Anxiety Disorders

Nursing 201

Introduction

– Anxiety provides the motivation for achievement, a necessary force for survival.

– Anxiety is often used interchangeably with the word stress; however, they are not the same.

– Anxiety may be differentiated from fear in that the former is an emotional process, whereas fear is cognitive.

Epidemiological statistics

– Anxiety disorders are the most common of all psychiatric illnesses

– More common in women than men

– Minority children and children from low socioeconomic environments at risk

– A familial predisposition probably exists

• How much is too much?– When anxiety is out of proportion to the situation that is

creating it.– When anxiety interferes with social, occupational, or other

important areas of functioning.

Assessment

Panic disorder

• Generalized anxiety disorder

• Panic disorder with agoraphobia

Predisposing Factors

• Psychodynamic theory

• Cognitive Theory

• Biological aspects• Transactional Model of Stress

Adaptation

Nursing Diagnosis

Outcomes

Planning/Implementation

PhobiasAssessment• Agoraphobia without history of panic disorder

– Fear of being in places or situations from which escape might be difficult or in which help might not be available if a limited-symptom attack or panic-like symptoms should occur

• Social phobia– Excessive fear of situations in which the affected person might do

something embarrassing or be evaluated negatively by other• Specific phobia

– Marked, persistent, and excessive or unreasonable fear when in the presence of, or when anticipating an encounter with, a specific

object or situation, Animal type, Natural environment type, Blood-injection-injury type, Situational type

Predisposing Factors

Nursing Diagnosis

Outcomes

Planning/Implementation

Evaluation

Obsessive-Compulsive Disorder (OCD)

Assessment

• Obsessions: Unwanted, intrusive, persistent ideas, thoughts, impulses, or images that cause marked anxiety or distress

• Compulsions: Unwanted repetitive behavior patterns or mental acts that are intended to reduce anxiety, not to provide pleasure or gratification

Predisposing Factors

Nursing Diagnosis

Outcomes

Planning/Implementation

Post-traumatic Stress Disorder (PTSD)

– Development of characteristic symptoms following exposure to an extreme traumatic stressor involving a personal threat to physical integrity or to the physical

integrity of others – Characteristic symptoms include reexperiencing the

traumatic event, a sustained high level of anxiety or arousal, or a general numbing of responsiveness. Intrusive recollections or nightmares of the event are common.

• Psychosocial theory– The traumatic experience

• Severity and duration of the stressor• Extent of anticipatory preparation before onset• Exposure to death• Numbers affected by life threat• Extent of control over recurrence• Location where trauma was experienced

– The individual• Degree of ego-strength• Effectiveness of coping resources• Presence of preexisting psychopathology

– Outcomes of previous experiences with stress/trauma– Behavioral tendencies– Current psychosocial developmental stage– Demographic factors

– The recovery environment• Availability of social supports

• Cohesiveness and protectiveness of family and friends

• Attitudes of society regarding the experience

• Cultural and subcultural influences

• Learning theory– Negative reinforcement as behavior that leads to a reduction in an

aversive experience, thereby reinforcing and resulting in repetition of the behavior

– Avoidance behaviors– Psychic numbing

• Cognitive theory– A person is vulnerable to post-traumatic stress disorder when

fundamental beliefs are invalidated by experiencing trauma that cannot be comprehended and when a sense of helplessness and hopelessness prevails.

• Biological aspects– It has been suggested that a person who has experienced

previous trauma is more likely to develop symptoms after a stressful life event.

– Disregulation of the opioid, glutamatergic, noradrenergic, serotonergic, and neuroendocrine pathways may be involved in the pathophysiology of PTSD.

• Transactional Model of Stress Adaptation– The etiology of PTSD is most likely influenced by multiple

factors

Nursing Diagnosis

Outcomes

Planning/Implementation

Client/Family Education

Treatment Modalities

• Psychopharmacology – PTSD

• Antidepressants

• Anxiolytics

• Antihypertensives

• Others