Anxiety & Stress-Related Disorders

8/22/2019 Anxiety & Stress-Related Disorders

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ANXIETY &

STRESS-RELATED

DISORDERS


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Anxiety-related disorders are the most common of all psychiatricdisorders.

Three quarters of those with anxiety disorders have their first episode by age

21.5 years.

Symptoms of anxiety that negatively affect the persons ability tofunction in work or interpersonal relationships are consideredsymptomatic of anxiety disorders.

Anxiety disorders may be associated with other mental & physicalillnesses such as respiratory, cardiac, and mood disorders

Panic attacks occur in many of the Anxiety Disorders.

Patients with Panic Disorders are often seen in a number ofhealth care settings.


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ETIOLOGY

Research points to a combination of biologic

and psychosocial factors that cause persistent

anxiety.

Other research demonstrates that personality

traits may predispose an individual to anxiety.Low self-esteem and some negative family

influences may contribute to development of

anxiety disorders.

In some cases, there may be a traumatic or

stressful precipitating event.


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ANXIETY DISORDERS

Panic Disorder

Acute Stress Disorder

Post Traumatic Stress Disorder

Obsessive-Compulsive Disorder

Generalized Anxiety Disorder

Phobias


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PANIC DISORDER

Characterized by the appearance of disabling attacks of

panic. Physical and psychological symptoms include:

Palpitations

Sweating

Shaking

Shortness of breath or smothering sensation

Sensation of choking

Chest pain

Nausea & vomiting of abdominal distress

Dizziness

Derealization or depersonalization

Fear of going crazy or fear of dying

Chills or hot flashes


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OBSESSIVE-COMPULSIVE DISORDER

Obsessions are excessive, unwanted, intrusiveand persistent thoughts, impulses or images that

cause anxiety and distress.

Compulsions are behaviors that are performed

repeatedly in a ritualistic fashion with the goal of

preventing or relieving anxiety & distress caused

by obsessions.


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GENERALIZED ANXIETY DISORDER

Excessive worry and anxiety that is unwarranted

more days than not.

Symptoms include uneasiness, irritability, muscle

tension, fatigue, difficulty thinking and sleep

alteration.

Adults with GAD often worry about matters such

as their job, household finances, health of familyor simple matters such as household chores or

being late for appointments.


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ACUTE & POSTTRAUMATIC STRESS DISORDERS

Develops after a traumatic event involving a personal

experience of threatened death, injury or perceived

threat to physical integrity.

They are hypervigilent, they re-experience the event

through images, thoughts or nightmares and try to

avoid people, places or things that are reminders of

the event.

Examples of events are violent personal assault, rape,

military combat, natural disasters, terrorist attacks,

incarceration as POW, torture, automobile accidents or

being diagnosed with a life-threatening illness.


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PHOBIAS

An Illogical, intense, persistent fear of a specific object or

social situation that causes extreme distress andinterferes with normal life functioning.

Agoraphobia- fear of open spaces

Specific Phobia an irrational fear of an object or

situation

Social Phobia- anxiety provoked by certain social or

performance situations.


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TREATMENT

Usually involves a combination ofmedication(anxiolytics & antidepressants) & therapy.

CognitiveBehavioral Therapy:Positive reframing

Decatastrophizing

Assertiveness trainingDesensitization

Psychoeducation:

Relaxation techniquesMedication

Education to understand disorders


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PHARMACOLOGIC INTERVENTIONS

Selective Serotonin Reuptake Inhibitors (SSRIS) &

Tricyclic Antidepressants(TCAS) are the most effective

treatment for clients with Anxiety Disorders.

Benzodiazepines are utilized short-term.

ToleranceSedation

Withdrawal

Buspirone (BuSpar) must be taken 3-4 weeks beforeanxiolytic effects are experienced.


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WORKING WITH ANXIOUS CLIENTS

Be aware of nurses own anxiety

Assess the persons anxiety levelSpeak in short, simple, easy-to-understand

sentences

Lower the persons anxiety level to moderate or mild

before proceeding with anything elseSpeak to the client in a low, calm, and soothing voice

Walk while talking, if the client cant sit still

Ensure safety during panic level of anxiety

Remain with the client until panic recedes

Use Cue Cards to help client restructure thoughtpatterns


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SOMATIC

SYMPTOM

DISORDERS


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DEFINITIONS

Somatization is the transference of mentalexperiences and states into bodily

symptoms.

Somatic Symptom Disorders are the

presence of physical symptoms that

suggest a medical condition without ademonstrable organic basis to account

fully for them.


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ESSENTIAL FEATURES

Physical complaints suggest major medicalillness but have no demonstrable organicbasis.

Psychological factors and conflicts seemimportant in initiating, exacerbating andmaintaining the symptoms.

Symptoms or magnified health concerns arenot under the clients conscious control.


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COMPLEX SOMATIC SYMPTOM DISORDER

Is a reconfiguration of Somatization, Hypochondriasis

and Pain Disorder.Clients perceive themselves as being very sick and

aspects of healthcare as poor.

Common features of somatization and cognitive

distortions.Nurses in Primary Care and MedicalSurgical settings

more likely to encounter these persons.

Symptoms tend to change, are diffuse and complex

and move from one body system to another.Clients tend to move from one practitioner to the next.

It is a chronic relapsing condition


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TREATMENT

Provide health teachingAssist client to express emotion

Teach coping strategies; emotion

focused & problem focusedUse of antidepressants for depression

Referral to pain clinic for Pain Disorder

Family Education

Anxiety & Stress-Related Disorders

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