Anxiety Disorders Flashcards
Anxiety
A vague feeling of dread or apprehension in response to internal or external stimuli
- Anxiety is unavoidable in life and can serve many positive functions
Stress
The wear and tear that life causes on the body
- It occurs when a person has difficulty dealing with life situations, problems, and goals
Stages of Reaction to Stress
Alarm reaction stage
Resistance stage
Exhaustion stage
Levels of Anxiety: Mild
Sensation that something is different and warrants special attention; sensory stimulation increases; attention is focused to learn; solve problems, think, act, feel, and protect self; motivated
Levels of Anxiety: Moderate
Feeling that something is definitely wrong; nervousness or agitation; can still process information, solve problems, and learn new things with assistance from others; concentration difficult but can be redirected
Levels of Anxiety: Severe
Trouble thinking and reasoning; muscles tighten, vital signs increase, pacing, restlessness, irritability, and anger; use of other emotional - psychomotor means to release tension
Levels of Anxiety: Panic
Fight, flight, or freeze responses; cognitive process focus on the person’s defense
Working with Anxious Clients
Be aware of nurse’s own anxiety level
Assess the person’s anxiety level
Speak in short, simple, easy to understand sentences
Lower the person’s anxiety level to mild or moderate before proceeding anything else
Talk to the client in a low, calm, and soothing voice
Walk while talking if the patient cannot sit still
Ensure safety during panic level anxiety
Remain with the client until the panic recedes
Short term use of anxiolytics
Anxiety Disorders
Agoraphobia with or without panic disorder Panic disorder Specific phobia Social phobia Obsessive Compulsive Disorder (OCD) Generalized anxiety disorder (GAD) Acute stress disorder Post traumatic stress disorder (PTSD)
Incidence of anxiety disorders
Anxiety disorders are the most common psychiatric disorders in the US, affecting 25% of adults
More prevalent in women
Prevalent in people younger than 45 years of age
More common in separated or divorced people
More common in people of lower socioeconomic status
Onset and clinical course are variable
Related Disorders
Anxiety disorder due to a general medical condition
Substance-induced anxiety disorder
Separation anxiety disorder
Adjustment disorder
Etiologies
Biologic Theories
- Genetic theories: anxiety may have an inherited component
- Neurochemical theories: neurotransmitters may be dysfunctional in persons with anxiety disorders
Psychodynamic Theories
- Intrapsychic/ psychoanalytic theories: overuse of defense mechanisms
- Interpersonal theory: results from problems in interpersonal relationships
- Behavioural theory: “learned” behavioural response
Cultural Considerations
Asian cultures often express anxiety through somatic symptoms such as headaches, backaches, fatigue, dizziness, and stomach problems
Hispanics experience high anxiety as weakness, sadness, agitation, weight loss, and heart rate changes; the symptoms are believed to occur because supernatural spirits or bad air from dangerous places and cemeteries invades the body
Treatment
Usually involves a combination of medication (anxiolytics and antidepressants) and therapy
- Cognitive - behavioural therapy:
- Positive reframing (turning negative messages into positive ones)
- Decatastrophizing (making a more realistic appraisal of the situation
- Assertiveness training (learn to negotiate interpersonal situations)
Elder Considerations
Later-life anxiety disorders are often associated with another condition, such as depression, dementia, physical illness, or medication toxicity or withdrawal
- Phobias, particularly agoraphobia and GAD, are the most common late-life anxiety disorders
The treatment of choice for anxiety disorders in the elderly is SSRI antidepressants
Community-Based Care
Treatment settings include family practitioner or advanced practice nurse, physician offices, psychiatric clinical specialists, psychologists, or other mental health counsellors
Referral to community resources such as anxiety disorder groups or self-help groups
Mental Health Promotion
Keep a positive attitude and believe in yourself
- Accept that there are events you cannot control
- Communicate assertively with others
- Talk about your feelings to others
- Expres your feelings through laughter, crying, etc.
- Learn to relax
Goal is effective management, not total elimination of anxiety
Mental Health Promotion Cont’d.
- Exercise regularly
- Eat well-balanced meals
- Limit intake of caffeine and alcohol
- Get enough rest and sleep
- Set realistic goals and expectations
- Find an activity that is personally meaningful
- Learn stress management techniques
Panic Disorder
Panic attacks involve 15-30 minute episodes of intense, escalating anxiety with emotional fear, and physiologic discomfort
Panic disorder is diagnosed when the person has recurrent, unexpected panic attacks followed by at least 1 month of persistent concern or worry about future attacks
Clinical Course
Onset of panic disorder peaks in the late adolescent and mid-30’s
Can lead to avoidance behaviour or agoraphobia
Primary or secondary gain are present
- Primary gain is the relief of anxiety
- Secondary gain is the attention received from others as the result of these behaviours
Treatment
Cognitive - behavioural techniques Deep breathing and relaxation Medications - Benzodiazepines - SSRI antidepressants - Tricyclic antidepressants - Antihypertensives
Application of the Nursing Process for Panic Disorder: Assessment
- Hamilton rating scale for anxiety
- Reports of several panic attacks
- May appear “normal” or may have signs of anxiety
- Anxious, worried, tense, depressed, serious, or sad
- Fears losing control or going insane
- Confused and disorientated
- Judgement is poor during an attack
- Self- blaming statements
- Alterations in his or her family, social, or occupational life
- Problems sleeping and eating
Application of the Nursing Process for Panic Disorder: Data Analysis
Nursing Diagnoses Include:
- Risk of injury
- Anxiety
- Situational low self-esteems (panic attacks)
- Ineffective coping
- Powerlessness
- Ineffective role performance
- Disturbed sleep pattern
Application of the Nursing Process for Panic Disorder: Outcome Identification
The client will:
- Be freed from injury
- Verbalize feelings
- Use effective coping techniques
- Manage own anxiety response
- Verbalize sense of personal control
- Re-establish adequate nutritional intake
- Sleep at least 6 hours per night
Application of the Nursing Process for Panic Disorder: Intervention
- Promoting safety and comfort
- Using therapeutic communication
- Managing anxiety
- Provide client and family education
Application of the Nursing Process for Panic Disorder: Evaluation
- Does the client understand the prescribed medication regimen, and is he or she committed to adhering to it?
