Stress and Anxiety Disorders

Stress and Coping

Overview

  • Anxiety Disorders

  • Crisis

  • Post-Traumatic Stress Disorder (PTSD)

Learning Outcomes

  • Symptom Comparison: Compare and contrast symptoms associated with various anxiety disorders.

  • Risk Factors: Describe risk factors and symptomatology associated with anxiety disorders.

  • Assessment of Comfort: Assess levels of physical and emotional comfort and discomfort for patients experiencing stress and inability to cope effectively (QSEN).

  • Community Resource Utilization: Discuss the utilization of community resources as a collaborative management strategy for patients with maladaptive coping.

  • Crisis Identification: Identify types of crisis that occur in a person’s life.

  • Crisis Development Phases: Describe the four phases in the development of a crisis.

  • Crisis Intervention Goals: Identify the goal of crisis intervention.

  • Nursing Role in Crisis: Relate the role of the nurse utilizing the nursing process in the phases of crisis intervention.

  • Benzodiazepine Classification: Identify classification, basic mechanism of action, therapeutic effectiveness, significant side effects, nursing implications, safe dose range, and both generic and trade names for benzodiazepines and anxiolytics.

Anxiety and Stress Disorders

  • Covered Disorders:

    • Panic Disorder

    • Generalized Anxiety Disorder (GAD)

    • Phobias

    • Obsessive-Compulsive Disorder (OCD)

    • Post-Traumatic Stress Disorder (PTSD)

    • Crisis

Understanding Anxiety Disorders

  • Prevalence: Anxiety disorders are the most common psychiatric illnesses, affecting 31% of adults at some point, resulting in significant functional impairment and distress.

  • Similar Symptoms: Share features of excessive anxiety and maladaptive behavioral disturbances.

    • Can disrupt daily activities including job performance, schoolwork, and relationships.

  • Gender Disparity: More common in women than men with a ratio of nearly 2:1.

  • Treatment Gap: Although highly treatable, only 36.9% of individuals receive treatment.

  • Comorbidity: Frequently occurs alongside other psychiatric disorders and can also signal the onset of a medical disorder.

Stress vs. Anxiety

  • Stress: The body’s response to danger or stress-inducing events, which is tied to specific situations. Stress fades once the situation resolves.

  • Anxiety: A feeling of dread or unease not necessarily linked to imminent danger; may be vague or free-floating.

  • Fear: A response to immediate danger; includes feelings similar to anxiety but in connection with a clear threat.

Levels of Anxiety

  1. Mild Anxiety: A normal level of anxiety that can be motivating.

  2. Moderate Anxiety: Increased physiological arousal; the person begins to feel nervous.

  3. Severe Anxiety: Markedly impaired functioning.

  4. Panic Anxiety: A state of extreme fear and apprehension, often with physiological three symptoms.

Theories of Anxiety

1. Genetics

  • Anxiety disorders often cluster in families, suggesting a genetic predisposition.

2. Behavioral Theory

  • Anxiety is learned through modeling behaviors. Example: A fearful mother transmits her anxiety to her child.

3. Cognitive Theory

  • Anxiety can be seen as a distortion in thinking that leads to acute feelings of anxiety.

4. Freud’s Theory

  • Anxiety arises from a weak or underdeveloped ego or unresolved psychological conflicts, leading to maladaptive responses in anxiety-producing situations.

Defense Mechanisms in Anxiety

Healthy Defense Mechanisms

  • Effective responses that help individuals manage stress or anxiety:

    • Lending items to new acquaintances.

    • Utilizing humor and laughter.

    • Keeping busy with constructive activities.

    • Maintaining politeness in adverse situations.

Unhealthy Defense Mechanisms

  • Maladaptive strategies that contribute to emotional distress:

    • Refusal to acknowledge problems.

    • Accusations without evidence in personal relationships.

    • Avoidance behaviors such as staying in bed to escape daily responsibilities.

    • Anger misdirection, such as taking out frustrations on loved ones.

Panic Disorder

  • Key Features:

    • Recurrent and unpredictable panic attacks.

    • Sudden onset, occurring at any time, not always associated with identifiable triggers.

    • Symptoms of panic include intense fear, palpitations, chest pain, sweating, muscle tension, difficulty breathing, chills, gastrointestinal distress, feelings of choking, and frequent urination.

