Anxiety Disorders-For Class

7/29/2019 Anxiety Disorders-For Class

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Anxiety Disorders


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Anxiety Disorders

Anxiety disorders can be a very nebulousphenomenon to recognize and therefore treat

Is anxiety a disorder/pathological? No!!!!!!

Some anxiety is advantageous. Anxiety oftenproduced in response to new situations, stress,confusion, etc.

Anxiety can heighten ones awareness, thereforeones caution in a threatening situation- improvesurvival


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Anxiety Disorders

If anxiety reaches level where it impairs ones function,may have a disorder

Freud wrote extensively about anxiety, often in a sexual

context What are normal anxiety symptoms?

Perspiration

Headache

Palpitations Restlessness

GI upset


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LEVELS OF ANXIETY

By Peplau

Mild

Moderate Severe

Panic


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MILD ANXIETY

Alertness

Optimum ability to solve problems and makeindependent decisions

Enhanced learning

Nursing Management: Help client identify and

describe feelings,develop the capacity to toleratemild anxiety and use it consciously andconstructively


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MODERATE ANXIETY

Perception narrowed

Selective inattention

Physical discomforts Nursing Management: Provide outlet for tension

such as walking ,crying,use of appropriate

relaxation exercises


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SEVERE ANXIETY

Severely impaired problem solving skills. Inability to grasp meaning of

communications,engage in self directed

activity,or make decisions. Nursing Management: Link clients behavior

with feelings.Remain with the patient and

provide constant attention until anxietydiminishes.Administer medications as needed.


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PANIC

Overwhelmed, inability to function orcommunicate

Possible bodily harm to self or others

Loss of rational thought.

Nursing Management: Provide non-

stimulating,structured environment ,avoidtouching,stay with client,speak in quiettones,medicate with tranquilizers if necessary.


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Anxiety Disorders

What are the anxiety disorders? Panic disorder with and without agoraphobia

Agoraphobia without panic

Social phobia Specific phobia

Generalized anxiety disorder

Obsessive compulsive disorder

Post traumatic stress disorder Acute stress disorder

Anxiety disorder due to medical conditions

Substance induced anxiety disorder


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Anxiety Disorders

Overall, anxiety disorders may be one of mostprevalent psychiatric disorders

Up to 25% of Americans will meet diagnostic

criterion for an anxiety disorder at some point intheir life

Women have higher incidence of anxiety disorders

There is some genetic component to anxietydisorders


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Anxiety Disorders

What are some of the medical problems which can look likeanxiety disorders? Tumors (including pheochromocytoma)

MS

Migraine headaches Seizures

Stroke

Hyperthyroid

Hypoxia

Lupus Hypoglycemia

Medications

Many others!!!


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Anxiety Disorders

What substances can make you feel/lookanxious?

First question, should be is it intoxication or

withdrawal

Alcohol/sedative withdrawal

Cocaine/stimulant intoxication

Cannabis intoxication Caffeine intoxication and withdrawal


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PANIC DISORDERS

Panic disorder with/withoutagoraphobia

3-5% lifetime prevalence of panic d/o, but 5-8%lifetime prevalence of panic attacks, female to maleratio is 3:1, usually in young adulthood

Up to 85-90% of patients with panic d/o will have

another co-morbid psychiatric disorder


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TREATMENT

Treatment is usually multi-modal

Psychoanalytical psychotherapy is indicated onlyif personality problems exist.

Supportive psychotherapy is used either alone orin combination with drug therapy.

Relaxation Techniques CBT,bio feedback and hyperventilation control

are therapies which can also be used


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PANIC DISORDERS What is a panic attack?

Palpitations Sweating Trembling Choking sensation,sensations of shortness of breath

Chest pain GI complaints-nausea or abdominal distress Fear of dying or going crazy Derealization Paresthesias Chills or hot flushes

Attacks come out of the blue, last about 10 minutes,often not in response to stress, need repeated attacksand fear of having another


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CHARACTERISTIC FEATURES OF

PHOBIA

Presence of the fear of an object ,situation oractivity.

Fear is out of proportion of the dangerousnessperceived.

Patient recognizes the fear as irrational andunjustified (insight is present)

Unable to control the fear and is very distressedby it.

Leads to phobic avoidance.


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AGORAPHOBIA

Very common for someone to develop a fear ofbeing away from home, going in public-somewhere they cannot get help

This is known as agoraphobia Common enough with panic disorder that to

diagnose panic disorder, you must specify either

with or without agoraphobia Responds well to cognitive behavioral therapy,

as well as other forms of therapy


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SOCIAL PHOBIA

Lifetime prevalence of 2-3%, initially thought to bemore prevalent in females, but clinically is equal sexdistribution

Demonstrate a marked fear of being in situationswhere they will be scrutinized by others, fear theywill be embarrassed, recognize fear is excessive

e.gs-public speaking ,public performance,eating in

public,participating in groups,speaking tostrangers,etc.

