NURS 665 Exam 2/58 questions and
answers
Two components of anxiety - -1.The awareness of the physiologic sensations
(ex: palpitations and sweating), 2. The awareness of being nervous or
frightened
- Anxiety is - -diffuse, unpleasant, vague sense of apprehension, usually
accompanied by autonomic symptoms; different from fear as it is not a
response to an overt danger, but rather an impending one
- Clinical presentation of anxiety - -Most common effects are on the
autonomic system (headache, perspiration, palpitations, chest tightness,
mild stomach discomfort); Motor symptoms include restlessness (inability to
sit still or stand still for long); Individual may describe themselves as
"nervous" or "frightened"; Mood is frequently observable; Classic fearful
expression - eyes and mouth open, eyebrows raised; Expression may be
more blunted for individuals with more chronic anxiety; Rapid thoughts,
possibly disorganized if anxiety is severe; in extreme forms, people may
have difficulty w/ thinking clearly (may ruminate or stammer); Hallucinations
are rare, but patients with severe anxiety may have distortions in perception,
not only of time and space but also of persons and meanings of events; Pts
with severe anxiety may become confused, have difficulty focusing their
attention, have trouble w/ recall
- Clinical presentation of anxiety in special populations - -Elderly and
children may present with more somatic sx
- Objective rating scales for anxiety - -Beck Anxiety Inventory (BAI); Hospital
Anxiety and Depression Scale (HADS); Generalized Anxiety Disorder Scale
(GAD-7); State-Trait Anxiety Inventory - differentiates between state and trait
anxiety, which is situational anxiety versus anxiety that seems characteristic
for a person and independent of the situation
- Comorbidity for anxiety disorders - -Depressive symptoms are often
present; In some pts, a depressive disorder coexists w/ the panic disorder;
Agoraphobia, other phobias, and OCD can coexist w/ panic disorder; Alcohol
and other substance use disorders occur in about 20-40% of all pts; OCD
may develop
- Panic attack - -Have a sudden onset and relatively short duration; First is
often spontaneous, although they occasionally follow excitement, physical
exertion, sexual activity, or moderate emotional trauma; Often begins with
10 minutes of rapidly increasing symptoms; Mental symptoms - extreme
, fear, sense of impending death or doom, may feel confused and have trouble
concentrating; Pts usually cannot name the source of their fear; Physical
symptoms - tachycardia, palpitations, dyspnea, sweating; Pts often try to
leave whatever situation they are n to seek help; Attack generally lasts 20-
30 minutes; rarely more than 1 hour
- Most anxiety disorders - -have long-term courses with multiple relapses;
they are chronic disorders; Most anxiety disorders have an increased risk of
suicide
- Epidemiology of Anxiety disorders and gender - -Twofold for most anxiety
disorders, with an exception being social anxiety disorder where the ratio is
about equal; This difference is true across all ages, and is most evident
during early and mid-adulthood
- Anxiety disorders and age - -One of the earliest onsets of all psychiatric
disorders; Most begin in childhood or adolescence; median age is 12; Phobic
disorders are the most stable over time; Panic and generalized anxiety
disorder tend to have exacerbations and remissions over the lifespan
- Anxiety disorders and sociocultural & ethnic variables - -Common in
people of lower socioeconomic status and educational level; Higher rates in
African Americans, lower in Hispanics
- Reactive attachment disorder & disinhibited social engagement disorder -
-characterized by aberrant social behaviors in a young child that reflect
grossly negligent parenting and maltreatment that disrupted the
development of normal attachment behavior; A diagnosis rests on the
presumption that the cause is caregiving deprivation
- Reactive Attachment Disorder DSM-5 Criteria - -Duration - begins < age 5;
Symptoms - Emotional inhibition, rarely seeking or responding to comfort
when distressed; Social and emotional disturbance: (must have > 2 of these)
↓ emotional/social responsiveness ↓ affect; Fear, sadness or irritability in
non-threatening interactions w/ adults; Hx of insufficient care: Neglect,
Deprivation, Repeated changes in caregivers, Institutional care; Child has
developmental age of > 9 mo; Required number of symptoms - Symptoms in
each category; > 2 of the social/emotional disturbance symptoms; Cannot be
a result of autism spectrum disorder
- reactive attachment disorder prognosis - -children who are later adopted
into caring environments improve int heir attachment behaviors and may
normalize over time, Duration and severity of neglect influence prognosis, as
does the degree of resulting impairment
