Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
UNDERSTANDING ANXIETY
WHAT IS ANXIETY?   Anxiety is one of the most simple of emotions;    common to everyone.   Normal anxiety: can be good, ...
ANXIETY VS FEAR         Anxiety has an unknown source       Fear is a reaction to a specific threat
CATEGORIES OF              ANXIETY   Normal Anxiety        Healthy life force necessary for survival   Acute Anxiety (S...
LEVELS OF ANXIETY   Mild       Moderate         Severe           Panic
INTERVENTIONS   Mild to Moderate               Severe to Panic       Assist with regaining          Safety of client a...
DEFENSE MECHANISMS     Manage Conflict and affect     Relatively unconscious     Discrete from one to another     Hall...
DEFENSES   Healthy (altruism, sublimation, humor, suppression)   Intermediate (repression, displacement, reaction    for...
ANXIETY DISORDERS
ANXIETY DISORDERS   13% of the US adult population are affected by    anxiety. It is the most common psychiatric disorder...
THEORY   Genetic: cluster in families   Biological: Limbic system irregularities   Psychological: (Freud, Learning theo...
PANIC DISORDERS   Panic without agoraphobia: panic attack ,    unexpected   Panic with agoraphobia: recurrent panic atta...
GENERALIZED ANXIETY         DISORDER   Excessive worrying about numerous things; this    can last for months or even long...
PHOBIASWhat is phobia?A persistent irrational fear of an object, activity, or    situation that leads to the desire for av...
PHOBIAS   Specific types ( snakes, bridges, small spaces)   Social Anxiety Disorder (SAD)       Severe anxiety provoked...
OBSESSIVE-COMPULSIVE       DISORDER (OCD)   Obsessions       Thoughts, impulses, or images that persist and        recur...
OCD   DSM- IV-TR criteria see pg 572 for criteria   Common Obsessions:       Doubt..need to double check everything (Di...
POST TRAUMATIC STRESS          DISORDER   Flashbacks   Avoidance with stimuli associated with trauma   Numbing of respo...
ACUTE STRESS             DISORDER   Usually occurs within 1 month after disturbance   To be dx with this the pt must hav...
SUBSTANCE –INDUCED         ANXIETY   Anxiety   Panic attacks   Obsession   Compulsion   These develop either due to s...
ANXIETY DUE TO MEDICAL          CONDITIONS    Anxiety can be the direct result of medical diagnosis    Cardiac History ...
BASIC NURSING           INTERVENTIONS   Reduce anxiety   Enhance coping/Instill hope   Psychopharmacological Interventi...
ADVANCED PRACTICE          INTERVENTIONS   Cognitive therapy       Cognitive restructuring   Behavioral Therapy       ...
MEDICATIONS   Antidepressants        SSRI’s * / Tricyclics/ MAOI inhibitors/ Serotonin-norepinephrine         reuptake i...
FAMILY AND CLIENT            TEACHING   Nurse should include:        Do not change dose without discussing with MD     ...
SOMATOFORM ANDDISSOCIATIVE DISORDERS
SOMATOFORM             DISORDERS   Physical symptoms suggest a physical disorder   Diagnostic tests are NEGATIVE for ill...
SOMATOFORM              DISORDERS   Somatization Disorder   Hypochondriasis   Pain Disorder   Body Dysmorphic Disorder...
SOMATOFORM D/O        VS OTHER DISORDERS:   Malingering        Intentionally producing symptoms to produce a goal   Fac...
ASSESSMENT   Overall assessment   Voluntary control?   Secondary gains   Cognitive style   Ability to communicate fee...
BASIC NURSING              INTERVENTIONS   Promotion of self care activities   Health teaching   Case Management   Psy...
DISSOCIATIVE              DISORDERS   Disturbances in the normally well integrated    continuum of consciousness, memory,...
DISSOCIATIVE             DISORDERS   Depersonalization   Dissociative Amnesia   Dissociative Fugue   Dissociative Iden...
ASSESSMENT   Identity and Memory       Disorientation vs A and O x 3; do they remember the        past?   Client Histor...
BASIC LEVEL           INTERVENTIONS   Milieu Therapy       SAFETY SAFETY!!!       Simple routines, nondemanding       ...
ADVANCED PRACTICE   Cognitive-behavioral therapy: find a logical    reason for the behavior then work to develop    alter...
MOVIE TIME!!!   If you are looking for other movies that    portray DID check out Sybil, Three Faces of    Eve, or Identity
Upcoming SlideShare
Loading in …5
×

