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ANXIETY DISORDERS

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Psychobiology of Anxiety. Threat Information enters the brain. Pathway. Cortex ... Psychobiology of Anxiety (continued) Hypotalamus. Pituitary gland. Adrenal ... – PowerPoint PPT presentation

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Title: ANXIETY DISORDERS


1
ANXIETY DISORDERS
A. Perez-Millan, ARNP MSN
2
INTRODUCTION
  • Stress is.
  • Anxiety is.
  • Fear is.
  • Defense mechanisms
  • Coping mechanisms

3
Psychobiology of Anxiety
Threat Information enters the brain
Pathway
Cortex Limbic System
(Center of emotions) Amygdala (Recognizes
threat)
4
Psychobiology of Anxiety (continued)
Hypotalamus Pituitary gland Adrenal Cortex
(cortisol) Sympatho-Adrenal Medulla (epinephrine,
nor-epinephrine)
Fight or flight
5
COPING WITH STRESS AND ANXIETY
EFFECTIVE MEDIATION
Anxiety Return to usual
coping
RELIEF BEHAVIORS
STRESS
ANXIETY
Psychological Physical Social
  • Defense Mechanisms Coping Mechanisms
    Social/Cultural/Spiritual Support systems

INEFFECTIVE MEDIATION
Anxiety Physical
Psychological
Illness

6
Anxiety Disorders (cont.)
  • Epidemiological statistics
  • Anxiety disorders most common type of all
    psychiatric illnesses.
  • More common in women than men
  • Occur in children from social minorities.
  • Poverty a factor.
  • Produces considerable functional impairment and
    distress.

7
Anxiety is pathological if
  • The response is disproportionate to the severity
    of the threat.
  • The response continues beyond the existence of
    the threat.
  • Functioning is impaired.

8
Application of Nursing Process
  • Panic disorder (P.D.) assessment
  • 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.
    (Townsend, p 515)

9
Application of Nursing Process (cont.)
  • Panic disorder with agoraphobia
  • Assessment
  • Characterized by same symptoms characteristic of
    panic disorder.
  • In addition, affected person 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.

10
Application of Nursing Process (cont.)
  • Generalized anxiety disorder (G.A.D.)
  • Assessment
  • Characterized by chronic,
  • unrealistic, and excessive
  • anxiety and worry.

11
Etiology
  • Panic and generalized anxiety disorders
  • Psychodynamic theory
  • Ineffective use of ego defense mechanisms.
  • Cognitive Theory
  • Distorted thinking results in maladaptive
    behaviors and emotional disorders.

12
Etiology (cont.)
  • Panic and generalized anxiety disorders (cont.)
  • Biological aspects
  • Genetics
  • Neuroanatomical
  • Biochemical
  • Neurochemical
  • Medical conditions

13
Nursing Diagnosis
  • Panic level of anxiety related to real or
    perceived threat to biological integrity or
    self-concept.
  • Powerlessness related to impaired
  • cognition.

14
Client Objectives- Outcomes
  • The client
  • Is able to recognize signs of anxiety and
    intervene so that it does not reach panic levels.
  • Uses adaptive coping mechanisms to prevent panic
    anxiety when stressful situations occur.
  • Performs activities of daily living independently

15
Client Objectives- Outcomes (cont.)
  • The client (cont.)
  • Is able to maintain anxiety at a manageable
    level.
  • Is able to participate in decision-making,
    thereby maintaining control over life situation.
  • Verbalizes acceptance of life situations over
    which he or she has no control.

16
Planning/ImplementationPanic and Generalized
Anxiety Disorder
  • Nursing intervention is aimed at relief of acute
    panic symptoms.
  • The nurse also works at assisting the client to
    take control of his or her own life situation and
    to accept those situations over which he or she
    has no control.

17
Phobias
  • Agoraphobia without history
  • of Panic Disorder
  • Assessment
  • Fear of being in places or
    situations
  • from which escape might be difficult
  • or in which help might not be
    available if an attack or panic-like
    symptoms should occur.

