Anxiety Disorders

  1. Anxiety
    • Subjective emotional response to a stressor
    • Can be normal
    • Pathological when it interferes with adaptive behavior, is disproportionate to risk and severity or threat, causes physical symptoms, exceeds tolerable level
    • Pain anxiety - feeling you are going to die; depersonalization
    • Stress is an external stressor
    • Fear is a cognitive response to a stressor
  2. Anxiety disorders
    • 2nd most common
    • Twice as common in females
    • Freq seen with other psychiatric disorders (depression, substance abuse, somatization)
    • Panic disorder
    • Phobias
    • OCD
    • Generalized anxiety disorder
    • PTSD
    • Acute stress disorder
    • Anxiety due to medical condition
    • Substance-induced anxiety disorder (stimulants, caffeine, PCP, cocaine, anticholinergics, inhalants)
  3. Etiology
    • Unknown etiology
    • Genetic: higher incidence in families with anxiety disorders
    • Biological: asthma, pre-surgery, heart attacks, hypoglycemia, hyperthyroidism, medications, pheochromocytoma, drug withdrawal, encephalitis
    • Psychological
  4. Symptoms of anxiety disorders
    • Feeling like one is going to die or having a sense of impending doom
    • Having narrowed perceptions (instead of seeing entire room, see only one thing or one person)
    • Difficulty concentrating or problem-solving
    • Incr vital signs
    • Muscle tension
    • Dilated pupils
    • Palpitations
    • Urinary frequency or urgency
    • Nausea
    • Tight throat
    • Fatigue and insomnia
    • Irritability
    • Disorganization
  5. Panic disorder
    • Overwhelming dread with distinctive features that include unusually intense physical sensations and at least 4 of the anxiety disorder symptoms
    • Usually lasts 10 minutes or less (time limited)
    • Unpredictable
    • Mild to severe
    • Derealization - environment seems unreal
    • Depersonalization - outer body experience
    • Feel tired after attack subsides
    • Person responds stronger and longer and can't decr feels of alertness
    • Can wake up in a panic attack
    • Comorbidity - major depression, personality disorders, alcoholism, history of separation anxiety
    • 60% of women who experienced sexual abuse as a child will have panic disorder
    • Nursing intervention - Benzodiazepines, decr stimuli, calm speaking, don't leave pt (have someone else get benzo)
    • Substance abuse is common (marijuana, alcohol, CNS depressants)
  6. Phobias
    • Persistent irrational thoughts; exaggerated fearful response to something
    • Use emotional cognitive distortion
    • Tx: gradual desensitization; flooding (seldom used)
    • Agoraphobia: fear of going to a place where you may have a panic attack and you can't get out or leave
    • Acrophobia: fear of heights
    • Mysophobia: fear of germs, dirt
    • Nyctophobia: fear of dark
    • Social phobia: predisposes one to substance abuse; avoid social settings b/c of fear of inadequacy; can teach pt what to do in social settings
  7. Anticipatory anxiety
    • Anxious about possibility of having a panic attack
    • Can be more debilitating than a panic attack
  8. Obsessive compulsive disorder
    • Axis 1
    • Obessions: unwanted intrusive, persistent thoughts/ideas/impulses/images in your mind
    • Compulsions: behavioral component; unwanted behavioral or mental acts; are intended to be behaviors that decr anxiety around obsession, not to give pleasure (counting, checking, hand washing)
    • Ego-dystonic: self doesn't like me
    • Nursing dx: altered role performance r/t need to perform rituals
    • Outcomes: use adapting coping to deal with anxiety, rather than obsessive compulsions
    • Combo of biological and psychological etiology; stress related
    • Equal in men and women
  9. Generalized anxiety disorder
    • Excessive anxiety or worry
    • 6 months or longer
    • Accompanied by symptoms of restlessness, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance
    • Depressed immune system
  10. PTSD
    • Preceded by traumatic event
    • Repeated experiencing
    • 1-8% will have some type of PTSD in lifetime
    • Caused by life-threatening trauma to self or witnessed of others, or repetitive traumas
    • Lasts more than 1 month (referred to as acute stress disorder if less than 1 month)
    • Symptoms: flashbacks (images, thoughts, perception, smell, nightmares), persistent avoidance of stimuli, numbness, detachment, increased arousal
  11. Acute stress disorder
    • Occurs within 1 month
    • Must display at least 3 dissociative symptoms (numbness, detachment, derealization, depersonalization, dissociative amnesia)
    • Similar to PTSD but is time limited
    • Resolve after 1 month
  12. Interventions
    • Id community resources that can offer the client effective therapy
    • Id community support groups for people with anxiety disorders
    • Assess need for interventions for families and significant others
    • Provide thorough teaching when medications are used
    • Assess past coping
    • Educate about negative coping (use of alcohol)
    • Benzos (short term for stress)
    • Cognitive therapy, cognitive behavioral therapy (change in faulty thinking)
    • Nutrition, fluid intake
    • Hygiene, grooming
    • Sleep
  13. Interventions - Behavioral therapy
    • Relaxation techniques
    • Modeling
    • Systematic desensitization
    • Flooding (implosion)
    • Thought stopping - useful for mild hallucinations, repetitive thinking, think of stop sign and replace with another thought
  14. Psychopharmacology
    • Anxiolytics:
    • Benzodiazepines (quick, short acting, addictive CNS depressants, potentiate GABA and inhibitory neurotransmitter; used until antidepressants kick in and work; gradually wean off)
    • Buspirone (5-7 days to begin working; not habit forming; must take on regular basis)
    • Antidepressants:
    • SSRIs (takes 1-2 months to be affective; 1st line tx)
    • TCAs
    • Betablockers (Inderol)
    • Antihistamines
Card Set
Anxiety Disorders
Psych Exam 3 - Anxiety Disorders