Anxiety disorders

1. Anxiety disorder
Dr. Muslih S. Kareem
MSc. , PhD in Psychiatric Nursing

2. Normal anxiety:
Which is characterized by a state of apprehension or unease
arising out of anticipation of danger (ahuja, 2011).

3. Fear versus Anxiety
Fear: is a response to a known, external, definite,
or non conflictual threat.
Anxiety: : is a response to a threat that is
unknown, internal, vague, or conflictual.
Stress: A negative emotional state is occurring in
response to events that are perceived as taxing
or exceeding a person's resources or ability to
cope.

4. Sensory Input 2. Amygdala
registers
danger
3. Amygdala
triggers fast
response
4. More considered
response based on
cortical processing
1. Thalamus receives
stimulus and sends to
both amygdala and
cortex
•
Parts of the brain involved in fear response = thalamus, amygdala, hypothalamus,
which then instruct the endocrine glands and autonomic nerv.sys.
•
Evolved fear module (pink) versus considered response (green) = “fight or flight”
versus “feel the fear and do it anyway (or do it differently)”!

5. The mechanism of Stress Response
Stress trigger
Neocortex and limbic system
Hypothalamus
Sympathetic nervous system
Adrenal medulla
Adrenalin and noradrenaline

8. Anxiety disorder
Group of conditions in which the affected
person experiences persistent anxiety that
interferes with daily activities.
•
Epidemiology: 5.3 per cent of the population
experience an anxiety disorder. In the United
States the lifetime prevalence of anxiety
disorders was about 29%. Anxiety is more
common in females.

11. Causes of anxiety:
1. Genetics.
2. Environmental factors.
3. Medical factors.
4. Brain chemistry.
5. Substance abuse.

12. Physical symptoms of anxiety
headache, vertigo, dizziness,
Flushes, blurred vision
Dry mouth,
Fatigue, Muscle pain
Breathlessness
Tachycardia
Dysphagia, nausea, vomitting, diarheoa
Frequency of urination
Trembling
sweating
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15. 1-worry, fear
2-restlessness
3-sensitive to noise
4-restlessness
5-poor concentration
7- sleep disturbances
8-depression,obssession
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Psychological symptoms of anxiety

16. Psychological symptoms of anxiety

17. Classification of anxiety:
1-Generalized Anxiety Disorder
2-panic disorder
3-Separation Anxiety Disorder
4-post traumatic stress disorder
5-phobias
6-obssessive-compulsive disorder(OCD)
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18. Generalized anxiety disorder
Is characterized by at least 6 months of
persistent and excessive worry and anxiety.
Prevalence In General Population Is About 2.5-8%.

20. Panic disorder
the episode is usually sudden in onset, lasts
for a few minutes and characterized by very
sever anxiety.
-The prevalence is 1.5-2% in general population.
-More in females.
-Onset in early third decade.

23. Treatment for anxiety disorder
1. lifestyle changes.
2.psychotherapy,especially cognitive behavioral
therapy.
3.Medication(anti anxiety drugs).
4.Education and Reassurance.

24. Nursing intervention for GA & panic
1.Use short, simple, and clear statements.
2.Remain with the client at all times when levels
of anxiety are high (severe or panic).
3.Keep immediate surroundings low in stimuli
(dim lighting, few people, simple decor).
4. Adequate sleeping and reducing consumption
coffee, tea, cola chocolate, alcohol.

25. Nursing intervention for GA & panic
5.Administer anti-anxiety drugs, Assess for
effectiveness and for side effects.
6. Teach signs and symptoms of escalating
anxiety, and ways to interrupt its progression
(relaxation techniques, deep-breathing
exercises, yoga and meditation, or physical
exercise, brisk walks, and jogging and
swimming).

26. Psych 26
Post-Traumatic Stress Disorder(PTSD)
Condition in people exposed to highly traumatic
event; accompanied by re-experiencing the
event. Symptoms begin within 3 months after
event and last more than 1 month.
For example:
Combat, Rape, hostage situations and serious
accident.
In USA , PTSD occurs in 8% of the general
population.

27. PTSD

30. Treatment of PTSD
1. Supportive psychotherapy.
2. Cognitive Behavior Therapy
3. Drug treatment:
a. Antidepressant
b. Benzodiazepines

31. Nursing interventions for PTSD.
1.Educate yourself, client, family and other staff about
PTSD.
2.Encourage the client to express his/her feelings through
talking, writing, crying, or other ways in which the
client is comfortable.
3.Provide social skills and leisure time counseling, or refer
to a recreational therapist.
4.Provide a safe environment for the client.
5.Encourage the client to engage in physical exercise or to
substitute safe physical activities for aggressive
behaviors (e.g, punching bag, lifting weights).
6. Teach the patient about treatment and relaxation
techniques.

