A small step to share some information for class presentation. Hope will be useful for students especially Nursing.

1. Guided by
Mr. Chetan BS

2. Anxiety
Disorde
rs
Introduction
Epidemiology
& Common
Etiology
Types & in
Depth
Description
Anxiety
Feedback
Loop
Treatment
Conclusion

3. # ANXIETY provides the motivation for achievement,
a necessary force for survival.
# ANXIETY is often used interchangeably
with the word STRESS ; however they are
not the same.
# Anxiety is differential from fear;
ANXIETY is an emotional process but
FEAR is cognitive.

4. Definition: Neurotic(Neurosis) is a less severe form
of psychiatric disorder where, patient show either
excessive or prolonged emotional reaction to any
given stress.
 These disorders are not caused by organic disease of the brain
&,however severe, do not involve Hallucination & Delusions

5. Anxiety can be described as an uncomfortable feeling of
vague fear or apprehension by characteristic physical
sensations.
 Anxiety can produce uncomfortable & potentially debilitating
psychological(e.g worry or feeling of threat) & physiological
arousal(e.g, tachycardia or shortness of breath)

6.  Definition:- Anxiety disorders are a group of
mental disorders characterized by exaggerated feelings
of anxiety and fear responses.
These feelings may cause physical symptoms, such as a fast heart rate
and shakiness.

8. Stress at work
Stress from school
Stress in a personal relationship such as marriage
Financial stress
Stress from an emotional trauma such as the death of a loved one
Stress from a serious medical illness
Side effect of medication
Use of an illicit(Band) drug, such as cocaine
Symptom of a medical illness (such as heart attack, heat
stroke, hypoglycemia)
Lack of oxygen in circumstances as diverse as high altitude
sickness, emphysema, or pulmonary embolism(a blood clot in the vessels of
the lung)

9. 1
•Separation Anxiety Disorder
2
•Selective Mutism
3
•Specific Phobia
4
•Social Anxiety Disorder
5
•Panic Disorder-Panic Attack
6
•Agoraphobia
Cont…

10. 7
• Generalized Anxiety Disorder
8
• Substance/Medication-induced Anxiety
9
• Anxiety Disorder Due to Another Medical
Condition

11.  The individual is fearful or anxious about separation from attachment figures to
a degree .
 There is persistent fear or anxiety about harm coming to attachment &
reluctance to go away from attachment figure, as well as nightmares & physical
symptoms of distress.
 Although the symptoms often develop in childhood, they can be expressed
throughout adulthood as well.

12.  It is characterized by a consistent failure to speak in social situations in which
there is an exception to speak(e.g school)even through the individual speaks in
other situation.
 The failure to speak has significant consequences on achievement in academic or
occupational settings or otherwise interferes with normal social communication.

13.  Excessive shyness.
 Social isolation.
 Fear of embarrassment in front of a group.
 Clinging to caregivers.
 Temper tantrums.
 Oppositional behavior.
 Negativity.

14.  Individual with specific phobia are fearful or anxious about or avoidant of circumscribed objects or
situations.
 There are various types of specific phobia: Animal, Natural Environment, Blood-Injection-injury, Situational
Phobias etc.
 Examples:-
Aerophobia-Fear of flying
Nyctophobia-Far of the dark
Xenophobia-Fear of strangers
Insectophobia-Far of insects
Emetophobia-Fear of vomiting
Tachophobia-Fear of speed
Ymophobia-Fear of contrariety

15.  Feeling of imminent danger or doom
 Need to escape
 Heart palpitations
 Sweating
 Trembling
 Shortness of breath or a smothering feeling
 Feeling of choking
 Chest pain or discomfort
 Nausea or abdominal discomfort
 Feeling faint, dizzy or lightheaded
 A sense of things being unreal, depersonalization
 A fear of losing control or “going crazy”
 A fear of dying
 Tingling sensation
 Chills or heat flush

16. Nursing Diagnosis Objective Nursing interventions Rationale Evaluation
Fear related to
a specific
stimulus(simple
phobia),or
causing
embarrassment
to self in front
of others,
evidenced by
behaviour
directed
towards
avoidance of
the feared
objective/situat
ion
Patient will be
able to function
in the presence
of a phobic
object or
situation
without
experiencing
panic anxiety
1. Reassure the patient that
he is safe .
2. Explore patient’s
perception of the threat
to physical integrity or
threat to self concept.
3. Include patient in making
decisions related to
selection of alternative
coping strategies(e.g-
Patient may choose either
to avoid the phobic
stimulus or attempt to
eliminate the fear
associated with it.)
4. If the patient elects to
work on eliminate the
fear, techniques of
desensitization or
implosion therapy may
be employed.
5. Encourage patient to
explore underlying
feelings that may be
contributing to
intentional fears.
1. At the panic level of
anxiety patient may fear
for his own life.
2. It is important to
understand patient’s
perception of the phobic
object or situation to
assist with the
desensitization process.
3. Allowing the patient to
choose provides a
measure of control &
serves to increase
feelings of self-worth.
4. Fear decreases as the
physical & psychological
sensations diminish in
response to repeated
exposure to the phobic
stimulus under non-
threatening conditions.
5. Facing these feelings
rather than suppressing
them may result in more
adaptive coping abilities.
The level of
fear of the
patient will be
reduced to
some extent.

