31

■ Is able to recognize signs of escalating anxiety and intervene before reaching panic level (panic and generalized anxiety disorders). ■ Is able to maintain anxiety at manageable level and make independent decisions about life situation (panic and generalized anxiety disorders). ■ Functions adaptively in the presence of the phobic object or situation without experiencing panic anxiety (phobic disorder). ■ Verbalizes a future plan of action for responding in the presence of the phobic object or situation without developing panic anxiety (phobic disorder). ■ Is able to maintain anxiety at a manageable level without resorting to the use of ritualistic behavior (OCD). ■ Demonstrates adaptive coping strategies for dealing with anxiety instead of ritualistic behaviors (OCD). ■ Verbalizes a realistic perception of his or her appearance and expresses feelings that reflect a positive body image (body dysmorphic disorder). ■ Verbalizes and demonstrates more adaptive strategies for coping with stressful situations (trichotillomania).

Answer 32

The patient will verbalize ways to intervene in escalating anxiety within 1 week. By time of discharge from treatment, the patient will be able to recognize symptoms of onset of anxiety and intervene before reaching panic level.

Answer 33

1. Stay with the patient and offer reassurance of safety and security. Do not leave the patient in panic anxiety alone. - Presence of a trusted individual provides a feeling of security and assurance of personal safety. 2. Maintain a calm, nonthreatening, matter-of-fact approach. - Anxiety is contagious and may be transferred from staff to patient or vice versa. Patient develops a feeling of security in the presence of a calm staff person. 3. Use simple words and brief messages, spoken calmly and clearly, to explain hospital experiences. - In an intensely anxious situation, the patient is unable to comprehend anything but the most elemental communication. 4. If hyperventilation occurs, assist the patient to breathe into a small paper bag held over the mouth and nose. Six to 12 natural breaths should be taken, alternating with short periods of diaphragmatic breathing. - Hyperventilation may result in injury to the patient, and patient safety is a nursing priority. 5. Keep immediate surroundings low in stimuli (dim lighting, few people, simple decor). - stimulating environment may increase level of anxiety. 6. Administer tranquilizing medication, as ordered by physician. Assess for effectiveness and for side effects. - Antianxiety medication provides relief from the immobilizing effects of anxiety. 7. When level of anxiety has been reduced, explore possible reasons for occurrence. - Recognition of precipitating factor(s) is the first step in teaching client to interrupt escalation of anxiety. 8. Teach signs and symptoms of escalating anxiety, and ways to interrupt its progression - Relaxation techniques result in a physiological response opposite that of the anxiety response. Physical activities discharge excess energy in a healthful manner.

Answer 34

Patient will discuss the phobic object or situation with the healthcare provider within (time specified). By time of discharge from treatment, patient will be able to function in presence of phobic object or situation without experiencing panic anxiety.

Answer 35

1. Reassure patient that he or she is safe. - At the panic level of anxiety, patient may fear for his or her own life. 2. Explore patient’s perception of the threat to physical integrity or threat to self-concept. - It is important to understand patient’s perception of the phobic object or situation to assist with the desensitization process. 3. Discuss reality of the situation with patient to recognize aspects that can be changed and those that cannot. - Patient must accept the reality of the situation before the work of reducing the fear can progress. 4. Include patient in making decisions related to selection of alternative coping strategies. - Allowing the patient choices provides a measure of control and serves to increase feelings of self-worth. 5. If patient elects to work on elimination of the fear, techniques of desensitization or implosion therapy may be employed. - Fear is decreased as the physical and psychological sensations diminish in response to repeated exposure to the phobic stimulus under nonthreatening conditions. 6. Encourage patient to explore underlying feelings that may be contributing to irrational fears and to face them rather than suppress them. - Exploring underlying feelings may help the patient to confront unresolved conflicts and develop more adaptive coping abilities.

