PSYCH ANXIETY

• Panic disorder


  Characterized by sudden onset of intense apprehension or terror that lasts for 15-30 min
• Panic disorder

  • After the attack it is followed by 1 month of one or more of the symptoms:
  • Persistent concern of having another attack
  • Feeling of "going crazy", losing control, or having a heart attack
  • Significant change in behavior
• Agoraphobia


  Fear of leaving an environment which one considers as safe/ fear of place or face
• Defense mechanisms used by patient with phobia

  Displacement, repression and projection
• Generalized anxiety disorder (GAD)


  Characterized by non-specific, excessive and uncontrollable which may last over days for 6 months
• Concerns of individual with GAD

  • Health issues
  • Money
  • Work difficulties
  • Death
  • Family problem
• Biologic domain treatments for panic disorders, phobia, GAD

  • Relaxation techniques:
  • Isometric exercise
  • Progressive muscle relaxation
  • Divert attention:
  • Increase physical activities to release energy
  • Stationary bicycling
  • Avoid situations that will provoke anxiety
  • Teach client about medications
• Medications for anxiety disorders

  • Panic disorder:
  • SSRI (Prozac and Zoloft)
  • SNRI (Effexor)
  • Benzodiazepines (Xanax, Klonipin, Valium)

  GAD:

  • Non-Benzodiazepine (BusPar)
  • Antidepressants
  • SNRI (Paxil-Paroxetine)
  • TCA (Tofranil[ Imipramine])

  Phobia:

  • Benzodiazepine (Xanax)
  • Non-benzodiazepine (BusPar)
  • SSRI (Paxil & Zoloft)
• Psychological domain treatments for panic disorders, phobia, GAD

  • Distraction techniques:
  • Performing simple repetitive activities
  • Rubber band, continue objects, counting backward from 100 by threes
  • Positive self-talk
  • Exposure therapy:
  • Systematic desensitization
  • Gradual exposure to feared object
  • Implosive therapy/ flooding technique
  • Abrupt exposure to feared object
  • Cognitive Behavioral Therapy:
  • Cognitive restructuring
  • Breathing training
  • Psychoeducation
• Selective mutism


  Failure to be able to speak in particular situations, such as the classroom, where they are expected to speak but are unable to do so
• Diagnostic criteria for selective mutism

  • Talkative at home with family, but changes speaking to words with one syllable and utters or gestures in order to communicate
  • Health professional must eliminate possibility that the child is unable to speak the language or does not have the knowledge about something they are asked about
  • Condition must be present for a minimum of 1 mo
  • Determination will be made if the condition is causing negative impact on school and other activities
  • Health professional must rule out other disorders, including stuttering or lack of verbal communication during a psychotic disorder
  • Extremely attached to parents
  • Extremely shy
  • Child does not have contact with other individuals (social isolation)
• Treatments for selective mutism

  • Cognitive Behavioral Therapy
  • Medications: Antidepressants and antianxiety medications
• Obsessive-compulsive disorder (OCD)


  Characterized by repetitive thoughts (obsession) and actions (compulsion)
• Common obsessions in OCD

  • Violence
  • Wealth
  • Cleanliness
  • Power
  • Sex
  • Contaminations
• Common compulsions in OCD

  • Checking
  • Handwashing
  • Arranging
  • Counting
  • Touching
  • Cleaning
• Nursing management for OCD

  • Teach client about medications as part of treatment plans
  • Allow client to perform rituals
  • Convey acceptance of client despite ritualistic behavior
  • Encourage expression of feelings
  • Diversional therapy
  • Encourage limit setting on ritualistic behaviors as part of the treatment plan
  • Keep a journal
  • Assist the client in listing all of the objects and places that triggers anxiety as part of exposure response prevention program
• Body dysmorphic disorder


  Mental health disorder in which an individual can't stop thinking about one or more perceived defects or flaws in their appearance

  
• Symptoms of body dysmorphic disorder

  • Intensely focus on appearance and body image
  • Repeatedly checking, mirror, grooming or seeking reassurance from others sometimes for many hours each day
  • Significant distress and impaired individual's ability to function in their daily life
  • Seek out numerous cosmetic procedures to try to "fix" the perceived flaw
• Treatments for body dysmorphic disorder

  • Cognitive behavioral therapy
  • Medication to reduce level of anxiety
• Hoarding disorder


  Characterized by excessively save items and the idea of discarding items causes extreme stress
• Symptoms of hoarding disorder

  • Unable to discard possessions
  • Severe anxiety over the idea of discarding possessions
  • Limited living space in the home
  • Floor and counter space within common areas of the home (Kitchen and living room)
  • Isolation
  • Loneliness
  • Depression
  • Fear or embarrassment of having visitors in the home
  • Withdrawn
  • Disorganized
  • Indecisive on where to put things
• Treatments for hoarding disorder

  • Psychotherapy:
  • Group-cognitive behavioral therapy has shown to decrease hoarding symptoms
  • Talk therapy address the cognitive and emotional challenges with hoarding behaviors

  Medications:

