- Subjective emotional response to a stressor
- Can be normal, mild is healthy
Pathological when it interferes with adaptive behavior, is disproportionate to risk and severity or threat, causes physical symptoms, exceeds tolerable level
Typically unknown etiology
- Genetic: esp. in anxiety disorders
What medical conditions can cause anxiety?
- Cardiac dysrhythmias
Substance- Induced: Meth, Cocaine, PCP, Inhalants
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
- Urinary frequency or urgency
- Tight throat
- Fatigue and insomnia
How long does it last?
- Overwhelming dread with distinctive features that include unusually intense physical sensations and at least 4 of the anxiety disorder symptoms
- 10 minutes
- 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)
What is it?
- Persistent irrational thoughts; exaggerated fearful response to something
- Use emotional cognitive distortion
- Tx: gradual desensitization; flooding (seldom used)
Obsessive Compulsive Disorder
- 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
Generalized anxiety disorder
What is it?
How long to be classified?
- 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
How does it come about?
How long does it last?
What if it doesn't last that long?
ALWAYS preceded by traumatic event
Caused by life-threatening trauma to self or witnessed of others, or repetitive traumas
- Lasts 1 month
- Less than a month = Acute Stress Disorder
Symptoms: flashbacks (images, thoughts, perception, smell, nightmares), persistent avoidance of stimuli, numbness, detachment, increased arousal
Acute Stress Disorder
How is it diagnosed?
- 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
- 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
Interventions - Behavioral therapy
- Relaxation techniques
- Systematic desensitization
- Flooding (implosion)
- Thought stopping - useful for mild hallucinations, repetitive thinking, think of stop sign and replace with another thought
- 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)
- SSRIs (takes 1-2 months to be affective; 1st line tx)
- Betablockers (Inderol)