ANXIETY DISORDERS

By: bogs b. fiesta, RN

Learning Objectives:
After the lecture, you will be able to:

Articulate the difference between anxiety and fear. Compare and contrast the signs and symptoms of the anxiety disorders. Discuss the treatment for each anxiety disorder. Formulate a nursing care plan for a client with anxiety disorder..

Anxiety is used to describe feelings of uncertainty, uneasiness, apprehension, or tension that a person experiences in response to an unknown object or situation.

Fear is bodys physiologic response to a known or recognized danger.

Types of Anxiety:
Signal anxiety- a response to an anticipated event. Anxiety trait- a component of personality that has been present over a long period. Anxiety state- occurs as the result of a stressful situation. Free-floating anxiety- always present and accompanied by a feeling of dread.

Levels of Anxiety

Mild anxiety Moderate anxiety Severe anxiety Panic anxiety

Mild Alert and perceptual field is increased. Sees, hears and grasps more than before. Can motivate learning. Produce growth and creativity.

Moderate

Narrowing of perceptual field Sees, hears, grasps less. Blocks selected areas but can attend to more if directed to do so.

Severe Tends to focus on a specific detail and not think anything else. All behavior is aimed at relieving anxiety. Much direction is needed to focus on another area.

Panic
Unable to do things without direction. Disorganization of personality and can be life threatening Increased motor activity, decreased ability to relate to others. Distorted perceptions. Loss of rational thought.

Working With Anxious Clients

Be aware of nurses own anxiety level Assess the persons anxiety level Speaking in short, simple, and easy-to-understand sentences Lower the persons anxiety level to moderate or mild before proceeding with anything else Talk to the client in a low, calm, and soothing voice Walk while talking if the patient cannot sit still Ensure safety during panic-level anxiety Remain with the client until the panic recedes Short-term use of anxiolytics

CAUSES:
1.

Biologic theories
Genetic theories Neurochemical theories

2.

Psychodynamic theories
Psychoanalytic theory Interpersonal theory Behavioral theory

Anxiety Disorders

Agoraphobia with or without panic disorder Panic disorder Specific phobia Social phobia Obsessive-compulsive disorder (OCD) Generalized anxiety disorder Acute stress disorder Posttraumatic stress disorder

Panic Disorder with or without Agoraphobia

Involves 15- to 30-minute episodes of intense, escalating anxiety with emotional fear and physiologic discomfort

Displays 4 or more of the following:

Palpitations /Sweating / Tremors SOB / Sense of suffocation Chest pain /Nausea Abdominal distress / Dizziness Paresthesia / Chills Hot flashes

DSM IV TR CRITERIA for PANIC DISORDER

1. 2.

3.

Recurrent, unexpected panic attacks Panic attacks followed by a month or more of worry about having additional attacks, worry about the results of the attacks, and behavior changes related to the attacks. Panic disorder possibly accompanied by agoraphobia.

Phobias
A phobia is an illogical, intense, persistent fear of a specific object or social situation that causes extreme distress and interferes with normal life functioning. 3 categories: Agoraphobia Specific phobia Social phobia

AGORAPHOBIA

SPECIFIC PHOBIA

Examples of specific phobia

Achluophobia - Fear of darkness. Acrophobia - Fear of heights. Aerophobia - Fear of flying. Agliophobia - Fear of pain. Agoraphobia - Fear of open spaces or crowds. Aichmophobia - Fear of needles or pointed objects. Amaxophobia - Fear of riding in a car. Androphobia - Fear of men. Anginophobia - Fear of angina or choking.

Anthrophobia - Fear of flowers. Anthropophobia - Fear of people or society. Aphenphosmphobia - Fear of being touched. Arachnophobia - Fear of spiders. Arithmophobia - Fear of numbers. Astraphobia - Fear of thunder and lightening. Ataxophobia - Fear of disorder or untidiness. Atelophobia - Fear of imperfection. Atychiphobia - Fear of failure. Autophobia - Fear of being alone.

CONT..
Bacteriophobia - Fear of bacteria. Barophobia - Fear of gravity. Bathmophobia - Fear of stairs/steep slopes. Batrachophobia - Fear of amphibians. Belonephobia - Fear of pins and needles. Bibliophobia - Fear of books. Botanophobia - Fear of plants.

CONT..

Cacophobia - Fear of ugliness. Catagelophobia - Fear of being ridiculed. Catoptrophobia - Fear of mirrors. Chionophobia - Fear of snow. Chromophobia - Fear of colors. Chronomentrophobia - Fear of clocks. Claustrophobia - Fear of confined spaces. Coulrophobia - Fear of clowns. Cyberphobia - Fear of computers. Cynophobia - Fear of dogs.

CONT..

Dendrophobia - Fear of trees. Dentophobia - Fear of dentists. Domatophobia - Fear of houses. Dystychiphobia - Fear of accidents. Ecophobia - Fear of the home. Elurophobia - Fear of cats. Entomophobia - Fear of insects. Ephebiphobia - Fear of teenagers. Equinophobia - Fear of horses.

CONT..

Gamophobia - Fear of marriage. Genuphobia - Fear of knees. Glossophobia - Fear of speaking in public. Gynophobia - Fear of women. Heliophobia - Fear of the sun. Hemophobia - Fear of blood. Herpetophobia - Fear of reptiles. Hydrophobia - Fear of water. Hypochonria - Fear of illness.

CONT..

