NSG 5720 Psychiatric Management II - Anxiety Disorders
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Questions and Answers

Which symptom is NOT associated with Generalized Anxiety Disorder according to diagnostic criteria?

  • Heightened sense of self-awareness (correct)
  • Difficulty concentrating
  • Irritability
  • Muscle tension

    • Which of the following is a requirement for the diagnosis of Generalized Anxiety Disorder?

  • Symptoms must significantly impair cognitive functioning
  • Three or more symptoms must be present for at least 6 months (correct)
  • Symptoms can only originate from a panic attack
  • Presence of anxiety for more than 3 months

    • What is NOT a possible effect of the anxiety and worry experienced in Generalized Anxiety Disorder?

  • Impairment in social functioning
  • Impairment in occupational functioning
  • Clinically significant distress
  • Increased physical fitness (correct)

    • Which statement accurately describes a characteristic of Generalized Anxiety Disorder?

    <p>Anxiety is often uncontrollable and pervasive</p> Signup and view all the answers

    Which factor is NOT considered a possible cause of Generalized Anxiety Disorder?

    <p>Continuation of a chronic medical condition</p> Signup and view all the answers

    Which symptom is specifically indicative of anxiety according to diagnosis criteria?

    <p>Difficulty falling or staying asleep</p> Signup and view all the answers

    What is behavioral inhibition (BI) primarily characterized by?

    <p>A low threshold for novel and unexpected stimuli</p> Signup and view all the answers

    Which system is primarily implicated in the neurobiological response to anxiety disorders?

    <p>GABA-ergic system</p> Signup and view all the answers

    What is the main objective of treating anxiety disorders in children?

    <p>To expose children to anxiety-producing situations</p> Signup and view all the answers

    Which of the following family practices is commonly associated with heightened anxiety in children?

    <p>Over-involvement and intrusive behavior</p> Signup and view all the answers

    Which statement correctly reflects the genetic factors associated with anxiety disorders?

    <p>Childhood anxiety symptoms show genetic variance with a significant hereditary component.</p> Signup and view all the answers

    How does early insecure attachment in children contribute to anxiety disorders?

    <p>It promotes viewing the environment as undependable and threatening.</p> Signup and view all the answers

    Which statement best describes the impact of the amygdala concerning anxiety disorders?

    <p>It responds to unfamiliar or unexpected events, triggering anxiety.</p> Signup and view all the answers

    Which of the following treatments targets distorted information processing related to anxiety?

    <p>Cognitive-behavioral therapy strategies</p> Signup and view all the answers

    In children experiencing anxiety, which physiological symptom is NOT typically observed?

    <p>Decreased muscle tension</p> Signup and view all the answers

    What effect does the experience of anxiety have in moderate amounts?

    <p>It can improve effective thinking and action.</p> Signup and view all the answers

    What is the average age of onset for Obsessive-Compulsive Disorder?

    <p>9-12 years</p> Signup and view all the answers

    Which type of medication is considered most effective for reducing symptoms of OCD?

    <p>Selective serotonin reuptake inhibitors (SSRIs)</p> Signup and view all the answers

    What technique is NOT typically used in behavioral therapy for anxiety disorders?

    <p>Medication intervention</p> Signup and view all the answers

    What percentage of children with OCD are likely to continue experiencing symptoms 2-14 years after diagnosis?

    <p>As many as two-thirds</p> Signup and view all the answers

    Cognitive-Behavioral Therapy (CBT) is primarily used to treat which type of disorders?

    <p>Anxiety disorders</p> Signup and view all the answers

    Which group is characterized by increasing symptoms of Generalized Anxiety Disorder over time?

    <p>Older children</p> Signup and view all the answers

    Family interventions for anxiety disorders are believed to achieve which of the following outcomes?

    <p>Have spillover effects into the family</p> Signup and view all the answers

    Which of the following comorbid conditions is most commonly associated with Obsessive-Compulsive Disorder?

    <p>Disruptive behavior disorders</p> Signup and view all the answers

    Exposure therapy in a behavioral context is primarily aimed at which of the following?

