Anxiety, Obsessive-Compulsive, and Trauma-Related Disorders - Cheat Sheet
Your last-minute revision companion for psychiatric-mental health nursing management of anxiety disorders, OCD, PTSD, and dissociative conditions. Master anxiety levels, nursing priorities, drug management, and Philippine mental health law (RA 11036) for exam success.
Anxiety: The Core Concept
Important facts
- Anxiety exists on a CONTINUUM — level determines nursing intervention
- Mild anxiety ENHANCES learning and problem-solving
- Moderate anxiety NARROWS perceptual field but client can still attend if directed
- Severe anxiety and panic SEVERELY REDUCE perceptual field — client cannot learn
- Defense mechanisms (repression, denial, projection, displacement, sublimation) are unconscious ego responses to anxiety
- Defense mechanisms become MALADAPTIVE when overused or rigid
Key definitions
Anxiety
Example
Client worries about 'something bad happening' without identifying the exact threat.
Vague, subjective feeling of apprehension or dread in response to a perceived threat that is often unknown or nonspecific.
Fear
Example
Client fears a specific dog because it bit them before.
Response to a known, identifiable, concrete threat.
Diagrams to know
- Anxiety continuum: mild → moderate → severe → panic
- Perceptual field narrowing as anxiety increases
- Common defense mechanisms and examples
Anxiety Levels and Nursing Response
Important facts
- NEVER attempt teaching during severe anxiety or panic — perceptual field too narrow; use simple, short directions only
- ALWAYS STAY WITH a panicking client — never leave them alone
- Use CALM, REASSURING, LOW voice during panic attacks
- Move client to QUIET, LOW-STIMULATION environment to reduce triggers
- Nursing priority in panic: SAFETY, comfort, and reducing stimulation — NOT problem-solving or teaching
- Once anxiety level decreases, THEN teach about triggers and coping strategies
Key definitions
Mild Anxiety
Example
Student feels alert during exam; mild worry improves focus.
Heightened perceptual field; anxiety acts as motivator for learning and problem-solving.
Moderate Anxiety
Example
Client worries about results but can still listen to nurse teaching if instructions are clear and simple.
Narrowed perceptual field; client can attend if directed; can still process information.
Severe Anxiety
Example
Client has palpitations, tremors, headache; cannot retain any new information; needs comfort and safety focus.
Greatly reduced perceptual field; focus scattered on physical symptoms; cannot process learning.
Panic
Example
Client has uncontrollable fear, may run away, fight, or freeze; believes they are dying or 'going crazy'.
Most extreme anxiety level; loss of rational thought, disorganized behavior, terror, possible loss of control — MEDICAL AND SAFETY EMERGENCY.
Diagrams to know
- Anxiety level pyramid with corresponding perceptual field width
- Nursing intervention matrix: what to do at each anxiety level
Generalized Anxiety Disorder (GAD)
Common values
Value
6 months
Symbol
6 mo
Quantity
Minimum duration for GAD diagnosis
Important facts
- Duration requirement: ≥6 months (distinguishes from acute worry)
- Client USUALLY RECOGNIZES the worry is out of proportion but CANNOT STOP IT
- Associated symptoms: restlessness, fatigue, concentration difficulty, irritability, muscle tension, sleep disturbance
- Chronic condition; often comorbid with depression
- Cognitive-behavioral therapy (CBT) is MAINSTAY of treatment
Key definitions
Generalized Anxiety Disorder
Example
Client worries daily for 7+ months about health, finances, family, work — recognizes worry is excessive but cannot stop it.
Excessive, uncontrollable worry about multiple events/activities occurring more days than not for AT LEAST 6 MONTHS, accompanied by restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance.
Diagrams to know
- GAD diagnostic criteria checklist
- Worry cycle: trigger → worry → physical symptoms → more worry
Panic Disorder
Common values
Value
Minutes (typically 5-10)
Symbol
Peak min
Quantity
Time to peak panic symptoms
Important facts
- Panic attack peaks within MINUTES (distinguishes from GAD, which is gradual)
- Physical symptoms often mimic HEART ATTACK — many ER presentations are panic, not cardiac
- Hyperventilation in panic → HYPOCAPNIA → TETANY and paresthesias (tingling)
- Panic disorder often COMPLICATED BY AGORAPHOBIA
- PRIORITY NURSING INTERVENTION: Slow, controlled breathing; reassurance; safe environment
- Do NOT leave panicking client alone
- Once panic subsides, teach GROUNDING and BREATHING TECHNIQUES for next episode
- SSRIs are first-line pharmacologic; benzodiazepines for acute episodes
Key definitions
Panic Attack
Example
Client suddenly feels chest pain and cannot breathe; convinced they are having a heart attack; actually a panic attack.