  • Used to relieve symptoms of depression and anxiety
• Trichotillomania


  Impulse control psychiatric disorder within the group of conditions known as Body Focused Repetitive Behaviors (BFRBs)
• Symptoms of trichotillomania

  • Constant pulling or twisting of hair
  • Bald patches or hair loss
  • Uneven hair appearance
  • Denial of hair pulling
  • Obstructed bowels if hair is consumed
  • Tension before hair is pulled and relief/ gratification after
  • Other self-injury behaviors
  • Poor self-image
  • Feeling sad, depressed, anxious
• Treatments for trichotillomania

  • Psychotherapy:
  • CBT helps patient develop techniques to reverse the habit and substitute unhelpful behaviors

  Medication:

  • Fluoxetine (Prozac)
  • Sertraline (Zoloft)
  • Fluvoxamine (Lucox)
  • Paroxetine (Paxil)
  • Clomipramine (Anafranil)
  • Valproate (Depakote)
  • Lithium (Lithobid, Eskalith)
• Excoriation disorder

  • Dermatillomania
  • Disorder of impulse control characterized by the urge to pick at the skin, even to the extent that damage is cause
• Treatments and management for excoriation disorder

  • Behavioral treatment
  • Habit reversal training
  • Competing response training
  • CBT
  • Protective clothing
• Post-traumatic stress disorder (PTSD)


  Mental health condition characterized by re-experiencing extreme traumatic events/ stressors through flashbacks and nightmare causing extreme level of anxiety
• Symptoms of PTSD

  • Persistently re-experiencing the events:
  • Thoughts/ perceptions
  • Flashbacks
  • Illusions/ hallucinations
  • Nightmares

  Increased arousal:

  • Startling behavior
  • Difficulty falling/staying asleep

  Avoidance of stimuli associated with trauma:

  • Avoidance of thoughts, feelings, conversations
  • Avoidance of people, places, activities
  • Dissociation
  • Depersonalization/ derealization
• Categories that may cause PTSD

  • Increased arousal:
  • Earthquake
  • Flood
  • Hurricane
  • Tornadoes

  Accidental man-made disasters:

  • Car crashes
  • Industrial accidents
  • Airplane crashes
  • Nuclear plant accidents

  Intentional man-made disasters:

  • War
  • Rape
  • Smuggling
  • Robbery
  • Assault military combat
  • Physical abuse
  • Bullying
• Nursing interventions for patients with PTSD & ASD

  • Promote client safety
  • Discuss self-harm thoughts
  • Help client to cope with stress and emotions
  • Use ground techniques to help client who is dissociating or experiencing flashbacks
  • Distraction techniques:
  • Physical exercise
  • Listening to music
  • Talking with others
  • Engaging in a hobby
  • Make a list of activities and provide materials close at hand
  • Help client promote self esteem
  • Make a list of people and activities in the community for client to contact when he/she needs help
• Acute stress disorder (ASD)


  Development of specific fear behaviors that last from 3 days to 1 month after a traumatic event
• Contributing factors resulting to ASD

  • Physical attack
  • Physical abuse
  • Mugging
  • Active combat
  • Sexual violence
  • Natural disasters
  • Serious accidents
  • Hearing or witnessing a violent or accidental trauma of a loved one
  • Repeated exposure to traumatic events
• Symptoms of acute stress disorders

  • Experiencing intrusion thoughts of memories of the traumatic event
  • Distressing dreams about the trauma
  • General sleep disturbances
  • Flashbacks or distress when exposed to triggers fo the traumatic event
  • "Block out" or be unable to remember parts or the entire traumatic event
  • Avoidance of external reminders, such as places or people related to traumatic event
  • Negative mood
  • Unrealistic feelings or beliefs about the event
  • Hypervigilance
  • Problems with concentration
  • Exaggerated startle response are also common physical symptoms, such as headaches, dizziness and sensitivity to light or sound may occur, even without injury
• Treatments for acute stress disorder

  • Debriefing crisis therapy:
  • Promote a sense of safety after trauma
  • Calm the victim
  • Promote a sense of self-efficacy
  • Encourage community or victim connectedness
  • Instill a sense of hope

  Group therapy

  Individual therapy:

  • Help victims of trauma share their personal narrative related to the traumatic event and quickly develop coping skills

  Acceptance and commitment therapy:

  • Acceptance and commitment therapy to promote the use of mindfulness to accept the traumatic event

  Stress management and reduction:

  • Thought stopping
  • Relaxation and breathing
  • Assertiveness training
  • Behavior rehearsal
  • Psycho-education
• Adjustment disorder


  When stress exceeds the individual's ability to cope and leads to the development of emotional or behavioral symptoms
• Primary treatment goal of acute stress disorder

  To prevent the disorder from developing into PTSD, which is chronic and involves long-term social and occupational impairment
• DEBRIEFING CRISIS THERAPY

  1. Promote a sense of safety after trauma

  2. Calm the victim

  3. Promote a sense of self-efficacy

  4. Encourage community or victim connectedness

  5. Instill a sense of hope
• Individual therapy

  Help victims of trauma share their personal narrative r/t the traumatic event and quickly develop coping skills
• Acceptance and commitment therapy

  To promote the use of mindfulness to accept the traumatic event