Can lead them to have a panic attack


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PHOBIC DISORDERS

So, how do you differentiate social phobia andpanic disorder with agoraphobia?

Agoraphobia has a fear of being somewhere they

cannot get help, so if someone were with them, theywould feel reassured

Social phobia has a fear of being scrutinized and

being embarrassed, so if someone accompaniesthem, they will feel worse


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SPECIFIC (SIMPLE) PHOBIA

Irrational fear of a specified object orsituation.Anticipatory anxiety leads to persistentavoidance behavior,while confrontation with the

avoided object or situation leads to panic attack e.gs-acrophobia-fear of high places

zoophobia-fear of animals

xenophobia -fear of strangers algophobia -fear of pain

claustrophobia-fear of closed places


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PHOBIAS( contd.)

Secondary defense mechanism is displacement.

Management:

Behavior therapy in the form of

Flooding Systematic desensitization

Relaxation techniques

Drug therapy in the form ofBenzodiazepines-to reduce anticipatory

anxiety.Alprazolam is the drug of choice

Antidepressants-to control the panic attacks


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GENERALIZED ANXIETY

DISORDER

Lifetime prevalence of 4-6%

Females to Male ratio is 2:1

Difficult to diagnose as definition is

Excessive worry/anxiety occurring more days than not for6 months about many areas of ones life (school, work,

money, relationships)

Three or more of the following six symptoms.Only

one required in children

Symptoms consist of restlessness, easily fatigued, difficultyconcentrating, irritable, muscle tension, sleep problems


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GENERALIZED ANXIETY

DISORDERS

These patients will often seek out primary caredoctors for physical complaints first

So, primary docs must be aware of this illness and

the somatic complaints the patients present withThis illness is very likely to be co-morbid with other

psychiatric illnesses, i.e. up to 25% of GAD patientswill have panic attacks at one point in their illness,also likely to experience major depression at somepoint


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OBSESSIVE COMPULSIVE

DISORDER

What is an obsession? Recurrent and intrusive thought, feeling, or sensation

What is a compulsion? Conscious behavior to reduce anxiety

Lifetime prevalence estimated at 2-3%

Females=males

Frequently co-morbid with other illnesses, i.e. majordepression, social phobia


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DISORDERS

Most common obsessions are Fear of contamination

Pathological doubt (forgot to turn off stove)

Somatic

Need for symmetry

To diagnose OCD, need either obsessions orcompulsions which are recognized as excessive by

patient, take more than 1 hour/day or interfere withfunctioning


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DISORDERS

Obsessions Must have repetitive thoughts, sensations, feelings which

intrude into mind and cause anxiety

Person must try to neutralize/ignore them

Recognize as excessive

Not just worrying about life stressors

Compulsions Repetitive behaviors or mental acts person feels driven to

perform by obsessions

Behaviors supposed to reduce anxiety of obsessions, butare not realistically connected or are excessive


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TREATMENT OF OCD

Poor prognosis is yielding to

obsessions/compulsions, childhood onset, bizarrecompulsions, co-morbid major depressive disorder,delusional beliefs, personality disorder presence,need for hospitalization

Treatment is not just meds OCD responds well to therapy, i.e. cognitive

behavioral therapy

In severe cases, will do psychosurgeryTypically is cingulotomy (25-30% success rate)


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POST TRAUMATIC STRESS

DISORDER

Develops after experiencing/witnessing a stressful/lifethreatening event to you or loved one which led to intensefear, helplessness, or horror

Been mentioned in literature since Civil War, described as

irritable heart, then shell shock in WW I, combatneurosis in WW II, then PTSD in Vietnam era

Lifetime prevalence of PTSD is 1-3%. About 30% Vietnamvets experience PTSD

Can occur after natural disaster, wars, rapes, assault, motorvehicle accidents


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PTSD

To diagnose PTSD, need 4 thingsTraumatic event

Re-experience traumatic event through nightmares,flashbacks, recurrent disturbing thoughts of event

Attempts to avoid stimuli associated with event, i.e. avoidgoing to places which remind you of event, avoid talkingabout events, cannot recall important parts of event,feeling detached/estranged from others, sense of

foreshortened future Increased autonomic arousal, i.e. difficulty falling asleep,

outbursts of anger, hypervigilance, exaggerated startleresponse, difficulty concentrating


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PTSD

About 30% of patients with PTSD recovercompletely, 40% have mild symptoms over time,20% have moderate symptoms, 10% stay unchanged

or worsenTreatment is with meds, group participation, as well

as individual therapy

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Anxiety Disorders-For Class

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