Anxiety dissoc and somato order 13

392 views

Published on

Published in: Health & Medicine
  • Be the first to comment

Anxiety dissoc and somato order 13

  1. 1. UNDERSTANDING ANXIETY
  2. 2. WHAT IS ANXIETY? Anxiety is one of the most simple of emotions; common to everyone. Normal anxiety: can be good, it gives you the energy and focus to overcome a task. It is necessary for survival. (Fight or Flight) (Butterflies before a race) Many times dysfunctional behavior is a defense against anxiety STRESS LEADS TO ANXIETY
  3. 3. ANXIETY VS FEAR  Anxiety has an unknown source Fear is a reaction to a specific threat
  4. 4. CATEGORIES OF ANXIETY Normal Anxiety  Healthy life force necessary for survival Acute Anxiety (State)  Crisis threatens sense of security Chronic Anxiety (Trait)  Long term anxiety  Discomfort in relationships
  5. 5. LEVELS OF ANXIETY Mild  Moderate  Severe  Panic
  6. 6. INTERVENTIONS Mild to Moderate  Severe to Panic  Assist with regaining  Safety of client and focus others  Recognize distress  Quiet environment  Listen  Medications  Clarify  Point out reality  Ask open-ended ?  Meet physical needs  Provide calm presence  Use short, simple statements
  7. 7. DEFENSE MECHANISMS  Manage Conflict and affect  Relatively unconscious  Discrete from one to another  Hallmarks for psych syndromes (reversible)  Adaptive as well as pathological
  8. 8. DEFENSES Healthy (altruism, sublimation, humor, suppression) Intermediate (repression, displacement, reaction formation, somatization, undoing, rationalization) Immature (passive aggressive, acting out, dissociation, idealization, splitting, projection)
  9. 9. ANXIETY DISORDERS
  10. 10. ANXIETY DISORDERS 13% of the US adult population are affected by anxiety. It is the most common psychiatric disorder in the US. The level of anxiety is so high in these client’s that it interferes with personal, occupational, and social functioning. Caused by : genetics, psychosocial factors, cultural factors, and traumatic life events
  11. 11. THEORY Genetic: cluster in families Biological: Limbic system irregularities Psychological: (Freud, Learning theories, cognitive theories, Sullivan) Cultural
  12. 12. PANIC DISORDERS Panic without agoraphobia: panic attack , unexpected Panic with agoraphobia: recurrent panic attacks with fear of being out in public when it happens. Agoraphobia: fear of being out and people seeing the attack, these clients may not leave home due to this fear
  13. 13. GENERALIZED ANXIETY DISORDER Excessive worrying about numerous things; this can last for months or even longer DSM –IV-TR criteria (p565)
  14. 14. PHOBIASWhat is phobia?A persistent irrational fear of an object, activity, or situation that leads to the desire for avoidance.
  15. 15. PHOBIAS Specific types ( snakes, bridges, small spaces) Social Anxiety Disorder (SAD)  Severe anxiety provoked by exposure to a social situation  Overwhelming and crippling anxiety when facing the situation
  16. 16. OBSESSIVE-COMPULSIVE DISORDER (OCD) Obsessions  Thoughts, impulses, or images that persist and recur, so that they can not be dismissed from the mind Compulsions  Ritualistic behaviors that an individual feels driven to perform in an attempt to reduce anxiety  These can be seen separately but usually they go hand in hand!
  17. 17. OCD DSM- IV-TR criteria see pg 572 for criteria Common Obsessions:  Doubt..need to double check everything (Did I..??)  Sexual imagery ( You see a man and want to rub his arm repetitively , uncontrollably)  Need for order (Felix )  Violence  Germs/ Dirt
  18. 18. POST TRAUMATIC STRESS DISORDER Flashbacks Avoidance with stimuli associated with trauma Numbing of responses persistently Persistent symptoms of increased arousal These symptoms usually begin within 3 months of disturbance See page 574 for criteria
  19. 19. ACUTE STRESS DISORDER Usually occurs within 1 month after disturbance To be dx with this the pt must have at least 3 symptoms:  Subjective sense of numbing  Amnesia  Detachment  Reduction in awareness of surroundings  Depersonalization(sense of unreality)  Usually resolves within 4 weeks