Phobias

  • Definition: A persistent and irrational fear of specific objects, activities, or situations, leading to avoidance behavior.

  • Specific Example: Fear of heights disrupting social settings.

  • Social Anxiety Disorder: Severe anxiety in social contexts, resulting in feelings of humiliation (e.g., fear of public speaking).

  • Agoraphobia: Intense fear of situations where escape may be difficult; can become debilitating, with some unable to leave home.

Generalized Anxiety Disorder (GAD)

  • Definition: Characterized by excessive anxiety about various events or activities.

  • Diagnostic Criteria: Three out of the following six symptoms must be present for at least six months:

    1. Restlessness

    2. Fatigability

    3. Irritability

    4. Difficulty concentrating

    5. Muscle tension

    6. Sleep disturbances

Obsessive-Compulsive Disorder (OCD)

  • Overview: A chronic disorder involving uncontrollable recurring thoughts (obsessions) and behaviors (compulsions).

  • Age of Onset: Typically begins in late teens or early twenties.

  • Treatment: SSRI medications are effective due to the hypothesis of serotonin dysfunction.

OCD Symptoms

  • Obsessions: e.g., fear of contamination or need for symmetry.

  • Compulsions: Ritualistic behaviors to alleviate anxiety, e.g., handwashing, counting, praying.

Separation Anxiety Disorder

  • Characteristics: Excessive worry, shyness, and difficulty being apart from significant others, which can hinder functioning in adulthood.

Post-Traumatic Stress Disorder (PTSD)

  • Definition: Arises from exposure to trauma beyond the range of typical human experiences (e.g., war, sexual assault).

  • Manifestations: Symptoms include re-experiencing the trauma, avoidance of trauma-related stimuli, and functional impairment.

The Nursing Process in Stress and Anxiety Management

1. Assessment

  • Conduct comprehensive physical and neurological examinations.

  • Assess for self-harm tendencies and psychosocial factors.

  • Cultural assessment to understand patient’s background.

2. Nursing Problems Identified

  • Impaired cognition, anxiety, distress, ineffective coping, hopelessness.

3. Goals of Nursing Care

  • Enable recognition of escalating anxiety.

  • Reduce distressing symptoms and improve independence.

  • Enhance concentration and problem-solving skills while managing anxiety.

4. Planning and Implementation

  • Engage in shared decision-making.

  • Utilize therapeutic communication and adequate support systems.

Nursing Interventions for High Anxiety Levels

  • Reduce external stimuli and remain present with the patient to provide reassurance.

  • Use calming and clear communication.

  • Administer PRN medications if necessary.

Therapeutic Modalities

Psychotherapy

  • Various methodologies including Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy, and exposure therapies.

Group/Family Therapy

  • Facilitated sharing among individuals with similar disorders, beneficial for family dynamics.

Therapies for PTSD

  • Prolonged Exposure Therapy: Safe repetitive exposure to trauma for emotional processing.

  • Cognitive Processing Therapy: Assists in examining and changing distressing post-trauma thoughts.

  • Self-Help Strategy: Utilization of PTSD coach smartphone app.

Pharmacological Treatments for PTSD

  • Approved medications: Sertraline and Paroxetine.

  • Second-line treatments: Include tricyclics and MAO inhibitors among others.

Anxiolytics and Anxiety Disorder Psychopharmacology

  • Benzodiazepines: Used for various anxiety disorders, effective by enhancing GABA action. Side effects include respiratory depression and potential dependence.

  • Prototype medications listed:

    • Lorazepam (Ativan)

    • Alprazolam (Xanax)

    • Clonazepam (Klonopin)

    • Diazepam (Valium)

  • Buspirone (BuSpar): Non-benzodiazepine anxiolytic, effective over a longer period (may take 1-2 weeks for effects).

  • Flumazenil (Romazicon): Benzodiazepine antagonist for reversal of overdose effects, with short half-life and potential seizure risks.

Medications Addressing Physical Symptoms of Anxiety

  • Propranolol: Beta-blocker reducing sympathetic symptoms related to anxiety.

  • Prazosin: Alpha blocker effective for nightmares or severe anxiety symptoms.

Conclusion

  • Understanding the multifaceted nature of anxiety disorders and their treatment options is crucial for effective patient management, fostering optimal recovery outcomes through a combination of therapeutic and pharmacological interventions.