Abrupt surge of intense fear that peaks within MINUTES with cardiac, respiratory, neurologic, and cognitive symptoms: palpitations, chest pain, SOB, choking, dizziness, trembling, sweating, paresthesias, derealization, fear of dying or 'going crazy'.
Panic Disorder
Example
After first panic attack, client avoids situations (car, public places) for fear another attack will occur.
Recurrent, UNEXPECTED panic attacks causing persistent worry about future attacks or behavioral change.
Agoraphobia
Example
Client avoids crowded places, elevators, leaving home alone because fears panic attack in inescapable situation.
Fear of situations from which escape is difficult or where help would be unavailable if panic occurs; often complicates panic disorder.
Diagrams to know
- Panic attack symptom cluster
- Hyperventilation → hypocapnia → alkalosis → symptoms cycle
- Panic attack vs. heart attack differential presentation
Phobias
Important facts
- Phobia = IRRATIONAL and EXCESSIVE (fear is out of proportion to real danger)
- AVOIDANCE is hallmark (avoidance reinforces phobia)
- Behavioral therapy (SYSTEMATIC DESENSITIZATION or FLOODING) is GOLD STANDARD
- Systematic desensitization = GRADUAL exposure + RELAXATION (step-by-step, client-paced)
- Flooding = PROLONGED exposure to feared stimulus until anxiety naturally decreases (rapid but intense)
- Nurse SUPPORTS client through exposure without FORCING confrontation
- SSRIs used adjunctively; benzodiazepines for acute anxiety during exposure therapy
Key definitions
Phobia
Example
Client fears heights so much they refuse to go above first floor; avoids bridges, airplanes, balconies.
Persistent, IRRATIONAL, EXCESSIVE fear of a specific object or situation, leading to AVOIDANCE.
Specific Phobia
Example
Fear of injections (needle phobia); client avoids medical care.
Fear of specific object/situation: animals, heights, blood, injections, enclosed spaces, flying.
Social Anxiety Disorder (Social Phobia)
Example
Client fears public speaking, eating in front of others, using public restrooms; isolates to avoid embarrassment.
Fear of scrutiny, judgment, or embarrassment in social/performance situations; avoids social contact.
Diagrams to know
- Systematic desensitization hierarchy: least to most feared situations
- Avoidance cycle: trigger → fear → avoidance → temporary relief → avoidance reinforces phobia
- Exposure therapy: fear curve showing habituation over time
Obsessive-Compulsive Disorder (OCD)
Common values
Value
>1 hour per day
Symbol
>1 hr/d
Quantity
Minimum time spent on obsessions/compulsions to meet OCD diagnosis
Important facts
- KEY PRINCIPLE: THE RITUAL IS THE CLIENT'S MEANS OF CONTROLLING ANXIETY
- NEVER ABRUPTLY STOP OR INTERRUPT the ritual early in treatment — ESCALATES ANXIETY
- ALLOW TIME FOR THE RITUAL while GRADUALLY setting reasonable limits as client improves
- Protect SKIN INTEGRITY if washing rituals cause breakdown (skin care, barriers)
- Provide STRUCTURED SCHEDULE of activities to reduce ritual time gradually
- RESPONSE PREVENTION and EXPOSURE THERAPY are evidence-based; client learns anxiety decreases WITHOUT ritual
- Cognitive-behavioral therapy (CBT) is primary; SSRIs (especially fluoxetine) are first-line pharmacologic
- Convey ACCEPTANCE of person while REDUCING ritual time and duration
- Common obsessions: contamination, harm, sexuality, religion, need for symmetry/exactness
- Common compulsions: washing, checking, counting, arranging, repeating, seeking reassurance
Key definitions
Obsessions
Example
Repeated thoughts of contamination from germs; fear of harm to family; repeated doubt about safety.
Recurrent, INTRUSIVE, UNWANTED thoughts, urges, or images that cause marked anxiety or distress; person tries to suppress or ignore them.
Compulsions
Example
Excessive handwashing (contamination obsession); repeated checking doors/stove (harm/doubt obsession); counting or arranging (perfectionism).
Repetitive BEHAVIORS or MENTAL ACTS person feels DRIVEN to perform to reduce anxiety or prevent dreaded event; are time-consuming and impairing.
