PANIC DISORDER
PHOBIA
It is composed of discrete episodes of panic
attacks, that is, 15 to 30 minutes of rapid,
intense, escalating anxiety in which the person
experiences great emotional fear as well as
physiologic discomfort.
Etiology
 Biologic
 Genetic
 Environmental
Signs & Symptoms
 Palpitations
 Tremors
 Sweating
 Shortness of breath
 Sense of suffocation
 Chest pain
 Nausea
 Abdominal distress
 Dizziness
 Paresthesias
 Chills or hot flashes
Medical Management
 Cognitive-behavioral techniques
 Deep breathing and relaxation
 Medications such as benzodiazepines,
SSRI antidepressants, tricyclic
antidepressants, and
antihypertensives such clonidine
(Catapress) and propanolol (Inderal).
Nursing Intervention
 Remain with client during panic
attack
 Promote Safety and Comfort
 Use Therapeutic Communication
 Provide Client and Family Education
It is an irrational, intense and persistent fear of
certain situations, activities, things, animals, or
people. The main symptom of this disorder is
the excessive and unreasonable desire to avoid
the feared stimulus.
Causes
 Known as an emotional response
learned because of difficult life
experiences.
Note: Generally phobias occur when fear
produced by a threatening situation is
transmitted to other similar situations,
while the original fear is often repressed
or forgotten.
Signs & Symptoms
 Chest pain or discomfort
 Trembling or shaking
 Feeling of choking
 Sweating
 Fear of losing control or going crazy
 Numbness or tingling sensations
Common Types of Phobia
 Hot or cold flashes
 Palpitations, pounding heart, or
accelerated heart rate
Treatment
 Desensitization - the therapist
progressively exposes the client to the
threatening object in a safe setting
until the client reduces his/her anxiety
level.
 Flooding - a form of rapid
desensitization in which a behavioral
therapist confronts the client with the
phobia object until it no longer
produces anxiety
 Agoraphobia - fear of public places
and open spaces.
 Animal phobias - fears caused by an
animal or insect. Examples include
fear of snakes, fear of spiders, fear of
rodents, and fear of dogs.
 Natural environment phobias - fears
cued by objects found in nature.
Examples include fear of heights, fear
of storms, fear of water, and fear of
the dark.
 Situational phobias - fears triggered
by a specific situation. Examples
include fear of enclosed spaces
(claustrophobia), fear of elevators,
fear of flying, fear of dentists.
 Blood-Injection-Injury phobia - fear
of blood, fear or injury, or a fear of
shots or another medical procedure.
 Social Phobia - also called social
anxiety disorder, is fear of social
situations where you may be
embarrassed or judged. If you have
social phobia you may be excessively
self-conscious and afraid of
humiliating yourself in front of
others..
OBSESSIVE-COMPULSIVE
DISORDER
OCD is an anxiety disorder characterized by
uncontrollable, unwanted thoughts and
repetitive, ritualized behaviors you feel
compelled to perform.
Etiology
 Family History
 Chemical Imbalances
Common obsessive thoughts in OCD
include:
• Fear of being contaminated by germs
or dirt or contaminating others
• Fear of causing harm to yourself or
others
• Fear of losing or not having things
you might need Order and symmetry:
the idea that everything must line up
“just right.”
• Superstitions; excessive attention to
something considered lucky or
unlucky
Common compulsive behaviors in OCD
include:
• Excessive double-checking of things,
such as locks, appliances, and
switches.
 • Counting, tapping, repeating certain
words, or doing other senseless things
to reduce anxiety.
• Spending a lot of time washing or
cleaning.
• Ordering, evening out, or arranging
things “just so.”
• Accumulating “junk” such as old
newspapers, magazines, and empty
food containers, or other things you
don’t have a use for.
Four Steps for Conquering Obsessive
Thoughts and Compulsive
Urges
1. RELABEL – Recognize that the
intrusive obsessive thoughts and
urges are the result of OCD.
2. REATTRIBUTE – Realize that the
intensity and intrusiveness of the
thought or urge is caused by OCD; it
is probably related to a biochemical
imbalance in the brain.
3. REFOCUS – Work around the OCD
thoughts by focusing your attention
on something else, at least for a few
minutes. Do another behavior.
4. REVALUE – Do not take the OCD
thought at face value. It is not
significant in itself.
ACUTE STRESS DISORDER
It is the anxiety and behavioral disturbances
that develop to individuals in the first month
following a traumatic event. It is a result of a
traumatic event in which the person
experienced or witnessed an event that
involved threatened or actual serious injury or
death and responded with intense fear and
helplessness.
Causes
 It is caused by extreme traumatic
events: Rape/physical assault,
Combat/war, Near-death experiences
in accidents, Witnessing a murder,
Natural disasters
Signs & Symptoms
 dissociative symptoms - numbing,
detachment from society, initial state
of feeling dazed, trouble experiencing
pleasure, restlessness , irritability,
significant anxiety, poor
concentration, difficulty sleeping
 autonomic signs - tachycardia,
sweating, hyperventilation
Management
a.) Medications: Clonidine (given for
hyperarousal), Propanolol (for anxiety & panic
reactions), Fluoxetine (for avoidance
symptoms), Trazodone (for insomnia and
nightmares), Antidepressants
b.) Psychotherapy: exposure therapy,
therapeutic writing (journaling), supportive
therapy, cognitive-behavioral therapy
c.) Alternative and Complementary
Treatments: Holistic and Naturopathic
approaches to recovery from ASD help:
 Good nutrition with appropriate
dietary supplements and regular
exercise
 Hydrotherapy for post-traumatic
muscular aches and cramps
 Peppermint or other herbal
preparations to calm pt’s. digestive
tract
 Prayer, meditation, counseling with
spiritual advisor has been found to be
helpful in treating pts. With ASD
whose belief systems have been
affected by the traumatic event.
POST TRAUMATIC
STRESS DISORDER
“You can never become a great man or
It can occur in a person who has witnessed an woman until you have overcome
extraordinarily terrifying and potentially anxiety, worry, and fear. It is
deadly event. The person persistently re- impossible for an anxious person, a
experiences the trauma through memories, worried one, or a fearful one to
dreams, flashbacks, or reactions to external perceive truth; all things are distorted
cues to the event and therefore avoids stimuli and thrown out of their proper
associated with the trauma. In PTSD, the relations by such mental states, and
symptoms occur 3 months or more after the those who are in them cannot read the
trauma, which distinguishes PTSD from acute thoughts of God.”
stress disorder. -Wallace D.
Wattles
Signs & Symptoms UNIVERSITY OF SAN CARLOS
 Recurrent, intrusive, distressing COLLEGE OF NURSING
memories of the event Nightmares CEBU CITY
 Flashbacks
 Avoidance of thoughts, feelings or
conversations associated with the
trauma
 Avoidance of activities, places, or
people that arouse memories of the
trauma
 Inability to recall important aspect of
the trauma NCM 501204
 Marked decrease in interest or
participation in significant events
 Feeling detached or estranged from
others
 Restricted range of effect
 Sense of foreshortened future
 Difficulty of falling or staying asleep
 Irritability or anger outbursts
 Difficulty concentrating
 Hypervigilance
 Exaggerated startle response
Treatment
 Group or Individual Therapy
 Cognitive Behavioral Therapy
 Medications:
-Paroxetine (Paxil)
-Sentraline (Zoloft)
 Alea, Ashley Fe D.
Andaya, Kathlene M.
Arias, Ariana J.
Baylosis, Wilfe Marie C.
Boncayao, Ferdinand P. II
GROUP 1
BSN 4 – A