ANXIETY RESPONSE AND ANXIETY DISORDER

Anxiety - is defined as an unpleasant emotional state for which the

cause is either not readily identified or perceived to be uncontrollable or

unavoidable.>: Anxiety is an alarm system that

is activated whenever a person perceives danger or threat.

Anxiety disorder - is a blanket term covering several different forms of abnormal and pathological fears

and anxieties.

Fear is an emotional and physiological response to a recognized external threat.

CLASSIFICATION OF ANXIETY DISORDERS:1. Panic disorder2. Phobias3.Obsessive – compulsive

disorder4. Post- traumatic stress disorder5. Acute stress disorder6. Generalized stress disorder7. Anxiety disorder not otherwise

specified

CAUSES:1. Genetic factors 2. Biochemical factors 3. Neuroanatomic factors 4. Psychological factors 5. Traumatic life events 6. Medical conditions

PANIC DISORDER

represents anxiety in its most severe form

Panic attacks occur suddenly, with no warning

peak intensity w/ in 10 to 15 minutes and rarely last longer than 30 minutes

occur both in men and women

Panic disorder - is one of the most treatable of the anxiety disorders, responding in most cases to medications or carefully targeted psychotherapy. Panic disorder - is often accompanied by other serious conditions such as

depression, drug abuse, or alcoholism and may lead to a pattern of avoidance of places or situations where panic attacks have occurred.

PANIC DISORDER:Signs and symptoms :

> dyspnea or SOB> palpitations> chest pain or discomfort> choking> vertigo-disabling sensation> diaphoresis> trembling or shaking> syncope –loc;insufficient blood flow in

brain> nausea or abdominal distress> hot or cold flashes> fear of losing control, going crazy, or

dying

Causes:

> GENETIC

> BIOCHEMICAL ABNORMALITIES

> AUTONOMIC FACTORS

> Cognitive and behavioral factors

> Psychological factors

> Medical conditions

> Life events

DIAGNOSIS:meets the criteria in DSM- IV

TREATMENT:

> Patient teaching > Cognitive therapy > Behavioral therapy > Relaxation technique > Pharmacologic therapy

NURSING INTERVENTIONS:DURING A PANIC ATTACK:

• stay with the patient • Avoid touching • guide client to a smaller, quite area.• Avoid insincere expressions of reassurance.• Maintain a calm serene approach.• Speak in simple short sentences• give the patient one direction at a time

• Reduce external stimuli• Provide safe environment• Dim bright lights as• Encourage the patient to express her

feelings, and to cry if necessary.• Allow her to pace around the room

BETWEEN PANICS:

• Encourage the patient to discuss her fear.

• Discuss alternative coping mechanisms.• Monitor therapeutic and adverse effects

of medications• Give instruction to the patient before

discontinuing the medication

PHOBIC DISORDERS:

•the most common form of anxiety disorders.•PHOBIA•These are intense fears of specific

situations or things that are not actually dangerous.

•The person has unconsciously displaced the original internal source of fear or anxiety, to an external source.

> Avoidance of the object or situation allows the person to remain free of anxiety.

includes all cases in which fear and anxiety is triggered by a specific stimulus or situation.

AGORAPHOBIA – most common phobic disorder.

• is the fear of being alone in the public places • normal activities become restricted and victims

refused to leave their home• 2/3 exhibiting the symptom are women• symptom develops between ages 18 – 35 y.o. • onset may be sudden or gradual• agoraphobic patients have higher depression

and suicide rates than the general population and may be prone to alcohol and sedative abuse.

CAUSES:> unknown> theories include biochemical

imbalance > Environmental factors

> Runs in the family

SIGNS AND SYMPTOMS:> fear and avoidance of open

spaces or public places> concern that help might not be

available in the publicDIAGNOSIS :

> Diagnosed when the patient meet the criteria in the DSM- IV

TREATMENT:> Treatment includes medication

> Behavioral therapy> Desensitazation > relaxation technique> psychotherapy

NURSING INTERVENTIONS:> Patient encouraged discuss the feared

object or situation.> Collaborate with the patient and

multidisciplinary team > Provide training in assertiveness skills > Adminster antianxiety or antidepressant

meds as ordered.

Social phobia, also called social anxiety disorder > involves overwhelming anxiety and excessive self-consciousness in everyday social situations.

> disorder usually begins in childhood or early adolescence.

SOCIAL PHOBIA > the person experiences persistent,

irrational fear of criticism, humiliation or embarrassment.

> the person does not realize that the fear is excessive or disproportionate to the activity or situation.

> example : fear of public speaking, using public restrooms, or using public transportation.

SPECIFIC PHOBIAS:DSM –IV lists five type of this disorder:

animal, natural, environment, blood-injection- injury, situational and

others There approximately 700 identified phobias

COMMON PHOBIAS:> Acrophobia- fear of heights> Androphobia- fear of men> Astraphobia-fear of storms,

lightning, thunder> Ceraunaphobia-fear of thunder> Claustrophobia- fear of enclosed

places> Hematophobia- fear of blood

Generalized anxiety disorder > is a common chronic disorder characterized by long-lasting anxiety that is not focused on any one object or situation. > experience non-specific persistent fear and worry and become overly concerned with everyday matters.

> Hydrophobia- fear of water> Iatrophobia- fear of doctors> Nyctophobia-fear of night> Oclophobia- fear of crowds> Pyrophobia- fear of fire> Zoophobia- fear of animals

> the disorder is characterized by unrealistic or excessive

anxiety and worry occurring more days than not in a six month period.

