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Mental Health Nursing II NURS 2310


... Benzodiazepines Alprazolam (Xanax ... Lorazepam (Ativan) Miscellaneous agents Buspirone (Buspar) Anti-Anxiety Agents (cont d) Efficacy may ... – PowerPoint PPT presentation

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Title: Mental Health Nursing II NURS 2310

Mental Health Nursing IINURS 2310
  • Unit IX
  • Anxiety and Somatoform Disorders

Objective 1
  • Discussing manifestations that identify and
    differentiate various anxiety disorders

  • Types of Anxiety Disorders
  • Panic disorder
  • Generalized anxiety disorder
  • Phobias
  • Obsessive-compulsive disorder
  • Post-traumatic stress disorder

  • Panic Disorder
  • Recurrent panic attacks
  • Unpredictable onset
  • Causes intense apprehension, fear, or terror
  • Associated with feelings of impending doom
  • Accompanied by intense physical discomfort
  • Attacks usually last only minutes
  • Symptoms of depression are common
  • Average age at onset is late 20s
  • May experience periods of remission and

  • Panic Disorder (contd)
  • 4 of these symptoms must be present
  • palpitations, pounding heart, or accelerated
    heart rate
  • sweating - parasthesias
  • trembling or shaking - chills or hot flashes
  • sensations of shortness of breath or smothering
  • feeling of choking
  • chest pain or discomfort
  • nausea or abdominal distress
  • feeling dizzy, unsteady, lightheaded, or faint
  • derealization or depersonalization
  • fear of losing control or going crazy
  • fear of dying

  • Generalized Anxiety Disorder (GAD)
  • Chronic, unrealistic, and excessive anxiety and
  • Symptoms must have existed 6 months or longer
  • Causes clinically significant distress or
    impairment in social, occupational, or other
    important areas of functioning
  • May begin in childhood or adolescence
  • Depressive symptoms are common
  • Numerous somatic complaints may be in evidence
  • Exacerbations are stress-related

  • Generalized Anxiety Disorder (contd)
  • Symptoms associated with GAD include
  • Excessive anxiety and worry about a number of
    events that the individual finds difficult to
  • Restlessness or feeling keyed up or on edge
  • Being easily fatigued
  • Difficulty concentrating/mind going blank
  • Irritability
  • Muscle tension
  • Sleep disturbances

  • Phobias
  • A phobia is a fear cued by the presence or
    anticipation of a specific object or situation,
    exposure to which almost invariably provokes an
    immediate anxiety response or panic attack even
    though the subject recognizes that the fear is
    excessive or unreasonable the phobic stimulus is
    avoided or endured with marked distress.
  • Agoraphobia
  • Social phobia
  • Specific phobia

  • Agoraphobia fear of being in places or
    situations from which escape might be difficult,
    or in which help might not be available if
    panic-like symptoms should occur.
  • Symptom onset commonly occurs in the 20s and 30s
    and persists for many years
  • Diagnosed more commonly in women than in men
  • Impairment can be severe
  • Individual may be confined to his or her home

  • Social phobia an excessive fear of situations
    in which a person might do something embarrassing
    or be evaluated negatively by others.
  • Extreme concerns about being exposed to possible
    scrutiny by others
  • Fear of social or performance situations in which
    embarrassment may occur
  • Onset of symptoms often begins in late childhood
    or early adolescence and runs a chronic,
    sometimes lifelong, course
  • Impairment interferes with functioning

  • Specific phobia a marked, persistent, and
    excessive or unreasonable fear when in the
    presence of, or when anticipating an encounter
    with, a specific object or situation.
  • Frequently occur concurrently with other anxiety
  • Exposure to the phobic stimulus produces
    overwhelming symptoms of panic, including
    palpitations, sweating, dizziness, and difficulty
  • Individual recognizes that fear is excessive, but
    powerless to change it

  • Obsessive-Compulsive Disorder (OCD)
  • Obsessions unwanted, intrusive, persistent
    ideas, thoughts, impulses, or images that cause
    marked anxiety or distress most common are
    repeated thoughts about contamination, repeated
    doubts, a need to have things in a particular
    order, aggressive or horrific impulses, and
    sexual imagery.
  • Compulsions unwanted repetitive behavior
    patterns or mental acts (praying, counting) that
    are intended to reduce anxiety, not to provide
    pleasure or gratification may be performed in
    response to an obsession or in a stereotyped

  • Obsessive-Compulsive Disorder (contd)
  • Obsessive-compulsive disorder recurrent
    obsessions or compulsions that are severe enough
    to be time consuming or to cause marked distress
    or significant impairment.
  • Individual recognizes behavior is excessive but
    is compelled to continue the act due to the
    relief from discomfort it promotes
  • Most common compulsions involve washing and
    cleaning, counting, checking, ordering
  • Usually begins in adolescence or early adulthood

  • Post-Traumatic Stress Disorder (PTSD)
  • PTSD development of characteristic symptoms
    following exposure to an extreme traumatic
    stressor involving a personal threat to physical
    integrity or to the physical integrity of others.
  • Not related to common experiences
  • Symptoms must be present for more than 1 month
    and cause significant interference with
    functioning to be diagnosed
  • Symptoms may begin within the first 3 months
    after trauma, or may be delayed

  • Post-Traumatic Stress Disorder (contd)
  • Characteristic symptoms include
  • Re-experiencing the traumatic event
  • Sustained high level of anxiety or arousal, or a
    general numbing of responsiveness
  • Intrusive recollections or nightmares of the
  • May not remember certain aspects of the trauma
  • Depression
  • Substance abuse

