Friday, February 6, 2009

Anxiety Disorders

ANXIETY DISORDERS

  1. Anxiety
    • Apprehension, fearfulness or a sense of powerlessness due to a threat that is less visible definable than fear, which has a visible object or trigger.
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  2. ANXIETY DISORDERS
    • Excessive anxiety responses
    • Demonstrates unusual behaviors
    • Disorder significantly impairs their daily routine, social life and occupational functioning.
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  3. GENERAL ETIOLOGY OF ANXIETY nursinglectures.blogspot.com
  4. Psychodynamic Theory nursinglectures.blogspot.com
  5. Psychoanalytical theory
    • Anxiety as a response to danger
    • Psychic conflict
    • Overuse of Defense mechanism
      • inhibit emotional growth
      • Poor PS skills
      • Difficulty with relationship.
    • Ego matures
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  6. Interpersonal theory
    • Values of their parents and family
    • Problems in interpersonal relationship = ANXIETY
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  7. Cognitive - Behavioral theory
    • Learned through experiences
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  8. Biological theory
    • Genetic theory
    • Brain abnormality
      • Impaired glucose metabolism in the prefrontal cortex & basal ganglia
      • Activation of the R frontal hemisphere
      • Diminished volume of the hippocampus
    • Neurochemical Theory
      • GABA, 5Ht, NE
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  9. TREATMENT
    • Combination of medication & therapy
    • Cognitive behavioral therapy
      • “ ASSERTIVENESS TRAINING”
      • “ POSITIVE REFRAMING”
      • “ DECATASTROPHIZING”
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  10. MENTAL HEALTH PROMOTION
    • Tips for Managing Stress
      • Positive attitude
      • Acceptance
      • Well balanced diet
      • Enough rest
      • Stress management techniques
      • Set realistic goals
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  11. ANXIETY DISORDERS
    • GAD
    • PD
    • OCD
    • Phobic disorder
    • ASD and PTSD
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  12. GENERAL ANXIETY DISORDER
    • “ free floating anxiety”
    • APPREHENSIVE WORRYING
    • UNCONTROLLABLE WORRYING = problems with ADL
    • AD
    • months
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  13. Primary symptoms
    • Nervousness
    • Irritability
    • Apprehension
    • Agitation
    • Tension
    • Tachycardia
    • Diaphoresis
    • SOB
    • Difficulty falling and staying asleep
    • Overlaps those with Panic and depressive
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    • Overeacts to mild stress
    • 50% of the time for months
    • Depression
    • Use of Alcohol or Drugs
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  14. TREATMENT:
    • Multimoda l
      • Psychopharmacology
      • Cognitive Behavioral Approach
      • Individual and Family therapy
        • Psychoeducation
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  15. TNPR
    • First , to reduce the level of anxiety
    • ULTIMATE GOAL: to assist patient’s with developing adaptive coping responses.
    • Initially, patient needs support and reassurance
    • TRUST
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  16. Reduce the Level of Anxiety, HOW?
    • Calm and quiet Environment
    • Awareness of the Problem
      • Ask patients to identify what and how they feel
      • Encourage to describe and discuss their feelings
      • Identify possible causes
    • Listen carefully for patient’s expression of helplessness and hopelessness
    • Provide Activities
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  17. AFTER THE REDUCING THE LEVEL OF ANXIETY
    • Assist in examining their coping behaviors = Problem Solving Skills
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  18. PSYCHOPHARMACOLOGY
    • Benzodiazepines
      • Alprazolam (XANAX)
      • Lorazepam (ATIVAN)
    • NON – Benzodiazepines
      • Buspar
    • Antidepressant
      • SSRI
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  19. MILIEU
    • To reduce tension
      • Recreational activities
      • Relaxation exercises and tapes that should be practice when she is relatively calm.
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  20. PANIC DISORDER
    • Greek word “PANIKOS” meaning FEAR.