> Affects estimated 3% of the general population, more often in women than men.

CAUSES: Genetic factors BiochemicalPsychosocialEnvironmental

RISK FACTORS:> unresolved conflicts> a tendency to misinterpret

events> such behaviors as shyness and

avoidance of new situations.

SIGNS AND SYMPTOMS:1. Excessive psychological arousal :

2. Distorted cognitive process

3. Poor coping

DIAGNOSIS:1. Patient should undergo psychiatric

evaluation2. Diagnosis is confirmed if the patient

meets the criteria in DSM- IV.

TREATMENT:1.For patient with mild anxiety-

nonpharmacologic mgt 2.Relaxation technique and

biofeedback 3.Psychotherapy 4.Other treatment includes cognitive

therapy and medications.

Medications:

1. Antianxiety agents – benzodiasepine as diazepam ( Valium).2. Buspirone (Buspar), TCA’s ( such as imipramine ( Tofranil), and SSRI’s maybe given.3. Buspirone.

NURSING INTERVENTIONS:> Provide nutrition counseling to reduce stress. Advise the patient to avoid caffeine and alcohol.

POSTTRAUMATIC STRESS DISORDER:

> is a debilitating condition that can develop following a terrifying

event.

person who experiences a psychological traumatic event that is considered to be outside the realm of usual human experience.

Ordinary events can serve as reminders of the trauma and trigger flashbacks or intrusive images.

DIAGNOSTIC CRITERIA ARE AS FOLLOWS:> The person has been exposed to a traumatic event, or a threat to physical integrity of self or others.

> The person’s response involve intense fear, helpless or horror.the traumatic event is persistently

experienced. The individual avoids stimuli associated w/ the traumatic event.> Persistent symptoms of increased

anxiety.

diagnosis of acute symptoms If onset of symptoms occurs at least six

months after the stressor- the diagnosis refers to delayed onset.

> Impaired role and social function may occur, > Low self concept and suicidal ideation or

thoughts may occur along w/ substance abuse

> Women are likely to be affected than men.

SIGNS ANS SYMPTOMS:> anger> poor impulse control> emotional detachment> decreased self esteem> hopelessness> relationship problems> survivors guilt

TREATMENT:Nonpharmacologic treatment psychotherapy.Pharmacological Other treatment.

NURSING INTERVENTIONS:1.Establish trust 2.Provide a safe, staff monitored room3.Administer medications as prescribed.4.Refer to clergy and community

resources5.Refer to group therapy.

ACUTE STRESS DISORDER:>this disorder is differentiated from post-

traumatic stress disorder in that symptoms occur during or immediately after the traumalasts for at least two days, and either resolve within four weeks Significant impairment in social and occupational functioning occurs.> The individual is unable to pursue necessary task.

TREATMENT:>includes social supports

>psychotherapy>cognitive >behavioral therapy and

>pharmacotherapy.

NURSING INTERVENTIONS:1. Encourage patient to discuss the

stressful event and identify it as traumatic.

2. Urge her to talk about her anxiety and her feelings about the trauma

3. Encourage patient to identify any feelings of survivor guilt, inadequacy or blame.

4. Teach relaxation technique.5. Administer antianxiety medications

as ordered.

OBSESSIVE- COMPULSIVE DISORDER:> is characterized by unwanted, recurrent, intrusive thoughts or images (obsessions) w/c the person tries to alleviate through

repetitive behaviors or mental acts (compulsion)

> the compulsion are meant to reduce anxiety or prevent some dreaded event from happening.

>disturbing thoughts or images are called obsessions

> Compulsions include both= overt behaviors> OC behaviors and activities take up more than 1 hour per day.> compulsive rituals take hours to complete and

become the major life activity.> Affects 2% of the general population , striking

men and women equally.

> rituals that are performed to try to prevent or get rid of them are

called compulsions.

CAUSES:1. Genetic2. Biological aspects 3. Psychological factors

RISK FACTORS:> for reasons not fully understood=

sociological factors as being young , divorced, separated or unemployed

SIGNS AND SYMPTOMS :1. exhibit or report repetitive thoughts that

causes stress ( obsessions).2. repetitive behavior ( compulsions) 3. Social impairment3. most of the patients are aware that

their obsessions are excessive or irrational and interfere with normal activities.

DIAGNOSIS:> confirmed if the patient meet the DSM-IV criteria.

TREATMENT:1. behavioral techniques2. relaxation techniques3. support groups4. partial hospitalization and day

treatment program5. medication

NURSING INTERVENTIONS:1.Approach the patient unhurriedly. 2. Identify disturbing topics of conversations

3.Keep the patients physical health in mind.EXAMPLE : COMPULSIVE HANDWASHING-

CAUSE SKIN BREAKDOWN4.Provide for basic needs5.Let the patient know your aware of the

behavior6.Maintain an accepting attitude.

7. Don’t show shock, amusement, or criticism of the ritualistic behavior.

8.Don’t block. Give the patient time to carry out the ritualistic behavior

9.Make reasonable demands and set reasonable limits

10.Encourage active diversions 11.Involve the patient in activities 12.Assist patient in exploring and developing

more effective coping 13.Monitor patient for suicidal behaviors and

thoughts

MEMORY JOGGER:to help the patient with OCD, remember the word COPING:C: concerns and feelings are discussed.O: offer a structured routine that allows time for

ritualP: practice thought stopping skillI: initiate a behavioral contract to decrease rituals and reward non ritualistic behavior.N: nurture effective ways to problem solve stressful situations.G: get the patient to perform relaxation techniques.