Anxiety and Anxiety Disorders

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Anxiety and Anxiety Disorders

• Rebecca Sposato MS, RN

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Anxiety

• A collection unpleasant emotions stemming from a
  real or perceived threat/stressor
• Often instinctual, necessary for survival and
  social order
• Increases when one is unable to deal with threat
• May present as fear, dread, nervousness,
  uneasiness or apprehension
• May be the primary syndrome or present as a
  symptom of another disorder
• Many behaviors emerge to counteract anxiety
• Comorbid w/ depression, substance abuse etc.

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Theories

• Biological genetic and neuro-chemical
  abnormalities
• Psychodynamic Internal and interpersonal
  conflict
• Behavioral learned response to a stressor
• Cognitive distorted and negative thinking

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Anxiety Diagram
Effective Medication
Ineffective Mediation
Reduced stressor Decreased anxiety
Stressor remains present Extreme coping
behaviors Increased Anxiety
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Levels of Anxiety

• Mild Adaptive heightened awareness to everyday
  living
• Greater focus and process additional sensory data
• Slight physiological arousal
• Moderate No longer normal
• impaired perceiving and processing sensory data
• Impaired reasoning and problem-solving
• Measurable physiological arousal

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Levels of Anxiety

• Severe Anxiety dominates experience
• Distorted perceiving and processing sensory data
• Impaired memory, reasoning, problem-solving
• Marked physiological changes
• Panic Terror dominates experience
• Disorganized perceiving and processing sensory
  data
• Unable to purposefully interact with other
  persons or environment
• Out of control physical behavior and movements
• Exaggerated physiological changes

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Panic Attacks

• Acute episode of marked anxiety and physiological
  changes
• Exaggerated for perceived threat
• Can be confused with heart attack
• Expected (cued) response to known trigger
• Unexpected (uncued) no known association
• DSM-IV Not a stand-alone disease, no numeric
  code,
• Must of 4 of the following tachycardia,
  diaphoresis, tremors, dyspnea, angina, nausea,
  de-realization, dizzy, fear of losing control,
  fear of dying, paresthesia, chills/hot flashes

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Panic Disorders

• Recurrent panic episodes with persistent concern
  lasting over 1 month and avoiding behaviors
• 1-2 one year prevalence in population
• Variable onset and duration, typical onset
  between adolescence and age 30.
• Chronic course w/ wax-wane pattern
• Often comorbid w/ agoraphobia

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Phobia

• Excessive fear, with a marked physiological
  response, to a specific thing or situation
• Predisposing event
• Acute onset
• 6 lifetime prevalence in population
• Often have childhood onset,
• 21 female to male
• Subtype categories animal, environment,
  blood/injury, situation

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Social Anxiety Disorder (SAD)

• Social phobia exaggerated concern over being
  embarrassed, ridiculed or judged in the presence
  of others
• Causes physical symptoms of anxiety
• Deters normal daily, social and occupational
  functioning
• May be general or specific to public performances
  or social gatherings (parties)
• Can be acute or chronic

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General Anxiety Disorder

• Persistent symptoms of anxiety not attached to
  specific triggers, lasting over 6 months
• Focus of worry is out of proportion to source
• Person may not insight into source of anxiety
• 5 lifetime prevalence, slightly more female
• DSM-IV a) excessive concern, b) difficult to
  control, c) 3 physical symptoms, d) not due to
  another Axis 1 condition, e) distress impairs
  functioning, f) the physical symptoms are not due
  to another condition

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Obsessive Compulsive Disorder

• OCD recurrent and time-consuming, often
  ritualized, behaviors causing significant
  impairment in daily function
• Often an exaggerated natural behavior (grooming,
  nesting, hoarding for winter)
• Often ego-dystonic, person may or may not have
  self insight into abnormality
• 2 lifetime prevalence
• Obsession persistent and anxiety producing
  ideas, impulses and images that something is
  wrong
• Compulsion the action extending from the
  obsession, to temporarily fix the anxiety

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Acute Stress Disorder Post Traumatic Stress
Disorder

• A normal response to an abnormal event
• Physiological arousal or emotionally numb,
  dissociation, amnesia or flashbacks, aversion or
  obsession with trigger,
• Triggered by an extreme life stressor/threat-
• A recipient or witness to violence, unnatural
  death, catastrophe perceived as threat to self
  and life
• Acute- Within one month of the event
• PTSD- Symptoms present 3 months after event, may
  last years
• 8 lifetime prevalence

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Interventions

• Pharmacological benzodiazepines, Buspirone,
  SSRI
• Milieu Therapy- supportive environment
• Therapy psych, REBT, CBT, DBT, relaxation
  training,
• Modeling- person watches anothers normal reation
• Systematic Desensitization- repeated increasing
  exposure to trigger to grow tolerance
• Flooding- excessive exposure to trigger to
  extinguish fear
• Not as popular as desensitization

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Nursing Care

• Symptom management and control
• Promote and support adaptation and coping
• Promote and support daily function
• Health teaching