Unit4 anxietydisorderspmh nonline

Anxiety

Normal human emotion life without anxiety is not possible

Exists on a continuum mild to severe

Anxiety Operational Definition

Expectations are heldExpectations are not metAnxiety feltAutomatic behaviorBehavior is rationalized

Stress Resistance

Internal locus of controlHealthy lifestyleRegular exerciseBalanced dietSocial support

Symptoms of Anxiety

Emotional Irritability Helplessness Social withdrawal Angry outbursts

Symptoms of Anxiety

Cognitive Forgetfulness Decreased concentration Decreased attention Decreased productivity Rumination

Symptoms of Anxiety

Physical Increased heart rate Increased BP Tightness or pain in chest Difficulty breathing Headache Urinary frequency Accident proneness

Symptoms of Anxiety

Physical Sleep disturbances Nausea and vomiting Decreased appetite Frequent minor illnesses Poor posture

Anxiety Disorders

Anxiety or the avoidance of anxiety is the main feature of these disorders

Affect 25% of the populationOccur at any point in lifespan

Theories

Cognitive-Behavioral Excessive anxiety is learned Change thoughts, change anxious behavior

Psychosocial Unconscious conflicts Overactive superego Disturbed self concept

Theories

Genetic 20% of first degree relatives with generalized anxiety disorder

(GAD) also have GADBiological

Dysfunction of GABA receptors in CNS GABA (natural anti-anxiety substance) is the major inhibitory

neurotransmitter

Medications

Benzodiazepines Immediate effect Risk of addiction

Buspirone Takes 2-4 weeks to affect anxiety No risk of addiction

SSRIs

Generalized Anxiety Disorder

Affects twice as many women as menChronic, free-floating anxietyNo panic attacksNo obsessions/compulsionsMay abuse substancesCulture may influence symptomsMay co-exist with depression

Panic Disorder

Severe anxiety attacks16% of adult AmericansNo stimulus neededWorry about more attacks or change in behavior

due to attacks (avoidance)Cardiac neurosis

Panic Disorder

Lactate HypothesisRespiratory and Carbon Dioxide HypothesisNorepinephrine HypothesisSerotonin HypothesisAdenosine HypothesisGABA - Benzodiazepine HypothesisLimbic System Dysfunction

Phobic Disorders

Panic response to a specific object, activity, or situation:

Agoraphobia (leaving home, crowds) Social phobia (eating, public speaking, walking into a room) Specific phobia (snakes, elevators)

Obsessive-Compulsive Disorder(OCD)

Obsessions recurring thoughts which cannot be dismissed from

consciousnessCompulsion

uncontrollable urge to perform certain actsNeed to control

Self Others Environment

Obsessive-Compulsive Disorder(OCD)

Genetics may play a roleSerotonin dysfunctionSSRIs therapeuticBasal ganglia and frontal lobe abnormalitiesPrognosis

15% show progressive deterioration

Posttraumatic Stress Disorder(PTSD)

Experience significant, unusual traumaRecurrent, intrusive, reexperiencing of the trauma

Acute (last up to 3 months) Chronic (more than 3 months) Delayed onset (after 6 months)

Symtoms of hyperarousalAvoidance behavior: May abuse substances

Dissociative Disorder

anxiety & dissociative sx within 1 month of trauma exposure to very threatening event feelings of helplessness, fear, horror dissociative symptoms: feeling detached, cut-off, dream-like

state avoidance hyperarousal

Dissociative Disorder

Dissociative amnesia difficulty remembering a past period of time

Dissociative fugue inability to remember one’s past or identity

Dissociative identity disorder 2 or more distinct personalities

Depersonalization disorder episodes of feeling detached or numb

Dissociative Disorder

Symptoms Flashbacks Numbing Nightmares Startle response Memory impairment

Nursing Intervention

Observe the nonverbalConnect relief behavior with feelingInvestigate preceding situation Help client connect what happened to anxietyHelp client state causes & remember similar patterns

Multidisciplinary Interventions

Cognitive-Behavior Therapy Cognitive restructuring Relaxation training Exposure therapy: confronting situation with support of

therapist Systematic desensitization: gradual exposure Implosive therapy: uses vivid imagery to expose Flooding: exposing to stimulus without relaxation until the anxiety

subsides

Multidisciplinary Interventions

Paradoxical intention Instruction to hyperventilate and bring on attack

Laboratory Values for Anxiety Disorders

Panic disorder Decreased serum Bicarbonate due to hyperventilation

syndrome Increased serum Chloride in hyperventilation

syndrome Decreased Fasting blood sugar

Assessment tools for Anxiety

Hamilton Rating Scale forAnxiety

Case Study

A 26 year old man has started to count in units of 4. As he walks he counts his steps, one two three, four. As he shops he counts items on the shelves, one, two, three, four. He has taken to insisting that when his wife and he kiss, that they kiss four times or a multiple of four times. He and his wife come to visit your for help. Both of them realize this behavior is irrational. How do your further this diagnosis?

Case Study

A 47 year old female client tells you that as a child she grew up on a farm. Her father would discipline her by humiliating her by calling her names, such as “stupid, and lazy”. For punishment, he would take her outside of the house and threaten her with a gun and then shoot the gun off near her. She was terrified that one day her could kill her. She has recently married for the second time to a “very nice man”; however, she has many flashbacks to her childhood, nightmares, and is suspicious of her husband. What is this client’s diagnosis and prognosis?