Obsessive-Compulsive Disorder
Example
Client spends 3 hours daily washing hands until skin bleeds; recognizes it's irrational but cannot stop.
Presence of obsessions AND/OR compulsions that are time-consuming (>1 hour daily), cause significant distress, and impair functioning; person usually recognizes obsessions/compulsions as EXCESSIVE.
Diagrams to know
- OCD cycle: obsession → anxiety → compulsion → temporary relief → obsession returns
- Response prevention model: block compulsion → anxiety increases initially → then naturally decreases → habituation
- Common obsession-compulsion pairs
Post-Traumatic Stress Disorder (PTSD)
Common values
Value
>1 month
Symbol
>1 mo
Quantity
Minimum duration for PTSD diagnosis
Value
3 days to 1 month
Symbol
3d-1mo
Quantity
Duration for acute stress disorder
Important facts
- PTSD duration requirement: >1 MONTH (acute stress disorder is <1 month)
- MUST have exposure to actual/threatened death, serious injury, or violence (not just hearing about it secondhand)
- FOUR symptom clusters: intrusion, avoidance, mood/cognition, hyperarousal (must have symptoms in EACH cluster)
- COMMON COMORBIDITIES: DEPRESSION, SUBSTANCE USE/ABUSE, SUICIDE RISK — ALWAYS ASSESS
- Philippine context: PTSD recognized after typhoons, earthquakes, armed conflict; RA 11036 supports disaster mental health
- NURSING PRIORITY: Establish TRUST and SAFETY FIRST
- Allow client to talk about trauma at THEIR OWN PACE without pressuring disclosure
- Provide NONJUDGMENTAL, SUPPORTIVE relationship
- Teach GROUNDING (5-4-3-2-1 technique) and RELAXATION for flashbacks
- Help re-establish ROUTINES, SLEEP, SOCIAL SUPPORT
- Trauma-focused cognitive-behavioral therapy (TF-CBT) is evidence-based
- Eye-movement desensitization and reprocessing (EMDR) is alternative evidence-based therapy
- SSRIs are first-line pharmacologic; monitor for suicidality and substance use
Key definitions
Post-Traumatic Stress Disorder
Example
Survivor of armed conflict/typhoon/accident experiences flashbacks, avoids reminders, feels numb/detached, hypervigilant, 2+ months after event.
Develops after exposure to actual or threatened DEATH, SERIOUS INJURY, or VIOLENCE with 4 symptom clusters: intrusion, avoidance, negative mood/cognition alterations, hyperarousal — LASTING >1 MONTH.
Acute Stress Disorder
Example
Victim of robbery has nightmares and avoidance for 2 weeks — acute stress disorder; if continues 6+ weeks, PTSD.
Similar to PTSD but occurs WITHIN 3 DAYS TO 1 MONTH of trauma; if symptoms continue beyond 1 month, diagnosis becomes PTSD.
Intrusion Symptoms
Example
Client hears loud noise; suddenly flashbacks to combat/accident as if it's happening now; sweating, heart racing.
FLASHBACKS (feels like trauma is happening now), NIGHTMARES, distressing memories, emotional distress when exposed to reminders, physical reactivity to cues.
Avoidance Symptoms
Example
Assault survivor avoids dark places, won't discuss event, changes route to avoid location of assault.
Active avoidance of thoughts/feelings/conversations about trauma and avoidance of external reminders (places, people, activities).
Negative Alterations in Mood/Cognition
Example
Client thinks 'it's my fault,' 'I'm bad,' 'nobody understands me'; feels empty; withdrawn from friends/activities.
Persistent distorted blame of self/others, persistent negative emotions (fear, anger, guilt, shame), diminished interest/participation, detachment, inability to remember trauma, numbing.
Hyperarousal Symptoms
Example
Client jumps at any sound, scans environment constantly, irritable with family, insomnia.
Exaggerated STARTLE response, hypervigilance, irritability/aggression, reckless/self-destructive behavior, concentration difficulty, sleep disturbance.
