Anxiety Disorders

Anxiety

a sense of psychological distress that provides the motivation for achievement, a necessary force for survival

Transient anxiety

a normal response to; job interview, tests, walking in unfamiliar places

T/F-- Feeling anxious, frightened, uneasy, or worried are normal responses to various life experiences that are perceived as disruptive, threatening, or dangerous

true

T/F-- Anxiety and stress are the same

false

Stress

not a disorder, it is a normal part of life and does not have good or bad connotations

Perception of stress is

individualized-- an event that that you perceive as stressful another may not

Stressors

frequently are cited as causes of anxiety

When the mind interprets events as threatening...

...the body responds with the s/s of anxiety

Physiologic response

fight or flight response

Fight or flight response

heart rate blood pressure increases, blood flow to muscles increases, breathing rate increases, perspirations increases, blood clotting increases, saliva production decreases, digestion decreases, immune response decreases, energy-producing stored glycogen is released

Anxiety affects

cognition, psychological, and physical functioning

Mild anxiety

results in improved functioning with heightening awareness

Increasing anxiety

cognitive functioning becomes distorted and the body must endure extended periods of high physical alertness

Anxiety disorder

a group of conditions in which the affected experience persistent anxiety that cannot be dismissed and coping mechanisms are ineffective

Anxiety interferes with

ADLs

Persons with anxiety disorders

feel the core of their personalities are threatened when there is no actual danger

Anxiety vs. fear

anxiety is emotional process, whereas fear is cognitive

Effects of anxiety

sensation, cognition, verbal ability

Mild anxiety includes

heightens sensations, sight, hearing, able to learn and verbalize rationally

Moderate anxiety

begins to dull perceptions can attend to greater sensory input if directed

Severe anxiety

perceptions become increasing distorted, become scattered, disorganized

Panic

perception is grossly distorted, cannot differentiate real from imaginary stimuli

Anxiety requires interventions when

it is of greater than expected intensity based on context, prevents fulfillment of professional, personal, or social roles, is accompanied by flashbacks, obsessions, or compulsions, unable to attend to daily and social activities, lasts longer than expected given the precipitating stress/events

Characteristics of anxiety disorders

most common of all psychiatric illnesses, more common in women, minority children and children from low socioeconomic environments at risk, and a familial predisposition likely exists

Adaptive and maladaptive coping mechanisms for anxiety

withdrawal or retreat from the anxiety-provoking situation, acting-out- the discharge of anxiety through aggression, psychosomatization, avoidance, problem-solving- systematic method for addressing difficult situations

Psychosomatization

physiologic expression of anxiety

Avoidance

evasive behaviors

Barriers of treatments for anxiety disorders

lack of knowledge related to nature and prevalence, lack of knowledge of the positive response to treatments, social stigma, cost 42 billion each year, misdiagnosed and untreated

Neurobiological theories

50% of all affected people have a similarly affected relative, genetic mutation with the development of OCD, body's ability to regulate serotonin and gamma-amino butyric acid (GABA) are likely to lead to anxiety disorders

Hippocampus

processing threatening stimuli and encoding information into memories

Locus coeruleus

initiates responses to danger could be overactive potential for PTSD

Psychological theory

low self-esteem, shy, timid as a child, critical and or anger parents, long term abuse, violence, poverty, anxiety results from conditioning- developed by linking dangerous or fear inducing event with a neutral event

Characteristics of panic

intense apprehension, terror without any real threat accompanied with somatic or cognitive symptoms, over response to stressors, incorrectly perceive circumstances, can feel depersonalized, derealization, chest pain, choking, dizziness, sweating, vertigo, fainting, hot and cold flashes, fear of dying, going crazy

Panic attacks

10-30 min, can continue up to 1 hr

Panic disorder

characterized by recurrent panic attacks, onset of which are unpredictable, and manifested by intense apprehension, fear, or terror, often associated with feelings of impending doom and accompanied by intense physical discomfort

Agoraphobia

characterized by same symptoms of panic disorder, but the individual experiences a fear of being in places or situations from which escape might be difficult or embarrassing or in which help might not be available in the event that a panic attack should occur; the limitations become so severe it diminishes quality of life, leading to depression

