Anxiety <ul><li>Normal human emotion </li></ul><ul><ul><li>life without anxiety is not possible </li></ul></ul><ul><li>Exi...
Anxiety  Operational Definition <ul><li>Expectations are held </li></ul><ul><li>Expectations are not met </li></ul><ul><li...
Stress Resistance <ul><li>Internal locus of control </li></ul><ul><li>Healthy lifestyle </li></ul><ul><li>Regular exercise...
Symptoms of Anxiety <ul><li>Emotional </li></ul><ul><ul><li>Irritability </li></ul></ul><ul><ul><li>Helplessness </li></ul...
Symptoms of Anxiety <ul><li>Cognitive </li></ul><ul><ul><li>Forgetfulness </li></ul></ul><ul><ul><li>Decreased concentrati...
Symptoms of Anxiety <ul><li>Physical </li></ul><ul><ul><li>Increased heart rate </li></ul></ul><ul><ul><li>Increased BP </...
Symptoms of Anxiety <ul><li>Physical </li></ul><ul><ul><li>Sleep disturbances </li></ul></ul><ul><ul><li>Nausea and vomiti...
Anxiety Disorders <ul><li>Anxiety or the avoidance of anxiety is the main feature of these disorders </li></ul><ul><li>Aff...
Theories <ul><li>Cognitive-Behavioral </li></ul><ul><ul><li>Excessive anxiety is learned </li></ul></ul><ul><ul><li>Change...
Theories <ul><li>Genetic </li></ul><ul><ul><li>20% of first degree relatives with generalized anxiety disorder (GAD) also ...
Medications <ul><li>Benzodiazepines </li></ul><ul><ul><li>Immediate effect </li></ul></ul><ul><ul><li>Risk of addiction </...
Generalized Anxiety Disorder <ul><li>Affects twice as many women as men </li></ul><ul><li>Chronic, free-floating anxiety <...
Panic Disorder <ul><li>Severe anxiety attacks </li></ul><ul><li>16% of adult Americans </li></ul><ul><li>No stimulus neede...
Panic Disorder <ul><li>Lactate Hypothesis </li></ul><ul><li>Respiratory and Carbon Dioxide Hypothesis </li></ul><ul><li>No...
Phobic Disorders <ul><li>Panic response to a specific object, activity, or situation: </li></ul><ul><ul><li>Agoraphobia (l...
Obsessive-Compulsive Disorder (OCD) <ul><li>Obsessions </li></ul><ul><ul><li>recurring thoughts which cannot be dismissed ...
Obsessive-Compulsive Disorder (OCD) <ul><li>Genetics may play a role </li></ul><ul><li>Serotonin dysfunction </li></ul><ul...
Posttraumatic Stress Disorder (PTSD) <ul><li>Experience significant, unusual trauma </li></ul><ul><li>Recurrent, intrusive...
Dissociative Disorder <ul><li>anxiety & dissociative sx within 1 month of trauma </li></ul><ul><ul><li>exposure to very th...
Dissociative Disorder <ul><li>Dissociative amnesia </li></ul><ul><ul><li>difficulty remembering a past period of time </li...
Dissociative Disorder <ul><li>Symptoms </li></ul><ul><ul><li>Flashbacks </li></ul></ul><ul><ul><li>Numbing </li></ul></ul>...
Nursing Intervention <ul><li>Observe the nonverbal </li></ul><ul><li>Connect relief behavior with feeling </li></ul><ul><l...
Multidisciplinary Interventions <ul><li>Cognitive-Behavior Therapy </li></ul><ul><ul><li>Cognitive restructuring </li></ul...
Multidisciplinary Interventions <ul><li>Paradoxical intention </li></ul><ul><ul><ul><li>Instruction to hyperventilate and ...
Laboratory Values for Anxiety Disorders <ul><li>Panic disorder  </li></ul><ul><ul><li>Decreased serum Bicarbonate due to h...
Assessment tools for Anxiety <ul><li>Hamilton Rating Scale forAnxiety </li></ul>
Case Study <ul><li>A 26 year old man has started to count in units of 4.  As he walks he counts his steps, one two three, ...
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 b...
Upcoming SlideShare
Loading in …5
×

Anxiety disorders

327
-1

Published on

0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
327
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
8
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

