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Anxiety & Stress-Related Disorders

Aug 08, 2018

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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