This document defines anxiety and anxiety disorders, listing their etiological factors and types. It discusses levels of anxiety from mild to panic, as well as genetic, biochemical, psychoanalytical, sociocultural, cognitive, and learning theories of causation. The major anxiety disorders described are generalized anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder, phobias including social phobia and specific phobia, and panic disorder. Nursing care plans aim to help patients cope with anxiety and insomnia and reduce distress through reassurance, relaxation techniques, and controlling environmental stimuli.

1. Anxiety Disorders

2. Define anxiety and anxiety disorders.
List levels of anxiety.
List etiological factors of anxiety disorders
Identify types of anxiety disorders.
Discuss nursing care plan for anxious patient.

3. Anxiety
Anxiety is a feeling of apprehension or fear.
o It is normal reaction to stressors in daily life and
can help people to more effectively deal with
everyday stressful situations, such as starting a
new job or passing an exam.

5. o If anxiety rises to excessive levels or becomes
recurring or continuous, it can develop into a
mental health condition, called anxiety disorder
which involve excessive anxiety or anxiety
without any stressful stimulus.

6. Anxiety
Anxiety Disorders affect about 40 million
American adults age 18 years and older (about
18%).
Anxiety is highly treatable (up to 90% of cases)
Women are affected more frequently than men.
The female-to-male ratio for any lifetime anxiety
disorder is 3:2.
Depression often accompanies anxiety disorders

7. 1- Mild anxiety: is associated with the tension of
daily living.
2- Moderate anxiety: in which the person
focuses only on immediate concerns involves
the narrowing of the perceptual field
3- Severe anxiety: is marked by a significant
reduction in perceptual field.
4- Panic: associated with dread and terror and
the person is unable to do things even with
direction.

8. Genetic theory
Biochemical factors
Psychoanalytical theory
Socieocultural theory
Learning theory
Cognitive theory

9. Genetic factors significantly influence risk for
many anxiety disorders. It is well established that
the tendency to develop anxiety disorders runs
in families.
This is similar to a predisposition to other
illnesses, such as diabetes and heart disease.
About 25% of the first degree relatives with GAD
are affected.

10. Brain chemical imbalance may increase the
anxiety response.
Example: Noradrenaline and Gamma
aminobutyric acid (GABA).

11. This theory has explained anxiety as a
conflict between the id and ego. These
drives may produce automatic anxiety.

12. Some people may learn responses that can be
unlearned e.g. a mother may transmit anxiety
to her children, who will continue to adopt her
behavior even into adult life.

13. Stressful life experiences e.g. societies with high
technology, urban area and changes places are
associated with the development of some
anxiety disorders, particularly post traumatic
stress disorder.

14. They believe that anxiety disorders are caused
by distortions in the way that individual thinks
and perceives e.g. people with social phobia
believe that they must be approved of all the
time by every one. They must never make a
mistake when they do, they respond to
embarrassment with acute anxiety.

15. Cont
Anxiety disorders take many forms:
Phobias
Panic disorder.
Posttraumatic stress disorder.
Acute stress disorder.
General anxiety disorder.
Obsessive-compulsive disorder.
Substances induced anxiety disorders
Anxiety disorders due to medical causes

17. Social phobia
Marked and persistent
fear of social or
performance situations.
Specific phobia
Marked and persistent
fear; excessive and
unreasonable; cued by
presence or anticipation
of object.
Agoraphobia
Anxiety about being in
places or situations
where escape may be
difficult or embarrassing,
and a panic attack may
occur.

18. Agoraphobia: involves
intense fear and anxiety
of any place or situation
where escape might be
difficult such as shopping
malls, or public
transportation, leading to
avoidance of situations
such as being alone
outside of the home.

19. Social phobia
Social phobia: is an anxiety disorder
characterized by overwhelming anxiety and
excessive self consciousness in everyday social
situations and it can be limited to only one
type of situation.
The DSM-5 define social phobia as "a marked
and persistent fear of social or performance
situations in which embarrassment may
occur".

20. Social phobia

21. Signs and symptoms
1.Racing heart.
2.Turning red.
3.Dry mouth and throat.
4.Dysphagia.
5.Trembling.
6.Nausea.
7.Sweating.
8. Muscle twitches.

22. Cont
Social phobia is common in females,
and appears in childhood and
adolescent ages, and decreased
gradually with aging.

23. Specific phobia
Specific phobia: is an intense, irrational
fear of something that poses little or no
actual danger.
It is also defined as a marked and
persistent fear of a particular object,
place, or situation (phobic stimulus) which
interfere with daily occupational function
and social life or cause marked personal
distress.

24. Specific phobia
It twice as common in
women as men.

26. Panic attacks—alone are not psychiatric illnesses
A discrete period of intense fear or in which 4 or more
of the following sx develop abruptly and reach a peak
within 10 minutes:
Palpitations, pounding heart, accelerated heart rate
Sweating
Trembling or shaking
Sensations of SOB or choking
Chest pain or discomfort
Nausea or abdominal distress
Dizziness, lightheadedness, unsteadiness
Derealization, depersonalization
Fear of losing control or going crazy
Fear of dying
Chills

28. Panic Disorder

29. Cont
Panic disorder: is diagnosed in people who
experience panic attacks and are preoccupied
with the fear of a recurring attack.

30. .

