anxiety disorders

  1. Anxiety introduction
    • anxiety is an emotional response to anticipation of danger the source of which is largely unknown or unrecognize
    • anxiety is necessary for for survival. it is not the same as stress
  2. anxiety disorder intro 2
    • a stressor is an external pressure that is borught to bear on the individual
    • anxiety is a subjective emotional response to that stressor
    • anxiety maybe distinguished from fear in that anxiety emotional response and fear is cognitive
  3. Historical aspect
    • anxiety once identified by its physiological symptoms, focusing largely on the CV system
    • for many yrs, anxiety disorders were viewed as purely psychological or purely biological in nature
  4. Epidemiological stats
    • anxiety disorders are the most common of all psychiatric illnesses
    • more common in women than men
    • minority children and children from low socioeconomic status at risk
    • a familial predisposition probably exists
  5. how much is too much
    • when anxiety is out of proportion to the situation that is creating it
    • when anxiety interfers with social, occupational and other areas of function
  6. response to anxiety: mild
    physiologic, cognitive
    • Physiologic:
    • - VS norm, minimal muscle tension
    • - pupil norm or constricted

    • Cognitive/perceptual
    • - perceptual field is broad, awareness of multiple stimuli
    • thought controlled
    • - sensory awareness
    • relaxed, calm, attentive movitated to achieve goals
    • you can see and know what is going on
  7. response to anxiety mild
    • feelings of comfort and safety
    • relaxed attentive calm
    • optimum state for problem solving and learning
  8. response to anxiety: moderate
    physiologic, cognitive
    • physiologic:
    • - VS norm or slightly elev
    • - tension experienced (labeled 'tense' or 'excited')
    • Cognitive "
    • - alert
    • - perception is narrowed
    • - focused- on what is going on
  9. moderate
    • feelings of readiness and challenge
    • energized
    • engaged in competitive activity
    • learn new skills (need direction)
  10. severe anxiety
    physiologic, cognitive
    • physiologic:
    • flight or fight response as ANS excessively stimulated
    • cardio- inc HR, RR, liver is being stimulated glycogan
    • cognitive/perceptual
    • perceptual gravity is narrowed, distorted
    • selective attention focused on detail
    • selective inattention, distorted of time
    • automatic behavior
  11. severe anxiety
    dissociative tendencies
    perception of unreality about self, environment or event
  12. panic level
    • above symptoms escalate until SNS release occurs
    • - pale, BP decrease
    • - muscle coordination poor
    • - pain, hearing sensation minimal
  13. panic level
    • scattered, distorted closed unable to take in stimuli
    • problem solving and logical thinking highly improbable, irrational
    • dissociation may occure
  14. Panic
    emotional behavioral
    • feels helpless, loss of control
    • angry, terrifed, combative, or withdrawn, cry or run
    • disorganized
    • decreased ability to relate to to others
  15. nursing process
    panic assessment
    • characterized by recurrent panic attacks, the onset is unpredictable
    • manifested by intense apprehension, fear or terror, often associated feelings of impending doom
    • accompanied by intense physical discomfort
    • may or may not agoraphobia (fear of public places-peggy)
  16. nursing process
    symptoms of panic attack
    • must have at least four of these symptoms to call it panic attack
    • sweating, trembling, shaking
    • shortness of breath, chest pain, or discomfort
    • nausea or abd distress
    • dizziness, chills, hot flashes
  17. more panic symptoms
    • numbness, tingling sensations
    • derealization (surroundings not real), depersonalization (thoughts + feelings unreal)
    • fear of losing control or going crazy
    • pp 463-64
  18. panic attack HRN for suicide
    • last minutes more rarely hours, frequency and severity very greatly
    • between attacks may feel nervous and apprension and depression is common
    • aver age late 20's
    • panic attack may occur sporidically over weeks, moments, yrs
    • peeps who have more frequent attack
  19. panic disorder intervention
    • stay with pt reassure
    • stay calm, nonthreatening
    • simple words, spoken calmly clear- cant cognitively procress what you are saying
    • tx hyperventialtion- o2 non breather (contra asthma COPD), o2 stat
    • low stimili (dim lights)
    • PRN antianxiety med
    • teaching
    • - why do you think this occured
    • - signs of panic attack
    • - medication
    • - using therapy to yell stop
  20. application of the nursing
    generalized anxiety definition
    characterized by chronic, unrealistic, and excessive anxiety and worry
  21. predisposing factors
    panic and generalized anxiety
    cognitive theory
    • faulty, distorted or counter-productive thinking patterns result in anxiety that is maintained by mistaken or dysfunctional appraisal of a situation
    • negative interpreting, environmental stimuli, worry
  22. predisposing factors 
    panic and generalized anxiety
    biological aspects
    • genetics- 30% of identical twins can have the same found familial tendencies
    • neuroanatomical- patho that cause anxiety is found in the temporal lobe, hippocampus
    • biochemical- inc in serotonin and lactate
    • neurochemical- incr in norepinephrine
  23. Norepinephrine/GABA
    • Nore
    • known to mediate arousal and causes hyperarousal and anxiety
    • fight or flight
    • GABA
    • NT which control the activity or firing rates of neurons responsible for producing anxiety
    • GABA is the most inhibitory NT in the brain- slows down neuron firing
    • anti-anxiety meds inc GABA and dec anxiety
Card Set
anxiety disorders