Diagrams to know
- PTSD symptom clusters and examples
- Trauma cycle: trigger → flashback → avoidance → isolation → worsening
- Grounding technique: 5 senses approach
- Difference between acute stress disorder and PTSD timeline
Dissociative Disorders
Important facts
- Dissociation is DEFENSE MECHANISM against overwhelming trauma/stress
- PRIORITY NURSING FOCUS: SAFETY (high risk for self-harm/harm to others)
- Provide CALM, SECURE environment; consistent, trustworthy staff
- BUILD TRUST slowly; do NOT FORCE trauma recall
- Avoid FLOODING client with information about trauma before therapeutic alliance established
- Help client recognize and COPE WITH STRESSORS that trigger dissociation
- Teach GROUNDING techniques to maintain connection to present/reality
- Keep environment low-stimulation; use SIMPLE, CLEAR communication
- Document carefully — memory gaps, behavioral changes, personality switches
- Trauma-focused therapy; sometimes medication for comorbid depression/anxiety
Key definitions
Dissociative Disorders
Example
Client 'blanks out' during stress; loses time; feels detached from body/surroundings.
Disruption in normally integrated functions of consciousness, memory, identity, or perception — usually defense against overwhelming trauma or stress.
Dissociative Amnesia
Example
Abuse survivor cannot remember childhood; wanders away from home with no memory of identity (fugue).
Inability to recall important personal information (usually traumatic) beyond ordinary forgetfulness; may include dissociative FUGUE (sudden travel with loss of identity).
Dissociative Identity Disorder
Example
Client switches between different personality states with different names, ages, memories, behaviors; each state unaware of others.
Presence of TWO or MORE distinct personality STATES with gaps in memory between them; formerly called 'multiple personality disorder'; usually severe trauma history.
Depersonalization/Derealization Disorder
Example
Client says 'I feel like I'm watching myself from outside my body' or 'the world looks like a movie.'
Persistent feelings of DETACHMENT FROM OWN BODY (depersonalization) or SURROUNDINGS (derealization); person feels like observer of self; world feels unreal.
Diagrams to know
- Dissociative continuum: normal → depersonalization/derealization → dissociative amnesia → DID
- Dissociation as response to trauma
- Grounding techniques for dissociative episodes
Pharmacology: SSRIs (Selective Serotonin Reuptake Inhibitors)
Common values
Value
2-4 weeks (up to 6)
Symbol
2-4w
Quantity
Therapeutic lag for SSRIs
Value
2 weeks minimum
Symbol
2w
Quantity
Washout time between SSRI and MAOI
Important facts
- FIRST-LINE agent for GAD, panic, phobias, OCD, PTSD, social anxiety
- Examples: FLUOXETINE (Prozac), SERTRALINE (Zoloft), PAROXETINE (Paxil), ESCITALOPRAM (Lexapro), FLUVOXAMINE (Luvox)
- FULL THERAPEUTIC EFFECT: 2-4 weeks (sometimes up to 6 weeks) — TEACH CLIENT NOT TO STOP EARLY
- Common EARLY side effects: nausea, headache, insomnia OR drowsiness, SEXUAL DYSFUNCTION (major adherence issue)
- NEVER STOP ABRUPTLY — taper to prevent DISCONTINUATION SYNDROME (dizziness, flu-like symptoms, irritability, 'brain zaps')
- MONITOR for INCREASED SUICIDAL IDEATION in first weeks, especially adolescents/young adults (as energy improves before mood lifts — increased ability to act on SI)
- SEROTONIN SYNDROME risk: NEVER combine SSRI with MAOI; observe 2-week washout between; AVOID triptans, tramadol, St. John's wort
- Serotonin syndrome symptoms: HYPERTHERMIA, agitation, tremor, hyperreflexia, clonus, diaphoresis, autonomic instability — MEDICAL EMERGENCY
- Teach: adherence essential, report suicidal thoughts immediately, avoid alcohol, no sudden stopping
Key definitions
SSRIs
Example
Fluoxetine, sertraline, paroxetine, escitalopram, fluvoxamine.
FIRST-LINE pharmacologic treatment for anxiety, OCD, PTSD, panic disorder; selective increase serotonin availability; safer in overdose than older agents.
