Anxiety Levels

Anxiety Levels

• Mild anxiety can enhance problem-solving abilities

• Mild anxiety is a normal part of everyday life

• Symptoms of mild anxiety include slight discomfort, restlessness, irritability, and tension-reducing behaviors like nail-biting

• Mild-to-moderate anxiety can motivate a person to take action

• Moderate anxiety narrows the perceptual field, making concentration difficult, but learning and problem-solving are still possible

• Problem-solving can occur, although learning and problem-solving are hindered with moderate anxiety

• Symptoms include voice tremors, increased heart rate and respiratory rate, and sweating

• Mild-to-moderate anxiety can motivate one to take action

• Severe anxiety significantly reduces perception, focusing it on specifics, and behavior becomes automatic

• Symptoms include trembling, pounding heart, hyperventilation, and a sense of impending doom

• Reasoning and cognitive abilities are impaired during severe anxiety and panic

• Panic-level anxiety is the most extreme, where loss of reality is possible

• Symptoms include shouting, screaming, withdrawal, and erratic/impulsive behavior

• Reasoning and cognitive abilities are impaired during panic-level anxiety

Compulsions and Related Disorders

• Compulsions involve repetitive behaviors or mental acts performed to reduce anxiety

• Compulsions are triggered by obsessive thoughts

• Examples of compulsions include hand washing, checking, counting, and praying

• A person feels driven to perform compulsions, even if they don't want to, to relieve anxiety or prevent feared events

• Obsessions are unwanted, intrusive thoughts that cause distress

• Obsessions are unwanted thoughts or images that keep returning, causing anxiety and difficulty focusing

• Compulsions are rituals/behaviors used to reduce anxiety from obsessions

• Compulsions are repeated actions that someone feels they must perform to alleviate anxiety stemming from obsessive thoughts

• Related disorders involve similar repetitive behaviors or urges

• Related disorders may not involve obsessions but still cause distress or impairment

• Examples of related disorders include excoriation (skin picking), trichotillomania (hair pulling), body dysmorphic disorder, and hoarding disorder

• Body Dysmorphic Disorder involves obsession with perceived body flaws

• Hoarding Disorder involves difficulty discarding items, even those with little value

• Related disorders fall under Obsessive-Compulsive Disorder (OCD)-related conditions as classified in the DSM-5

Excoriation Disorder

• Excoriation (skin-picking) disorder involves repetitive, compulsive skin picking, causing tissue damage
• Key features: recurrent skin picking causing lesions, repeated attempts to stop, significant distress or impairment, and association with anxiety or OCD
• Also known as dermatillomania, Excoriation is classified under Obsessive-Compulsive and Related Disorders in the DSM-5

Trichotillomania

• Trichotillomania (hair-pulling) involves recurrent, irresistible urges to pull out one’s own hair, leading to noticeable hair loss
• Key features: repetitive hair pulling from various body areas, inability to stop despite efforts, distress or impairment, and tension followed by relief or gratification
• Trichotillomania is categorized under Obsessive-Compulsive and Related Disorders in the DSM-5

Body Dysmorphic Disorder (BDD)

• Body Dysmorphic Disorder (BDD) involves excessive preoccupation with perceived physical flaws that are either minor or not observable
• Key features: obsessive focus on perceived defects, repetitive behaviors like mirror-checking, distress or impairment, and co-occurrence with anxiety, depression, or eating disorders
• BDD is classified under Obsessive-Compulsive and Related Disorders in the DSM-5.

Hoarding Disorder

• Hoarding Disorder involves persistent difficulty discarding possessions, regardless of value, due to a perceived need to save them
• Key features: excessive accumulation of items, strong emotional attachment and distress when discarding, impairment in functioning, and association with indecisiveness, perfectionism, and anxiety
• Hoarding Disorder is classified under Obsessive-Compulsive and Related Disorders in the DSM-5

Body Identity Integrity Disorder (BIID)

• Body Identity Integrity Disorder (BIID) is a rare condition where a person has a strong desire to amputate or disable a healthy body part
• Key features include an intense mismatch between the physical body and internal identity
• BIID involves a desire to amputate limbs or become disabled, beginning in early childhood or adolescence
• BIID causes significant distress, potentially leading to self-amputation if untreated
• BIID is related to body image disturbances and identity disorders but isn't the same as gender dysphoria or body dysmorphic disorder

Depersonalization

• Depersonalization involves feeling detached from one's body or mind
• It feels like watching oneself focused on self

Derealization

• Derealization involves a dreamlike state where the environment seems foggy or unreal
• It is a sensation of being in a dream-like state where the environment seems foggy, distorted or unreal

Dissociative Disorders

• Dissociative disorders involve disruption in memory, identity, consciousness, or perception
• Dissociative disorders are used as a defense against trauma

Types of Dissociative Disorders

• Dissociative Amnesia: Memory loss of personal information
• Dissociative Identity Disorder: Two or more distinct personalities controlling behavior, accompanied by an inability to recall personal information
• Depersonalization/Derealization Disorder: Feeling disconnected from your body or mind like watching yourself from the outside vs sensation that the world around you is unreal

Generalized Anxiety Disorder (GAD)

• GAD involves excessive anxiety/worry more days than not for 6+ months
• Diagnostic criteria include experiencing 3+ of restlessness, fatigue, irritability, muscle tension, sleep problems, or poor concentration
• Excessive anxiety and worry is present at least 50% of the time
• Anxiety is out of proportion to the actual situation