Anxiety disorders

  1. 1. Anxiety <ul><li>Normal human emotion </li></ul><ul><ul><li>life without anxiety is not possible </li></ul></ul><ul><li>Exists on a continuum </li></ul><ul><ul><li>mild to severe </li></ul></ul>
  2. 2. Anxiety Operational Definition <ul><li>Expectations are held </li></ul><ul><li>Expectations are not met </li></ul><ul><li>Anxiety felt </li></ul><ul><li>Automatic behavior </li></ul><ul><li>Behavior is rationalized </li></ul>
  3. 3. Stress Resistance <ul><li>Internal locus of control </li></ul><ul><li>Healthy lifestyle </li></ul><ul><li>Regular exercise </li></ul><ul><li>Balanced diet </li></ul><ul><li>Social support </li></ul>
  4. 4. Symptoms of Anxiety <ul><li>Emotional </li></ul><ul><ul><li>Irritability </li></ul></ul><ul><ul><li>Helplessness </li></ul></ul><ul><ul><li>Social withdrawal </li></ul></ul><ul><ul><li>Angry outbursts </li></ul></ul>
  5. 5. Symptoms of Anxiety <ul><li>Cognitive </li></ul><ul><ul><li>Forgetfulness </li></ul></ul><ul><ul><li>Decreased concentration </li></ul></ul><ul><ul><li>Decreased attention </li></ul></ul><ul><ul><li>Decreased productivity </li></ul></ul><ul><ul><li>Rumination </li></ul></ul>
  6. 6. Symptoms of Anxiety <ul><li>Physical </li></ul><ul><ul><li>Increased heart rate </li></ul></ul><ul><ul><li>Increased BP </li></ul></ul><ul><ul><li>Tightness or pain in chest </li></ul></ul><ul><ul><li>Difficulty breathing </li></ul></ul><ul><ul><li>Headache </li></ul></ul><ul><ul><li>Urinary frequency </li></ul></ul><ul><ul><li>Accident proneness </li></ul></ul>
  7. 7. Symptoms of Anxiety <ul><li>Physical </li></ul><ul><ul><li>Sleep disturbances </li></ul></ul><ul><ul><li>Nausea and vomiting </li></ul></ul><ul><ul><li>Decreased appetite </li></ul></ul><ul><ul><li>Frequent minor illnesses </li></ul></ul><ul><ul><li>Poor posture </li></ul></ul>
  8. 8. Anxiety Disorders <ul><li>Anxiety or the avoidance of anxiety is the main feature of these disorders </li></ul><ul><li>Affect 25% of the population </li></ul><ul><li>Occur at any point in lifespan </li></ul>
  9. 9. Theories <ul><li>Cognitive-Behavioral </li></ul><ul><ul><li>Excessive anxiety is learned </li></ul></ul><ul><ul><li>Change thoughts, change anxious behavior </li></ul></ul><ul><li>Psychosocial </li></ul><ul><ul><li>Unconscious conflicts </li></ul></ul><ul><ul><li>Overactive superego </li></ul></ul><ul><ul><li>Disturbed self concept </li></ul></ul>
  10. 10. Theories <ul><li>Genetic </li></ul><ul><ul><li>20% of first degree relatives with generalized anxiety disorder (GAD) also have GAD </li></ul></ul><ul><li>Biological </li></ul><ul><ul><li>Dysfunction of GABA receptors in CNS </li></ul></ul><ul><ul><li>GABA (natural anti-anxiety substance) is the major inhibitory neurotransmitter </li></ul></ul>
  11. 11. Medications <ul><li>Benzodiazepines </li></ul><ul><ul><li>Immediate effect </li></ul></ul><ul><ul><li>Risk of addiction </li></ul></ul><ul><li>Buspirone </li></ul><ul><ul><li>Takes 2-4 weeks to affect anxiety </li></ul></ul><ul><ul><li>No risk of addiction </li></ul></ul><ul><li>SSRIs </li></ul>
  12. 12. Generalized Anxiety Disorder <ul><li>Affects twice as many women as men </li></ul><ul><li>Chronic, free-floating anxiety </li></ul><ul><li>No panic attacks </li></ul><ul><li>No obsessions/compulsions </li></ul><ul><li>May abuse substances </li></ul><ul><li>Culture may influence symptoms </li></ul><ul><li>May co-exist with depression </li></ul>
  13. 13. Panic Disorder <ul><li>Severe anxiety attacks </li></ul><ul><li>16% of adult Americans </li></ul><ul><li>No stimulus needed </li></ul><ul><li>Worry about more attacks or change in behavior due to attacks (avoidance) </li></ul><ul><li>Cardiac neurosis </li></ul>
  14. 14. Panic Disorder <ul><li>Lactate Hypothesis </li></ul><ul><li>Respiratory and Carbon Dioxide Hypothesis </li></ul><ul><li>Norepinephrine Hypothesis </li></ul><ul><li>Serotonin Hypothesis </li></ul><ul><li>Adenosine Hypothesis </li></ul><ul><li>GABA - Benzodiazepine Hypothesis </li></ul><ul><li>Limbic System Dysfunction </li></ul>
