ANXIETY

ANXIETY
DISORDERS
DISORDERS

PART IV
Review Levels of Anxiety
PSYCHOPHARMACOLOGY
ANTI – ANXIETY DRUGS
VALIUM
LIBRIUM
ATIVAN
SERAX
TRANXENE
MILTOWN
EQUANIL
VISTARIL
ATARAX
INDERAL
XANAX
BUSPAR
 ANTI – ANXIETY DRUGS
• Used only in a short time (1-2 weeks)
• Tolerance (after 7 days) and dependence (after 1 month)
• Hepatotoxic: LFTs
• Monitor for side effects.
• Avoid machines, activities needing concentration
• Z track if given parenterally
• Avoid mixing with alcohol, antacids
• Don’t stop abruptly but gradually for 2-6 weeks
• Avoid caffeine
 Categories of
ANXIETY DISORDERS
Anxiety
Disorders

Basic
Anxiety Somatoform
Disorder Dissociative Disorders
BASIC ANXIETY
DISORDER
 Basic anxiety disorders

• Generalized Anxiety Disorder

• Panic
• Phobia
• PTSD
• Obsessive Compulsive
 Chronic Anxiety Disorder or
Generalized Anxiety Disorder
• Excessive worry and anxiety for days but not more
than 6 months
• Difficulty in controlling the worry
• Anxiety and worry are evident by 3 or more of the
following :
– Restlessness, keyed up
– Fatigue and irritability
– Decreased ability to concentrate
– Muscle tension
– Disturbed sleep
• Anxiety or worry causes significant impairment in
interpersonal relationship or activities of daily living
Post Traumatic Stress
Disorders
 Post Traumatic Stress
Disorders
• Disturbing pattern of behavior occurring after a traumatic
event that is outside the range of usual experience.
• Characteristics
– Persistent re-experiencing of the trauma through recurrent
intrusive recollections of the event, through dreams or
flashbacks
– Persistent avoidance of the stimuli
– Feeling of detachment of estrangement from others
– Chemical abuse to relieve anxiety
• Definition
Phobias
– Persistent, irrational fear of a specific object,
activity or situation that leads to a desire for
avoidance or actual avoidance of the object of fear
• Treatment: Systematic Desensitization
• Defense mechanisms
– Repression and displacement
Major Types of Phobias
 Major Types of Phobias
• Agoraphobia
– Comes from the Greek word “Agora”
– Meaning “market place”
– Fear of being alone in open or public spaces
• Social Phobia
– Fear of situations where one might be seen and embarrassed or
criticized
• Specific Phobias
– Fear of a single object, situation or activity that cannot be
avoided
 Obsessive Compulsive
Disorder
Obsessions
 Preoccupation with persistent intrusive thoughts, impulses
or images
Compulsions
> Repetitive behaviors or mental acts that the person feels
driven to perform in order t reduce distress or prevent a
dreaded event or situation
Cues:
• Ritualistic behavior
• Constant doubting if he/she has performed the activity
 Examples Obsessions Compulsions

Washing or cleaning “Wash away my sins”. Young woman repeatedly

Thought appeared after washes hands
sexual encounter with a
married man
Need for order “Everything must be in Arranges and
place”. rearranges items

