Mr.

Terry Campbell The University of Technology, Jamaica College of Health Sciences School of Allied Health & Nursing October 26, 2010

OBJECTIVES At the end of this lecture-discussion,

students will be able to:
Conceptualize a definition for anxiety and anxiety disorders. Describe the differences between anxiety and fear. Differentiate normal anxiety responses from those suggestive of an anxiety disorder.

OBJECTIVES
Identify specific types of anxiety disorders. Discuss the epidemiology, etiology,
symptomatology, and treatment of selected anxiety disorders.

Utilize the nursing process in developing a plan of care for persons with anxiety disorders.

Key Terms Systematic desensitization Implosive therapy

Agoraphobia Depersonalization Flooding conditioning Phobia Positive self-talk Exposure therapy Distraction Interoceptive

Panic attacks Thought Stopping

What is Anxiety?

Overview
Anxiety is an uncomfortable feeling of apprehension or dread occurring in response to stimuli (internal or external) resulting in cognitive, physical, emotional and behavioral symptoms. Boyd, 2008

Overview
Anxiety is a state wherein an individual feels a strong sense of dread frequently accompanied by physical symptoms, without having a specific source or reason for the emotions
Frisch & Frisch, 2006

Anxiety is a normal alerting response that is universal and integral to human existence. Some anxietys are necessary to enhance performance.

Overview

Anxiety disorders are a group of disorders characterized by the presence of anxiety symptoms, avoidance reaction, and possible interference in functioning. Patterns of symptoms and behavior in which anxiety is either the primary disturbance or the secondary

Overview

Fear is a state wherein an individual feels a strong sense of dread with autonomic system responses that are focused on a specific object or event.
Frisch & Frisch, 2006

Overview

Both fear and anxiety are common experiences, and it seems likely that no matter how distressing the experience is- appropriate fear is necessary for individual and species survival.

Overview

Stages of Anxiety PANIC

(awe, uncannines s, terror, horror)

SEVERE MODERAT E

MILD

MILD
Normal Vital Signs Pupils constricted Feeling of comfort & safety Person relaxed and calm

MODERAT E

Vital signs normal or slightly elevated May be tense or elated Person is alert Optimum state for problem solving Feeling of readiness Engage in competitive activities

SEVERE
Fight/flight response ANS is excessively stimulated Vital signs increase Excessive sweating Urinary urgency & frequency Diarrhea Dry mouth Decreased appetite Person feels threatened

PANIC (awe, uncannines s, terror, horror)

As in severe but they escalate and person may become pale Blood pressure reduced Person feels helpless Person feels out of control

Categories of Anxiety Disorder (DSM-IV-TR)

PANIC DISORDER POSTTRAUMATIC STRESS DISORDER

PHOBIAS

ANXIETY DISORDER S
GENERALIZED ANXIETY DISORDER ACUTE STRESS DISORDER OBSESSIVE COMPULSIVE DISORDER

Generalized Anxiety Disorder

Persistent chronic, excessive, unrealistic worry or anxiety over two or more situations in an individuals life. Symptoms (3 or > of the following):
Restlessness, easy fatigue, difficulty concentrating, muscle tension and sleep disturbance.

Obsessive Compulsive Disorder

Recurrent thought and behavior that are extremely distressing and interferes with normal life pattern.
Obsession - (see handout) Compulsion (see handout)

The affected often knows that the feelings are irrational

Post-Traumatic Stress Disorder

Development of anxiety symptoms following an excessively distressing life event that is experienced with terror, fear or helplessness for example post-disaster, war, witnessing a murder.
Refer to Page 2 of handout for other defining characteristics.

PTSD Response to the exposure must

have been one of fear or helplessness and the event needs to be persistently re-experienced through recurrent recollections, dreams, or hallucinatory-like flashbacks. Duration > 1 month and causes

Defining CharacteristicsPTSD
Avoidance thoughts, feelings, conversations Repression Grief Difficulty concentrating Intrusive thoughts Enuresis in children Intrusive dreams Nightmares

Defining CharacteristicsPTSD
Inability to recall an important aspect of the trauma. Feeling of detachment or estrangement from others. Unable to have loving feelings Sense of a foreshortened future.