Answer 36

Within 1 week, the patient will decrease participation in ritualistic behavior by half. By time of discharge from treatment, patient will demonstrate ability to cope effectively without resorting to obsessive-compulsive behaviors.

Answer 37

1. Work with patient to determine types of situations that increase anxiety and result in ritualistic behaviors. - Recognition of precipitating factors is the first step in teaching the patient to interrupt the escalating anxiety. 2. In the beginning of treatment, allow plenty of time for rituals. Do not be judgmental or verbalize disapproval of the behavior. - To deny patient this activity may precipitate panic anxiety. Conversely, indulging the patient’s need for ritualistic behavior initially decreases anxiety and promotes the ability to learn alternative coping strategies. 3. Support patient’s efforts to explore the meaning and purpose of the behavior - Patient may be unaware of the relationship between emotional problems and compulsive behaviors. Recognition is important before change can occur. 4. Provide structured schedule of activities for patient, including adequate time for completion of rituals. - Structure provides a feeling of security for the anxious patient. 5. Gradually begin to limit amount of time allotted for ritualistic behavior as patient becomes more involved in other activities. - Anxiety is minimized when patient is able to replace ritualistic behaviors with more adaptive ones. 6. Give positive reinforcement for nonritualistic behaviors. - Enhances self-esteem and encourages repetition of desired behaviors. 7. Help patient learn ways of interrupting obsessive thoughts and ritualistic behavior with techniques such as thought stopping, relaxation, and physical exercise. - Knowledge and practice of coping techniques that are more adaptive will help patient change and let go of maladaptive responses to anxiety.

Answer 38

Patient will verbalize understanding that changes in bodily structure or function are exaggerated out of proportion to the change that actually exists. (Time frame for this goal must be determined according to individual patient’s situation.) Patient will verbalize perception of own body that is realistic to actual structure or function by time of discharge from treatment.

Answer 39

1. Assess patient’s perception of his or her body image. Keep in mind that this image is real to the patient. - Assessment info is necessary in developing an accurate plan of care. Denial of the pt’s feelings impedes the development of a trusting, therapeutic relationship. 2. Help pt to see that his/her body image is distorted or that it is out of proportion in relation to the significance of an actual physical anomaly. - Recognition that a misperception exists is necessary before the patient can accept reality and reduce the significance of the imagined defect. 3. Encourage verbalization of fears and anxieties associated with identified stressful life situations. Discuss alternative adaptive coping strategies - Helps the patient come to terms with unresolved issues. May help the patient respond to stress more adaptively in the future. 4. Involve patient in activities that reinforce a positive sense of self not based on appearance. - When the patient is able to develop self-satisfaction based on accomplishments and unconditional acceptance, significance of the imagined defect or minor physical anomaly will diminish 5. Make referrals to support groups of individuals with similar histories. - Having a support group of understanding, empathic peers can help the patient accept the reality of the situation, correct distorted perceptions, and make adaptive life changes.

Answer 40

Patient will verbalize adaptive ways to cope with stress by means other than pulling out own hair (time dimension to be individually determined). Patient will be able to demonstrate adaptive coping strategies in response to stress and a discontinuation of pulling out own hair (time dimension to be individually determined).

Answer 41

1. Support pt in his or her effort to stop hair pulling. Help pt understand that it is possible to discontinue the behavior. - Pt realizes that the behavior is maladaptive but feels helpless to stop. Support from the nurse builds trust. 2. Ensure that a nonjudgmental attitude is conveyed, and criticism of the behavior is avoided. - An attitude of acceptance promotes feelings of dignity and self-worth. 3. Assist patient with habit reversal training (HRT). - Shown to be an effective tool in treatment of hair-pulling disorder. 4. Once patient has become aware of hair-pulling times, suggest that patient hold something (a ball, paperweight, or other item) in his or her hand at times when hair pulling is anticipated. - This would help to prevent behaviors occurring without patient being aware that they are happening. 5. Practice stress management techniques: deep breathing, meditation, stretching, physical exercise, listening to soft music. - Hair pulling is thought to occur at times of increased anxiety. 6. Offer support and encouragement when setbacks occur. Help patient to understand the importance of not quitting when it seems that change is not happening as quickly as he or she would like. - Although some people see a decrease in the behavior within a few days, most will take several months to notice the greatest change.

