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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
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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)
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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
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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
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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)
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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
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Anticipatory anxiety
- Anxious about possibility of having a panic attack
- Can be more debilitating than a panic attack
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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
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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
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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
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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
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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
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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
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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
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