Week 4 - Anxiety disorders Flashcards
(20 cards)
Compare anxiety to an anxiety disorder
Anxiety - normal human response of apprehension or stress about an event or experience
* is not usually debilitating, and is often motivating
* has a clear trigger eg. an exam
Anxiety becomes a disorder when symptoms are persistent, prolonged, excessive, and cause significant distress/disability
* debilitating
* with no obvious trigger
* response is disproportionate to the trigger
Physical symptoms of anxiety
- tachucardia
- dry mouth
- chestb pain
- sweating
- shortness of breath
- headaches
- muscle tension
- insomnia/not switching off
- trembling/shaking
- N+V
Psychological symptoms of anxiety
- feeling of impending doom
- feeling on edge
- extreme or irrational fear
- rumination - the repetitive dwelling on negative feelings which perpetuates distress
- hypervigilance - the elevated state of constantly assessing/being aware of threats around you caused by excessive stress
- low tolerance for stress
- irritable
- impaired concentration
Behavioural symptoms of anxiety
- Catastrophising - a way of irrationally imagining the worst possible outcome of a situation or event will come true
- avoidance behaviours
- isolation
- agression
- increased substance consumption
- shutting down
Physiological cause of anxiety
The amygdala (which tempers fear and anxiety) is overactive of people with anxiety
* therefore the stress response and fight flight freeze response in response to stressors or stimuli is increased
* sometimes there is anxiety with no stimuli
Also serotonin, norepinephrine and dopamine irregularities in brain, similar to depressive disorders
Internal factors causing anxiety
Childhood temprament/temprament in general
* shyness
* distress when separated from parents
* fear of new situations
* reluctance to interact with new people/things
* withdrawal from social situations
External factors causing anxiety
- serious physical illness
- school/work stress
- overuse of caffeine
- relationship issues
- trauma eg. death of a loved one
- use of illicit drugs
- financial worries
- abuse
- sudden life changes eg. pregnancy
Environmental factors causing anxiety
Childhood trauma
* sexual
* physical
* neglect
Parenting style
* controlling
* over-protective
* over-involved
* critical/cold
rates are higher where parents are also anxious
Generalised anxiety disorder
An anxiety disorder characterised by anxiety or worry about a number of events or activies which is excessive, difficult to control, debilitating, and often chronic
- restlessness
- poor concentration
Social anxiety disorder (social phobia)
An anxiety characterised by excessive or inappropriate worry in social situations which is debilitating and chironic
- fear of being judged or scrutinused
- fear of being observed
- hyperaware
- leads to isolative or avoidant behaviours
Specific phobia
eg. agoraphobia
Marked and disproportionate fear or anxiety about a specific object or situation which consistent provokes intense fear and consequent avoidant behaviour, and is debilitating
- most of the time are aware the fear is irrational, but cant control the response
- can develop in response to traumatic event eg. afraid of spiders after being bitten
Obsessive compulsive disorder
An anxiety disorder charactersed by a pattern of uneanted throughts and fears (obsessions) which lead to repetetive behaviours (compulsions), which is extreme and debilitating
- cleaning
- checking (eg. is the door locked)
- counting
- ordering
- reassurance
- hoarding
- repetitive thinking
Agoraphobia
An anxiety disorder characterised by a fear of being in unfamiliar open or enclosed spaces which is debilitating
* catastrophising
* avoidant behaviour - may never leave the house
* may have panic attacks at thought of fear or when confronted by fear
Panic disorder
A physically symptomatic anxiety disorder characterised by reccuring, unexpected panic attacks, and is debilitating
Panic attacks - experience of a distressing array of symptoms with or without trigger (typically no trigger or in certain situations)
* hyperventilation
* sudden impending feeling of stress or danger
* dizziness
* loss of concentration
- happen when resting, relaxing, waking from sleep
- sometimes leads to avoidant behaviours
Panic disorder is common in conjunction with any of the other anxiety disorders
SSRIs
long term
Long term treatment alongside beta blockers
MOA: inhibits the reuptake of serotonin at the synaptic cleft to increase serotonin activity
* reduce anxiety symptoms
takes 2-4 weeks to take therapeutic effect
eg. prozac, zoloft, lexapro, luvox
Side effects: fatigue, hot flashes, insomnia, headache, tremor, sexual dysfunction
Avoid concurrent administraation with other SSRIs, MAOIs and St John’s Wort
SNRIs
Long term treatment alongside beta blockers
MOA: Inhibit the reuptake of serotonin and norepinephrine at the synaptic cleft, increasing the activity of these neutrotransmitters in the brain
* reduce anxiety symptoms
Takes 2-4 weeks to take therapeutic effect
eg. Duloxetine
Side effects: dry mouth, fatigue, naursea and vomiting, diarrhoea and constipation
Avoid concurrent administration with SSRIs, MAOIs, and St Johns Wort
Beta blockers
long term
Long term treatment alongside antidepressants
Especially perscribed when person displays panic symptoms
* mitigates palpitations, dizziness, feeling of stress
* be aware of hypotension in the process of reducing tachycardia - educate consumer on symptoms
*Dizziness, blurred vision, syncope, nausea
Anxiolytics
Short term
Short term management of occasional acute symptoms of panic attacks
* known to be addictive
* 2-3 weeks use max, or sporatic acute treatment
* be alert for signs of overdose
Typically benzodiazepines - increase the effects of GABA neurotransmitter
* cause sedation so need to be mindful when treating acute symptoms
* eg. cant drive
* falls risk
* avoid drugs and alcohol
* withdrawal syndrome - needs to be tapered
GABA - universal inhibitory neural transmitter and decreases nuerotransmission, thus calming neural activity
Non-pharmacological treatment for anxiety disorders
Graded exposure therapy
* Consumer fear heirarchy is created
* consumer and therapist address these fears in a graded way
* helps to break the pattern of avoidance and confront fears to overcome them
Systematic desensitisation
* combination of exposure to feared object/situation with relaxation techniques
* classically conditions - conditioned to respond differently
* promotes feelings of control in fearful situations
* done in same graded heirarchal way as GET
CBT
ACT
relaxation methods
* progressive muscle relaxation
* breathing techniques
* rituals
Identify nursing interventions and rationale for people with anxiety disorders
- risk and MSE
- medication management
- support and implement relaxation/coping techniques for times of anxiety/panic
- psychoeducation on anxiety to empower
- therapeutic relationship and create comfortable atmosphered
- low stimulus environment
