Psychobiology, Anxiety Disorders, and Anti-anxiety Medications The mind body connection
Primary and Secondary Gain <ul><li>Primary Gain: the reduction of felt tension/anxiety through a neurotic symptom </li></u...
A little bit of pathophysiology
General Nursing Issues <ul><li>Easy to become frustrated with this client, b/c behaviors seem like they should be under vo...
Generalized Anxiety Disorder: Frequently found in women <ul><li>Excessive, uncontrollable worrying x 6 mo. </li></ul><ul><...
Panic Disorder: affects about 1.2 million in US <ul><li>Recurrent panic attacks: unexpected, situation bound, or situation...
Specific Nursing Measures <ul><li>During P. Attack: remain calm, use short acting antianxiety med, NI that are for panic l...
Somatoform Disorders: Physical illness issues and anxiety <ul><li>Somatization disorder: multiple prolonged physical probl...
Obsessive Compulsive Disorder <ul><li>Obsession: recurring intrusive thoughts, ego dystonic </li></ul><ul><li>Compulsion: ...
Specific Nursing Interventions <ul><li>During compulsive episode, do not abruptly interrupt or stop client </li></ul><ul><...
Dissociative Disorders <ul><li>Dissociation: impaired integration of different aspects of consciousness (may feel numb, un...
Dissociative Identity Disorder:alias Multiple Personality disorder <ul><li>More than one distinct identity state alternate...
Not Anxiety Disorders: But Maladaptive Behavior, for sure <ul><li>Malingering: intentional production of false or very exa...
Antianxiety Meds: Benzodiazepines <ul><li>You will need to study: Valium, Klonopin, Librium, Xanax, and Ativan </li></ul><...
Antianxiety Meds: Buspirone <ul><li>You will need to know Buspar. </li></ul><ul><li>How it works: </li></ul>
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Anxiety Disorder

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Anxiety Disorder

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Anxiety Disorder

  1. 1. Psychobiology, Anxiety Disorders, and Anti-anxiety Medications The mind body connection
  2. 2. Primary and Secondary Gain <ul><li>Primary Gain: the reduction of felt tension/anxiety through a neurotic symptom </li></ul><ul><li>Secondary Gain: The “fringe benefits” derived from the expression of a neurotic symptom (eg pity, nurturance, sick role) </li></ul>
  3. 3. A little bit of pathophysiology
  4. 4. General Nursing Issues <ul><li>Easy to become frustrated with this client, b/c behaviors seem like they should be under voluntary control. </li></ul><ul><li>Form therapeutic trust relationship with the PERSON, address unmet needs/issues </li></ul><ul><li>Balance: not ignoring real symptoms but also not dwelling on them or reinforcing them </li></ul>
  5. 5. Generalized Anxiety Disorder: Frequently found in women <ul><li>Excessive, uncontrollable worrying x 6 mo. </li></ul><ul><li>Motor tension symptoms—trembling, fatigue, etc </li></ul><ul><li>Scanning behavior—trouble concentrating, insomnia, startle response </li></ul><ul><li>Autonomic hyperreactivity—SOB, sweating, N/V, dry mouth </li></ul><ul><li>Tx: antidepressants, therapy </li></ul>
  6. 6. Panic Disorder: affects about 1.2 million in US <ul><li>Recurrent panic attacks: unexpected, situation bound, or situation predisposed </li></ul><ul><li>Concern/worry about future attacks, fear death or illness, feel crazy, fear loss of control </li></ul><ul><li>Changes of behavior to protect from future attacks: avoidance, self medication </li></ul><ul><li>Treated well with antidepressants </li></ul>
  7. 7. Specific Nursing Measures <ul><li>During P. Attack: remain calm, use short acting antianxiety med, NI that are for panic level anxiety </li></ul><ul><li>Others: educate about illness and how treatable it is; teach ways to moderate anxiety before it escalates, cognitive reframing, systematic desensitization </li></ul><ul><li>Medical: anti-depressants </li></ul>
  8. 8. Somatoform Disorders: Physical illness issues and anxiety <ul><li>Somatization disorder: multiple prolonged physical problems, multi system, not in line with actual observed symptoms </li></ul><ul><li>Conversion disorder: pseudoneurological symptoms. Eg blindness, paralysis, seizure </li></ul><ul><li>Hypochondriasis: preoccupation with and fear of being ill/disease </li></ul><ul><li>Pain disorder: chronic pain with strong component of psychiatric factors. </li></ul>
  9. 9. Obsessive Compulsive Disorder <ul><li>Obsession: recurring intrusive thoughts, ego dystonic </li></ul><ul><li>Compulsion: Recurring ritualistic behavior that lowers anxiety temporarily </li></ul><ul><li>Themes: sex, violence, death, germs </li></ul><ul><li>Treatable with behavior therapy, anti depressant therapy </li></ul>
  10. 10. Specific Nursing Interventions <ul><li>During compulsive episode, do not abruptly interrupt or stop client </li></ul><ul><li>Work WITH client to establish target behaviors to gradually decrease compulsive behavior </li></ul><ul><li>Teach alternative ways of coping with anxiety </li></ul><ul><li>Through therapeutic relationship address underlying issues as client is ready </li></ul><ul><li>Medical: antidepressant therapy, education re this </li></ul>
  11. 11. Dissociative Disorders <ul><li>Dissociation: impaired integration of different aspects of consciousness (may feel numb, unattached from body, etc) </li></ul><ul><li>Dissociative amnesia: extensive gaps in memory involving personal life, often from a traumatic time period </li></ul><ul><li>Dissociative fugue: Episode of sudden identity loss leading to travelling, wandering, etc. </li></ul><ul><li>Depersonalization: feeling detached, spacey, unreal </li></ul>
  12. 12. Dissociative Identity Disorder:alias Multiple Personality disorder <ul><li>More than one distinct identity state alternately controls the consciousness of an individual. </li></ul><ul><li>Develops as a response to severe trauma, as in childhood. States represent different periods in development </li></ul><ul><li>Often called an adaptive response to an unmanageable situation. </li></ul><ul><li>Treatable with long term therapy and support. Goal is often to integrate personality structures. </li></ul>
  13. 13. Not Anxiety Disorders: But Maladaptive Behavior, for sure <ul><li>Malingering: intentional production of false or very exaggerated symptoms motivated by secondary gains. </li></ul><ul><li>Factitious Disorder (Munchausen’s): intentional production of physical symptoms through tampering with the body. </li></ul><ul><li>Nurse: gather evidence and document. Confront only as a team, and not prematurely. </li></ul>
  14. 14. Antianxiety Meds: Benzodiazepines <ul><li>You will need to study: Valium, Klonopin, Librium, Xanax, and Ativan </li></ul><ul><li>How they work: </li></ul>
  15. 15. Antianxiety Meds: Buspirone <ul><li>You will need to know Buspar. </li></ul><ul><li>How it works: </li></ul>

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