Germs or dirt “Everything is Avoids touching all

contaminated” objects. Scrubs hands
if she is forced to
touch any object
Symmetry “Secretaries who practice Secretary lines up
neatness never gets fired’ objects in rows on her
desk, then realigns
them repeatedly during
 Care Strategies
• Be nonjudgmental and honest; offer empathy and support
• Help patient to recognize the connections between the trauma experience and their
current feelings, behaviors and problems.
• Encourage verbalizations of feelings, especially anger.
• Encourage adaptive coping strategies and techniques
• Encourage patients to establish or reestablish relationships
• Explore shattered assumptions. “I’m a good person. This is a safe world”.
• Promote discussion of possible meaning of the events.
SOMATOFORM
DISORDERS
 Somatoform Disorders
• Body Dysmorphic Disorder
• Somatization
• Conversion Disorders
• Hypochondriasis
• Psychogenic pain
 Body Dysmorphic
Disorder
• Preoccupation with an imagined defect
in his or her appearance
– Ex. Michele, a young, attractive woman, is
preoccupied that her nose is too long and
“ugly”. She is preoccupied and quite
distressed over her perception. Two plastic
surgeons she consulted are hesitant to
reshape her nose but have not altered her
thinking that her nose makes her ugly.
 Somatization
• A client expresses emotional turmoil or conflict through
a physical system, usually with a loss or alteration of
physical functioning
• Hx of pain in at least 4 sites
• Hx of at least 2 GIT symptoms other than pain
• Hx of at least one sexual/reproductive symptom
• Hx of at least one neurologic disorder
• Ex. Deanna, 27, presents at the doctor’s office with
excessive heavy menstruation. She tells the nurse
that recently she experienced pain “first in my back
and then going to every part of my body”. She states
that she is often bothered with constipation and
frequent vomiting when she “eats the wrong food.”
She states she had been “unwell” and had suffered
from seizures and still has them occasionally. The
nurse becomes confused, not knowing what symptoms
she wants the doctor to evaluate. Deanna tells the
nurse she lives at home with her parents because her
poor health makes it hard for her to hold a job.
Conversion Disorders
• A psychological condition in which an
anxiety-provoking impulse is converted
unconsciously into functional symptoms
• Development of a symptom suggesting
neurologic disorder (blindness, deafness
etc.) or involuntary motor function
(paralysis, seizures)
• Ex. Jan, a 28 year old former secretary,
awakes one morning to find that she has
a tingling in both hands and cannot move
her fingers. Two days earlier, her
husband had told her that he wanted a
separation and that she would have to go
back to work to support herself.
 Hypochondriasis
• Presentation of unrealistic or exaggerated
physical complaints
– Ex. Julio, 52 lost his wife to colon cancer 5
months ago, which he “took very well”.
Recently he saw the sixth physician with
the same complaint. He believes that he has
liver cancer, despite repeated and
extensive diagnostic tests, which are all
negative. He has ceased seeing his friends,
has dropped his hobbies and spends much
of his time checking his sclera and “resting
his liver”.
NURSING DIAGNOSIS
• INEFFECTIVE INDIVIDUAL
COPING
• SELF-CARE DEFICIT
• DIVERSIONAL ACTIVITY DEFICIT
 INTERVENTIONS
• Offer explanations and support during diagnostic
testing-reduces anxiety while ruling out organic illness
• After physical complaints have been investigated, avoid
further reinforcement-directs focus away from physical
symptoms
• Spend time with client at all times other than when
client summons nurse to offer physical complaint-
rewards non-illness related behaviors and encourages
repetition of desired behavior
• Observe and record frequency and intensity of somatic
symptoms-establishes a baseline and later evaluation of
effectiveness of interventions
• Do not imply that symptoms are not real-psychogenic
symptoms are real to the client even though causation is
not organic
• Shift focus from somatic complaints to feelings or to
neutral topics-conveys interest in client as a person rather
than in client’s symptoms
• Assess secondary gains that “physical illness” provides for
client-nurse can work with the client to meet these needs
in healthier ways and thus minimize secondary gains
• Use matter-of-fact approach to clients exhibiting
resistance or covert anger-avoids power struggles,
demonstrates acceptance of anger and permits discussion
of angry feelings
• Set limits on manipulative behavior that violates rights
of others-protects other clients and significant others
• Help client look at result of manipulative behavior on
others-encourages insight and can help improve intra-
family relationships
• Show concern for client while avoiding fostering
dependency needs-shows respect for client’s feelings
while minimizing secondary gains
• Reinforce client’s strengths and problem-solving
abilities-contributes to positive self-esteem
DISSOCIATIVE
DISORDERS
 Dissociative Disorders
• Dissociative amnesia
• Dissociative fugue
• Depersonalization
• Dissociative Identity Disorder /
Multiple Identity Disorder
 Dissociative
amnesia
• Characterized by the inability to recall an
extensive amount of important personal
information because of physical or
psychological trauma
– Ex. A young woman was partly dressed and poorly
nourished when found by a police road patrol.
She had no knowledge of who she was. Her
parents identified her when she appeared on a
morning news television program. Hospital
examination revealed the probability of recent
rape. She was able to remember going to a party
off-campus but had no recall of the party or the
events after.
 Dissociative fugue
• The person suddenly and unexpectedly
leaves home or work and is unable to
recall the past
 Depersonalization
• Person experiences a strange alteration in
the perception or experience of the self,
often associated with a sense of unreality
– Ex. Mrs. Terry became highly distressed when
she perceived changes in her appearance when
she looked in a mirror. She thought her image
looked wavy and indistinct. Soon after, she
described feeling as though she was floating in a
fog with her feet not actually touching the
ground. During therapy, it was learned that Mrs.
Terry’s son had revealed to her his HIV-positive
status
 Dissociative Identity Disorder
/ Multiple Identity Disorder
• A person is dominated by at least one of
two or more definitive personalities at
one time
– Ex. Gertrude, a passive, conservative
woman alternated personalities with Diana,
who was sexy and flirtatious. During
therapy, Jane and Evelyn revealed
themselves as other distinct personalities.
PSYCHOSOMATIC
DISORDER
 Psychosomatic Disorder
- True (but unconscious) because of
hormonal and bodily changes
- Increase anxiety may result to
asthma, stress ulcers or migraine