17. Nursing Diagnosis Objective Nursing interventions Rationale Evaluation
Social isolation
related to fear
of being in a
place from
which one is
unable to
escape,
evidenced by
staying alone,
refusing to
leave the
room/home.
Patient will
voluntarily
participate in
group activities
with peers(like
playing, singing
etc.)
1. Convey an accepting
attitude &
unconditional positive
regard. Make brief,
frequent contacts. Be
honest & keep all
promises
2. Attend group activities
with the patient that
may be frightening for
him.
3. Administer anti-anxiety
medications as ordered
by the physician,
monitor for
effectiveness & adverse
affects.
4. Discuss with the patient’s
signs & symptoms of
increasing anxiety &
techniques to interrupt
the response(e.g
Relaxation exercises,
thought stopping)
5. Give recognition &
positive reinforcement
for voluntary
interactions with
others.
1. These interactions
increase feelings of
self-worth & facilitate
a trusting relationship.
2. The presence of a
trusted individual
provides emotional
security.
3. Anti-anxiety
medications help to
reduce the level of
anxiety in most
individuals , thereby
facilitating interactions
with others.
4. Maladaptive behaviour
such as withdrawal &
suspiciousness are
manifested during
times of increase
anxiety.
5. To enhance self-esteem
encourage repetition of
acceptable behaviours.
Patient will
feel or will
voluntarily
involve in
group
activities
with peers to
some extent.

18.  The individual is fearful or anxious about or avoidant of social interactions &
situations that involve the possibility of being scrutinized.
 These include social interactions such as meeting unfamiliar people, situations in
which the individual may be observed eating or drinking,& situation in which the
individual performs in front of others.
 The cognitive ideation is being negatively evaluated by others, by being
embarrassed , humiliated, or rejected, or offending others.

19.  Hyperventilation
 Sweating
 Cold & clammy hands
 Blushing
 Palpitations
 Confusion
 Gastrointestinal Symptoms
 Trembling hands & voice
 Urinary urgency
 Muscle tension
 Anticipatory anxiety

20.  Panic attacks are sudden waves of intense fear or intense discomfort that reach a peak within
minutes, accompanied by physical &/or cognitive symptoms.
 The individual experiences recurrent unexpected panic attacks & is persistently concerned or
worried about having more panic attacks or changes his or her behavior in maladaptive ways because
of panic attacks (e,g avoidance of exercise or of unfamiliar locations)

21.  Palpitations
 Sweating
 Shaking or trembling
 Feeling Shortness of breath or smothering
 Sensation of choking
 Chest pains or tightness
 Nausea or gastrointestinal problems
 Dizziness, light-headedness, or feeling faint
 Feeling hot or cold
 Numbness or tingling sensations (Paresthesia)
 Feeling detached from oneself or reality, known as depersonalization
 Fear of “going crazy” or losing control
 Fear of dying

22. Nursing Diagnosis Objective Nursing Interventions Rationale Evaluation
Panic anxiety
related to real
or perceived
threat to
biological
integrity or self-
concept
,evidenced by
various physical
& psychological
manifestation.
Patient will be
able to
recognize
symptoms of
onset of anxiety
before reaching
panic level.
1. Stay with the patient &
offer reassurance of
safety & security.
2. Maintain a calm, on
threatening matter of
affect approach.
3. Use simple words &
brief message, spoken
calmly & clearly to
explain hospital
experiences.
4. Keep immediate
surroundings low in
stimuli(dim lighting,
few people)
5. Administer tranquilizing
medications as
prescribed by the
physician. Assess for
effectiveness & for
side-effects.
6. When level of anxiety
has been reduced ,
explore possible
reasons for occurrence.
1. Presence of trusted
individual provides
feeling of security &
assurance of personal
safety.
2. Anxiety is contagious &
may be transferred
from staff to patient or
vice-versa.
3. In an intensely anxious
situation, patient is
unable to comprehend
anything but the most
elementary
communication.
4. A stimulating
environment may result
in increase of anxiety
level.
5. Anti-anxiety
medication provides
relief from the
immobilizing effects of
anxiety.
6. Recognition of participating
factors is the first step in
teaching patient to control
anxiety.
Patient will be
able to
recognize
symptoms of
onset of anxiety
to some extent.