Persistent fear of a specific object or situation Phobias are categorized as:

Social phobia (Social Anxiety Disorder) Specific phobia

Phobias

 Acrophobia fear of heights

Common Phobias

Brontophobia fear of thunder Nyctophobia fear of night or dark places Microphobia fear of germs Arachnophobia fear of spiders

Common Phobias
Ophidiophobia fear of snakes Claustrophobia fear of closed spaces Hydrophobia fear of water Zoophobia fear of animals

Most common of the psychiatric illnesses Anxiety is a nearly universal experience Symptoms can be found in healthy adults given particular circumstances. More than 19 million people are

Overview

Women are more affected than men Affects individuals at all ages

Overview

High Risk Groups:

Overview

Smokers < 45 years Separated or divorced Survivors of abuse Low SES

(Isensee, Wittchen, Stein, Hofler, & Lieb, 2003; Sheikh, Leskin, & Klein, 2002 as cited in Boyd, 2008)

Causative Factors

Causative Factors
Genetics Interpersonal Neuro-physiological Environmental Behavioral

Y G O L O T A M O T P M Y S

Physical Symptoms
SOB Dizziness Choking sensation Palpitations Trembling Fidgeting Pacing Sweating Dry mouth Nausea Diarrhea Spasm Unsteadiness Wobbly Legs Flushed face Itching Loss of Appetite Abdominal Discomfort Dilated pupils Urinary frequency Elevated blood pressure

 Fearful Terrified Apprehensive Frightened Scared Jittery Jumpy Uneasy Impatient

Affective Symptoms

 Confusion Difficulty recalling Difficulty focusing & concentrating Distractibility Blocking Fear of: losing control, not being able to cope, physical injury, death, mental disorder. hypervigilance

Cognitive Symptoms

 Inhibited Flight

Behavioral Symptoms

Avoidance Speech dysfluency Impaired coordination Restlessness Postural collapse hyperventilation

Treatment

Pharmacotherapy Behavior therapy

Treatment

Systematic desensitization Flooding Psychodrama Thought stopping Thought blocking

Psychotherapy

Treatment

Combination Therapy

Anxiety r/t a subjective sense of uneasiness and tension.

Nursing Diagnosis

Fear r/t a specific object, for example, a phobis fear of heights. Social isolation r/t restriction of travel away from home or places felt to be safe

Nursing Diagnosis out of control Powerlessness r/t feeling

of ones own thoughts and behaviors. Post-trauma syndrome r/t anxiety felt following a significant, life threatening event. Dysfunctional grieving r/t inability to cope with grief following significant losses associated with a significant life

Patients Goals patient will: At the end of therapy,

Express or verbalize a decrease in anxiety levels Effectively employ learned relaxation techniques Be able to describe early warning signs of anxiety

Assess the level of anxiety to provide baseline data

Interventions/Rational es

Initiate supportive therapy to build trust Teach skills of cognitive restructuring to assist client in controlling anxious feelings.

Interventions/Rationale s
Provide information on medications to aid compliance. Encourage expression of thoughts and feelings to set the context for acceptance. Teach problem solving techniques to assist the client find reasonable solutions.

References
American Psychiatric Association. (2000). Diagnostic & Statistical Manual of Mental Disorders, 4th (Ed.).Text Revision. Washington, DC, American Psychiatric Association. Boyd, M. (2008). Psychiatric Nursing: Contemporary Practice 4th (Ed.). Lippincott Williams & Wilkins: USA. Frisch, N., C., & Frisch, L., E. (2005). Psychiatric Mental Health Nursing 3rd (Ed.). Thompson Delmar Learning: New York.