class 4 Flashcards by Rebecca Penney

Q

what is anxiety

A

feelings of dread, apprehension from a real of perceived threat fear= body’s physical reaction intellectual appraisal of a fearful situation emotion response top fear=anxiety

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Q

somatic symptoms of anxiety

A

increased HR, stomach ache, lump throat, numb extremities

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Q

physiological conditions that can increase anxiety

A

cardiovascular medical conditions: arrhythmias, CHF, HTN
endocrine: thyroid dysfunction, hyperthyroid, hypoglycemia
respiratory: COPD, asthma

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Q

genetic anxiety causality

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biological link: temperament and fears are inherited charcateristics

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Q

psychological anxiety causality

A

social support: paramount with all health-related issues
childhood dx of mental disorder

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Q

mild level of anxiety

A

heightened alertness of all senses
able to problem solve
physical: slight discomfort, restlessness, irritable
mannerisms: leg shaking, nail biting, fidgety

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Q

moderate level of anxiety

A

perception narrows
not taking in as much information- selective inattention
problem solving less effective
physical: tension, pounding pulse in ears, increased RR and HR, headache, urinary urgency,gastric upset,tremulous voice

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Q

severe level of anxiety

A

preception dramatically reduced
only focus on ONE specific detail: difficulty in being aware of things surrounding them
problem solving not possible
dazed and confused; pacing helps lessen anxiety
physical:trembeling, heart pounding, hyperventilate, impending doom

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Q

panic level of anxiety

A

noticeably disturbed behaviour
may loose touch with reality
have hallucinations
pacing helps lessen anxiety
physical: running, shouting, screaming, withdrawal
actions have no purpose and are erratic
may lead to exhaustion

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Q

‘STUDENTS’ panic s&s

A

S-sweating
T-trembling
U-unsteadiness
D-derealization
E-excessive HR
N-nausea
T-tingling
S-shortness of breath
s&s usually peak within 10 mins

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Q

generalized anxiety disorder (GAD)

A

-a syndrome of persistent,excessive, unrealistic worry about everyday things
-individuals can experience hyperarousal(restlessness, decreased concentration, sleep disturbance)

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Q

management for anxiety

A

Behavioural therapy
Cognitive behavioural therapy
coping strategies
education(individual & family)
imagery
relaxation techniques(journaling, yoga, massage therapy)
pharmacological

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Q

obsessive compulsive Disorder (OCD)

A

obsessions: unwanted, aversive cognitive experiences
compulsions: ritualistic behaviours and/or thoughts that the individual has to complete in order to reduce the anxiety and the aversive obsession

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Q

examples of obsessions

A

thoughts, images, or impulses that persist, reoccur and cannot be dismissed

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Q

examples of compulsions

A

the behaviour causes the anxiety to decrease BUT it is only temporary. therefore, the individual must repeat it again and again
the compulsion is rigid with specification

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Q

common obsessions in OCD

A

-loss of control
-harm
-contamination
-perfectionism
-sexual
-religious

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Q

common compulsions in OCD

A

-washing
-cleaning
-checking
-repeating

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Q

physical s&s of OCD

A

-stomach-aches
-dizziness
-racing heart
-shallow breathing
-headaches
-muscle tension
-short of breath
-feeling detached from one’s body (derealization)

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Q

emotional s&s OCD

A

-Guilt
-Anger/rage
-Anxiety/worry/fear
-sadness
-shame

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Q

behavioral s&s in OCD

A

-checking
-repeating
-doubting
-avoiding(not a compulsion but a secondary symptom)

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Q

first line drugs to treat anxiety

A

SSRI’s
-Fluoxetine HCL (Prozac)
-Fluvoxamine maleate (Luvox)
-sertraline HCL (Zoloft)
-Paroxetine HCL (Paxil)
-Escitalopram oxalate (Cpiralex)
-Citalopram HCL (Celexa)

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Q

Fluoxetine HCL (Prozac)

A

SSRI First Line
tx: OCD

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Q

Fluvoxamine maleate (Luvox)

A

SSRI First Line
tx: OCD and social anxiety disorder

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Q

Sertraline Hcl (Zoloft)

A

SSRI First Line
tx:panic disorder, social anxiety disorder, OCD, PTSD

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Paroxetine HCL (Paxil)

