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
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 (State) Crisis threatens sense of security Chronic Anxiety (Trait) Long term anxiety Discomfort in relationships
LEVELS OF ANXIETY Mild Moderate Severe Panic
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
DEFENSE MECHANISMS Manage Conflict and affect Relatively unconscious Discrete from one to another Hallmarks for psych syndromes (reversible) Adaptive as well as pathological
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
THEORY Genetic: cluster in families Biological: Limbic system irregularities Psychological: (Freud, Learning theories, cognitive theories, Sullivan) Cultural
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
GENERALIZED ANXIETY DISORDER Excessive worrying about numerous things; this can last for months or even longer DSM –IV-TR criteria (p565)
PHOBIASWhat is phobia?A persistent irrational fear of an object, activity, or situation that leads to the desire for avoidance.
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
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!
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
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
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
SUBSTANCE –INDUCED ANXIETY Anxiety Panic attacks Obsession Compulsion These develop either due to substance use or after stopping the chronic use of substances
ANXIETY DUE TO MEDICAL CONDITIONS Anxiety can be the direct result of medical diagnosis Cardiac History Strokes Trauma that effects cognition or mobility
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
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
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
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
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
ASSESSMENT Overall assessment Voluntary control? Secondary gains Cognitive style Ability to communicate feelings and emotional needs Dependence on Medications
BASIC NURSING INTERVENTIONS Promotion of self care activities Health teaching Case Management Psychobiological Interventions: Anxiolytics (short term) , antidepressants (greatest help, SSRI’s) ADVANCED: PSYCHOTHERAPY
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.
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?
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
ADVANCED PRACTICE Cognitive-behavioral therapy: find a logical reason for the behavior then work to develop alternative coping mechanisms Psychodynamic Psychotherapy: group therapy
MOVIE TIME!!! If you are looking for other movies that portray DID check out Sybil, Three Faces of Eve, or Identity