2009 Anxiety Disorders Lecture

8/8/2019 2009 Anxiety Disorders Lecture

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NUR 2520

Anxiety

andAnxiety Disorders


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Topics Coveredy Stress

y Stress Management

y Understanding Anxietyy Defense Mechanisms

yAnxiety Disorders

y Somatoform Disorders

y Dissociative Disorders


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KEY TERMSy Internal Locus of Control- assume personal

responsibility for managing ones life.

y

Resilience-

toughness, ability to bounce back

yAdaptation- on going process

y Coping- what a person does in response tointerruptions caused by stress


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INTRODUCTIONy Stress is.the bodys arousal response to any

demand, change,or perceived threat

yAnxiety is a diffuse, apprehensivenessassociated with feelings of uncertainty andhelplessness. It is subjective,

y Fear is the intellectual appraisal of danger

y Coping mechanisms are resources to deal with

stress and anxiety. There are 2 types: taskoriented reactions, Ego defense mechanisms


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STRESS AS AN ETIOLOGICAL FACTOR IN ILLNESS

y Stressors have beenassociated with adownward alterationin immune function.

Factors that determinepersons response tostress

y Number of stressorsy Intensity of stressory

Duration of stressory Perception of controly Past experiencesy Capacity for coping


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Stress as a response

Hans Selye-General Adaptation Syndrome (GAS)

3 stages of GAS

1. alarm phase- fight or flight

2. resistance- tries to adapt

3. exhaustion- depletion of energy

Individual perception of stressful event is seen as a major

influence on mind-body response


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Stress as a stimulus

May be positive or negative

May be endogenous-internally (ex. Biochemical,

sickness, diseases)May be exogenous-externally (financial, past, divorce)

According to Selye and Porth, the stimulus elicits anadaptive response that requires an expenditure ofenergy and a change in the normal pattern of living


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Holmes andRahe Social Readjustment Scale

y Contains both positive and negative life changes

y

The severity of each event is assigned a numerical valuey The stress level is correlated with the total number and

severity of life changes the person has encountered duringthe recent past

y Persons who experience a high level of stress are moreprone toward illness and have lower coping abilitywithsubsequent stress


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examples ofpsychosocial stressors

y Daily situations

y Frustrations

y Life eventsy Major disasters

yWar, terrorism


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Mediating Factorsy Individual and Social Factors

y Spirituality

y Culture


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Holistic Model Responses to Stressy Fight or Flight response

y General Adaptation Theory

y Psychoneuroimmunological model


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Some Healthy Coping Activities

y Guided Imagery- cancer pty Deep Breathingy Meditationy Progressive relaxationy Mindful WalkingyJournalingy Biofeedbacky Restructuring and setting priotitiesy Humory Exercising, Dancingy Musicy

Pets


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LEVE

LS OF ANXIETY

y Mild tension of daily living (long line in grocerystore, ice cream going to melt)

y

Moderate focus on immediate concerns, narrowsperceptual field (taking a test)

y Severe- behavior aimed at getting relief, unable tofocus, oblibious to surroundings, confused

y Panic-dread, terror, increased motor acitivity,distorted perception- psych pt

Varcarolis Table 13-1 p. 214


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Freuds Ego Defense Mechanisms

yAre a major way of managing conflict and affect

y Relativelyuncounscious

y Discrete from one another

y They are reversible

yAdaptive as well as maladaptive

y See pps 218-221 Varcarolis


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ANXIETY DISORDERS

THEORY

y GENETIC tend to cluster in families

y BIOLOGICAL-limbic system

y BIOCHEMICAL

y NEUROANATOMICAL


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y GABA benzodiazepine theory- ur gonna have anxiety

y carbon dioxide if inhale it gives u anxiety

y Changes in anatomy of brain (hippocampus isreduced)


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Psychological Theoriesy Freud- threatened breakthrough ofrepressed ideas or

emotions from the unconscious into consciousness.

