ANXIETY DISORDERS

Some Stats about Anxiety D/Os:

Affect an estimated 19.1 million Americans (13.3% of U.S population ages: 18-54) Approx. one third of the yearly mental health bill of $148 billion (approx. $42 billion) is used to treat anxieties. A person with an anxiety D/O is 3-5 times more likely to go to the doctor and 6 times more likely to be hospitalized for psychiatric D/Os than non-sufferers are

HISTORICAL PERSPECTIVES

Anxiety was first recognized as a medical Dx in the late 1800s. S. Freud first introduced the concept of anxiety in the early 1900s ( a danger signal that a person exhibits in response to the perception of physical pain or danger)

Terminology

Anxiety is used to describe feelings of uncertainty, uneasiness, apprehension, tension in response to an unknown object, situation (fight-or-flight) Fear is the bodys response to a known or recognized danger Signal anxiety is a response to an anticipated event

Etiology of Anxiety

Genetic Theory: gene 5-HTTP influences how the brain makes use of serotonin Biologic Theory: Ineffective gammaaminobutyric acid (GABA) neurotransmitter process, depletion of norepinephrine

Etiology of Anxiety (cont.)

Psychoanalytic Theory: anxiety is the result of unresolved, unconscious conflicts Cognitive Behavior Theory: anxiety is a learned or conditioned response to a stressful event or perceived danger Social-Cultural Theory: integrated social or cultural factors cause anxiety

Etiology of Anxiety (cont.)

General Health Issues: COPD, pulmonary embolism, hypoxia, menopause, hyperthyroidism, fatigue

Levels of Anxiety

Mild +1: increased alertness to inner feelings or the environment, increased ability to learn, may experience restlessness Moderate +2: narrowing ability to concentrate, focus on only one specific thing at a time, pacing, voice tremors, increased rate of speech

Levels of Anxiety (cont.)

Severe +3: focus on small or scattered details, decreased intellectual thought process, why bother?, Whats the use? Panic state +4: individual becomes immobilized, unable to function normally, unable to focus on reality, experiences a loss of control

Anxiety: Clinical Symptoms

Physiologic Psychological/Emotional Behavioral Intellectual/Cognitive

Physiological Symptoms

Elevated BP, P, R Dyspnea or hyperventilation Diaphoresis Blurred vision Nausea, vomiting Frequency of urination

Physiological Symptoms (cont.)

Headache Insomnia, sleep disturbances Muscle weakness or tension Tightness in the chest Sweaty palms Dilated pupils

Psychological, emotional symptoms

Withdrawal Depression Irritability, hypercriticism Crying Lack of interest or apathy Feelings of anger, worthlessness, helplessness

Behavioral Symptoms

Pacing Inability to sit still Fingering hair continuously or other nervous habits Hypervigilance

Intellectual or Cognitive Symptoms

Decreased interest Inability to concentrate Decreased productivity Preoccupation Forgetfulness Rumination Orientation to past rather than present or future

Nursing Diagnoses

Anxiety Powerlessness Ineffective individual coping Impaired verbal communication Self-esteem disturbance Risk for injury Impaired social inter.

Sleep pattern disturbance Ineffective breathing pattern Alteration in nutrition Alteration in bowel/ urinary elimination Knowledge deficit Social isolation Adjustment, impaired

Implementation Plan

Assist with meeting basic needs, safety Medication management Patient and family illness teaching Coping skills Psychotherapy Alternative and Behavioral therapies

Crisis Intervention Delivery

Community Clinics Emergency Departments Walk-in centers Mobile crisis teams 24-hour telephone hot lines Mobile disaster teams

Medication Management

Benzodiazepines (Xanax, klonopin, valium, ativan) Antidepressants and atypical agents ( Celexa, prozac, luvox, effexor, buspar) Beta Blockers (atenolol, propranolol) Antihistamines (Benadryl, atarax, vistaril)

Anxiety-Related Disorders

Generalized Anxiety D/O

Panic D/O Obsessive-Compulsive Phobic D/Os Acute Stress D/O PTSD Somatoform D/O Somatization D/O

Pain D/O Hypochondriasis Conversion D/O Dissociative D/Os Dissociative Amnesia Dissociative Fugue Depersonalization Dissociative Identity