    • Panic attacks that is 15 to 30 minutes (some for an hour) of rapid intense, escalating anxiety
    • peak: 10 mins.
    • NO precipitating factor
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  21. DSM IV CRITERIA for PANIC ATTACK
    • Increase HR, Palpitations or chest pain
    • Chills or hot flushes, sweating trembling, dizziness or light headedness
    • Feeling of choking or SOB
    • Nausea or abdominal distress
    • Numbness or tingling
    • Fear of dying, “going crazy” or losing control
    • Derealization or Depersonalization
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  22. DSM IV CRITERIA for PANIC DISORDER
    • Recurrent , unexpected panic attacks
      • “ Out of the blue”
      • Situationally bound
    • Panic Attacks are followed by a month or more of worry about having additional attacks, worry about the results of the attacks, and behavioral changes related to the attacks
    • Can be accompanied by agoraphobia
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  23. Onset
    • Late adolescence and mid 30’s
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  24. ETIOLOGY:
    • Genetics
    • Environmental factors
    • Neurotransmitter
      • SEROTONIN
    • BRAIN ABNORMALITY
      • Abnormalities benzodiazepine receptors
      • Burst of activity in the raphe nuclei and locus ceruleus
    • Caffeine, Carbon Dioxide and sodium lactate
    • Psychological factors
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  25. TNPR
    • Key Nursing Intervention:
      • To help patients to get through the panic attack safely with as little discomfort as possible.
        • Education
        • Reassurance
        • Cognitive Restructuring
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    • Stay with the patient and acknowledge the patient’s discomfort
    • Speak in short, simple sentences
    • If the patient is hyperventilating, provide a brown paper bag and focus on breathing with the patient.
    • Allow the patient to pace or cry
    • “ REASSURANCE”
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  26. Psychopharmacology
    • SSRI “drug of choice”
    • TCA’s
      • Imipramine (TOFRANIL)
    • Benzodiazepines
      • Alprazolam (ZANAX)
      • Clonazepam (KLONOPIN)
    • MAOI
      • Phenelzine (NARDIL)
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  27. Milieu
    • Same with GAD
    • Gross motor activities
      • Walking
      • Jogging
      • Basketball
      • Stationary Bicycle
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  28. OBSESSIVE COMPULSIVE DISORDER
    • O - recurrent thoughts, ideas, impulses or images that are experienced as intrusive and senseless.
    • C - are repetitive behavior that are performed in a particular manner in response to an obsession
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    • OCD recognize that thoughts are products of their own mind
    • Obsession = Compulsion
    • Compulsion are performed to prevent discomfort and to bind or neutralize anxiety.
    • Central feature: subjective experience of loss of voluntary control.
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  29. 2 Forms:
    • Washers
    • Checkers
    • Others
      • counting, touching, hoarding, ordering
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    • “ Doubt”
    • DEPRESSION is a feature
      • Self esteem and self worth
    • DM:
      • Reaction formation
      • Isolation
      • Undoing
    • Magical thinking “ thinking equals doing”
    • Strong SE
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  30. ETIOLOGY:
    • Genetics
    • BRAIN
      • Increase brain activity in the frontal lobe and basal ganglia
    • NT
      • SEROTONIN dysregulation
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  31. TNPR
    • Ensure that Basic needs of food, rest and grooming are met
    • Provide patients with time to perform rituals
    • Explain expectataions, routines, and changes
    • Empathy
    • Structure simple activities, games, task for patients
    • Reinforce recognize positive non ritualistic behaviors
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  32. Psychopharmacology
    • C L O MIPRAMINE (ANAFRANIL) “drug of choice”
    • SSRI
      • Fluoxetine (PROZAC)
      • Setraline (ZOLOFT)
      • Fluvoxamine(LUVOX)
    • Benzodiazepines
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  33. Milieu
    • Stress management groups
      • Recreational and social skills group
      • Cognitive therapy
      • Problem solving groups
      • Communication or assertiveness training groups
    • Behavior treatment
    • Response prevention – delaying rituals
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  34. PHOBIC DISORDER
    • Specific
    • Are intense irrational fear responses to an external object, activity or situation.