SSRI First Line tx: panic disorder, social anxiety disorder, OCD, PTSD

Escitalopram Oxalate (Cipralex)

SSRI first line tx:generalized anxiety disorder

Citalopram HCL (Celexa)

SSRI first line tx:panic disorder, social anxiety disorder, OCD, GAD, PTSD **off label use; wasn't originally for anxiety

Benzodiazepines

-Alprazolam (Xanax) -Clonazepan (Rivotril) -Diazepam (Valium) -Lorazepam (ativan) -Oxazepam (Serax)

Alprazolam (Xanax)

Benzodiazepine tx: panic disorder, GAD off label use: social anxiety disorder

Clonazepan (Rivotril)

Benzodiazepine tx: GAD, social anxiety disorder

Diazepam (Valium)

Benzodiazepine tx: panic disorder, social anxiety disorder

lorazepam (Ativan)

Benzodiazepine tx: off label use: panic disorder, GAD, social anxiety disorder

Oxazepam (Serax)

Benzodiazepine tx: off label use: panic disorder, GAD, social anxiety disorder

important points about benzodiazepines

-short term use ONLY -risk for falls d/t sedation -effective but not always curative -not effective with alcohol or persons w/substance use disorder

treatment alternative for benzodiazepines

Buspirone (Wellbutrin) (serotonin receptor partial agonist) -non-habit forming, no interactions, takes ~3 weeks to work, risk to increase anxiety in people

second-line drugs for anxiety disorder (TCA's)

TCA's -Clomipramine HCL (Anafranil) -Amitriptyline HCL (Elavil) -Desipramine HCL (Norpramin) -Imipramine HCL (Tofranil) -Nortriptyline HCL (Aventyl) -Doxepin HCL (Sinequan)

Clomipramine HCL (Anafranil)

TCA second-line OCD off label use: panic disorder, GAD, PTSD

Amitriptyline HCL (Elavil)

TCA second-line off label use: panic disorder, GAD, PTSD

Desipramine HCL (Norpramin)

TCA second-line off label use: panic disorder, GAD, PTSD

Imipramine HCL (Tofranil)

TCA second-line off label use: panic disorder, GAD, PTSD

Doxepin HCL (sinequan)

TCA second-line off label use: panic disorder, GAD, PTSD

Nortriptyline HCL (Aventyl)

TCA second-line off label use: panic disorder, GAD, PTSD

second-line drugs for anxiety disorders (MAOIs)

Phenelzine sulphate (Nardil) Tranylcypromine sulphate (Parnate)

Phenelzine sulphate (Nardil)

MAOI second line off label use: panic disorder, social anxiety disorder, GAD, PTSD *dietary restrictions & hypertensive issues

Tranylcypromine sulphate (Parnate)

MAOI second line off label use: panic disorder, social anxiety disorder, GAD, PTSD *dietary restrictions & hypertensive issues

anxiety in children

if a child id Dx with multiple disorders they need treatment for each one common dx tourettes, trigatillomania 17% of ages 9-17 are dx with anxiety screening tool available for children

ADHD in children

-difficulty with focusing, emotion regulation, and executive functioning 7.2% of children diagnosed -more boys than girls diagnosed (d/t difference in presentation in symptoms) -difficulty with academics -depression, anxiety, decreased self esteem, poor sleep -changes in frontal lobe -genetic connection; parent 1:4 chance of kid having it

risk factors for ADHD in children

-structure and function of the brain -genetics other causes: lead exposure, substance use during pregnancy, premature birth, low birth weight

predominantly inattentive presentation - ADHD in children

difficulty focusing, organizing and staying on task

predominantly hyperactive/impulsive presentation - adhd in children

fidgeting with or tapping hands or feet, squirming frequently, trouble playing or engaging in leisure activities quietly, interrupting or intruding on others' conversations or games etc

combined presentation - adhd in children

display behaviours from both inattentive and hyperactive/impulsive category

medication management - adhd in children

behavioural therapy: "parent training" therapy, goal is to strengthen positive behaviours medications: stimulants, non-stimulants, antidepressants

medications: non-stimulants for ADHD (neurotransmitter involved)

