- 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.
- ANXIETY DISORDERS
- Excessive anxiety responses
- Demonstrates unusual behaviors
- Disorder significantly impairs their daily routine, social life and occupational functioning.
- GENERAL ETIOLOGY OF ANXIETY nursinglectures.blogspot.com
- Psychodynamic Theory nursinglectures.blogspot.com
- 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
- Interpersonal theory
- Values of their parents and family
- Problems in interpersonal relationship = ANXIETY
- Cognitive - Behavioral theory
- Learned through experiences
- 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
- TREATMENT
- Combination of medication & therapy
- Cognitive behavioral therapy
- “ ASSERTIVENESS TRAINING”
- “ POSITIVE REFRAMING”
- “ DECATASTROPHIZING”
- MENTAL HEALTH PROMOTION
- Tips for Managing Stress
- Positive attitude
- Acceptance
- Well balanced diet
- Enough rest
- Stress management techniques
- Set realistic goals
- ANXIETY DISORDERS
- GAD
- PD
- OCD
- Phobic disorder
- ASD and PTSD
- GENERAL ANXIETY DISORDER
- “ free floating anxiety”
- APPREHENSIVE WORRYING
- UNCONTROLLABLE WORRYING = problems with ADL
- AD
- months
- Primary symptoms
- Nervousness
- Irritability
- Apprehension
- Agitation
- Tension
- Tachycardia
- Diaphoresis
- SOB
- Difficulty falling and staying asleep
- Overlaps those with Panic and depressive
- Overeacts to mild stress
- 50% of the time for months
- Depression
- Use of Alcohol or Drugs
- TREATMENT:
- Multimoda l
- Psychopharmacology
- Cognitive Behavioral Approach
- Individual and Family therapy
- Psychoeducation
- 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
- 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
- AFTER THE REDUCING THE LEVEL OF ANXIETY
- Assist in examining their coping behaviors = Problem Solving Skills
- PSYCHOPHARMACOLOGY
- Benzodiazepines
- Alprazolam (XANAX)
- Lorazepam (ATIVAN)
- NON – Benzodiazepines
- Buspar
- Antidepressant
- SSRI
- MILIEU
- To reduce tension
- Recreational activities
- Relaxation exercises and tapes that should be practice when she is relatively calm.
- 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
- 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
- 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
- Onset
- Late adolescence and mid 30’s
- 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
- TNPR
- Key Nursing Intervention:
- To help patients to get through the panic attack safely with as little discomfort as possible.
- Education
- Reassurance
- Cognitive Restructuring
- 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”
- Psychopharmacology
- SSRI “drug of choice”
- TCA’s
- Imipramine (TOFRANIL)
- Benzodiazepines
- Alprazolam (ZANAX)
- Clonazepam (KLONOPIN)
- MAOI
- Phenelzine (NARDIL)
- Milieu
- Same with GAD
- Gross motor activities
- Walking
- Jogging
- Basketball
- Stationary Bicycle
- 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
- 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.
- 2 Forms:
- Washers
- Checkers
- Others
- counting, touching, hoarding, ordering
- “ Doubt”
- DEPRESSION is a feature
- Self esteem and self worth
- DM:
- Reaction formation
- Isolation
- Undoing
- Magical thinking “ thinking equals doing”
- Strong SE
- ETIOLOGY:
- Genetics
- BRAIN
- Increase brain activity in the frontal lobe and basal ganglia
- NT
- SEROTONIN dysregulation
- 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
- Psychopharmacology
- C L O MIPRAMINE (ANAFRANIL) “drug of choice”
- SSRI
- Fluoxetine (PROZAC)
- Setraline (ZOLOFT)
- Fluvoxamine(LUVOX)
- Benzodiazepines
- 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
- 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?
- 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
- ETIOLOGY:
- Individual factors
- Environment
- Family environment and Genetic
- Develop based on the influence of the environment and genetic predisposition.
- TNPR
- Safety
- Empathy
- Help patients to recognize that their behavior is a method of coping with anxiety.
- Psychopharmacology
- Non specific; meds that reduces depression and blocks panic attacks
- Milieu
- Assertiveness training and goal setting groups
- Social skills groups
- Behavior therapy
- Systematic desensitization
- Flooding
- Self exposure
- 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.
- Traumatic stressors:
- War
- Community violence
- Torture
- Natural and manmade disasters
- Accidents
- Catastrophic illness
- Major personal or business losses.
- 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
- 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
- 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
- PTSD may develop problems with depression. Anxiety related disorders and substance abuse.
- ETIOLOGY:
- Fear conditioning to auditory and visual stimuli
- Failure of Extinction
- Behavioral sensitization
- 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
- 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
- Psychopharmacology
- Benzodiazepines
- Clonidine and Propanolol
- Lithium
- SSRI (fluoxetine, fluvoxamine)
- TCA’s
- MAOI’s
- Neuroleptics
- Milieu
- Inpatient or outpatient
- Social activities
- Recreational and exercise programs
- Community Resources
- Group therapy or Self Help Groups
- S AFETY
- V erbalization of feelings
- C alm Environment and Activities
Friday, February 6, 2009
Anxiety Disorders
ANXIETY DISORDERS
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