Answer 42

1. Awareness training. Help the patient become aware of times when the hair pulling most often occurs (e.g., client learns to recognize urges, thoughts, or sensations that precede the behavior; the therapist points out to the patient each time the behavior occurs). - This helps the patient identify situations in which the behavior occurs or is most likely to occur. Awareness gives the patient a feeling of increased self-control. 2. Substituting an incompatible behavior may help to extinguish the undesirable behavior. - Competing Response Training, For example, when a patient experiences a hair-pulling urge, suggest that the individual ball up his/her hands into fists, tightening arm muscles, and “locking” his/her arms so as to make hair pulling impossible at that moment. 3. Social support. Encourage family members to participate in the therapy process and to offer positive feedback for attempts at habit reversal. - Enhances self-esteem and increases patient’s desire to continue with the therapy. It also provides cues for family members to use in their attempts to help the patient in treatment.

Answer 43

Symptoms: 0= Not present 1 = Mild 2 = Moderate 3 = Severe 4 = Very severe Scoring: 14 – 17 = Mild Anxiety 18 – 24 = Moderate Anxiety 25 – 30 = Severe Anxiety

Answer 44

- Recognize signs and symptoms of escalating anxiety? - Use skills learned to interrupt the escalating anxiety before it reaches the panic level? - Demonstrate the activities most appropriate for him or her that can be used to maintain anxiety at a manageable level (e.g., relaxation techniques, physical exercise)? - Maintain anxiety at a manageable level without medication? - Verbalize a long-term plan for preventing panic anxiety in the face of a stressful situation? - Discuss the phobic object or situation without becoming anxious? - Function in the presence of the phobic object or situation without experiencing panic anxiety? - Refrain from performing rituals when anxiety level rises? - Demonstrate substitute behaviors to maintain anxiety at a manageable level? - Recognize the relationship between escalating anxiety and the dependence on ritualistic behaviors for relief? - Refrain from hair pulling (for patients with trichotillomania)? - Successfully substitute a more adaptive behavior when urges to pull hair occur (for patients with trichotillomania)? - Verbalize a realistic perception and satisfactory acceptance of personal appearance (for patients with body dysmorphic disorder)?

Answer 45

- Most clients experience a decrease in anxiety when given the opportunity to discuss their difficulties with a therapist - Supportive psychotherapy: helps clients identify personal strengths and explore adaptive coping mechanisms. - Insight-oriented psychotherapy, (Freudian): designed to help clients identify, explore, and resolve internal psychological conflicts that are contributing to anxiety. - Can use logical and rational explanations to increase the client’s understanding about various situations that create anxiety in his or her life. - Psychoeducational info may also be presented in individual psychotherapy.

Answer 46

- Cognitive therapy strives to assist the individual to reduce anxiety responses by altering cognitive distortions. - Cognitive therapy for anxiety is brief and time limited. This discourages the client’s dependency on the therapist and encourages the client’s self-sufficiency. - A sound therapeutic relationship is a necessary condition for effective cognitive therapy. - A major component of treatment is encouraging the client to face frightening situations in order to view them realistically, and talking about them is one way of achieving this goal. - The therapist uses questions to encourage the client to correct his or her anxiety-producing thoughts. - Client is encouraged to become aware of the thoughts, examine them for cognitive distortions, substitute more balanced thoughts, and develop new patterns of thinking. - Cognitive therapy is structured and orderly, which is important for the client who is often confused and lacks self-assurance - Cognitive therapy is based on education. With practice, individuals can learn more effective ways of responding to life experiences through cognitive reframing