Diagrams to know
- SSRI timeline: early side effects → therapeutic lag → full effect
- Serotonin syndrome: symptom cluster and management
- SSRI drug-drug interactions to avoid
Pharmacology: Benzodiazepines
Common values
Value
2-4 weeks (short-term)
Symbol
2-4w
Quantity
Typical duration of benzodiazepine therapy
Important facts
- Examples: LORAZEPAM (Ativan), DIAZEPAM (Valium), ALPRAZOLAM (Xanax), CLONAZEPAM (Klonopin), CHLORDIAZEPOXIDE (Librium)
- RAPID ONSET — ideal for acute panic/anxiety; NOT suitable for chronic anxiety management
- HIGH RISK of TOLERANCE, DEPENDENCE, WITHDRAWAL with prolonged use
- Cause CNS DEPRESSION — sedation, drowsiness, impaired coordination; caution re: driving, machinery, FALLS in elderly
- NEVER MIX WITH ALCOHOL or other CNS depressants — risk of FATAL RESPIRATORY DEPRESSION
- DO NOT DISCONTINUE ABRUPTLY after regular use — withdrawal can cause REBOUND ANXIETY, tremors, SEIZURES (medical emergency)
- MUST TAPER GRADUALLY over weeks/months per protocol
- Best for SHORT-TERM crisis use (2-4 weeks typically); use in acute panic attacks, severe anxiety, acute alcohol withdrawal
- FLUMAZENIL is REVERSAL AGENT for benzodiazepine overdose
- Monitor for RESPIRATORY DEPRESSION, especially in elderly, respiratory disease, or with opioids
- Teach: dependence risk, never stop abruptly, avoid alcohol, report respiratory symptoms
Key definitions
Benzodiazepines
Example
Lorazepam (Ativan), diazepam (Valium), alprazolam (Xanax), clonazepam (Klonopin), chlordiazepoxide (Librium).
Enhance GABA; provide RAPID RELIEF of acute anxiety/panic; used SHORT-TERM due to high dependence/tolerance risk.
Diagrams to know
- Benzodiazepine withdrawal timeline and symptoms
- Benzodiazepine vs. SSRI comparison: onset, duration, dependence, uses
- Tapering schedule conceptualization
Pharmacology: Buspirone and Other Agents
Common values
Value
2-4 weeks
Symbol
2-4w
Quantity
Buspiron onset time
Important facts
- BUSPIRONE: serotonin 1A agonist; NO dependence; NO sedation; works in 2-4 weeks; for CHRONIC anxiety
- NOT effective for acute panic — takes too long
- Fewer side effects than benzodiazepines; better for long-term chronic anxiety
- Other agents: propranolol (beta-blocker for performance anxiety symptoms); hydroxyzine (sedating antihistamine for acute anxiety)
- Medication ALWAYS paired with therapy — medication alone is rarely sufficient
Key definitions
Buspirone
Example
Client with chronic GAD takes buspirone daily; not suitable for panic attack in ER.
Non-benzodiazepine anxiolytic; does NOT cause dependence; NO SEDATION; takes 2-4 weeks to work; used for CHRONIC anxiety, NOT acute panic.
Diagrams to know
- Anxiety medication comparison: onset, duration, dependence, uses
Philippine Mental Health Law and Context
Important facts
- RA 11036 protects CLIENT RIGHTS: dignity, privacy, informed consent, least restrictive environment
- Emphasizes COMMUNITY-BASED mental health services, not just hospital/institution-based care
- INTEGRATES mental health into general healthcare systems
- Mandates anti-stigma programs and prevention
- Nurse must practice per RA 9173 (Nursing Practice Act) AND RA 11036 (Mental Health Act)
- Philippine healthcare delivery includes barangay health centers, rural health clinics, community mental health services
- Disaster mental health response supported by RA 11036 (relevant to PTSD from typhoons, earthquakes, conflict)
- Nurse role: advocate for client rights, ensure informed consent, facilitate community integration, reduce stigma
Key definitions
Mental Health Act (Republic Act No. 11036)
Example
Nurse counsels panic disorder client about community mental health clinic options; ensures client understands treatment options before medication starts.
Philippine law affirming CLIENT RIGHTS to humane, non-discriminatory, community-based mental health services and INFORMED CONSENT; reduces stigma; promotes integration in community.
Diagrams to know
- Philippine mental health services structure: barangay level → municipal/city → provincial → national
Nursing Process and Diagnoses
Important facts
- PRIORITIZATION per Maslow: SAFETY first (suicide risk, self-harm), then physiologic (sleep, nutrition), then psychosocial (coping, relationships)
- Assessment: Use standardized anxiety scales (Generalized Anxiety Disorder 7-item scale [GAD-7]; Panic Disorder Severity Scale [PDSS])
- Planning: Client-centered goals with measurable outcomes and realistic timelines
- Intervention: Therapeutic relationship, anxiety-reduction techniques, medication management, coping skills, psychoeducation, family/community support
- Evaluation: Did anxiety decrease? Did client learn coping strategies? Is client adherent to treatment? Is client safe?
- Document: Client subjective experience, objective signs, interventions performed, client response, progress toward goals
- Nursing considerations per NCM levels: Level 3 (community-based care) emphasizes prevention, health promotion, support groups; Level 2 (facility-based) includes crisis intervention, medication management
Key definitions
NANDA Nursing Diagnoses (anxiety disorders)
Example
Diagnosis: Anxiety (panic disorder) related to perceived threat/stressor as evidenced by palpitations, shortness of breath, fear of dying.
