2Anxiety Vague feeling of dread or apprehension Different from fear (feeling afraid or threatened by identifiable stimulus representing danger)Anxiety disorders: key feature of excessive anxiety with behavioral, emotional, cognitive, physiologic responsesStress: wear and tear of life on the body
3Anxiety as a Response to Stress General adaptation syndrome (physiologic aspects of stress; identified by Selye)Alarm reaction stage (preparation for defense)Resistance stage (blood shunted to areas needed for defense)Exhaustion stage (stores depleted; emotional components unresolved)
4Levels of AnxietyMild: special attention; increased sensory stimulation; motivationalModerate: something definitely wrong; nervousness/agitation; difficulty concentrating; able to be redirected
5Levels of Anxiety (cont.) Severe: trouble thinking and reasoning; tightened muscles; increased vital signs; restless, irritable, angryPanic: fight, flight, or freeze response; increased vital signs; dilated pupils; cognitive processes focusing on defense
6Working with Anxious Patients Self-awareness of anxiety levelAssessment of person’s anxiety levelUse of short, simple, easy-to-understand sentencesLower person’s anxiety level to moderate or mild before proceeding
7Working with Anxious Patients (cont.) Low, calm, soothing voiceSafety during panic levelShort-term use of anxiolytics
8Question Is the following statement true or false? Anxiety and fear are considered to be two different things.
9AnswerTrueRationale: Anxiety is different from fear. Anxiety is a vague feeling of dread or apprehension. Fear is a feeling of being afraid or threatened by an identifiable stimulus representing danger.
10Anxiety Disorders Agoraphobia with or without panic disorder Specific phobiaSocial phobiaGeneralized anxiety disorder
11Anxiety Disorders (cont.) Incidence: most common psychiatric disorders in the United StatesMore prevalent: women; people under 45 years oldOnset, clinical course are variable
12Anxiety Disorders: Etiology Biologic theoriesGenetic theoriesNeurochemical theories (GABA, serotonin)Psychodynamic theoriesIntrapsychic/psychoanalytic theories (Freud and defense mechanisms)Interpersonal theories (Sullivan, Peplau)Behavioral theory
13Cultural Considerations Each culture has rules for expressing, dealing with anxietyAsian cultures: often with somatic symptoms; koroHispanics: susto (high anxiety as sadness, agitation, weight loss, weakness, heart rate changes); due to supernatural spirits or bad air from dangerous places and cemeteries invading body
14Treatment Combination of medications, therapy Medications: anxiolytics; antidepressantsCognitive–behavioral therapyPositive reframing (turning negative messages into positive ones)Decatastrophizing (making more realistic appraisal of situation)Assertiveness training (learn to negotiate interpersonal situations)
15Question Is the following statement true or false? The neurotransmitter dopamine is associated with anxiety disorders.
16AnswerFalseThe neurotransmitters, GABA and serotonin, are thought to play a role in anxiety disorders.
17Elder Considerations Late-life anxiety disorders Phobias (GAD most common)Often associated with another condition, such as depression, dementia, physical illness, or medication toxicity or withdrawalSSRIs as treatment of choice for anxiety disorders in the elderly
18Mental Health Promotion Anxiety as warning of not dealing with stress effectively
19Mental Health Promotion (cont.) Tips for managing stress:Positive attitude; belief in self; acceptance of lack of control over certain eventsAssertive communication; expression of feelings: talking, laughing, cryingRealistic goals; personally meaningful activityWell-balanced diet, exercise, adequate rest/sleepUse of stress management techniques
20Panic DisorderDiscrete episodes of panic; no stimulus for panic responseAvoidance behaviorPrimary, secondary gain
22Panic Disorder and Nursing Process Application AssessmentHamilton Rating Scale for Anxiety (see Box 14.1)HistoryGeneral appearance, motor behavior (automatisms)Mood, affect (depersonalization, derealization)Thought process, content (disorganized thoughts, loss of rational thinking)
23Panic Disorder and Nursing Process Application (cont.) Assessment (cont.)Sensorium, intellectual processes (confusion, disorientation)Judgment, insightSelf-concept (self-blaming)Roles, relationships (avoidance of others)Physiologic, self-care concerns (sleeping, eating)
24Panic Disorder and Nursing Process Application (cont.) Nursing diagnosesOutcome identificationInterventionsSafety, comfortTherapeutic communicationAnxiety managementPatient, family educationEvaluation
25QuestionWhich of the following would a nurse expect to assess in a patient with a panic disorder?A. Rational thinkingB. Blaming of othersC. AutomatismsD. Organized thoughts
26AnswerC. AutomatismRationale: A patient with panic disorder would demonstrate automatisms, irrational thinking, self- blame, and disorganized thoughts.
27Phobias Intense illogical persistent fear Categories: agoraphobia; specific phobia; social phobia (social anxiety disorder)Categories of specific phobia: natural environment; blood—injection; situation; animal; other types
28Phobias (cont.) Treatment Behavioral therapy: positive reframing; assertiveness training; systematic desensitization; floodingMedications (see Tables 14.2 and 14.3 [Drugs Used to Treat Anxiety Disorders])
29Question Is the following statement true or false? Phobias result from a past negative experience.
30AnswerFalseRationale: Phobias usually do not result from past negative experiences. In fact, the person may never have had contact with the object of the phobia.
31Other Anxiety Disorders Generalized anxiety disorderChronic; longer than 6 monthsTreatment: buspirone, SSRIsAnxiety disorder due to a general medical conditionSubstance-induced anxiety disorderSeparation anxiety disorder
32Self-Awareness Issues Need to understand how, why anxiety behaviors workNurses as vulnerable as others to stress, anxietyEveryone occasionally suffers from stress, anxietyAvoid trying to “fix” patient’s problemUse techniques to manage stress, anxiety in personal life