Answer 47

- The client is gradually exposed to the phobic stimulus, real or imagined - Emphasis is placed on reciprocal inhibition (counterconditioning):the restriction of anxiety prior to the effort of reducing avoidance behavior. - Rationale: Because relaxation is antagonistic to anxiety, individuals cannot be anxious and relaxed at the same time. 2 main elements: 1. Training in relaxation techniques 2. Progressive exposure to a hierarchy of fear stimuli while in the relaxed state - The individual is taught several relaxation techniques and is encouraged to use the one that is most effective for them - When the individual has mastered the relaxation technique, exposure to the phobic stimulus is initiated. - The client is asked to present a hierarchal list of situations involving the phobic stimulus in order from most disturbing to least disturbing. - While in a state of maximum relaxation, the client may be asked to imagine the phobic stimulus. Initial exposure is focused on a concept of the phobic stimulus that produces the least amount of fear or anxiety. - In subsequent sessions, the individual is gradually exposed to stimuli that are more fearful.

Answer 48

- Therapeutic process in which the client, for a prolonged period, must imagine situations or participate in real-life situations that he or she finds extremely frightening. - The therapist “floods” the client with information concerning situations that trigger the client’s anxiety by describing anxiety-provoking situations in vivid detail. - The more anxiety is provoked, the more expedient the therapeutic endeavor. This tactic is continued for as long as it arouses anxiety in the client. - The therapy concludes when a topic no longer elicits inappropriate anxiety on the part of the client. - Relaxation training is not a part of this technique. Plenty of time must be allowed for these sessions because brief periods may be ineffective or even harmful. - Session ends when the client responds with considerably less anxiety than at the beginning of the session.

Answer 49

ANXIOLYTICS: - Benzos: used for GAD. Alprazolam, lorazepam, and clonazepam are used for Panic disorder - Buspirone: used for GAD ANTIDEPRESSANTS: - Tricyclics: clomipramine and imipramine are used for Panic disorders - SSRIs: Paroxetine (Paxil), fluoxetine (Prozac), and sertraline (Zoloft) are used for Panic disorder. Paroxetine (Paxil) and escitalopram (Lexapro) are used for GAD. - SNRI: Venlafaxine is used for Panic Disorder. Duloxetine (Cymbalta), and extended-release venlafaxine (Effexor XR) are used for GAD - nefazodone (Serzone) and mirtazapine (Remeron) ANTIHYPERSTENSIVES - Beta blockers (e.g., propranolol) and alpha2-receptor agonists (e.g., clonidine) in the amelioration of anxiety symptoms - Clonidine is effective in blocking the acute anxiety effects in conditions such as opioid and nicotine withdrawal

Answer 50

Antihistamines: - Hydroxyzine (Vistaril) Benzodiazepines: - Alprazolam (Xanax, Niravam) - Chlordiazepoxide (Librium) - Clonazepam (Klonopin) - Clorazepate (Tranxene) - Diazepam (Valium, Diastat) - Lorazepam (Ativan) - Oxazepam (Serax) - Midazolam (Versed)* Carbamate derivative - Meprobamate (Miltown, Equanil) Azaspirodecanedione - Buspirone (BuSpar)

Answer 51

■ Drowsiness, confusion, lethargy. ■ Tolerance; physical and psychological dependence (does not apply to buspirone or hydroxyzine). Client should be tapered off long-term use. ■ Potentiates the effects of other CNS depressants. Client should not take alcohol or other CNS depressants with the medication. ■ May aggravate symptoms of depression. ■ Orthostatic hypotension. Client should rise slowly from lying or sitting position. ■ Paradoxical excitement. If symptoms opposite of desired effect occur, notify physician immediately. ■ Dry mouth. ■ Nausea and vomiting. May be taken with food or milk. ■ Blood dyscrasias. Symptoms of sore throat, fever, malaise, easy bruising, or unusual bleeding should be reported to the physician immediately. ■ Delayed onset (with buspirone). Lag time of 10 to 14 days for anxiety symptoms to diminish with buspirone. Buspirone is not recommended for prn administration.