Anxiety, ineffective coping, disturbed sleep pattern, social isolation, low self-esteem, risk for self-harm.
Diagrams to know
- Nursing process cycle for anxiety disorders
- NANDA diagnosis formulation: Problem related to etiology as evidenced by signs/symptoms
- Maslow hierarchy applied to mental health priorities
Must remember
- ANXIETY LEVELS: Mild → Moderate → Severe → Panic. As anxiety increases, perceptual field NARROWS and ability to LEARN DROPS. During panic: stay with client, use simple directions, reduce stimulation, guide slow breathing. NEVER teach a panicking client.
- PANIC ATTACK vs. HEART ATTACK: Panic has rapid onset, peaks in minutes, hyperventilation → hypocapnia → tetany/paresthesias. Physical symptoms mimic MI. Priority: slow breathing, reassurance, safe environment.
- OCD KEY PRINCIPLE: The ritual is the client's means of CONTROLLING ANXIETY. NEVER abruptly interrupt rituals early in treatment — this ESCALATES anxiety. ALLOW time for ritual while GRADUALLY setting limits. Response prevention therapy teaches client anxiety DECREASES without ritual.
- PTSD vs. ACUTE STRESS DISORDER: Both have same 4 symptom clusters (intrusion, avoidance, mood/cognition, hyperarousal). Acute stress disorder = <1 month; PTSD = >1 month. If symptoms continue past 1 month, diagnosis becomes PTSD.
- SSRIs (fluoxetine, sertraline, etc.): FIRST-LINE for anxiety disorders, OCD, PTSD, panic. FULL EFFECT takes 2-4 weeks — teach client NOT to stop early. Monitor for SUICIDAL IDEATION in first weeks (especially youth). NEVER combine with MAOI — serotonin syndrome risk. NEVER stop abruptly — taper to prevent discontinuation syndrome.
- BENZODIAZEPINES (lorazepam, diazepam, alprazolam): RAPID onset; best for ACUTE panic/anxiety SHORT-TERM (2-4 weeks). HIGH dependence and withdrawal risk. DO NOT stop abruptly — taper gradually to prevent withdrawal seizures. AVOID alcohol (fatal respiratory depression). FLUMAZENIL reverses overdose.
- DISSOCIATIVE DISORDERS: Priority is SAFETY (high self-harm risk). Build trust slowly; provide calm, secure environment; do NOT force trauma recall; teach grounding techniques; consistent staff. Client may not remember interactions between dissociative episodes.
- PHOBIAS: IRRATIONAL, EXCESSIVE fear of specific object/situation → avoidance (which reinforces phobia). Treatment: SYSTEMATIC DESENSITIZATION (gradual exposure + relaxation, client-paced) or FLOODING (prolonged exposure). Nurse SUPPORTS exposure without forcing.
- GAD DIAGNOSIS: ≥6 MONTHS excessive worry about multiple topics; cannot control it; restlessness, fatigue, concentration difficulty, irritability, muscle tension, sleep disruption. CBT is mainstay; SSRIs for pharmacologic support.
- RA 11036 (MENTAL HEALTH ACT): Affirms client rights to HUMANE, NON-DISCRIMINATORY, COMMUNITY-BASED mental health services and INFORMED CONSENT. Nurse role: advocate for client rights, ensure informed consent, reduce stigma, facilitate community integration. Supports disaster mental health (typhoons, earthquakes, conflict in Philippines).
Last minute tips
- ANXIETY LEVEL QUESTION TRAP: If asked 'what nursing action during panic attack?' → STAY WITH CLIENT + SLOW BREATHING + QUIET ENVIRONMENT + SIMPLE DIRECTIONS. Do NOT chart patient history, do NOT teach coping (perceptual field too narrow), do NOT leave client alone.
- OCD RITUAL TRAP: If question asks 'client doing handwashing ritual — what is best response?' → DO NOT interrupt, stop, or prevent ritual abruptly. Instead: allow time, gradually set limits, teach response prevention in therapy phase. Many students incorrectly answer 'stop the ritual immediately.'
- SSRI TIMING TRAP: If question states 'client on fluoxetine 1 week, reports no improvement' → Correct response is 'continue medication; allow 2-4 weeks for full effect.' Many students incorrectly change medication too early. Also: monitor for SI in first 2 weeks as energy improves before mood lifts.
