Presentation on theme: "Mental Health Nursing: Anxiety Disorders"— Presentation transcript:
1 Mental Health Nursing: Anxiety Disorders Stress Produces Anxiety
2 Anxiety Disorders Objectives At the completion of this unit you will be able to:Explain anxiety and five specific anxiety disordersIdentify behavioral and physical manifestations of anxiety disordersDescribe nursing care and treatment modalities for anxiety disorders
3 Anxiety DisordersStress and anxiety can be associated with both positive and negative situations
4 Anxiety DisordersEustress: stress associated with positive experiences.Stressor: any person or situation that produces anxiety.What is stressful to one person might be relaxing to another.
5 Anxiety Disorders Anxiety is: A feeling of uneasiness or apprehension A response to extreme or prolonged periods of stressAn uncomfortable feeling of dread
6 Anxiety may be influenced by one’s culture: Anxiety DisordersAnxiety may be influenced by one’s culture:Some believe that personal problems should be kept to themselvesOthers believe it is therapeutic to acknowledge and discuss stressMachoism
7 Anxiety DisordersFree-floating anxiety: a gut feeling that something bad may happen; feeling of impending doom. Stressor is not clear.Signal anxiety: A clear & known stressor causes stress & anxiety
8 Anxiety Disorders In Children & Teenagers Stress & Anxiety Indicators:Withdrawal from friends and usual activitiesChanges in eating habitsChanges in sleeping patternsDecline in school performance
9 Anxiety Disorders In Children & Teenagers More than 50% of juveniles who are offenders of the law &/or are incarcerated also have a mental illness that is associated with anxiety and substance abuse.
10 Anxiety Disorders Freud’s Psychoanalytic Theory Unconscious forces act to determine personality & behaviorId: primitive drives, pleasure principle; i.e.: hunger, sexEgo: Rational & reasonable; buffer between the outside world & the idSuperego: Conscious distinctions between right & wrong.
11 Anxiety Disorders Freud’s Psychoanalytic Theory Anxiety is caused by conflict between the id and the superego.
12 Anxiety Disorders Sympathetic Nervous System Responses Initiates the “fight or flight response”Epinephrine & norepinephrine are released.↑ BP, ↑pulse, pupil dilation
13 Anxiety Disorders Effects of chronic or uncompensated stress Review Table 11-1 (p. 188)
14 Anxiety Disorders Effects of chronic or uncompensated stress Individuals with stress/anxiety are 2/3s more likely to develop cold and flu symptoms than those who are not.
15 Anxiety DisordersSuppressed anger also has the same negative effects on general health.Chronic anger is frequently associated with chronic headaches.
16 Anxiety Disorders Anxiety Types Generalized Anxiety DisorderExcessive worry or stress that is related to 2 or > things & lasts > 6 months.Must show 6 or > symptoms of anxiety
19 Anxiety Disorders Anxiety Types Panic DisorderExtreme fear that cannot be controlled.Panic AttackAgoraphobiaDiagnosis requires 4 out of 12 DSM symptoms.
20 Anxiety Disorders Anxiety Types Common Symptoms of Panic DisorderFear, dissociation, nausea,diaphoresis, chest pain, shaking,Increased pulse, unsteadinessInterventions: are the same as those for anxiety disorder
21 Anxiety Disorders Anxiety Types Common Symptoms of Panic Disorder
22 Anxiety Disorders Anxiety Types PhobiaMost common anxiety disorderIrrational fearIndividuals are aware that it is an irrational fearEstimated that 700 different things cause phobias
24 Anxiety Disorders Anxiety Types Phobia SubcategoriesAgoraphobia: fear of being in open spaces.Social phobia: fear humiliation in social situationsSimple phobia: fear of a specific thing (i.e.: claustrophobia, hematophobia, acrophobia)
26 Anxiety Disorders Anxiety Types Obsessive-Compulsive Disorder (OCD): 2 PartsObsession: repetitive thought, urge, or emotionCompulsion: repetitive act that may appear purposefulBehaviors are ritualistic and occur to reduce anxietyUnable to stop the thought or action.