    <p>Facilitating coping strategies through exposure</p> Signup and view all the answers

    Which of the following statements regarding the prevalence of anxiety disorders in children is correct?

    <p>Up to 2.5% in children and adolescents</p> Signup and view all the answers

    What differentiates a normal fear from a debilitating one in children?

    <p>Duration and intensity of fear experience</p> Signup and view all the answers

    Which characteristic is most commonly associated with Social Anxiety Disorder in children?

    <p>Avoidance of social interactions due to fear of judgment</p> Signup and view all the answers

    Which cognitive characteristic is frequently observed in children with Generalized Anxiety Disorder?

    <p>Reduced memory capacity regarding academic tasks</p> Signup and view all the answers

    Which of the following symptoms is most consistent with Separation Anxiety Disorder in children?

    <p>Excessive fear of being away from primary caregivers</p> Signup and view all the answers

    Which feature is most likely observed in children with specific phobias?

    <p>Persistent and excessive fear related to particular objects or situations</p> Signup and view all the answers

    Which emotional challenge is closely linked to children facing multiple anxiety disorders?

    <p>Increased likelihood of experiencing depression</p> Signup and view all the answers

    Which statement accurately describes normal worries in children?

    <p>Moderate worry can aid children in preparing for future challenges.</p> Signup and view all the answers

    What is a characteristic feature of social anxiety disorder in children?

    <p>An overwhelming fear of social situations requiring public performance.</p> Signup and view all the answers

    What distinguishes generalized anxiety disorder from other anxiety disorders?

    <p>Exceedingly uncontrollable worry over everyday matters.</p> Signup and view all the answers

    What is a key characteristic of separation anxiety disorder?

    <p>Excessive anxiety about being apart from parents or home.</p> Signup and view all the answers

    At what age do specific phobias typically onset in children?

    <p>7-9 years, often related to animals or darkness.</p> Signup and view all the answers

    Which factor is most likely associated with the prevalence of social anxiety disorder in children?

    <p>Presence of peer rejection and fear of negative evaluation.</p> Signup and view all the answers

    Which of the following statements accurately reflects the typical age range for the onset of Obsessive-Compulsive Disorder?

    <p>Average onset is usually between 9-12 years with notable peaks.</p> Signup and view all the answers

    What primary treatment strategy distinguishes Cognitive-Behavioral Therapy (CBT) from other interventions for anxiety disorders?

    <p>Incorporation of skill training combined with exposure.</p> Signup and view all the answers

    In children experiencing Separation Anxiety Disorder, which of the following symptoms is most likely to be exhibited?

    <p>Fear of losing a parent or caregiver, leading to distress.</p> Signup and view all the answers

    Which of the following best describes the nature of Generalized Anxiety Disorder in children?

    <p>Anxiety persists over time and encompasses various aspects of daily life.</p> Signup and view all the answers

    What is the predominant reason that medication must often be combined with CBT for treating OCD?

    <p>Medications reduce symptoms, allowing CBT to be more effective.</p> Signup and view all the answers

    Which of the following correctly identifies a common comorbidity observed with anxiety disorders in children?

    <p>Most children with anxiety also experience depressive disorders.</p> Signup and view all the answers

    Which combination of symptoms is indicative of Generalized Anxiety Disorder according to the diagnostic criteria?

    <p>Restlessness, muscle tension, sleep disturbance</p> Signup and view all the answers

    What condition must be ruled out for a diagnosis of Generalized Anxiety Disorder?

    <p>Substance abuse or another medical condition</p> Signup and view all the answers

    Which symptom is least likely to be present in children diagnosed with Generalized Anxiety Disorder?

    <p>Excessive sleepiness during the day</p> Signup and view all the answers

    Which of the following symptoms is associated with Generalized Anxiety Disorder?

    <p>Persistent worry</p> Signup and view all the answers

    Which of the following statements accurately reflects the implications of anxiety, worry, or physical symptoms?

    <p>They create significant impairment in various areas of functioning.</p> Signup and view all the answers

    Which symptom is NOT considered part of the diagnostic criteria for Generalized Anxiety Disorder?