31.  is a severe anxiety disorder that
can develop after someone
exposure to extremely traumatic
event and reacted to the event
with intense fear, horror or
helplessness.
PTSD

32. Exampleortraumatic events:
Learning events
Witnessing
events
Personal
experience by
the client
Events
experienced by
family members
of close friends
Injury or death
experienced by
another persons
seen by the client
Military fight
Sever auto
accident,
Diagnosed with
life threatening
illness

33. Classification
Acute
if the duration of the
symptoms less
than 3 months
Chronic
If the symptoms
last 3 months of
longer Delayed onset
6 months passed
between the
traumatic event the
onset symptoms

34. Diagnostic Criteria ofPTSD
Exposure and Response
Experienced the traumatic events, witnessing or
learning then response in fear hopelessness and horror
Re-experiencing
Recurrent image, thoughts and perception about
the events or distress dreaming, and flashback
Avoidance
Avoid thought, activities, places involved in
traumatic event
Inability to recall important aspect of the event
Inability to act in some activities

35. Diagnostic Criteria of PTSD
-Hyper arousal
-Irritable
-Sleeplessness
-Difficult concentration
Significant
Impairment
Duration
More than 1 month

37. Cognitive-behavioral therapy for PTSD
Systemic desensitization
involves carefully and gradually
“exposing” to thoughts, feelings, and
situations that remind person of the
trauma. Therapy also involves identifying
upsetting thoughts about the traumatic
event–particularly thoughts that are
distorted and irrational and replacing
them with more balanced picture.

38. .

39. Acute stress disorder
Anxiety symptoms that occur
within one month after exposure to
traumatic events. Last two days but no
more than one month.
( if more it considers PTSD)

40. .

41. Obsessive Compulsive Disorder
An anxiety disorder characterized by
- Obsession (repetitive thought that make little
sense).
- Compulsive behaviors (repetitive behaviors that
strive to neutralize the anxiety related to
obsession).

42. Obsessive compulsive disorder
Common obsessions – violence, sex,
contamination, order
Common compulsions – washing,
cleaning, checking, seeking reassurance,
ordering or arranging objects

43. Clinical features
OCD must marked distress, be time consuming
(take more than 1 hour per day) and
significantly interfere with socio-occupational
functions.
Person with obsession of contamination may
avoid public restroom or shaking hand.

44. Diagnostic criteria
-Recurrent thoughts that are inappropriate
and caused marked anxiety or distress.
-The person attempts to ignore these
thought.
-The person recognize that these thought
are product of his mind.

45. -Repetitive behaviors such as washing,
checking or ordering are developed.
-These behaviors induced to reduce the
distress and the anxiety.
-The person should recognize that these
behaviors are excessive and not appropriate.
-The obsession and compulsion should cause
marked distress with time consuming.
Diagnostic criteria

46. Psychological Treatment of OCD
Exposure with response prevention
Person is gradually and systematically exposed to
the feared thought or situation
Promotes habituation to the feared stimulus

47. Nursing intervention
Gradually limit the time to neutralizing the obsessive
thought
Provide patients with positive reinforcements
Help the client learn more coping technique such as
relaxation, thought stopping, or physical activities

48. .

49. Generalized anxiety disorder
GAD is characterized by
persistent and excessive worry
about a number of different
things. People with GAD may
anticipate disaster and may be
overly concerned about money,
health, family, work, or other
issues.
An excessive anxiety or worry
occurring most days over at least 6
months.

50. Clinical feature
Muscle tension.
Fatigue and difficult concentration.
Restlessness, irritability, sleep disturbance.
Somatic symptom such as nausea or diarrhea.
Increase heart rate, S.O.B and dizziness.

51. Nursing intervention
Provide the patient with reassurance of safety
and security
Provide patient with calm environments
Help the client to identify area that can control
Provide patient positive feedback

52. It is characterized by symptoms of anxiety
which develop during the use of substance or
after stopping using. The evidence needs to be
obtained through the history, physical
examination or laboratory finding. Substances
like alcohol, cocaine, heroin and hallucinogens.

53. Anxiety may occur due to medical causes such
as hyperthyroidism, pulmonary embolism, or
cardiac dysrthythmias so a careful and
comprehensive assessment of multiple factors is
necessary through history, physical examination
or laboratory findings.

54. 1- Ineffective individual coping
Related to anxiety.
Evidenced by increased muscles tension and
restlessness, report feeling apprehensive,
sweating, frequent urination, pulse elevated,
skin pale.

55. The client will recognize his own anxiety and care
effectively with symptoms associated with
anxiety.

56. - Stay with the client and listen.
- Acknowledge the client anxiety.
- Speak slowly and calmly.
- Have the client use positive, self-talk e.g. I can
handle this or I can come.
- Administer anti-anxiety drugs as indicated.

57. -The nurse must monitor and control own feeling because
anxiety is transmissible.
- Use short simple sentences.
- Give brief directions.
- Decrease excessive stimuli and provide quite
environment.
-Walk with pacing client to give him support.

58. - Related to physiologic disturbances caused by
anxiety.
- Evidenced by difficulty getting in sleep.
- The goal
- client will achieve adequate sleep.

59. Provide measures appropriate to reduce
insomnia, if indicated:-
 Quite, secure environment.
 Relaxation techniques.
 Night light.
 Decreased number of distraction. e.g. .taking
temperature during night.

60.  Structured bed time routine for the client e.g.
bath, reading, warm milk, music…….etc
 Maximum measures for comfort of bed,
clothing,……..etc.
 Discourages napping.