The document discusses panic disorder and generalized anxiety disorder (GAD), detailing definitions, symptoms, causes, diagnosis, and treatment options. Panic disorder is marked by unexpected panic attacks characterized by intense fear and physical symptoms, while GAD involves chronic and excessive anxiety lasting over six months. Treatments for both disorders include pharmacotherapy, behavioral therapy, and cognitive therapy, with specific nursing diagnoses outlined to address related patient needs.

1. PANIC DISORDER
AND
GENERALIZED ANXIETY
DISORDER
PREPARED BY
KANKANA
CHAKRABORTY
COLLEGE OF NURSING
AIIMS PATNA

2. PANIC DISORDER

3. DEFINITION
• This disorder is characterized by recurrent panic attacks, the onset of which is
unpredictable, and manifested by intense apprehension, fear, or terror, often
associated with feelings of impending doom and accompanied by intense physical
discomfort.

4. PANIC ATTACK
 Panic attack is an episode of intense fear or apprehension with a sudden onset. Such symptoms develop
abruptly and usually reach its peak within 10 - 15 minutes.
 At least four of the following symptoms must be present to identify the presence of a panic attack.
● Palpitations, pounding heart, or accelerated heart rate
● Sweating
● Trembling or shaking
● Sensations of shortness of breath or smothering
● Feeling of choking
● Chest pain or discomfort
● Nausea or abdominal distress
● Feeling dizzy, unsteady, lightheaded, or faint
● Derealization or depersonalization
● Fear of losing control or going crazy
● Fear of dying
● Paresthesias (numbness or tingling sensations)
● Chills or hot flash

5. EPIDEMIOLOGY
• 3% to 5% of the population.
• More common in women.
• The age of onset is usually between 15 and 24.

6. ETIOLOGY OF
PANIC DISORDER AND GAD
• Biological Aspects
• Psychological Aspects

7. BIOLOGICAL ASPECTS
Genetics :The concordance rate for identical twins is 30 percent, and the risk for
the disorder in a close relative is 10 to 20 percent.
Neuroanatomical : Structural brain imaging studies in patients with panic
disorder have implicated pathological involvement in the temporal lobes,
particularly the hippocampus and the amygdala.
Biochemical : Abnormal elevations of blood lactate have been noted in clients
with panic disorder.
Neurochemical : Stronger evidence exists for the involvement of the
neurotransmitter norepinephrine in the etiology of panic disorder (Daniels & Yerkes,
2006). Norepinephrine is known to mediate arousal, and it causes hyper arousal and
anxiety.
Alteration in GABA level may lead to production of anxiety.

8. CONTD….
Medical conditions :
● Abnormalities in the hypothalamic–pituitary–adrenal and hypothalamic–pituitary thyroid
axes
● Acute myocardial infarction
● Pheochromocytomas
● Substance intoxication and withdrawal (cocaine, alcohol, marijuana, opioids)
● Hypoglycemia
● Caffeine intoxication
● Mitral valve prolapse
● Complex partial seizures

9. PSYCHOLOGICAL ASPECTS
Psychodynamic theory : The psychodynamic view focuses on the inability of the
ego to intervene when conflict occurs between the id and the superego, producing
anxiety.
Learning factor : The learning theorists have tried to explain panic attacks as
learnt phenomena – specifically as responses to conditioned stimuli.
Cognitive theory : According to this theory , anxiety is related to cognitive
distortions and negative automatic thoughts

10. DIAGNOSIS
• Tests to rule out organic or pharmacologic basis for symptoms
• Serum glucose measurements to rule out hypoglycemia
• TFT to rule out hyperthyroidism
• Urine and serum toxicology tests to rule out presence of psychoactive substances
such as barbiturates , caffeine, and amphetamines.
• Based on ICD 10 criteria

11. TREATMENT MODALITIES
Pharmacotherapy:
 Benzodiazepines — alprazolam , clonazepam
 Antidepressants
 Betablockers -- propranolol
Behavioural therapy:
 Relaxation techniques
 Deep breathing exercise
 Positive verbalization or guided imagery
 Listening calm music
Cognitive therapy:
 Replacing negative thoughts with more realistic ,positive ways
 Helping to identify possible triggers of panic attacks
 Identify and evaluate thoughts that precede anxiety and restructures them

12. GENERALIZED ANXIETY DISORDER

13. GENERALIZED ANXIETY DISORDER
• GAD is characterized by chronic , unrealistic, and excessive anxiety and worry.
• Symptoms have existed for 6 months or longer and can not be attributed to specific
organic factors ,such as caffeine intoxication and hyperthyroidism.

14. COURSE AND PREVALENCE
• Onset occurring after age 20 years
• 1 year prevalence rate for GAD is 3 % and life time rate 5%

15. SYMPTOMS OF GAD
• The DSM IV TR identifies the following symptoms associated with GAD
Excessive anxiety and worry about a number of events that the individual finds
difficult to control
Restlessness or feeling keyed up
Being easily fatigued
Difficulty concentrating or mind “going back”
Irritability
Muscle tension
Sleep disturbances(difficulty falling asleep)
• Depressive symptoms are common

16. PSYCHOLOGICAL SYMPTOMS
• Fearful anticipation
• Irritability
• Sensitivity to noise
• Restlessness
• Poor concentration
• Worrying thoughts
• Apprehension

17. PHYSICAL SYMPTOMS
Gastrointestinal:
• Dry mouth
• Difficulty swallowing
• Epigastric discomfort
• Frequent or loose motions
Respiratory:
• Constriction in the chest
• Difficulty inhaling
Cardiovascular:
• Palpitation
• Discomfort in chest
Genitourinary:
• Frequency or urgent micturition
• Failure of erection
• Menstrual discomfort
Neuromuscular:
• Tremor
• Tinnitus
• Dizziness
• Headache
Sleeping disturbances:
• Insomnia
• Night terror
Other symptoms:
• Depression
• Obsessions
• Depersonalization
• Derealization

18. TREATMENT OF GAD
Behavioural therapy :
 Biofeedback
 Relaxation techniques – Jacobson’s progressive muscle relaxation technique, yoga,
pranayama, meditation.
 Supportive psychotherapy
Cognitive therapy : by restructuring thoughts.
Pharmacotherapy :
 Antianxiety agents – Benzodiazepines (alprazolam, clonazepam)
 Beta blockers – propranolol

19. NURSING DIAGNOSIS
• Panic Anxiety
• Powerlessness
• Fear
• Social Isolation
• Ineffective Coping
• Ineffective Role Performance