23. Nursing Diagnosis Objective Nursing Interventions Rationale Evaluation
Powerlessness
related to
impaired
cognition,
evidenced by
impaired verbal
expression, lack
of control over
life situations &
non-
participation in
decision making
Patient will be
able to
effectively
solve problems
& take control
of his life.
1. Allow patient to take as
much responsibility as
possible for self-care
activities, provide
positive feedback for
decisions made.
2. Assist patient to
set realistic goals.
3. Help identify life
situations that are
within patient's
control.
4. Help patient
identity areas of life
situation that are
not within his ability
to control.
Encourage
verbalization of
feelings related to
this inability.
1. Providing choices
will increase
patient's feeling of
control.
2. Unrealistic goals set
the patient up for
failure & reinforce
feelings of
powerlessness.
3. Patient's emotional
condition interferes
with the ability to
solve problems.
4. Assistance is required
to perceive the
benefits &
consequences of
available alternatives
accurately, to deal with
unresolved issues &
accept what can't be
changed.
Patient will be
able to
effectively
solve problems
& take control
of his life to
some extent.

24. Individual with agoraphobia are fearful & anxious about two or more of the following
situations:
 Using public transportation
 Being in open spaces
 Being in enclosed places
 Standing in line
 Being in crowd
 Being outside of the home alone

25.  Generalized anxiety disorder is an anxiety disorder that is characterized by
excessive uncontrollable & irrational worry about everyday things.
 GAD is common chronic disorder characterized by long-lasting anxiety that is not
focused on any one objects or situation.
 Risk factors:-
 Family members with an anxiety disorder
 Increase in stress
 Exposure to physical or emotional trauma
 Unemployment
 Poverty
 Drug Abuse

26. •Nervousness,
• Restlessness,
•Being tense
•Feelings of danger, panic
•Rapid heart rate
•Rapid breathing, or hyperventilation
•Increased or heavy sweating
•Trembling or muscle twitching
•Weakness and lethargy
•Difficulty focusing or thinking clearly
•Insomnia
•Digestive or Gastrointestinal Problems:-
 Gas,
 Constipation or Diarrhea
•A strong desire to avoid the things that trigger your anxiety
•Performing certain behaviors over and over again
•Anxiety surrounding a particular life event or experience that has occurred in the past,
especially indicative of post-traumatic stress disorder (PTSD)

27. This disorder involves anxiety due to substance
intoxication or withdrawal or to a medication
treatment .

28. Patients feel anxiety due to other medical conditions. Like:-
 Endocrine Disorder-
 Hypothyroidism
 Hyperglycemia etc.
 Cardiovascular Disease-
 Congestive Heart Failure
 Arrhythmias
 Pulmonary Embolism etc.
 Respiratory Illness-
 Asthma
 Pneumonia etc.
 Neurological Illness-
 Neoplasm
 Encephalitis
 Seizure etc.

31.  Benzodiazepines—
 Alprazolam
 Clonazepam
 Lorazepam
 Diazepam
 Antidepressants—
 Imipramine
 Sertraline
 Phenelzine
 Anxiolytics—
 Alprazolam
 Antivan
 Beta-blocker—
 Propranolol
Pharmacotherapy

33.  SUPPORTIVE PSYCHOTHERAPY-Supportive psychotherapy uses direct measures to
maintain, restore, or improve self-esteem, ego functions, and adaptive skills.
 PSYCHODYNAMIC THERAPY-Psychodynamic psychotherapy or psychoanalytic psychotherapy is
a form of depth psychology, the primary focus of which is to reveal the unconscious content of a client's
psyche in an effort to alleviate psychic tension.
 FAMILY AND MARITAL THERAPY-Marriage and Family Therapy (MFT) is a form of psychotherapy
that addresses the behaviors of all family members and the way these behaviors affect not only
individual family members, but also relationships between family members and the family unit as a
whole.
 COGNITIVE BEHAVIOUR THERAPY-A type of psychotherapy in which negative patterns of thought
about the self and the world are challenged in order to alter unwanted behavior patterns or treat mood
disorders such as depression.

34.  Anxiety is the most common disorder especially in children & teen age
group.
 The vast majority of kids with significant anxiety develop symptoms
during their grade school years(or earlier) & receive no treatment for
their condition.
 Kids with anxiety may be over represented among the student body at
independent schools.
 Cognitive behavior Therapy(CBT) & Medications are effective
treatment for the children with Anxiety Disorder ……best response
when CBT & Medications are used Together.

35. Bibliography:
• R Sreevani, a guide to mental health and psychiatric
nursing,
jaypee publishers,
3rd edition, pg.no: 216-221
• Townsend c Mary, text book on “Psychiatric Mental
Health Nursing.”
Jaypee publications.
5th edition, page240-245