18
Phobias (cont.)
  • Social phobia
  • Assessment
  • Excessive fear of situations in which the
    affected person might do something embarrassing
    or be evaluated negatively by other.

19
Phobias (cont.)
  • Specific phobia
  • Assessment
  • Marked, persistent, and excessive or unreasonable
    fear when in the presence of, or when
    anticipating, an encounter with a specific object
    or situation.

20
Phobias (cont.)
  • Specific phobia assessment
  • Animal type
  • Natural environment type
  • Blood-injection-injury type
  • Situational type
  • Other type

21
Phobias (cont.)
  • Predisposing factors for phobias
  • Psychoanalytical theory
  • Unconscious fears are expressed
  • in a symbolic manner .
  • Learning theory Fears are
  • conditioned responses.
  • Early experiences

22
Phobias (cont.)
  • Cognitive theory
  • Anxiety is the result of anxiety-inducing
    self-talk.
  • Negative self-statements
  • Irrational beliefs
  • Biological aspects
  • Temperament
  • Innate fears

23
Nursing Diagnosis
  • Fear related to causing embarrassment to self in
    front of another, to being in a place from which
    one is unable to escape, or to a specific
    stimulus.
  • Social isolation related to fears of being in a
    place from which one is unable to escape.

24
Objectives- Outcomes
  • The client
  • Is able to functions in the presence of the
    phobic object or situation.
  • Uses coping mechanisms to maintain anxiety at a
    manageable level.
  • Voluntarily attends group activities and
    interacts with peers.

25
Objectives- Outcomes
  • The client (cont.)
  • Discusses feelings that may have contributed to
    irrational fears.
  • Verbalizes a future plan of action to deal with
    the phobic object or situation.

26
Planning/ImplementationPhobias
  • Nursing intervention is aimed at decreasing the
    clients fear and increasing his or her ability
    to function in the presence of the phobic
    stimulus.

27
Obsessive-Compulsive Disorder (OCD)
  • Assessment data
  • Recurrent obsessions or compulsions that are
    severe enough to be time-consuming and cause
    severe distress or significant
  • impairment.

28
Obsessive-Compulsive Disorder (OCD) (cont.)
  • Obsessions Unwanted, intrusive, persistent ideas
    or thoughts.
  • Compulsions Unwanted repetitive actions to
    reduce anxiety.
  • Rituals Repetitive actions that a person must do
    over and over to decrease anxiety.

29
Obsessive-Compulsive Disorder (OCD) (cont.)
  • Predisposing factors to OCD
  • Psychoanalytical theory
  • A weak ego.
  • Regression to the pre-oedipal phase of
    development.

30
Obsessive-Compulsive Disorder (OCD) (cont.)
  • Predisposing factors to OCD (cont.)
  • Learning theory
  • Conditioned response to a traumatic event.
  • Biological theory.
  • Neuroanatomy
  • Abnormalities in basal ganglia and
    orbital-frontal cortex of the brain.
  • Biochemical
  • Decreased serotonin. (5-HT)

31
Obsessive-Compulsive Disorder (OCD) (cont.)
Diagnosis
  • Ineffective coping related to underdeveloped
    ego, possible biochemical changes.
  • Ineffective role performance related to need to
    perform rituals

32
Obsessive-Compulsive Disorder (OCD) (cont.)
Outcomes
  • The client
  • Is able to maintain anxiety at a manageable
    level.
  • Verbalizes understanding of relationship between
    anxiety and ritualistic behavior.
  • Identifies situations that produce anxiety and
    result in rituals.

33
Obsessive-Compulsive Disorder (OCD) (cont.)
Outcomes (cont.)
  • The client (cont.)
  • Able to use more adaptive coping strategies to
    deal with stress. (thought stopping, relaxation
    techniques, and physical exercise)
  • Is able to perform ADLs role-related
    responsibilities without the need for ritualistic
    behaviors.