    <p>Episodic panic attacks</p> Signup and view all the answers

    What factor is essential in determining clinically significant distress caused by anxiety disorders?

    <p>The impact on important areas of functioning</p> Signup and view all the answers

    Study Notes

    Description of Anxiety Disorders

    • Anxiety is a mood state marked by intense negative emotions and physical tension in anticipation of future threats.
    • Anxiety disorders encompass various debilitating forms of anxiety, often co-occurring in children.

    Associated Characteristics

    • Common traits in anxious children include cognitive disturbances, physical symptoms, social-emotional deficits, and comorbid anxiety and depression.

    Cognitive Disturbances

    • Information perception and processing can be disturbed, affecting memory and attention.
    • Children with anxiety may exhibit biased attention towards threats, leading to hypervigilance.
    • Cognitive biases result in dangerous thoughts and reduced perception of control over anxiety-related events.

    Physical Symptoms

    • Somatic complaints like stomachaches and headaches are prevalent, especially in those with Generalized Anxiety Disorder (GAD), Panic Disorder (PD), and Social Anxiety Disorder (SAD).
    • Sleep disturbances, including nocturnal panic, affect 90% of those with anxiety disorders.
    • Higher adolescent anxiety levels correlate with decreased accidents and deaths in early adulthood.

    Social and Emotional Deficits

    • Anxious children often struggle socially, experience low self-esteem, and report challenges forming friendships.
    • Difficulty understanding emotions and distinguishing thoughts from feelings are common.

    Depression in Anxiety Disorders

    • Comorbidity with depression is frequent among children with multiple anxiety disorders, influenced by negative affectivity and physiological hyperarousal.

    Gender, Ethnicity, and Culture

    • Anxiety disorders are more prevalent in girls, suggesting genetic and neurobiological factors.
    • Cultural context can shape the expression and interpretation of anxiety symptoms.

    Theories and Causes

    • Psychoanalytic theory sees anxieties as defenses against early conflicts.
    • Behavioral theories suggest fears are learned behaviors, maintained by operant conditioning.
    • Bowlby's attachment theory links insecure attachments to perceived environmental threat, promoting anxiety.

    Temperament

    • Temperament traits influence reactions to novelty and can heighten the risk for anxiety disorders, especially in behaviorally inhibited children.

    Genetic Factors

    • Genetic studies indicate that about one-third of childhood anxiety variance is hereditary.
    • Genetic links exist with serotonin and dopamine systems related to anxiety and behavioral inhibition.

    Neurobiological Factors

    • The anxiety response system involves the HPA axis, limbic system, and other brain structures.
    • Overactivity in the behavioral inhibition system (BIS) can result from early stress, influencing anxiety development.

    Family Factors

    • Parenting styles, particularly overinvolvement and limitations on independence, can contribute to childhood anxiety.
    • High levels of family dysfunction and low socioeconomic status correlate with increased anxiety behaviors.

    Treatment and Prevention

    • Effective treatments often involve gradual exposure to anxiety-provoking situations and modifying cognitive distortions and avoidance behaviors.
    • Moderate anxiety can be beneficial; however, excessive anxiety is counterproductive.

    Three Interrelated Anxiety Response Systems

    • Physical responses include increased heart rate and tension.
    • Cognitive symptoms involve apprehension and concentration difficulties.
    • Behavioral responses manifest through aggression and avoidance.

    Common Symptoms of Anxiety

    • Physical: dizziness, nausea, muscle tension, sweating.
    • Cognitive: intrusive thoughts, fear of harm, difficulty concentrating.
    • Behavioral: avoidance behaviors, fidgeting.

    Anxiety Versus Fear and Panic

    • Anxiety is a future-oriented mood state, potentially occurring without immediate danger.
    • Fear is a present-oriented response to immediate threats, while panic can arise unexpectedly, even without clear triggers.

    Normal Fears and Anxieties

    • Normal fears vary by age and can change over time, potentially becoming debilitating.

    Prevalence of Anxiety Disorders

    • Generalized Anxiety Disorder (GAD) lifetime prevalence is about 2.2%, with a balanced distribution between genders.
    • Comorbidities include higher rates of other anxiety disorders and depression.

