1. Anxiety and Anxiety Disorders Chapter 8

2. Definition  Feeling of apprehension, uneasiness, uncertainty or dread resulting from a real or perceived threat, whereas fear is reaction to a specific threat Types  Normal: healthy life force necessary for survival  Acute: precipitated by imminent loss or change that threatens one’s sense of security  Chronic: anxiety that a person has lived with for a long time Anxiety

3. Mild Occurs in normal experience of everyday living Moderate Occurs as anxiety escalates, perceptual field narrows and details are excluded from observation Selective inattention: only certain things are seen and heard Severe Perceptual field is greatly reduced. May focus on particular detail or scattered details Panic Most extreme form and results in markedly disturbed behavior Levels of anxiety

4. Mild to Moderate -Use of specific communication techniques-open ended questions, giving broad openings, exploring and seeking clarification -Be calm, recognize persons distress, listen Severe to Panic -Quiet environment with minimal stimulation and providing gross motor activities to drain some of the tension -Firm, short, and simple statements are useful Anxiety interventions

5. Defense mechanisms The degree of distortion of reality and disruption in interpersonal relationships determines if the use of a defense mechanism is adaptive (healthy) or maladaptive (unhealthy) (Vaillant, 1994) Defenses are major means of managing conflict and affect Defenses are relatively unconscious Defenses are discrete from one another Although defenses are hallmark of psychiatric syndromes they are reversible Defenses are adaptive as well as pathological

6. Altruism -Emotional conflicts and stressors are dealt with by meeting the needs of others Sublimation -Unconscious process substituting constructive and socially acceptable activity for strong impulses that are not acceptable in original form Humor -Emphasizing the amusing or ironic aspects of conflict or stressor Suppression -Conscious denial of disturbing situation or feeling Healthy defenses

7. Repression: exclusion of unwanted experiences, emotions or ideas from conscious awareness Displacement: transfer of emotions associated with person, object or situation to another Reaction formation: unacceptable behavior or feelings are kept out of awareness by developing opposite behavior or emotion Somatization: transforming anxiety unconsciously to physical symptom Undoing: Making up for act or communication Rationalization: Justifying illogical ideas, actions by developing acceptable explanations that satisfy both Immediate defenses

8. Passive Aggression : indirect aggression toward others Acting-Out Behavior : actions rather than feelings or reflections Dissociation : integrating consciousness, memory, identity or perception of environment Devaluation : attributing negative qualities to others Idealization : attributing exaggerated positive qualities to others Splitting : inability to integrate positive & negative qualities of oneself into cohesive image Projection : reject unacceptable personal features & attributes them to other people, objects or situations Denial : escaping unpleasant reality by ignoring their existence Immature defenses

9. Anxiety disorders Refers to number of disorders including: panic disorders, phobias, obsessions, compulsions, and PTSH (post traumatic stress) Prevalence and co-morbidity  Most prevalent lifetime psychiatric disorder in US  1 in 4 will experience in lifetime Co-occurs with other psychiatric disorders Theory  Genetic, Biological, Learning, & Cognitive

10. Cultural considerations Data on incidence in cultures is sparse Some cultures express anxiety through physical symptoms (somatic) while in other cultures cognitive symptoms are predominant Barrier for some cultural groups seeking health care for anxiety is the stigma associated with mental illness

11. Panic Disorder  Sudden onset extreme apprehension or fear associated with impending doom Panic Disorder with Agoraphobia  Combination of above symptoms and agoraphobia(intense phobic disorder) excessive anxiety or fear about being in places from which escape might be difficult or help unavailable Phobias  Persistent, irrational fear of specific object, activity, or situation that leads to desire fro avoidance of the object, activity or situation Social anxiety disorder  Severe anxiety or fear provoked by exposure to social or performance situation Types of anxiety disorders

12. Obsessive-Compulsive Disorder -Obsessions: thoughts, impulses or images that persist & recur and can’t be dismissed from mind -Compulsions: ritualistic behavior that person feels driven to perform in order to reduce anxiety -Obsessions and compulsions that occur together Generalized Anxiety Disorder -Excessive anxiety or worry about numerous things that lasts for 6 months or longer Post Traumatic Stress Disorder (PTSD) -Repeated re-experiencing of highly traumatic event that involved actual or threatened death or serious injury to self or others Acute Stress Disorder -Occurs 1 month after exposure to traumatic event Anxiety cause by Medical Conditions -Anxiety caused by medical disorder (hyperthyroidism, cardiac, pulmonary embolus)

13. Assessment -Symptoms of anxiety -Defenses used in anxiety disorders -Assessment guidelines Diagnosis -NANDA Outcomes Identification -NOC Planning Implementation -Follow psychiatric-mental health nursing: scope & standards of practice -Communication guidelines -Health teaching and health promotion -Milieu therapy -psychotherapy: CBT (Cognitive Behavioral Therapy) Applications of nursing process

14. Antidepressants -SSRI’s - 1 st line treatment for anxiety -Also treat co-morbid depressive disorders Anxiolytic -Treat somatic and psychological symptoms of anxiety -Can be addictive (Seroquel, Xanax) Other classes of medications -Beta-blockers, antihistamines (Vistaril) & anticonvulsants Complementary interventions -“Natural” substances include kava kava, gotu kola & St John’s Wort -Not subject to same rigorous testing as prescription medications Pharmacological, biological and integrative therapies