Anxiety Disorders

• 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
• Biological
• Psychological

• Hypoglycemia
• Cardiac dysrhythmias
• Hyperthyroidism
• Pheochromocytoma

Substance- Induced: Meth, Cocaine, PCP, Inhalants

• 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

• 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)

• Persistent irrational thoughts; exaggerated fearful response to something
• Use emotional cognitive distortion
• Tx: gradual desensitization; flooding (seldom used)

• 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

• 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

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

• 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
• Sleep

• Relaxation techniques
• Modeling
• Systematic desensitization
• Flooding (implosion)
• Thought stopping - useful for mild hallucinations, repetitive thinking, think of stop sign and replace with another thought

• 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