  15. 15. Phobic Disorders <ul><li>Panic response to a specific object, activity, or situation: </li></ul><ul><ul><li>Agoraphobia (leaving home, crowds) </li></ul></ul><ul><ul><li>Social phobia (eating, public speaking, walking into a room) </li></ul></ul><ul><ul><li>Specific phobia (snakes, elevators) </li></ul></ul>
  16. 16. Obsessive-Compulsive Disorder (OCD) <ul><li>Obsessions </li></ul><ul><ul><li>recurring thoughts which cannot be dismissed from consciousness </li></ul></ul><ul><li>Compulsion </li></ul><ul><ul><li>uncontrollable urge to perform certain acts </li></ul></ul><ul><li>Need to control </li></ul><ul><ul><li>Self </li></ul></ul><ul><ul><li>Others </li></ul></ul><ul><ul><li>Environment </li></ul></ul>
  17. 17. Obsessive-Compulsive Disorder (OCD) <ul><li>Genetics may play a role </li></ul><ul><li>Serotonin dysfunction </li></ul><ul><li>SSRIs therapeutic </li></ul><ul><li>Basal ganglia and frontal lobe abnormalities </li></ul><ul><li>Prognosis </li></ul><ul><ul><li>15% show progressive deterioration </li></ul></ul>
  18. 18. Posttraumatic Stress Disorder (PTSD) <ul><li>Experience significant, unusual trauma </li></ul><ul><li>Recurrent, intrusive, reexperiencing of the trauma </li></ul><ul><ul><li>Acute (last up to 3 months) </li></ul></ul><ul><ul><li>Chronic (more than 3 months) </li></ul></ul><ul><ul><li>Delayed onset (after 6 months) </li></ul></ul><ul><li>Symtoms of hyperarousal </li></ul><ul><li>Avoidance behavior: May abuse substances </li></ul>
  19. 19. Dissociative Disorder <ul><li>anxiety & dissociative sx within 1 month of trauma </li></ul><ul><ul><li>exposure to very threatening event </li></ul></ul><ul><ul><li>feelings of helplessness, fear, horror </li></ul></ul><ul><ul><li>dissociative symptoms: feeling detached, cut-off, dream-like state </li></ul></ul><ul><ul><li>avoidance </li></ul></ul><ul><ul><li>hyperarousal </li></ul></ul>
  20. 20. Dissociative Disorder <ul><li>Dissociative amnesia </li></ul><ul><ul><li>difficulty remembering a past period of time </li></ul></ul><ul><li>Dissociative fugue </li></ul><ul><ul><li>inability to remember one ’s past or identity </li></ul></ul><ul><li>Dissociative identity disorder </li></ul><ul><ul><li>2 or more distinct personalities </li></ul></ul><ul><li>Depersonalization disorder </li></ul><ul><ul><li>episodes of feeling detached or numb </li></ul></ul>
  21. 21. Dissociative Disorder <ul><li>Symptoms </li></ul><ul><ul><li>Flashbacks </li></ul></ul><ul><ul><li>Numbing </li></ul></ul><ul><ul><li>Nightmares </li></ul></ul><ul><ul><li>Startle response </li></ul></ul><ul><ul><li>Memory impairment </li></ul></ul>
  22. 22. Nursing Intervention <ul><li>Observe the nonverbal </li></ul><ul><li>Connect relief behavior with feeling </li></ul><ul><li>Investigate preceding situation </li></ul><ul><li>Help client connect what happened to anxiety </li></ul><ul><li>Help client state causes & remember similar patterns </li></ul>
  23. 23. Multidisciplinary Interventions <ul><li>Cognitive-Behavior Therapy </li></ul><ul><ul><li>Cognitive restructuring </li></ul></ul><ul><ul><li>Relaxation training </li></ul></ul><ul><ul><li>Exposure therapy: confronting situation with support of therapist </li></ul></ul><ul><ul><ul><li>Systematic desensitization: gradual exposure </li></ul></ul></ul><ul><ul><ul><li>Implosive therapy: uses vivid imagery to expose </li></ul></ul></ul><ul><ul><ul><li>Flooding: exposing to stimulus without relaxation until the anxiety subsides </li></ul></ul></ul>
  24. 24. Multidisciplinary Interventions <ul><li>Paradoxical intention </li></ul><ul><ul><ul><li>Instruction to hyperventilate and bring on attack </li></ul></ul></ul>
  25. 25. Laboratory Values for Anxiety Disorders <ul><li>Panic disorder </li></ul><ul><ul><li>Decreased serum Bicarbonate due to hyperventilation syndrome </li></ul></ul><ul><ul><li>Increased serum Chloride in hyperventilation syndrome </li></ul></ul><ul><ul><li>Decreased Fasting blood sugar </li></ul></ul>
  26. 26. Assessment tools for Anxiety <ul><li>Hamilton Rating Scale forAnxiety </li></ul>
  27. 27. Case Study <ul><li>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? </li></ul>
  28. 28. 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?

×