- PTSD vs. ACUTE STRESS DISORDER TIMELINE: Acute stress disorder <1 month; PTSD >1 month. If question gives timeline of trauma 6 weeks ago + symptoms → answer PTSD. If 2 weeks post-trauma → acute stress disorder. Duration is KEY differentiator.
- BENZODIAZEPINE WITHDRAWAL EMERGENCY: If question about patient on benzodiazepine regularly who stopped abruptly → anticipate WITHDRAWAL SEIZURES, rebound anxiety, tremors. Answer should include: taper gradually, never stop abruptly, seizure precautions, monitor vitals. Flumazenil reverses overdose (not withdrawal).
Comparison tables
Anxiety Levels: Characteristics and Nursing Response
| Anxiety Level | Perceptual Field | Client Can Learn? | Physical Symptoms | Nursing Priority | Intervention Focus |
|---|---|---|---|---|---|
| MILD | HEIGHTENED; alert | YES — optimal for learning | Minimal | Motivate; facilitate problem-solving | Teaching, positive reinforcement |
| MODERATE | NARROWED; focused | YES — if directed; can attend | Present but manageable | Maintain focus; provide structure | Clear, simple instructions; support coping |
| SEVERE | GREATLY REDUCED; scattered details | NO — cannot process learning | Headache, palpitations, tremors, GI symptoms | SAFETY and comfort; reduce stimulation | Stay present; calm reassurance; move to quiet space; simple directions only |
| PANIC | LOST; disorganized | NO — no rational thought; cannot learn | SEVERE: chest pain, SOB, terror, loss of control, feels like dying | IMMEDIATE SAFETY; prevent harm; reduce stimulation | STAY WITH CLIENT; calm voice; slow breathing; guided; quiet environment; may need emergency care |
Anxiety Disorders: Quick Comparison
| Disorder | Key Feature | Duration | Triggers | Avoidance? | Treatment Focus |
|---|---|---|---|---|---|
| GAD | Excessive worry multiple topics | ≥6 months | Nonspecific; multiple | Usually NO | CBT; SSRIs; relaxation |
| Panic Disorder | Recurrent panic attacks (abrupt, peaks in min) | Recurrent | UNEXPECTED; often no clear trigger | YES — situations where attack feared (agoraphobia) | Breathing techniques; SSRIs; benzodiazepines acute; CBT |
| Specific Phobia | Irrational fear specific object/situation | Lifelong if untreated | Specific object/situation (heights, dogs, needles) | YES — strong avoidance | Systematic desensitization; exposure therapy |
| Social Anxiety | Fear of social scrutiny/judgment | Lifelong if untreated | Social/performance situations | YES — avoids social contact | Exposure therapy; SSRIs; social skills training |
| OCD | Obsessions + compulsions for control | Lifelong; waxes/wanes | Intrusive thoughts; need for control/symmetry | Ritual temporarily relieves | RESPONSE PREVENTION; exposure; SSRIs; CBT |
| PTSD | Trauma → intrusion, avoidance, hyperarousal | >1 month post-trauma | Reminders of specific trauma | YES — avoids trauma reminders | TF-CBT; EMDR; build safety/trust; SSRIs |
Medication Comparison: SSRIs vs. Benzodiazepines vs. Buspirone
| Agent | Onset | Duration of Effect | Dependence Risk | Best Use | Key Caution | Nursing Teaching |
|---|---|---|---|---|---|---|
| SSRIs (fluoxetine, sertraline, etc.) | 2-4 weeks full effect | Long-term (stay in system) | NO dependence | Chronic anxiety, OCD, PTSD, panic (long-term) | Suicidal ideation early; serotonin syndrome if mixed with MAOI/triptans; sexual dysfunction | Take as prescribed; allow 2-4 weeks; don't stop abruptly; report SI; avoid alcohol |
| Benzodiazepines (lorazepam, diazepam, etc.) | Minutes to 1 hour | 2-4 hours typically | HIGH — tolerance, dependence, withdrawal seizures | Acute panic/anxiety crisis (2-4 weeks max) | Respiratory depression; fall risk; withdrawal seizures if stopped abruptly; CNS depression | Take as prescribed; short-term only; never stop abruptly; avoid alcohol; report respiratory symptoms |
| Buspirone | 2-4 weeks | Chronic management | NO dependence | Chronic anxiety (NOT acute panic) | Slower than SSRIs; not for acute crisis | Take regularly; allow 2-4 weeks; not for panic attacks; report no improvement after 4 weeks |
Trauma-Related Disorders: Acute Stress Disorder vs. PTSD
| Aspect | Acute Stress Disorder | PTSD |
|---|---|---|
| ONSET | Within 3 days of trauma | Can be days to months/years after trauma |