Answer 52

ANXIOLYTICS - Benzos: Social Anxiety Disorder (alprazolam and clonazepam) ANTIDEPRESSANTS - Tricyclic: imipramine used in Agoraphobia Social Anxiety Disorder - MAOIs: phenelzine, selegiline, isocarboxazid, and tranylcypromine used in Agoraphobia and Social Anxiety Disorder - Additional clinical trials have also indicated efficacy with other antidepressants, including nefazodone, venlafaxine, and bupropion. - SSRIs ANTIHYPERTENSIVES - Beta Blockers: propranolol and atenolol used for anticipatory performance anxiety or “stage fright.” - Reduces sweaty palms, racing pulse, trembling hands, dry mouth, labored breathing, nausea, and memory loss

Answer 53

ANTIDEPRESSANTS - SSRIs fluoxetine, paroxetine, sertraline, and fluvoxamine Doses in excess of what is effective for treating depression may be required for OCD. Common side effects are sleep disturbances, headache, and restlessness. - Tricyclics: Clomipramine

Answer 54

ANTIDEPESSANTS - Tricyclic: clomipramine - SSRI: fluoxetine

Answer 55

No medications have demonstrated consistent benefits for clients with trichotillomania but SSRIs have yielded moderate results for some clients with this condition 1) Chlorpromazine 2) Amitriptyline 3) Lithium carbonate 4) SSRIs/pimoz 5) Olanzapine

Answer 56

Acrophobia: Height Ailurophobia: Cats Algophobia: Pain Anthophobia: Flowers Anthropophobia: People Aquaphobia: Water Arachnophobia: Spiders Astraphobia: Lightning Belonephobia: Needles Brontophobia: Thunder Claustrophobia: Closed spaces Cynophobia: Dogs Dementophobia: Insanity Equinophobia: Horses Gamophobia: Marriage Herpetophobia: Lizards, reptiles Homophobia: Homosexuality Murophobia: Mice Mysophobia: Dirt, germs, contamination Numerophobia: Numbers Nyctophobia: Darkness Ochophobia: Riding in a car Ophidiophobia: Snakes Pyrophobia: Fire Scoleciphobia: Worms Siderodromophobia: Railroads or train travel Taphophobia: Being buried alive Thanatophobia: Death Trichophobia: Hair Triskaidekaphobia: The number 13 Xenophobia: Strangers Zoophobia: Animals

Answer 57

Sedation, dizziness, weakness, ataxia, decreased motor performance, dependence, withdrawal

Answer 58

Nausea, diarrhea, headache, insomnia, somnolence, sexual dysfunction

Answer 59

Headache, dry mouth, nausea, somnolence, dizziness, insomnia, asthenia (physical weakness), constipation, diarrhea

Answer 60

Bradycardia, hypotension, weakness, fatigue, impotence, gastrointestinal upset, bronchospasm

Answer 61

Dry mouth, sedation, fatigue, hypotension

Answer 62

Somnolence, agitation, confusion, ataxia, dizziness, bradycardia, hypotension, constipation

Answer 63

Dizziness, drowsiness, dry mouth, headache, nervousness, nausea, insomnia

Answer 64

Amygdala Hippocampus Locus ceruleus Brainstem Hypothalamus Frontal cortex Thalamus Basal ganglia

Answer 65

lightheadedness, rapid heart rate, shortness of breath, numbness or tingling in the hands or feet, and syncope

Answer 66

Anxiety disorders, anxiety symptoms, acute alcohol withdrawal, skeletal muscle spasms, convulsive disorders, status epilepticus, and preoperative sedation

Answer 67

Common comorbidities include another anxiety disorder, depression, and substance abuse. Vulnerability to comorbidities includes parental psychiatric history, childhood trauma, and negative life events

Ch. 18 Anxiety/OCD Related Disorders Flashcards

(91 cards)