32. Separation Anxiety Disorder
almost always occurs in children. It is suspected
in children who are excessively anxious about
separation from important family members or
from home(person, place).

34. Treatment
1.Psychotherapy
2.Relaxation techniques(exercise, yoga, self-
hypnosis and meditation).
3.Drug Treatment
a. Antianxiety; (Buspirone, alprazolam and
clonazepam).
b. Antidepressants;(fluoxetine, sertraline).
c. Beta-blockers;(propranolol)

35. Phobic disorders
Phobias, manifested by overwhelming and
irrational fears, are common.
There are three types:
1-Specific Phobias,
2-Social Phobia
3-Agoraphobia

36. Specific Phobia (simple phobias)
are an irrational fear of specific objects (fear of
animals) or situations.

37. Social Phobia
are an irrational fear of being publicly
scrutinized and humiliated and is manifested
by extreme shyness and discomfort in social
settings, so leads to avoid social
situations(parties, meeting, TV).

38. Agoraphobia
are an irrational fear in a place or situation
where escape is difficult or embarrassing
(enclosed places, supermarkets, crowds
places, driving and public transportation).

39. Treatment of phobias
1. Psychotherapy; (supportive Psychotherapy and
CBT ).
2. Behaviour therapy:
a. Flooding
b. Systematic desensitisation
c. Exposure and response prevention
d. Relaxation techniques
3. Drug treatment;
a. Antianxiety; Benzodiazepines(alprazolam,
diazepam and clonazepine).
b. Antidepressants;(paroxetine, fluoxetine and
imipramine).

40. Obsessive-Compulsive Disorder (OCD)
Repeated obsessions that cause marked anxiety,
compulsions that reduce anxiety
Obsessions: recurrent, intrusive or inappropriate
thoughts or impulses
Compulsions: repetitive behaviors designed to
reduce the anxiety of the obsessions

42. Obsessive-Compulsive Disorder (OCD)
OCD is equally in adult men and women,
Though more boys than girls have onset in
childhood.
Up to 2.5% of the population may have OCD.
OCD can occur with other psychiatric problems;
including depression, phobias, eating
disorders, personality disorders, overuse of
alcohol and anxiolytic medications.
(Judith and sheila, 2009)

43. Treatment of (OCD)
1. Psychotherapy; Behavior and Cognitive therapy the
techniques used are listed below:
• thought –stopping
• Response prevention
• Systematic desensitisation
2.Drug treatment
a. Benzodiazepines; (alprazolam, clonazepam).
b.Antidepressants; (clomipramine 75-300mg/day,
fluoxetine 20-80mg/day).
3. Electroconvulsive therapy
4. psychosurgery(stereotactic limbic leucotomy, stereotactic
subcaudate tractotomy).

44. Nursing interventions
1.The client may need to be secluded or restrained if he or she
attempts self- mutilation or harm.
2.Encourge the client to verbally identify his/her concerns, life
stresses, fears and so forth.
3.Encourge the client to express feelings through talking, crying,
physical activities and so forth.
4.Observe the client's eating, drinking and elimination patterns.
5.Assess the client's sleep and hygiene patterns.
6.Encourge the client to try to gradually decrease the frequency of
compulsive behaviors.
7. Teach the client and family about the illness, treatment and
medications.
8.Gradually decrease the time allowed(e.g hand washing 10 time/
day for next day 8 time/ day).

45. References
1-Trevor turner( 2006). Anxiety, copyright in India rakmo press,p.8
2-Wanda K. Mohr (2003) psychiatric-mental health nursing, fifth
edition,copyright 2003,by Lippincott Williams and Wilkins. Pp.
351.
3-Kessler RC, Berglund P, Demler 0, Jin R, Merikangas KR, Walters
EE(June 2005). “Lifetime prevalence and age-of-onset
distributions ofDSM-IV disorders in the Oxford University Press,
2005 p.75
4-Kessler RC, Berglund P, Demler 0, Jin R, Merikangas KR, Walters
EE(June 2005). “Lifetime prevalence and age-of-onset
distributions of DSM-IV disorders in the Oxford University Press,
c 2005 p. 75

47. Any
comments
Any
questions

48. With My Respects