34
Planning/Implementation Obsessive- Compulsive
Disorder
  • Nursing intervention is aimed at helping the
    client maintain his or her anxiety at a
    manageable level without using ritualistic
    behavior.
  • The focus is in the the development of more
    adaptive methods of coping with anxiety. Never
    interrupt a ritual!

35
Post-traumatic Stress Disorder
  • Assessment
  • Development of symptoms after exposure to an
    extreme traumatic situation involving a threat
    to the safety of self or others.
  • Re-experiencing the traumatic event, maintaining
    a high level of anxiety, and a general numbing of
    responsiveness.
  • Intrusive recollections or nightmares of the
    event are common. Flashbacks

36
Post-traumatic Stress Disorder (cont.)
Predisposing factors
  • Psychosocial theory- Severity of the trauma.
  • Learning theory- Negative reinforcement
  • Cognitive theory- Extreme sense of helplessness.
  • Biological aspects- Addiction to the trauma

37
Post-traumatic Stress Disorder (cont.) Diagnosis
  • Post-trauma syndrome related to distressing event
    outside the range of usual human experience.
  • Dysfunctional grieving related to loss of self
    or other actual or perceived losses incurred
    during or after the event.

38
Post-traumatic Stress Disorder (cont.) Outcomes
  • The client (cont.)
  • Can identify goals for future and demonstrate
    adaptive coping strategies.
  • Includes significant others in the recovery
    process and willingly accepts their support.
  • Verbalizes no ideas or intent of self-harm.

39
Post-traumatic Stress Disorder (cont.) Outcomes
(Cont.)
  • The client (cont.)
  • Identifies community resources for assistance in
    times of stress.
  • Gets enough sleep to avoid risk of injury.
  • Has worked through feelings of survivors guilt.
  • Attends support group.

40
Post-traumatic Stress Disorder (cont.)
Planning/Implementation
  • Nursing intervention id aimed at
  • Reassurance of safety.
  • Decrease in maladaptive symptoms (e.g.
    nightmares)
  • Demonstration of more adaptive coping strategies.
  • Adaptive progression through the grief process.

41
Anxiety Disorder due to General Medical
Condition
  • Assessment
  • Symptoms of this disorder are
  • judged to be the direct
  • physiological
  • consequence of
  • a general medical
  • condition.

42
Substance-Induced Anxiety Disorder
  • Assessment (cont.)
  • Prominent anxiety
  • symptoms that
  • are judged to be
  • due to the direct
  • physiological effects
  • of a substance.

43
Substance-Induced Anxiety Disorder
  • Assessment (cont.)
  • Prominent anxiety symptoms that are judged to be
    due to the direct physiological effects of a
    substance.

44
EVALUATION
  • Reassessment is conducted to determine whether
    nursing actions have been successful in achieving
    the objectives of care.

45
Client/Family Education
  • Nature of the illness
  • What is anxiety?
  • What might it be related to?
  • What is OCD?
  • What is PTSD?
  • Symptoms of anxiety disorders

46
Client/Family Education (cont.)
  • Management of the illness
  • Medication management
  • Possible adverse effect
  • Length of time to take effect
  • What to expect from the medication
  • Stress management
  • Teach ways to interrupt escalating anxiety.
  • Teach relaxation techniques.

47
Client/Family Education (cont.)
  • Support services
  • Crisis hotline
  • Support groups
  • Individual psychotherapy

48
Treatment Modalities
  • Individual psychotherapy
  • Group/family therapy
  • Cognitive therapy
  • Behavior therapy
  • Systematic desensitization
  • Implosion therapy

49
Treatment Modalities (cont.)
Psychopharmacology
  • Panic and generalized anxiety disorder
  • Anxiolytics (Benzodiazepines, Buspirone)
  • Antidepressants
  • Beta Blockers
  • Phobic disorders
  • Anxiolytics (Benzodiazepines, Buspirone)
  • Antidepressants
  • Beta Blockers

50
Treatment Modalities (cont.)
Psychopharmacology
  • OCD
  • Antidepressants
  • PTSD
  • Antidepressants
  • Anxiolytics (Benzodiazepines, Buspirone)
  • Beta Blockers
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