Generalized anxiety disorder

chronic, unrealistic, and excessive anxiety and worry for at least 6 months

Characteristics of generalized anxiety disorder

so much discomfort causes interference with ADL's and relationships, persistent and chronic s/s of muscle tension, autonomic hyperactivity, apprehension, feeling "on edge", unable to concentrate, chronic fatigue, impaired sleep patterns, depression

Phobia

persistent irrational fear attached to an object, situation that objectively does not pose a danger, always anticipated and never unexpected, may be simple and specific to certain situations, events, objects

Panic disorder can occur when

phobias are accompanied with panic attacks

Social phobia

compelling fear and desire to avoid situations that involve strangers or scrutiny from others; fear of speaking in front of others, eating and using public bathrooms

Specific phobias

acro(heights), claustro(closed spaces), etc

Nursing diagnosis panic disorders

panic and anxiety related to real or perceived threat to biological integrity or self-concept evidenced by inability to perform ADL's secondary to .............., powerlessness related to impaired cognition evidenced by inability to complete tasks of bathing secondary to....

Client outcomes/goals for anxiety disorders

is able to recognize signs of escalating anxiety, is able to intervene so that anxiety does not reach level of panic, is able to discuss long-term plan to prevent panic anxiety when stressful situations occur, practices techniques of relaxation daily, engages in physical exercise three times a week

Obsessive-compulsive disorder

significant impairment distress, time consuming- more than 1 hr a day

Obsessions

recurrent, intrusive, persistent ideas, thoughts, impulses, cognitively invasive; usually client sees them as repugnant, meaningless, remain preoccupied with them

Compulsions

ritualistic behaviors, clients are compelled to perform them, to prevent or reduce anxiety; can be mild or severe- if not treated can be so uncomfortable it can lead to depression or suicide

Acute stress disorder

occurs within the first month of exposure to extreme trauma (combat, rape, physical assault), symptoms begin shortly after the incident, and usually resolves within 2-28 days

Dissociation

symptom of acute stress disorder that is a state of detachment, dream state, poor memory esp. r/t event- dissociative amnesia

Post-traumatic stress disorder

symptoms continue greater than 1 month, functional impairment or stress, and after 3 months it is considered chronic

Functional impairment or stress

generalized anxiety, intrusive thoughts, flashbacks, nightmares, sleep disturbances, need to avoid triggers

Clinical S/S of anxiety disorders

substance use/abuse, barbiturate and benzodiazepine dependence, chronic relationship difficulties, frequent healthcare services for somatic complaints, negative outlook, obsessive or compulsive behaviors, eating disorders

Diagnostic testing

done to rule out any underlying illnesses that could be leading to the s/s related to anxiety

Identification

done to differentiate medical illness from an anxiety and once this occurs, the goal is to improve s/s and decrease recurrence

Tx for anxiety disorders

CBT, relaxation, psychopharmacology, benzodiazepines

CBT

recognize thoughts that causes anxiety, gain insight and learn new responses

Relaxation

desensitization, replacing anxiety with relaxation responses

Psychopharmacology

SSRI'S, BUSPIRONE, BETA BLOCKERS, TCA'S

Benzodiazepines

short term, lowest dosage, DO NOT DISCONTINUE ABRUPTLY

Nursing diagnosis for anxiety disorders

ANXIETY related to perceived threat or stress (state), INEFFECTIVE COPING related to inadequate individual resources (state), INEFFECTIVE BREATHING related to hyperventilation related to severe anxiety (state)

Outcomes of Tx for anxiety disorders

the client will report a decrease in aggressive behaviors and a decrease in the intensity of anxiety, the client will report the effective use of coping strategies to deal with symptoms of anxiety, the client will demonstrate breathing techniques to control anxiety and hyperventilation

Successful management of an anxiety disorder

involves helping the client identify thoughts and behaviors that lead to anxiety, identify stressors, then finding effective coping strategies that are developed with the client and the nurse through a therapeutic, holistic approach