anxiety disorders

anxiety

•sense of psychological distress

•Transient anxiety is a normal response to; job interview, tests, walking in unfamiliar places,

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

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

stress

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

•Stress is 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.

•Frequently stressors are cited as causes of anxiety. When the mind interprets events as threatening, the body responds with the s/s of anxiety.

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 as a Continuum

•Anxiety affects cognition, psychological, and physical functioning. Is rated as mild, moderate, severe

•Mild anxiety results in improved functioning with heightening awareness

•As anxiety increases it interferes with all aspects of functioning.

•With 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. Coping mechanisms are ineffective.

•Anxiety interferes with ADL’s

•Persons with Anxiety D/O feel the core of their personalities are threatened when there is no actual danger.

•Anxiety may be differentiated from fear in that anxiety is an emotional process, whereas fear is cognitive.

mild

severe anxiety

perceptions become increasing distorted, become scattered, disorganized

panic anxiety

perception is grossly distorted, cannot differentiate real from imaginary stimuli

When Does Anxiety Require 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

anxiety disorders relevance

•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 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- physiologic expression of anxiety

•Avoidance- evasive behaviors

•Problem-solving- systematic method for addressing difficult situations

Anxiety Disorders Barriers of Treatments

•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 anxiety disorders

•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

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

•Attacks last- 10-30 minutes, can continue up to 1hr.

•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

•In addition, 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

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

•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

When phobias are accompanied with panic attacks-…

panic disorder

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

goals for treating anxiety disorders

•The client:

•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

•dissociation- state of detachment, dream state, poor memory esp.   r/t event- dissociative amnesia

•Duration- usually resolves within 2-28 days

POST-TRAUMATIC STRESS DISORDER-

•symptoms continue greater than 1 month

•Functional impairment or stress

•Generalized Anxiety

•Intrusive Thoughts

•Flashbacks

•Nightmares

•Sleep Disturbances

•Need to avoid triggers

AFTER 3 MONTHS

•Considered chronic

Clinical Signs and Symptoms 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

Diagnosis anxiety disorders

•DIAGNOSTIC TESTING to rule out any underlying illnesses that could    be leading to the s/s related to anxiety

•IDENTIFICATION to differentiate medical illness from an anxiety

•Once anxiety disorder is identified goal is to improve s/s and decrease recurrence

treatments anxiety disorders

Cognitive Behavioral Therapy- 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

outcomes 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.