    Obsessive-Compulsive Disorder (OCD)

    • OCD is characterized by persistent obsessions and compulsions that disrupt normal functioning.
    • Lifetime prevalence ranges from 1-2.5%, with common comorbidities including other anxiety disorders and depression.

    Behavior Therapy

    • Key techniques involve gradually exposing children to fear-inducing stimuli while teaching coping mechanisms to reduce avoidance.

    Cognitive-Behavioral Therapy (CBT)

    • CBT is effective for treating anxiety disorders, often in conjunction with exposure-based treatments to address distorted thinking.

    Family Interventions

    • Family involvement in treatment can enhance effectiveness, providing education and coping strategies for all members.

    Psychopharmacological Treatment

    • SSRIs (e.g., fluvoxamine, sertraline, clomipramine) are commonly prescribed for OCD and other anxiety disorders, most effective when combined with CBT.

    Description of Anxiety Disorders

    • Anxiety is a mood state involving strong negative emotions and bodily tension in anticipation of danger.
    • Anxiety disorders present excessive and debilitating anxieties in various forms.
    • Many children affected by anxiety disorders often experience multiple types.

    Associated Characteristics

    • Cognitive disturbances can manifest in memory, attention, and language despite normal intelligence.
    • Physical symptoms like stomachaches or headaches are prevalent, especially in Generalized Anxiety Disorder (GAD), Panic Disorder (PD), and Social Anxiety Disorder (SAD).
    • Children often display low social performance, high social anxiety, low self-esteem, loneliness, and difficulty forming friendships.

    Cognitive Disturbances

    • Distorted perception and processing of information linked to anxiety, influencing academic performance.
    • Threat-related attentional biases lead children to focus on potential dangers, resulting in anxious vigilance.
    • Cognitive errors contribute to heightened perceptions of threat, with affected children feeling less control over anxiety-related events.

    Physical Symptoms

    • A high percentage of children with anxiety disorders (90%) report sleep problems, including nocturnal panic.
    • Anxiety in adolescence correlates with reduced accident rates in early adulthood.

    Depression and Anxiety

    • Depression is more frequently diagnosed in children with multiple anxiety disorders.
    • Negative affectivity denotes a consistent negative mood, while positive affectivity is linked to positive emotional states.
    • Physiological hyperarousal, characterized by symptoms like shortness of breath and dizziness, is unique to anxious children.

    Gender, Ethnicity, and Culture

    • Higher anxiety disorder prevalence in girls suggests genetic and neurobiological factors.
    • Cultural influences can shape the expression and interpretation of anxiety symptoms.

    Theoretical Perspectives

    • Classical psychoanalytic theory views anxiety as a defense against unconscious conflicts.
    • Behavioral theories attribute anxiety to learned experiences via classical and operant conditioning.
    • Bowlby’s attachment theory posits that insecure attachments may lead to viewing the environment as threatening, fostering anxiety.

    Temperament

    • Behavioral inhibition (BI) reflects a low tolerance for unfamiliar stimuli, increasing anxiety disorder risk.
    • The development of anxiety in BI children depends on gender, early maternal stress exposure, and parental responses.

    Genetic and Neurobiological Factors

    • Twin and family studies indicate approximately one-third of childhood anxiety symptoms may be genetic.
    • Key neurotransmitter systems, particularly serotonin and dopamine, relate to anxiety traits.
    • The anxiety response system involves multiple structures, including the HPA axis and limbic system, with brain abnormalities noted in anxious or inhibited children.

    Family Dynamics

    • Anxious children often have over-involved or intrusive parents, linked to greater anxiety levels.
    • Exposure to dysfunction within families and low socioeconomic status (SES) can exacerbate anxious behaviors.

    Treatment and Prevention

    • Effective treatment involves exposing children to anxiety-inducing stimuli to modify distorted thinking and excessive avoidance behaviors.
    • Moderate anxiety can enhance functioning, while excessive anxiety may be debilitating.

    Anxiety Response Systems

    • Anxiety triggers responses across physical, cognitive, and behavioral systems, leading to varied symptoms such as increased heart rate, difficulty concentrating, and avoidance behaviors.

