Anxiety and Obsessive- Compulsive Related Disorders Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

 Describe the positive and negative effects of anxiety.  Recognize how anxiety disorders impair function  Understand the causes of anxiety disorders  Demonstrate the type of assessments and interventions needed for patients with anxiety disorders.  Understand the various pharmaceutical drugs used in the treatment of these disorders. Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 2

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 Agoraphobia  Anxiety  Body dysmorphic disorder  Hoarding disorder  Panic disorder  Separation anxiety disorder  Skin picking disorder  Social anxiety disorder  Hair pulling disorder Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 4

 Anxiety – Apprehension, uneasiness, uncertainty, or dread from real or perceived threat  Fear – Reaction to specific danger  Normal anxiety – Necessary for survival Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.5

 Mild anxiety  Moderate anxiety  Severe anxiety  Panic Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.6

7 FIG 15-1 Anxiety operationally defined.

 Separation Anxiety Disorder  Panic Disorders  Agoraphobia  Generalized Anxiety Disorder (GAD)  Social Anxiety Disorder (Social phobia) Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 8

 Defense mechanisms ◦ Automatic coping styles ◦ Protect people from anxiety ◦ Maintain self-image by blocking  Feelings  Conflicts  Memories ◦ Can be healthy or unhealthy Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.9

 Obsessions ◦ Thoughts, impulses, or images that persist and recur, so that they cannot be dismissed from the mind  Compulsions ◦ Ritualistic behaviors an individual feels driven to perform in an attempt to reduce anxiety Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.10

 Obsessive-compulsive disorder  Body dysmorphic disorder  Hoarding disorder  Hair pulling and skin picking disorders  Other compulsive disorders Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.11

 Epidemiology  Comorbidity  Etiology ◦ Biological  Genetics ◦ Neurobiological Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.12

 Psychodynamic theories ◦ Sigmund Freud ◦ Harry Stack Sullivan ◦ Behavior theories ◦ Cognitive theories  Cultural considerations Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.13

 Assessment ◦ General assessment of symptoms ◦ Self-assessment ◦ Assessment guidelines: anxiety and obsessive- compulsive disorders  Nursing diagnosis  Outcomes identification  Planning Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.14

 Implementation  Mild to moderate levels of anxiety  Severe to panic levels of anxiety  Counseling  Teamwork and safety  Promotion of self-care activities Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.15

 Pharmacological interventions ◦ Antidepressants ◦ Anti-anxiety drugs ◦ Other classes  Psychobiological interventions  Integrative therapy  Health teaching Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.16

 Cognitive therapy  Behavioral therapy  Relaxation training  Modeling  Systematic desensitization  Flooding  Response prevention  Thought stopping  Cognitive-behavioral therapy Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.17

Anxiety has an unknown or unrecognized source whereas fear is a reaction to a specific threat. Peplau operationally defined four levels of anxiety (mild, moderate, severe, and panic). The patient’s perceptual field, ability to learn, and physical and other characteristics are different at each level. Defenses against anxiety can be adaptive or maladaptive and in a hierarchy from healthy to intermediate to immature. Anxiety disorders are the most common psychiatric disorders in the United States and frequently co-occur with depression or substance abuse. Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 18

Another closely related set of disorders is obsessions, in which anxiety results in abnormal selective over-attention. Research has identified biological, psychological, and environmental factors in the etiology of anxiety and obsessive-compulsive disorders. Patients with anxiety and obsessive-compulsive disorders suffer from debilitating anxiety, panic attacks, irrational fears, excessive worrying, uncontrollable rituals, or severe reactions to stress. Embarrassment and shame often prevent people from seeking psychiatric help. Instead, they may go to primary care providers with multiple somatic complaints. Psychiatric treatment is effective for anxiety and obsessive-compulsive disorders. Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 19

 Basic-level nursing interventions include counseling, milieu therapy, promotion of self-care activities, psychobiological intervention, and health teaching.  Understanding the levels of anxiety will help in planning basic care, including how much direction your patient will need, what precautions should be taken to prevent harm, and how able your patient is to learn.  Advanced practice nursing interventions include behavioral and cognitive-behavioral therapies.  Quality improvement initiatives will help to measure severity of symptoms and to establish interventions that are evidence based rather than tradition based. Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 20