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
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Anxiety dissoc and somato order 13

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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

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