GAD Treatment

• Common treatments SSRIs, SNRIs, or Buspirone
• SSRIs (e.g., sertraline, paroxetine) are first-line medications for GAD
• Another medication is Buspirone, which is as a non-sedating anxiolytic
• Benzodiazepines are for short-term use because of the risk of dependence
• Lorazepam (Ativan) is another medication for anxiety and behavioral crises; could be used with haloperidol
• Chlordiazepoxide (Librium) treats anxiety and alcohol withdrawal
• Diazepam (Valium) can stop seizures and treat acute anxiety
• Cognitive Behavioral Therapy (CBT) helps to identify and change negative thought patterns
• Teach people to only stop taking benzos by tapering off the drug, bc sudden withdrawal can be fatal
• Relaxation techniques include deep breathing, meditation, and progressive muscle relaxation
• Lifestyle modifications include exercise, balanced diet, sleep hygiene, and reduced caffeine
• Psychoeducation involves learning about the symptoms, triggers, and healthy coping strategies

Obsessive-Compulsive Disorder (OCD)

• Obsessions are intrusive thoughts/images that cause anxiety and disrupt daily life
• Compulsions are behaviors performed to relieve obsession-related anxiety
• Person knows it's irrational but can't stop the compulsions
• OCD interferes with normal functioning, however mild obsessions can be normal- unless it significanlty interferes with you

Common Compulsions

• Checking rituals, counting rituals, washing/scrubbing, praying/chanting, touching/rubbing/tapping, ordering, exhibiting rigid performance, aggressive urges

OCD Treatment

• Treatments are SSRIs, SNRI, or atypical antipsychotics
• Atypical antipsychotics: second-generation antipsychotics (risperidone, quetiapine, olanzapine) for treatment resistant OCD
• CBT with Exposure and Response Prevention helps people face their fears or resist the urge to do rituals
• Exposure is practicing facing the things they usually avoid
• Response Prevention is learning to pause or stop rituals, even if it feels uncomfortable
• Relaxation Techniques (like deep breathing or guided imagery) help manage anxiety and build confidence

Panic Attack

• Panic attacks are sudden onsets of extreme apprehension or fear associated with impending doom
• Associated with intense fear or doom
• During a panic attack, normal functioning is limited; disorganization; perceptual field is limited; misinterpretation of reality
• Symptoms of a panic attack can present as a cardiac concern, feeling of choking, chills, and hot flashes
• Panic attacks can be spontaneous, with no trigger, and may mimic a cardiac emergency

Anxiety: Nursing interventions

• Nursing interventions for mild to moderate anxiety involve helping the patient identify anxiety, using nonverbal language, exploring and seeking clarification, encouraging expression, promoting problem-solving, and providing physical outlets
• Nursing interventions for severe to panic anxiety levels focus on maintaining calm, minimizing stimuli, remaining with the person, using a calm voice, reinforcing reality, meeting physical needs, offering exercise, and evaluating medication needs

Phobias

• Phobias are irrational fears of specific objects or situations that cause problems in daily life
• Types of phobias: Acrophobia, claustrophobia, xenophobia, agoraphobia, and social anxiety
• Social anxiety can cause panic and social dysfunction
• Treatments are Exposure therapy, CBT, or SSRIs
• Cognitive Behavioral Therapy (CBT) helps change negative thought patterns about the feared object or situation

Phobia Treatments

• Exposure Therapy is repeated exposure to the phobia to reduce fear response
• Systematic Desensitization combines relaxation techniques with gradual exposure
• Medications such as SSRIs or benzodiazepines are only used for short-term relief
• Relaxation Techniques includes deep breathing, visualization, and muscle relaxation exercises
• Support Groups include sharing experiences and coping strategies with others

Primary vs. Secondary Gain

• Primary gain involves internal relief from anxiety or conflict (e.g., avoiding public places)

• Secondary gain involves external benefits from being sick (e.g.,attention, avoiding work)

• Primary gain is an internal, emotional benefit from being sick, reduces anxiety, conflict or distress; avoid going home, etc

• Secondary gain is an external or personal benefit from others, includes attention, affection, or relief from responsibilities; getting extra care

PTSD

• PTSD develops after exposure to trauma (threatened death, serious injury, abuse)
• Onset may be delayed by >1 month, can occur 3 months + after the trauma
• Symptoms can include disturbing pattern of behavior from the traumatic event, intense fear, helplessness, or terror
• PTSD is diagnosed with symptoms last >1 month, which can potentially be exacerbated by life events

Signs/Symptoms of PTSD

• Common occurrences are clients developing other psychiatric disorders, such as depression, anxiety disorders, or alcohol and drug abuse
• Other signs of PTSD are flashbacks, nightmares, avoidance, hyperarousal/hypervigilance, numbing, substance abuse or relationship trouble
• Signs of hyperarousal are a constant state of tension, easily startled, and trouble sleeping
• Emotional Numbing causes the patient to feel detached and have a lack of joy/ inability to feel
• Relationship/social problems: Difficulty maintaining personal, social, or work relationships
• Treatment SSRIs, trauma-focused CBT, or grounding techniques

PTSD vs ASD

• PTSD involves delayed onset; symptoms last longer than 1 month; it is persistent if untreated.
• Acute Stress Disorder (ASD) involves onset within 3 days of trauma; symptoms last 3 days – 1 month; it may resolve or progress