Ego defense mechanisms are used to keep anxiety atmanageable levels


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Ego Defense Mechanisms

Defenses against Anxiety


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Cultural TheoriesSociocultural variations

- Panic attacks

- Stoic- do not showemotion- Intellectualizes

- Somatic

- Magic

- Rituals


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Anxiety Disorders

terms and conceptsGAD-general anxiety disorder

Phobia

ObsessionsCompulsions

Panic disorders

Post Traumatic Stress Disorder


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PrevalenceMost common form of psychiatric disorder in the

US


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ANXIETY DISORDERSy PREVALENCE

yAffecting 13.3% of Americans ages 18-54 years-

oldy Produces considerable functional impairment and

distress

y COMORBIDITY

y

Major depressiony Substance abuse


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ANXIETY DISORDERS

THEORY- continuedy PSYCHOLOGICAL

y FREUD

y LEARNING

y COGNITIVE

y CULTURAL CONSIDERATION


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PANIC DISORDER (P.D.)y Panic disorder(P.D.)

y Assessment

y Characterized by recurrent panic attacks, onset ofwhich are unpredictable.

y Manifested by intense apprehension, fear, or terror

associated with feelings of impending doom and

intense physical discomfort.


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Panic Attack - Characteristicsy Flight and fight symptoms

y Racing heart, chest pains, dizziness and nausea,

chocking sensations, breathing difficulties,numbness and tingling, trembling and diaphoresis

y Feelings of having a heart attack

y Feelings of going crazy

y Fear of loss of control

y Decreased perceptual ability

y Decreased cognitive abilities


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Panic Disorder with AgoraphobiayAssessment

y Characterized by same symptoms

characteristic of panic disorder.y In addition, affected person experiences a

fear of being in places or situations fromwhich escape might be difficult or in which

help might not be available in the event of apanic attack


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Generalized anxiety disorder

(G.A.D.)

y Assessment

y Characterized by chronic, unrealistic, and

excessive anxiety and worry lasting at least

6 mo..

y Restlessness, fatigue, difficult

concentrating, irritability, muscle

tension, sleeping disturbances.


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Panic or G.A.D.

Nursing Diagnosis

y Panic level of anxiety related to real or perceived

threat to biological integrity or self-concept.

y Powerlessness related to impaired

cognition.


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Outcomes

y The clienty

Is able to recognize signs of anxiety and intervene toprevent panic levels.

y Uses coping mechanisms to prevent panic anxietywhen stressful situations occur.

y Verbalizes acceptance of life situations over which he

or she has no control.


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Planning/Implementation

For severe or panic anxiety levels

y Stay with the client and provide support

y

Reduce environmental stimuli- get them to a calm quiteplace

y Keep demands to a minimum- tell them to deep breath

y Encourage physical activity like walking- encouragegross motor activity

y Administer meds in a timely manner

y Assist in relaxation breathing techniques

y Teach to limit nicotine, caffeine

y Promote sleep with comfort measures


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PHOBIAS

AA persistent irrational fear which ispersistent irrational fear which isout of proportion to the object,out of proportion to the object,

activity or situation.activity or situation.


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Phobias

Assessmenty Specific phobia:

Object or situation

Animal

Environment

Blood, injectionSituation


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Social Phobia:

Assessment

Excessive fearof a social situation or a performance

situation in which the affected person might dosomething embarrassing or be evaluated negatively by

others.


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Agoraphobia

Fear of being in places or situation from which

escape might be difficult or help might not beavailable.


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Phobias

Nursing Diagnosis Fear related to causing embarrassment to self in

front of another, to being in a place from which one is

unable to escape, or to a specific stimulus. Social isolation related to fears of being in a place

from which one is unable to escape.


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Phobias

Outcomes

y The client

y Is able to functions in the presence ofthe phobic object or situation.

y Uses coping mechanisms to maintain

anxiety at a manageable level.

y Voluntarily attends group activities and

interacts with peers.