    Symptoms of Anxiety

    • Common physical symptoms include fatigue, dizziness, nausea, and muscle tension.
    • Cognitive symptoms often present as thoughts of harm or inadequacy, panic, and self-critical thoughts.
    • Behavioral symptoms can include avoidance behaviors, trembling, and stuttering.

    Distinction Between Anxiety, Fear, and Panic

    • Anxiety is future-oriented, while fear pertains to immediate danger; panic involves sudden fight/flight responses without obvious threats.

    Normal Fears and Anxieties

    • Normal fears evolve with age and can become debilitating if persistent.
    • Common fears and anxieties vary by developmental periods, with specific symptoms and corresponding DSM-5 diagnoses for different age groups.### Childhood Anxiety Disorders Overview
    • Anxieties during childhood and adolescence are common.
    • Normal worries serve a developmental purpose, aiding in preparation for future events.
    • Separation anxiety disorder (SAD) is prevalent from age 7 months to preschool years.

    Types of Anxieties by Age Group

    • 2-3 Years: Common fears include thunder, lightning, natural elements, and separation from caregivers.
    • 4-5 Years: Separation anxiety from parents and fears surrounding death.
    • 5-7 Years: Fears of specific objects (e.g., animals, monsters) and medical concerns.
    • 5-11 Years: Performance anxiety related to school and social settings.
    • 12-18 Years: Increased focus on personal relationships, appearance, and fear of natural disasters.

    Normal Anxieties

    • Normal anxieties include separation anxiety, performance anxiety, and excessive need for reassurance.
    • Girls often show more anxiety than boys, though symptoms may stabilize with age.

    Anxiety Disorders

    • Seven categories include:
      • Separation Anxiety Disorder (SAD)
      • Generalized Anxiety Disorder (GAD)
      • Specific Phobia
      • Social Anxiety Disorder
      • Panic Disorder
      • Agoraphobia
      • Selective Mutism

    Separation Anxiety Disorder (SAD)

    • Occurs in 4-10% of children, more prevalent in girls.
    • Usually begins between ages 7-8, characterized by high levels of distress over separation from parents.
    • Can lead to comorbid depression in affected children and may persist into adulthood for more than a third.

    School Refusal

    • Common refusal to attend classes in children aged 5-11.
    • Integrates fear of separation and potential underlying anxieties.

    Specific Phobias

    • Affect roughly 20% of children; involve fears of animals, darkness, and specific objects.
    • More enduring than typical childhood fears.

    Social Anxiety Disorder

    • Marked persistence of fear over social situations, affecting about 6-12% of children.
    • More prevalent in girls; often associated with other anxiety disorders and major depression.

    Selective Mutism

    • Characterized by the inability to speak in certain social situations while being communicative in others.
    • Affects approximately 0.7% of children, commonly starting around ages 3-4.

    Panic Disorder

    • Characterized by sudden panic attacks, rare in young children but common in adolescents.
    • Leads to avoidance behaviors, potentially resulting in agoraphobia.

    Generalized Anxiety Disorder (GAD)

    • Involves excessive worry about everyday occurrences, affecting 2.2% of the population.
    • Symptoms often manifest as physical complaints (headaches, muscle tension).

    Obsessive-Compulsive Disorder (OCD)

    • Characterized by intrusive thoughts (obsessions) and repetitive behaviors (compulsions).
    • Lifetime prevalence in children is around 1-2.5%, more common in boys.

    Treatment Approaches

    • Behavior Therapy: Uses exposure techniques and response prevention to help manage fears.
    • Cognitive-Behavioral Therapy (CBT): Most effective for treating anxiety disorders, often combined with exposure therapy.
    • Family Interventions: Educates family members about the child’s disorders, which can enhance treatment effectiveness.
    • Medication: Selective serotonin reuptake inhibitors (SSRIs) are most effective for OCD and anxiety disorders, particularly when used alongside CBT.

    Medication Details

    • Fluvoxamine and sertraline are common SSRIs for OCD.
    • Avoid use of Paxil and benzodiazepines in treating anxiety disorders.

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