    • Phobia is a response to experienced anxiety
    • Phobias are ways of coping with anxiety by displacing it onto an object or situation that can be avoided.
    • Phobic symptoms become phobic disorders when?
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  35. three types
    • A GORAPHOBIA s hx of Panic
      • Greek for “fear of marketplace”
      • separation anxiety in childhood
    • S OCIAL PHOBIA
    • S PECIFIC PHOBIA
      • Natural environmental, Blood injections phobias, Situational, Anima and Others
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  36. ETIOLOGY:
    • Individual factors
    • Environment
    • Family environment and Genetic
      • Develop based on the influence of the environment and genetic predisposition.
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  37. TNPR
    • Safety
    • Empathy
    • Help patients to recognize that their behavior is a method of coping with anxiety.
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  38. Psychopharmacology
    • Non specific; meds that reduces depression and blocks panic attacks
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  39. Milieu
    • Assertiveness training and goal setting groups
    • Social skills groups
    • Behavior therapy
      • Systematic desensitization
      • Flooding
      • Self exposure
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  40. ASD and PTSD
    • develops after exposure to a clearly identifiable traumatic event that threatens the self, others, resources and or a sense of control or hope.
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  41. Traumatic stressors:
    • War
    • Community violence
    • Torture
    • Natural and manmade disasters
    • Accidents
    • Catastrophic illness
    • Major personal or business losses.
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  42. DSM IV CRITERIA
    • ASD
      • Exposure to a traumatic event
      • Responses of horror, helplessness and or fear
      • Dissociative symptoms during or immediately after the event
        • absence of emotions, numbing
        • decreased awareness of surroundings
        • Derealization & Depersonalization
        • Amnesia
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    • Avoidance of stimuli related to trauma; feeling, thoughts, people, conversations, places, activities . Distress when exposed
    • Increased arousal or anxiety; hypervigilance, startle response, irritability, restlessness, decreased concentration.
    • Re-experiencing or reliving traumatic event; distressing thoughts, dreams, flashbacks, illusions
    • Impairment or distress in functioning
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  43. Duration
    • ASD
      • Onset: within 4 weeks after the event
      • Duration: 2 days to weeks
    • PTSD
      • Onset: Acute within 6 months after the event, Delayed: 6 months or more after the event
      • Duration: A= 1 – 3 months. D: 3 or more
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    • PTSD may develop problems with depression. Anxiety related disorders and substance abuse.
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  44. ETIOLOGY:
    • Fear conditioning to auditory and visual stimuli
    • Failure of Extinction
    • Behavioral sensitization
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  45. TNPR
    • TRUST
    • Be Non judgmental, honest, empathic and supportive.
    • Assure patients that their feelings and behaviors are typical reactions to serious trauma
    • Take time for the patient to recognize the relationship between current problems and original traumatic event.
    • Evaluate their past behaviors
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    • Eye Movement Desensitization and Reprocessing (EMDR)
    • Encourage adaptive coping strategies, exercise, relaxation techniques and sleep promoting strategies.
    • Facilitate progressive review of the trauma and it’s consequences
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  46. Psychopharmacology
    • Benzodiazepines
    • Clonidine and Propanolol
    • Lithium
    • SSRI (fluoxetine, fluvoxamine)
    • TCA’s
    • MAOI’s
    • Neuroleptics
    nursinglectures.blogspot.com
  47. Milieu
    • Inpatient or outpatient
      • Social activities
    • Recreational and exercise programs
    • Community Resources
    • Group therapy or Self Help Groups
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    • S AFETY
    • V erbalization of feelings
    • C alm Environment and Activities
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