  20. 20. SUBSTANCE –INDUCED ANXIETY Anxiety Panic attacks Obsession Compulsion These develop either due to substance use or after stopping the chronic use of substances
  21. 21. ANXIETY DUE TO MEDICAL CONDITIONS Anxiety can be the direct result of medical diagnosis Cardiac History Strokes Trauma that effects cognition or mobility
  22. 22. BASIC NURSING INTERVENTIONS Reduce anxiety Enhance coping/Instill hope Psychopharmacological Interventions Enhance self esteem Use relaxation techniques Locate community resources Support groups / counseling/ Milieu Therapy Medication Education
  23. 23. ADVANCED PRACTICE INTERVENTIONS Cognitive therapy  Cognitive restructuring Behavioral Therapy  Relaxation  Modeling/ Desensitization  Flooding/ Response prevention  Thought stopping
  24. 24. MEDICATIONS Antidepressants  SSRI’s * / Tricyclics/ MAOI inhibitors/ Serotonin-norepinephrine reuptake inhibitors Anxiolytics  Benzodiazepines  Buspar (nonbenzodiazeoine) increase available serotonin/ not a strong sedative Antihistamines Beta Blockers Anticonvulsants
  25. 25. FAMILY AND CLIENT TEACHING Nurse should include:  Do not change dose without discussing with MD  The meds will reduce your ability to handle mechanical equipment; cars, machinery  No alcohol.. No caffeine  If taking MAOI instruct about tyramine free diet  Can cause congenital abnormalities in fetus, do not breast feed  Meds need to be taken with Meals to avoid GI upset  After taking Benzos for 3-4 months, you may experience withdrawal signs if stopped abruptly
  26. 26. SOMATOFORM ANDDISSOCIATIVE DISORDERS
  27. 27. SOMATOFORM DISORDERS Physical symptoms suggest a physical disorder Diagnostic tests are NEGATIVE for illness Symptoms are linked to Psychobiological factors Many times this disorder will co-exist with another Psychological disturbance
  28. 28. SOMATOFORM DISORDERS Somatization Disorder Hypochondriasis Pain Disorder Body Dysmorphic Disorder Conversion Disorder
  29. 29. SOMATOFORM D/O VS OTHER DISORDERS: Malingering  Intentionally producing symptoms to produce a goal Factitious Disorder  Fabrication of symptoms to assume the “sick role” Psychosomatic Illness  General medical condition affected by stress or psychological factors
  30. 30. ASSESSMENT Overall assessment Voluntary control? Secondary gains Cognitive style Ability to communicate feelings and emotional needs Dependence on Medications
  31. 31. BASIC NURSING INTERVENTIONS Promotion of self care activities Health teaching Case Management Psychobiological Interventions: Anxiolytics (short term) , antidepressants (greatest help, SSRI’s) ADVANCED: PSYCHOTHERAPY
  32. 32. DISSOCIATIVE DISORDERS Disturbances in the normally well integrated continuum of consciousness, memory, identity, and perception Dissociation is an unconscious defense mechanism that protects the person from overwhelming anxiety We all dissociate: do you remember every minute of driving here today? But this client spends their life in that psychological state.
  33. 33. DISSOCIATIVE DISORDERS Depersonalization Dissociative Amnesia Dissociative Fugue Dissociative Identity Disorder
  34. 34. ASSESSMENT Identity and Memory  Disorientation vs A and O x 3; do they remember the past? Client History: memories from childhood? Moods: depressed..anxious Use of ETOH and other drugs Impact on client? Family?  Miss a lot of work especially DID due to multiple personalities being in control Suicide Risk?
  35. 35. BASIC LEVEL INTERVENTIONS Milieu Therapy  SAFETY SAFETY!!!  Simple routines, nondemanding  Don’t flood client with past events  Stress reduction, coping mechanisms  Health Teaching  Psychobiological Interventions : no specific meds; but antidepressants vs anxiolytics as needed
  36. 36. ADVANCED PRACTICE Cognitive-behavioral therapy: find a logical reason for the behavior then work to develop alternative coping mechanisms Psychodynamic Psychotherapy: group therapy
  37. 37. MOVIE TIME!!! If you are looking for other movies that portray DID check out Sybil, Three Faces of Eve, or Identity

×