answers
Two components of anxiety - -1.The awareness of the physiologic sensations
(ex: palpitations and sweating), 2. The awareness of being nervous or
frightened
- Anxiety is - -diffuse, unpleasant, vague sense of apprehension, usually
accompanied by autonomic symptoms; different from fear as it is not a
response to an overt danger, but rather an impending one
- Clinical presentation of anxiety - -Most common effects are on the
autonomic system (headache, perspiration, palpitations, chest tightness,
mild stomach discomfort); Motor symptoms include restlessness (inability to
sit still or stand still for long); Individual may describe themselves as
"nervous" or "frightened"; Mood is frequently observable; Classic fearful
expression - eyes and mouth open, eyebrows raised; Expression may be
more blunted for individuals with more chronic anxiety; Rapid thoughts,
possibly disorganized if anxiety is severe; in extreme forms, people may
have difficulty w/ thinking clearly (may ruminate or stammer); Hallucinations
are rare, but patients with severe anxiety may have distortions in perception,
not only of time and space but also of persons and meanings of events; Pts
with severe anxiety may become confused, have difficulty focusing their
attention, have trouble w/ recall
- Clinical presentation of anxiety in special populations - -Elderly and
children may present with more somatic sx
- Objective rating scales for anxiety - -Beck Anxiety Inventory (BAI); Hospital
Anxiety and Depression Scale (HADS); Generalized Anxiety Disorder Scale
(GAD-7); State-Trait Anxiety Inventory - differentiates between state and trait
anxiety, which is situational anxiety versus anxiety that seems characteristic
for a person and independent of the situation
- Comorbidity for anxiety disorders - -Depressive symptoms are often
present; In some pts, a depressive disorder coexists w/ the panic disorder;
Agoraphobia, other phobias, and OCD can coexist w/ panic disorder; Alcohol
and other substance use disorders occur in about 20-40% of all pts; OCD
may develop
- Panic attack - -Have a sudden onset and relatively short duration; First is
often spontaneous, although they occasionally follow excitement, physical
exertion, sexual activity, or moderate emotional trauma; Often begins with
10 minutes of rapidly increasing symptoms; Mental symptoms - extreme
, fear, sense of impending death or doom, may feel confused and have trouble
concentrating; Pts usually cannot name the source of their fear; Physical
symptoms - tachycardia, palpitations, dyspnea, sweating; Pts often try to
leave whatever situation they are n to seek help; Attack generally lasts 20-
30 minutes; rarely more than 1 hour
- Most anxiety disorders - -have long-term courses with multiple relapses;
they are chronic disorders; Most anxiety disorders have an increased risk of
suicide
- Epidemiology of Anxiety disorders and gender - -Twofold for most anxiety
disorders, with an exception being social anxiety disorder where the ratio is
about equal; This difference is true across all ages, and is most evident
during early and mid-adulthood
- Anxiety disorders and age - -One of the earliest onsets of all psychiatric
disorders; Most begin in childhood or adolescence; median age is 12; Phobic
disorders are the most stable over time; Panic and generalized anxiety
disorder tend to have exacerbations and remissions over the lifespan
- Anxiety disorders and sociocultural & ethnic variables - -Common in
people of lower socioeconomic status and educational level; Higher rates in
African Americans, lower in Hispanics
- Reactive attachment disorder & disinhibited social engagement disorder -
-characterized by aberrant social behaviors in a young child that reflect
grossly negligent parenting and maltreatment that disrupted the
development of normal attachment behavior; A diagnosis rests on the
presumption that the cause is caregiving deprivation
- Reactive Attachment Disorder DSM-5 Criteria - -Duration - begins < age 5;
Symptoms - Emotional inhibition, rarely seeking or responding to comfort
when distressed; Social and emotional disturbance: (must have > 2 of these)
↓ emotional/social responsiveness ↓ affect; Fear, sadness or irritability in
non-threatening interactions w/ adults; Hx of insufficient care: Neglect,
Deprivation, Repeated changes in caregivers, Institutional care; Child has
developmental age of > 9 mo; Required number of symptoms - Symptoms in
each category; > 2 of the social/emotional disturbance symptoms; Cannot be
a result of autism spectrum disorder
- reactive attachment disorder prognosis - -children who are later adopted
into caring environments improve int heir attachment behaviors and may
normalize over time, Duration and severity of neglect influence prognosis, as
does the degree of resulting impairment