Iatrophobia - Fear of doctors. Insectophobia - Fear of insects. Koinoniphobia - Fear of rooms. Leukophobia - Fear of the color white. Lilapsophobia - Fear of tornadoes and hurricanes. Lockiophobia - Fear of childbirth. Mageirocophobia - Fear of cooking. Megalophobia - Fear of large things. Melanophobia - Fear of the color black. Microphobia - Fear of small things. Mysophobia - Fear of dirt and germs.

CONT..

Necrophobia - Fear of death or dead things. Noctiphobia - Fear of the night. Nosocomephobia - Fear of hospitals. Nyctophobia - Fear of the dark. Obesophobia - Fear of gaining weight. Octophobia - Fear of the figure 8. Ombrophobia - Fear of rain. Ophidiophobia - Fear of snakes. Ornithophobia - Fear of birds.

CONT..

Papyrophobia - Fear of paper. Pathophobia - Fear of disease. Pedophobia - Fear of children. Philophobia - Fear of love. Phobophobia - Fear of phobias. Podophobia - Fear of feet. Porphyrophobia - Fear of the color purple. Pteridophobia - Fear of ferns. Pteromerhanophobia - Fear of flying. Pyrophobia - Fear of fire.

CONT..

Venustraphobia - Fear of beautiful women. Verminophobia - Fear of germs. Wiccaphobia - Fear of witches and witchcraft. Xenophobia - Fear of strangers or foreigners. Zoophobia - Fear of animals.

CONT..

Samhainophobia - Fear of Halloween. Scolionophobia - Fear of school. Selenophobia - Fear of the moon. Sociophobia - Fear of social evaluation. Somniphobia - Fear of sleep. Tachophobia - Fear of speed. Technophobia - Fear of technology. Tonitrophobia - Fear of thunder. Trypanophobia - Fear of needles / injections

Obsessive-Compulsive Disorder
Obsessions are recurrent, persistent, painful intrusive, and unwanted thoughts, images, or impulses. Compulsions are ritualistic or repetitive behaviors or mental acts that a person carries out continuously in an attempt to neutralize anxiety.

Generalized Anxiety Disorder

Excessive worry and anxiety that is unwarranted, at least 50% of the time for 6 months or more.

DSM IV TR CRITERIA for GAD

1.

2.
3.

Excessive worry and anxiety Difficulty in controlling the worry Anxiety and worry are evident in 3 or more of the following: Restlessness Fatigue Irritability Decreased ability to concentrate Muscle tension Disturbed sleep

Post Traumatic Stress Disorder

Onset: acute 1-3 months delayed: 6 months or more after the event Duration: acute: 1- 3 months chronic : 3 months or more

ACUTE STRESS DISORDER

Acute Stress Disorder

Onset: within 4 wks after the event. Duration: 2 days to 4 wks

ACUTE STRESS DISORDER

is a psychological condition brought on by a person experiencing an extremely traumatic event in their life. This event would be one that would give the person an intense feeling of helplessness by either having them experience extreme, unexpected fear, stress or pain, or could possibly involve serious injury or perhaps a perceived serious injury or potential death to them self or someone else.

Techniques to reduce anxiety

1.

2.
3. 4. 5. 6. 7. 8. 9. 10.

Visual imagery Change of pace or scenery Exercise or massage Transcendental meditation Bio feedback Systemic desensitization Relaxation exercise Therapeutic touch/ healing touch Hypnosis Implosion therapy

Treatment
1.

Benzodiazepines helps tone down or inhibit the anxiety response to stressors.

S/E: drowsiness, fatigue, decreased

coordination, constipation, double vision, hypotension, incontinence, urinary retention,

Triazolam (Halcion) 2. Alprazolam (Xanax) 3. Lorazepam (Ativan) 4. Oxazepam (Serax) 5. Temazepam (Restoril) 6. Chlordiazepoxide (Librium) 7. Clonazepam (Klonopin) 8. Clorazepate (Tranxene) 9. Diazepam (Valium) 10. Flurazepam (Dalmane)
1.

2. Non-benzodiazepine

Buspirone (Buspar) S/E: dizziness, nausea, headache, nervousness, light headedness, excitement

SOMATOFORM DISORDERS

Body dysmorphic disorder Preoccupation of an imagined defect in his or her appearance. If the defect is present, concern is excessive.

Somatization disorders

Many physical complaints over several years, resulting in treatment being sought or impairment in functioning. It is characterized by 4 pain, 2 gastrointestinal, 1 sexual, and 1 pseudoneurologic symptom.

Conversion disorder
1 or more symptoms or deficits affecting voluntary motor or sensory function that suggest neurologic or general medical condition. La belle indifference / hysteria A naive, inappropriate lack of emotion or concern for the perceptions by others of one's disability.

Pain disorder

Pain in 1 or more areas of the body that is severe enough to seek treatment; causes impairment in functioning or significant distress.

Hypochondriasis

Preoccupation with fear of having, or the idea that 1 has, a serious disease; includes misinterpretation of bodily symptoms, preoccupation persist despite medical evaluation and reassurance.

DISSOCIATIVE DISORDERS

Dissociative Amnesia
Loss of memory of important personal events that were traumatic or stressful in nature. One or more episodes of inability to recall information - usually traumatic or stressful nature Localized amnesia Selective amnesia Generalized Continuous

Dissociative Fugue

Sudden, unexpected travel away from home or work with a loss of memory about the past.

Dissociative Identity Disorder

Presence of 2 or more identities or personalities that take control of the persons behavior. At least two of these identities take control of the persons behavior.

Depersonalization

Experiences of feeling detached from, or an outside observer of ones body or mental processes. If Im not really me, then who am I?