Objective 2
  • Reviewing definitions and types of somatoform

  • Somatization the process by which psychological
    needs are expressed in the form of physical
    symptoms somatization is thought to be
    associated with repressed anxiety.
  • Somatoform disorders physical ailments for
    which no medical explanation has been found.
  • Associated with psychological distress and
    long-term seeking of assistance from health-care
  • Symptoms may be vague, dramatized, or exaggerated
    in their presentation

  • Types of Somatoform Disorders
  • Pain disorder
  • Hypochondriasis
  • Conversion disorder
  • Body dysmorphic disorder

  • Pain Disorder
  • Persistent and chronic pain at one or more sites
    in which psychological factors are thought to
    play a role
  • Suffering is so severe that it impairs clients
    ability to function
  • Risk factors include
  • underlying medical condition (i.e. fibromyalgia,
  • uncontrolled or inadequately managed pain
  • depression
  • anxiety

  • Hypochondriasis
  • Excessive preoccupation or worry about having a
    serious illness
  • Characteristics include
  • fears that minor bodily symptoms may indicate
    serious illness
  • constant self-examination and self-diagnosis
  • preoccupation with ones body
  • Fear is persistent and disabling in spite of
    reassurances that no organic pathology can be
  • History of doctor shopping

  • Conversion Disorder
  • Disorder in which emotional distress or
    unconscious conflicts are expressed through
    physical symptoms
  • Sudden onset of symptoms following a stressful
  • Involves involuntary loss of one or more bodily
    functions in which diagnostic testing uncovers no
    physical cause
  • Risk factors include
  • medical illness
  • dissociative disorder
  • personality disorder

  • Body Dysmorphic Disorder
  • Exaggerated belief that the body is deformed or
    defective in some specific way
  • Most common complaints involve imagined or slight
    flaws of the face or head
  • Risk factors include
  • chemical imbalance of the brain
  • obsessive-compulsive disorder (OCD)
  • eating disorder
  • generalized anxiety disorder (GAD)
  • higher socioeconomic status
  • strict cultural standards

Objective 3
  • Identifying primary and secondary gains
    obtained by clients with somatoform disorder

  • In primary gain, the physical symptom(s) allows
    the client to avoid some unpleasant activity or
    difficult situation about which he or she is
  • Secondary gain involves the promotion of
    emotional support or attention for the physical
    symptom(s) that the client might not otherwise

Objective 4
  • Examining therapies appropriate for clients
    with anxiety disorder

  • Individual psychotherapy
  • Cognitive and/or behavioral therapy
  • Systematic desensitization
  • Implosion therapy (flooding)
  • Group/family therapy
  • Psychopharmacology

Objective 5
  • Reviewing the use, classifications, side effects,
    and nursing care related to medications for
    anxiety disorders

  • Most commonly treated with anti-anxiety agents
    and sedative-hypnotics
  • Depress subcortical levels in the limbic system
  • CNS depression ranges from mild sedation to coma
  • Classes of anti-anxiety agents include
    antihistamines, benzodiazepines, and
    miscellaneous agents
  • Buspirone (Buspar) does not depress the CNS
  • 10-day to 2-week onset
  • Does not build tolerance or dependence
  • Sedative-hypnotics include barbiturates,
    benzodiazepines, and miscellaneous agents

  • Anti-anxiety agents
  • Antihistamines
  • Hydroxyzine (Atarax, Vistaril)
  • Benzodiazepines
  • Alprazolam (Xanax)
  • Chlordiazepoxide (Librium)
  • Clonazepam (Klonopin)
  • Clorazepate (Tranxene)
  • Diazepam (Valium)
  • Lorazepam (Ativan)
  • Miscellaneous agents
  • Buspirone (Buspar)

  • Anti-Anxiety Agents (contd)
  • Efficacy may vary
  • Alcohol, narcotics, barbiturates, antipsychotics,
    and antidepressants increases effects
  • Nicotine and caffeine decreases effects
  • Common side effects include drowsiness,
    confusion, and lethargy
  • Abrupt withdrawal can be life-threatening
  • Insomnia
  • Increased anxiety
  • Vomiting
  • Tremors, convulsions, and delirium

  • Sedative-hypnotics
  • Barbiturates
  • Secobarbital (Seconal)
  • Benzodiazepines
  • Flurazepam (Dalmane)
  • Temazepam (Restoril)
  • Triazolam (Halcion)
  • Miscellaneous Agents
  • Chloral Hydrate (Noctec)
  • Zaleplon (Sonata)
  • Zolpidem (Ambien)
  • Eczopiclone (Lunesta)

  • Sedative-Hypnotic Agents (contd)
  • Short-term use
  • Chronic use may induce tolerance and
    physical/psychological dependence
  • Additive effect on CNS depression with alcohol,
    antihistamines, antidepressants, or other CNS
  • Watch for decreased effectiveness of other
    medications metabolized by the liver

Objective 6
  • Applying the nursing process to a client with
    an anxiety or somatoform disorder

  • Assessment
  • Gather information about clients mood and level
    of anxiety, thoughts to harm self/others
  • Diagnosis
  • Risk for self-directed violence R/T
    anxiety-related depression
  • Imbalanced nutrition, less than body requirements
    R/T lack of interest in food
  • Disturbed sleep pattern R/T anxiety
  • Anxiety R/T panic disorder
  • Social isolation R/T agoraphobia

  • Planning
  • Care plan
  • Concept map
  • Implementation
  • Establish trust
  • Provide for safety
  • Perform risk assessment
  • Administer scheduled and PRN medications
  • Evaluation
  • Mental health/psychiatric assessment tool
  • Review safety plan/contract
  • Assess for medication side effects