Anxiety Disorders

  1. Anxiety
    • 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
  2. Etiology
    Typically unknown etiology

    • Genetic: esp. in anxiety disorders
    • Biological
    • Psychological
  3. What medical conditions can cause anxiety?
    • Hypoglycemia
    • Cardiac dysrhythmias
    • Hyperthyroidism
    • Pheochromocytoma

    Substance- Induced: Meth, Cocaine, PCP, Inhalants
  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:
    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
  6. Panic Disorder:
    • 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)
  7. Phobias
    What is it?
    • Persistent irrational thoughts; exaggerated fearful response to something
    • Use emotional cognitive distortion
    • Tx: gradual desensitization; flooding (seldom used)
  8. 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
  9. 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
  10. PTSD
    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
  11. Acute Stress Disorder
    Onset time?
    How is it diagnosed?
    Similar to?
    Resolves after?
    • 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