| DURATION of SYMPTOMS | 3 days to 1 month | >1 month (often months/years) |
| SYMPTOMS | Intrusion, avoidance, mood/cognition changes, hyperarousal (same as PTSD) | Same 4 clusters (intrusion, avoidance, mood/cognition, hyperarousal) |
| DIAGNOSIS PATH | If symptoms PERSIST >1 month → diagnose PTSD (not acute stress disorder) | PTSD is the diagnosis if >1 month post-trauma |
| EXAMPLE | Survivor of typhoon has nightmares, avoidance, hypervigilance for 2 weeks | Same survivor still has symptoms 6 weeks later → PTSD |
Dissociative Disorders Quick Reference
| Disorder | Key Feature | Memory Status | Identity | Nursing Priority |
|---|---|---|---|---|
| Dissociative Amnesia | Cannot recall personal info (usually trauma) | Memory gaps for traumatic period | Single identity intact | Safety; grounding; build trust |
| Dissociative Fugue | Amnesia + sudden travel/relocation | Cannot remember identity | Loss of identity during fugue | Safety; prevent harm; re-orient |
| Dissociative Identity Disorder | Two+ distinct personality states | Gaps between states; states unaware of each other | Multiple identities with different names, ages, traits | Safety (highest risk); consistent staff; grounding |
| Depersonalization/Derealization | Persistent detachment from body or surroundings | Normal memory | Single identity maintained but feels 'outside' self | Reality orientation; grounding; reassurance |
OCD vs. Generalized Anxiety Disorder
| Feature | OCD | GAD |
|---|---|---|
| CORE SYMPTOM | OBSESSIONS (intrusive unwanted thoughts) + COMPULSIONS (repetitive behaviors to reduce anxiety) | EXCESSIVE WORRY about multiple topics; no compulsions |
| PATTERN | Thought → anxiety → RITUAL (compulsion) → temporary relief → thought returns | Worry → fatigue/restlessness/muscle tension; no ritual; worry continuous |
| INSIGHT | Person USUALLY recognizes obsessions/compulsions as IRRATIONAL | Person RECOGNIZES worry is excessive BUT CANNOT STOP |
| NURSING APPROACH | DO NOT interrupt ritual; allow time; gradually set limits; response prevention therapy | Support coping; teach relaxation; problem-solve; provide structure |
| TREATMENT | Response prevention + exposure therapy; SSRIs (especially fluoxetine); CBT | CBT; SSRIs; relaxation techniques |
Diagrams
Nursing Management of Panic Attack: Immediate Response Algorithm
Step-by-step flowchart showing the priority nursing interventions during an acute panic attack, emphasizing safety, staying with client, managing acute symptoms, and postponing teaching until anxiety decreases.
Anxiety Disorders: Comprehensive Classification and Management
Comprehensive mind map organizing all anxiety and trauma-related disorders covered in the chapter, showing key diagnostic features and primary management approaches for each condition.
OCD Cycle and Response Prevention Model
Dual flowchart showing the OCD anxiety-compulsion cycle and how response prevention therapy breaks the cycle by preventing the ritual while anxiety habituates naturally.
PTSD and Acute Stress Disorder: Timeline and Diagnosis Progression
State diagram showing the temporal progression from trauma exposure through acute stress disorder to PTSD diagnosis, clarifying the critical >1 month threshold for PTSD diagnosis.
Medication Decision Tree: Anxiety Disorders Treatment
Decision flowchart guiding medication selection based on acuity (acute vs. chronic anxiety) and client preferences, emphasizing that medication is paired with psychotherapy for all anxiety disorders.
SSRI Timeline: What to Expect
Timeline illustrating what clients should expect when starting SSRIs, highlighting the critical 2-4 week lag, early side effects, and importance of monitoring for suicidal ideation in the first weeks.
Systematic Desensitization for Phobias: Hierarchy and Process
Flowchart showing the step-by-step process of systematic desensitization for phobias, emphasizing the hierarchy approach, pairing with relaxation, and client-paced progression without forcing confrontation.
Philippine Mental Health Service Delivery Levels (RA 11036 Implementation)
Distribution pie chart showing the levels of mental health service delivery in the Philippine healthcare system under RA 11036, emphasizing community-based and decentralized approach to mental health care.