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Anxiety
Normal human emotion life without anxiety is not possible
Exists on a continuum mild to severe
Anxiety Operational Definition
Expectations are heldExpectations are not metAnxiety feltAutomatic behaviorBehavior is rationalized
Stress Resistance
Internal locus of controlHealthy lifestyleRegular exerciseBalanced dietSocial support
Symptoms of Anxiety
Emotional Irritability Helplessness Social withdrawal Angry outbursts
Symptoms of Anxiety
Cognitive Forgetfulness Decreased concentration Decreased attention Decreased productivity Rumination
Symptoms of Anxiety
Physical Increased heart rate Increased BP Tightness or pain in chest Difficulty breathing Headache Urinary frequency Accident proneness
Symptoms of Anxiety
Physical Sleep disturbances Nausea and vomiting Decreased appetite Frequent minor illnesses Poor posture
Anxiety Disorders
Anxiety or the avoidance of anxiety is the main feature of these disorders
Affect 25% of the populationOccur at any point in lifespan
Theories
Cognitive-Behavioral Excessive anxiety is learned Change thoughts, change anxious behavior
Psychosocial Unconscious conflicts Overactive superego Disturbed self concept
Theories
Genetic 20% of first degree relatives with generalized anxiety disorder
(GAD) also have GAD
Biological Dysfunction of GABA receptors in CNS GABA (natural anti-anxiety substance) is the major inhibitory
neurotransmitter
Medications
Benzodiazepines Immediate effect Risk of addiction
Buspirone Takes 2-4 weeks to affect anxiety No risk of addiction
SSRIs
Generalized Anxiety Disorder
Affects twice as many women as menChronic, free-floating anxietyNo panic attacksNo obsessions/compulsionsMay abuse substancesCulture may influence symptomsMay co-exist with depression
Panic Disorder
Severe anxiety attacks16% of adult AmericansNo stimulus neededWorry about more attacks or change in behavior
due to attacks (avoidance)Cardiac neurosis
Panic Disorder
Lactate HypothesisRespiratory and Carbon Dioxide HypothesisNorepinephrine HypothesisSerotonin HypothesisAdenosine HypothesisGABA - Benzodiazepine HypothesisLimbic System Dysfunction
Phobic Disorders
Panic response to a specific object, activity, or situation:
Agoraphobia (leaving home, crowds) Social phobia (eating, public speaking, walking into a room) Specific phobia (snakes, elevators)
Obsessive-Compulsive Disorder(OCD)
Obsessions recurring thoughts which cannot be dismissed from
consciousnessCompulsion
uncontrollable urge to perform certain actsNeed to control
Self Others Environment
Obsessive-Compulsive Disorder(OCD)
Genetics may play a roleSerotonin dysfunctionSSRIs therapeuticBasal ganglia and frontal lobe abnormalitiesPrognosis
15% show progressive deterioration
Posttraumatic Stress Disorder(PTSD)
Experience significant, unusual traumaRecurrent, intrusive, reexperiencing of the trauma
Acute (last up to 3 months) Chronic (more than 3 months) Delayed onset (after 6 months)
Symtoms of hyperarousalAvoidance behavior: May abuse substances
Dissociative Disorder
anxiety & dissociative sx within 1 month of trauma exposure to very threatening event feelings of helplessness, fear, horror dissociative symptoms: feeling detached, cut-off, dream-like
state avoidance hyperarousal
Dissociative Disorder
Dissociative amnesia difficulty remembering a past period of time
Dissociative fugue inability to remember one’s past or identity
Dissociative identity disorder 2 or more distinct personalities
Depersonalization disorder episodes of feeling detached or numb
Dissociative Disorder
Symptoms Flashbacks Numbing Nightmares Startle response Memory impairment
Nursing Intervention
Observe the nonverbalConnect relief behavior with feelingInvestigate preceding situation Help client connect what happened to anxietyHelp client state causes & remember similar patterns
Multidisciplinary Interventions
Cognitive-Behavior Therapy Cognitive restructuring Relaxation training Exposure therapy: confronting situation with support of
therapist Systematic desensitization: gradual exposure Implosive therapy: uses vivid imagery to expose Flooding: exposing to stimulus without relaxation until the anxiety
subsides
Multidisciplinary Interventions
Paradoxical intention Instruction to hyperventilate and bring on attack
Laboratory Values for Anxiety Disorders
Panic disorder Decreased serum Bicarbonate due to hyperventilation
syndrome Increased serum Chloride in hyperventilation
syndrome Decreased Fasting blood sugar
Assessment tools for Anxiety
Hamilton Rating Scale forAnxiety
Case Study
A 26 year old man has started to count in units of 4. As he walks he counts his steps, one two three, four. As he shops he counts items on the shelves, one, two, three, four. He has taken to insisting that when his wife and he kiss, that they kiss four times or a multiple of four times. He and his wife come to visit your for help. Both of them realize this behavior is irrational. How do your further this diagnosis?
Case Study
A 47 year old female client tells you that as a child she grew up on a farm. Her father would discipline her by humiliating her by calling her names, such as “stupid, and lazy”. For punishment, he would take her outside of the house and threaten her with a gun and then shoot the gun off near her. She was terrified that one day her could kill her. She has recently married for the second time to a “very nice man”; however, she has many flashbacks to her childhood, nightmares, and is suspicious of her husband. What is this client’s diagnosis and prognosis?
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