27 Anxiety Disorders Anxiety Types Obsessive-Compulsive DisorderThe thought or action is a substitute for the source of anxiety.Individuals with this disorder tend to be rule-oriented and perfectionistic
28 Anxiety Disorders Anxiety Types Obsessive-Compulsive DisorderIf the individual is prevented from performing the act, the anxiety converts into somatic symptoms.
29 Anxiety Disorders Anxiety Types Post-Traumatic Stress DisorderDevelops in response to a emotional or physical trauma that could not be controlled.
30 Anxiety Disorders Anxiety Types Post-Traumatic Stress DisorderCommon CausesSolders in warRape victimsWitnessed sufferingExperienced the effects of violent acts or storms
31 Anxiety Disorders Anxiety Types Post-Traumatic Stress DisorderWorld Trade Center
32 Anxiety Disorders Anxiety Types Post-Traumatic Stress DisorderSurvivor GuiltGuilt experienced by survivors of a traumatic event.
33 Anxiety Disorders Anxiety Types Post-Traumatic Stress DisorderSymptomsMay appear immediately or be repressed for years.Flashbacks: reliving or acting out the traumatic event.Social WithdrawalLow self-esteem
34 Anxiety Disorders Anxiety Types Post-Traumatic Stress DisorderSymptoms (continued)Changes in relationships & difficulty forming new relationshipsIrritability and outbursts of anger with seemingly no obvious reasonDepressionChemical dependency: self-medicating
35 Anxiety Disorders Anxiety Types Post-Traumatic Stress DisorderNursing InterventionsCommunication & listening skillsDevelop a working rapportFirst step is important: encourage the patient to express thoughts & feelings about the traumatic eventHelp to identify the sourceValidate the patient’s feelings
36 Anxiety Disorders Medical Treatment PsychopharmacologyAntianxiety MedicationsBenzodiazepinesStrong potential for dependencyAntidepressantsSelective serotonin reuptake inhibitorsMonoamine oxidase inhibitors
37 Anxiety Disorders Antianxiety/Anxiolytic Medications Uses: Treatment of anxiety, stress, mild depression, ETOH withdrawal, muscle relaxationAction: Depress activities of the cerebral cortex (CNS Depressant)Benzodiazepines: largest sub-category of anxiolytics
39 Anxiety Disorders Benzodiazepines: Side effects & Precautions:Fatigue, drowsiness, postural hypotension & ataxiaPotential for physical & psychological dependenceConfusion in the elderlySleep pattern disturbancePotentiates ETOH and other narcotics
41 Anxiety Disorders Alternative Interventions BiofeedbackForm of behavior modificationPromotes relaxation
42 Anxiety Disorders Alternative Interventions HypnosisIs a licensed professionNeeds to be done routinely to be effective
43 Anxiety Disorders Alternative Interventions AromatherapyEssential oils: aid in relaxation
44 Anxiety Disorders Alternative Interventions Teaching deep breathing and other relaxation techniques provides an avenue for individuals with an opportunity to manage their anxietyindependently
45 Anxiety Disorders Nursing Interventions Maintain a calm milieuMinimizing stimuli helps the individual to focus and find their center.II. Encourage activities:should be of interest, enjoyable, and have meaning to the individual. Should not cause stress. Provide diversion; individual will think about something else.
46 Anxiety Disorders Nursing Interventions III: Maintain open communication:Encourage individual to verbalize feelings and thoughts. Show respect and encourage reflection to facilitate understanding themselves. Individuals need to feel that they have value.Observe affect & body language:reveal more about thoughts, esteem, attitudes, & feelings.
47 Anxiety Disorders Nursing Interventions Observe for suicidal thoughts:risk of suicide results from feelings of decreased self-worth and low self-esteem. Any statements made in relation to suicide need to be reported. Ask if they have a plan.Document changes in behavior:i.e.: they ways in which the individual responds to the nurse, to other people, to treatments, or in interactions.
48 Anxiety Disorders Concluding Statements Trust & communication techniques are important skills for the nurse.Interventions that facilitate a calm milieu are also important.Therapies and psychopharmacology should be individualized to the individual.
49 Anxiety Disorders Closure Table 11-2 (p. 194): Review common anxiety disordersTest Questions (p )What is a therapeutic Milieu? (p. 126: lets read together)