-no controlled substances like stimulants -work by increasing the levels of norepinephrine in your brain -take longer to start working than stimulants ex: Atomoxetine (Strattera)

reasons to be prescribed a non-stimulant in adhd

-stimulants arent effective -intolerable side effects from stimulants -pairing it with a stimulant to increase effectiveness

medications: stimulants for ADHD

dopamine + norepinephrine formats: intermediate or extended release child rx: careful history, cardiac workup, EKG, etc two drug classes: Methylphenidates(ritalin, concerta) Amphetamines: amphetamine(adderall)

paradoxical effect of ritalin

typically increases motor activity and decreases fatigue but does the opposite in people with ADHD, that's why its used

adverse effects of stimulants

-headache, dizziness -decreased appetite -weight loss -dry mouth -irritability -trouble sleeping -nausea, vomiting

serious side effects of stimulants

-slowed growth -chest pain -shortness of breath -cold or numb fingers -fainting -increased violence/violent thoughts -auditory hallucinations -painful erections -addiction

warnings for stimulants

-controlled substances -need to taper to avoid withdrawal -high misuse potential -increased risk for suicide ideation under age 25

warnings for SSRI's

FDA and Health Canada has issued "black box warning" for SSRI's "start low and go slow" start lowest dose and slowly increase to therapeutic dose needed -Fluoxetine(prozac) citalopram(celexa) sertraline(zoloft)

ADHD in adults

-symptoms start in childhood and continue to adulthood -sometimes ADHD may not be recognized or diagnosed until the person is an adult -hyperactivity may decrease

s&s of adhd in adults

impulsiveness, disorganization and problems prioritizing, poor time management skills, problems focusing on a task, coping with stress etc

treatment for ADHD in adults

medications, psychotherapy, treatment of concurrent mental health conditions -similar to treatment of childhood adhd

conduct disorder

a condition characterized by hostile & sometimes physically violent behaviour and general disregard for others

behaviours associated with conduct disorder

-exhibit cruelty -push, hit, bite, progress to relentless bullying -hurt animals -pick fights -lying -theft -arson

associated risks with developing conduct disorder

-first degree relative -family history -parental abuse/neglect -exposure to violence -conflict with the judicial system

management of conduct disorder

-psychotherapy -behavioural therapy -parental training

autism spectrum disorder

1:66 canadians ages 1-16 26% of females also diagnosed with a seizure disorder -condition related to brain development -impacts how a person perceives and socializes with others, causing problems in social interaction and communication -includes limited and repetitive behaviour

symptoms of autism spectrum disorder

sandifer's syndrome: sign in children, head,neck,back spasm associated with reflux problems with social interaction and communication skills(i.e. rather play alone, resists hugs, poor eye contact) limited, repetitive patterns of behaviour, interests or activities(i.e performs activities that could cause self-harm. develops specific routines/rituals & becomes disturbed with change)

treatment for autism spectrum disorder

behavioural analysis parent management training speech language & occupational therapy social skills training medications for concurrent issues

characteristics of cluster C personality disorders

intense fearfulness, insecurity, & perfectionism

avoidant personality disorder

-pattern of inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation and disapproval -shy,timid,socially inept,avoid social situations -low/poor self esteem -use fantasy for gratification of needs, confidence, and conflict resolution -nurses must be self aware of their approach to assessment and interaction (d/t struggle w socialization) -slow development of therapeutic relationship

dependent personality disorder

-pervasive and excessive need to be taken care of, leads to clinging behaviour, fear of separation/being alone -passive, submissive, tolerate abusive situations -difficulty making own decisions -affects interpersonal relationships -nursing assess: feelings of self worth, interpersonal relationships, and social behaviour -meds may be used -assertiveness training

obsessive compulsive personality disorder

-pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control -may hoard resources -high expectations of selves and others -rigid thoughts and behaviours; difficulty w/affection -less demonstration of obsession and compulsions -psychotherapy helpful -short term pharmacotherapy may used -note physical symptoms, interpersonal relationships, and social problems -NOT OBSESSIVE COMPULSIVE DISORDER

cause of obsessive compulsive personality disorder

genetics, trauma, temperament, culture

treatments fo obsessive compulsive personality disorder

therapeutic relationships: develops slowly psychotherapy: individual, family, group, CBT, DBT, psychoanalytic, psychoeducational medication: to treat s&s of concurrent mental health dx