- Have the client’s episodes of anxiety decreased in frequency or intensity?
- Does the client understand various coping methods and when to use them?
- Does the client believe that his or her quality of life is satisfactory?
Phobias
A phobia is an illogical, intense, persistent fear of a specific object or social situation that causes extreme distress and interferes with normal life functioning.
- Agoraphobia: fear of being outside
- Specific phobia: an irrational fear of an object or situation
- Social phobia: anxiety provoked by certain social or performance situations
Onset and Clinical Course
Specific phobias usually occur in childhood or adolescence; in some cases, merely thinking about or handling a plastic model of the dreaded object can cause fear
Specific phobias that persist into adulthood are lifelong 80% of the time
Treatment and prognosis
Psychopharmacology - Anxiolytics - SSRI antidepressants - Beta blockers to slow heart rate and lower blood pressure Behavioural Therapies - Systemic desensitization - Flooding
Obsessive - Compulsive Disorder
Obsessions are recurrent, persistent, intrusive, and unwanted thoughts, images, or impulses that cause marked anxiety and interfere with interpersonal, social, or occupational functioning
Compulsions are ritualistic or repetitive behaviours or mental acts that a person carries out continuously in an effort to neutralize anxiety
The person knows the rituals are unreasonable but feels forced to continue them in an attempt to relieve anxiety caused by obsessions
Onset and Clinical Course
- Can start in childhood or in the 20’s
- Affects males and females equally
- Onset is usually gradual
- Exacerbation of symptoms may be related to stress
- 80% of those treated with behaviour therapy and medication report success
Treatment and Prognosis
Treatment is most successful with behaviour therapy and medication
Medications:
- SSRI antidepressants, fluvoxamine, clomipramine, buspirone, clonazepam
Behaviour Therapy
- Exposure (confronting anxiety provoking stimuli)
- Response prevention (delaying or avoiding ritual performance)
Application of the Nursing Process for OCD: Assessment
- Yale-Brown Obsessive-Compulse Scale
- Reports of obsessions becoming too overwhelming; compulsions interfere with daily life
- Tense, anxious, worried, and fretful
- Ongoing, overwhelming feelings of anxiety
- Intact intellectual functioning with difficulty concentrating
- Recognizes that the obsessions are irrational but he or she cannot stop them
- Powerlessness
- Relationships also suffer
- Trouble sleeping or loss of appetite
Application of the Nursing Process for OCD: Data Analysis
- Anxiety
- Ineffective coping
- Fatigue
- Situational low self-esteem
- Impaired skin integrity (if scrubbing or washing rituals)
Application of the Nursing Process for OCD: Outcome Identification
The client will:
- Complete daily routine within realistic time frame
- Demonstrate effective use of relaxation techniques
- Discuss feelings with others
- Demonstrate effective use of behaviour therapy techniques
- Spend less time performing rituals
Application of the Nursing Process for OCD: Intervention
- Using therapeutic communication
- Teaching relaxation and behavioural techniques
- Completing a daily routine
- Providing client and family education
Application of the Nursing Process for OCD: Evaluation
- Do the symptoms no longer interfere with the clients ability to carry out responsibility?
- When the obsessions occur, does the client manage resulting anxiety without engaging in complicated or time-consuming rituals?
- Does the client report regained control over his or her life?
- Does the client report ability to tolerate and manage anxiety with minimal disruption?
Generalized Anxiety Disorder (GAD)
- Excessive anxiety and worry that is unwarranted more days than not
- Symptoms include uneasiness, irritability, muscle tension, fatigue, difficulty thinking, and sleep alterations
- Seen most often by family physicians
- Treated with SSRI antidepressants and buspirone
Post- Traumatic Stress Disorder
- After witnessing a terrifying and potentially deadly event, the person re-experiences all or some of it through dreams or waking recollections and responds defensively to these flashbacks
- New behaviours develop r/t the trauma such as sleep difficulties, hyper vigilance, thinking difficulties, severe startle response, and agitation
Acute Stress Disorder
- A dissociative response develops following the experience of a traumatic situation
- The person has a sense that the event was unreal, thinks he or she is unreal, and forgets some aspects of the event through amnesia, emotional detachment, and muddled obliviousness to the environment
Self-Awareness Issues
- Nurses must understand what and how anxiety behaviours work
- Nurses are just as vulnerable to stress and anxiety as others
- Avoid allowing your own feelings and needs to hinder the care of your clients