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Phobias

Implementationy Do not force client to be in contact

with phobic object.

y Help the client describe feelingsprior to a response to a phobic object

y Help identify alterative coping mechanisms to

manage anxiety about encountering a phobic

situationy Practice relaxation techniques with client


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Obsessive-Compulsive

Disorder (OCD)

Assessment data

y Recurrent obsessions or compulsions that are

distressing and time-consuming and produce severedistress and impairment.

y Obsessions- Unwanted persistent thoughts

y Compulsions- Unwanted repetitive actions

y Rituals- Repetitive actions that the person

must do over and over to decrease anxiety


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Obsessive-Compulsive Disorder (OCD)

Nursing Diagnosis

y Ineffective coping related to underdeveloped ego,

possible biochemical changes.y Ineffective role performance related to need to

perform rituals


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Obsessive-Compulsive Disorder

(OCD) Outcomesy The client

y Is able to maintain anxiety at a manageable level.

y

Identifies situations that produce anxiety and result inrituals.

yAble to use more adaptive coping strategies to deal

with stress.

y

Is able to function without the need for ritualisticbehaviors.


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Obsessive Compulsive Disorder

(OCD)

Implementation

y Convey acceptance of the client, despiteritualistic behaviors.

y

Allow time to perform rituals. Never interrupt aritual!

y Encourage limit setting on ritualistic behaviors aspart of the established treatment plan.

y

Use active listening to encourage verbalization offeelings.

y The focus is in the development of moreadaptive methods of coping with anxiety.


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Post-Traumatic Stress Disorder

PTSD

y Reaction to a severe traumatic situation.

y

Re-experiencing traumatic event, nightmaresand flashbacks

y Experiences of persistent numbing of responsiveness,

the person refuses to talk, feels detached or turned off

by others.

y Increased anxiety, irritability, hypervigilance, difficulty

concentrating, high startle response.


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Post-traumatic Stress Disorder

Nursing Diagnosis

yPost-trauma syndrome related todistressing event .

y Dysfunctional grieving related to loss of self or

othersafter the event.

y Disturbed sleep pattern related to intrusive

thoughts, fear.


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Outcomesy The client

y Able to verbalize feelings and attend

support group.

y Can identify goals for future.

y Includes significant others in the recoveryprocess.

y Verbalizes no ideas or intent of self-harm.

y Identifies adaptive coping mechanisms andcommunity resources.

y Gets enough sleep to avoid risk of injury.


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Planning/Implementationy Use implementations to reduce anxiety

(see panic anxiety interventions).

yValidate for the client severity of traumaexperienced.

y Help verbalize his thoughts and feelings.

y Teach about coping mechanisms and support

groups.y Refer to AA, NA if substance abuse is a problem.


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Anxiety Disorders

y Substance Induced- Symptoms of

anxiety due to the use of a substance

or within a month of stopping using it.

y General Medical Condition- Symptoms ofanxiety are a direct physiological result of a

medical condition.


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Client/Family Educationy Teach about Illness

y What is?

y

Symptomsy Management of Illness

y Medications

y Stress Management

y Support servicesy Crisis hotline, support groups, psychotherapy.


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Treatment Modalities

Psychopharmacologyy Antidepressants-

y SSRIs- (1st line treatment)* (PTSD, social

phobias, GAD, Depression)y TCAs- Anafranil (OCD)

y SNRI- Venlafaxine (Effexor)

y MAOIs

y

Anti-Anxiety-y Benzodiazepines

y Buspirone (BuSpar) (GAD, Social phobias)

y B- blockers- (PD, PTSD, Social Phobia)


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Treatment Modalitiesy Individual psychotherapy- getting the pt to verbalize

y Group/family therapy- it affect the family

y Cognitive-behavioral therapy (CBT)- cognition of problem

y Behavior therapyy Relaxation training

y Modeling

y Systematic desensitization- reduce sensitation slowly

y

Floodingy Thought stopping- hit yourself with ruber band before

thought

y Milieu


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Treatment Modalities

y Exercise

y Meditation

y Relaxation

y Breathing

y Guided Imagery

yHypnosis

y Yoga

y Massage

y Herbal- Valerian, Linden flower tea

Documents

2009 Anxiety Disorders Lecture