Mental Health Nursing: Anxiety Disorders Stress Produces Anxiety

Anxiety Disorders Objectives At the completion of this unit you will be able to: Explain anxiety and five specific anxiety disorders Identify behavioral and physical manifestations of anxiety disorders Describe nursing care and treatment modalities for anxiety disorders

Anxiety Disorders Stress and anxiety can be associated with both positive and negative situations

Anxiety Disorders Eustress: stress associated with positive experiences. Stressor: any person or situation that produces anxiety. What is stressful to one person might be relaxing to another.

Anxiety Disorders Anxiety is: A feeling of uneasiness or apprehension A response to extreme or prolonged periods of stress An uncomfortable feeling of dread

Anxiety may be influenced by one’s culture: Anxiety Disorders Anxiety may be influenced by one’s culture: Some believe that personal problems should be kept to themselves Others believe it is therapeutic to acknowledge and discuss stress Machoism

Anxiety Disorders Free-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

Anxiety Disorders In Children & Teenagers Stress & Anxiety Indicators: Withdrawal from friends and usual activities Changes in eating habits Changes in sleeping patterns Decline in school performance

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.

Anxiety Disorders Freud’s Psychoanalytic Theory Unconscious forces act to determine personality & behavior Id: primitive drives, pleasure principle; i.e.: hunger, sex Ego: Rational & reasonable; buffer between the outside world & the id Superego: Conscious distinctions between right & wrong.

Anxiety Disorders Freud’s Psychoanalytic Theory Anxiety is caused by conflict between the id and the superego.

Anxiety Disorders Sympathetic Nervous System Responses Initiates the “fight or flight response” Epinephrine & norepinephrine are released. ↑ BP, ↑pulse, pupil dilation

Anxiety Disorders Effects of chronic or uncompensated stress Review Table 11-1 (p. 188)

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.

Anxiety Disorders Suppressed anger also has the same negative effects on general health. Chronic anger is frequently associated with chronic headaches.

Anxiety Disorders Anxiety Types Generalized Anxiety Disorder Excessive worry or stress that is related to 2 or > things & lasts > 6 months. Must show 6 or > symptoms of anxiety

Anxiety Disorders Anxiety Types Generalized Anxiety Disorder Symptoms: Nausea, dry mouth, muscle aches, restlessness, shakes, fatigue, polyuria, chills, hot flashes, sleep disturbances, dry mouth, nausea, vomiting, palpitations, difficulty swallowing

Anxiety Disorders Anxiety Types Generalized Anxiety Disorder Nursing Actions: Calm milieu, open communication, explore causes & effects of anxiety, encourage enjoyed activities, suicide precautions, document behaviors.

Anxiety Disorders Anxiety Types Panic Disorder Extreme fear that cannot be controlled. Panic Attack Agoraphobia Diagnosis requires 4 out of 12 DSM symptoms.

Anxiety Disorders Anxiety Types Common Symptoms of Panic Disorder Fear, dissociation, nausea, diaphoresis, chest pain, shaking, Increased pulse, unsteadiness Interventions: are the same as those for anxiety disorder

Anxiety Disorders Anxiety Types Common Symptoms of Panic Disorder

Anxiety Disorders Anxiety Types Phobia Most common anxiety disorder Irrational fear Individuals are aware that it is an irrational fear Estimated that 700 different things cause phobias

Anxiety Disorders Anxiety Types Phobia Arachnophobia Ophidiophobia

Anxiety Disorders Anxiety Types Phobia Subcategories Agoraphobia: fear of being in open spaces. Social phobia: fear humiliation in social situations Simple phobia: fear of a specific thing (i.e.: claustrophobia, hematophobia, acrophobia)

Anxiety Disorders Anxiety Types Obsessive-Compulsive Disorder (OCD)

Anxiety Disorders Anxiety Types Obsessive-Compulsive Disorder (OCD): 2 Parts Obsession: repetitive thought, urge, or emotion Compulsion: repetitive act that may appear purposeful Behaviors are ritualistic and occur to reduce anxiety Unable to stop the thought or action.

Anxiety Disorders Anxiety Types Obsessive-Compulsive Disorder The thought or action is a substitute for the source of anxiety. Individuals with this disorder tend to be rule-oriented and perfectionistic

Anxiety Disorders Anxiety Types Obsessive-Compulsive Disorder If the individual is prevented from performing the act, the anxiety converts into somatic symptoms.

Anxiety Disorders Anxiety Types Post-Traumatic Stress Disorder Develops in response to a emotional or physical trauma that could not be controlled.

Anxiety Disorders Anxiety Types Post-Traumatic Stress Disorder Common Causes Solders in war Rape victims Witnessed suffering Experienced the effects of violent acts or storms

Anxiety Disorders Anxiety Types Post-Traumatic Stress Disorder World Trade Center

Anxiety Disorders Anxiety Types Post-Traumatic Stress Disorder Survivor Guilt Guilt experienced by survivors of a traumatic event.

Anxiety Disorders Anxiety Types Post-Traumatic Stress Disorder Symptoms May appear immediately or be repressed for years. Flashbacks: reliving or acting out the traumatic event. Social Withdrawal Low self-esteem

Anxiety Disorders Anxiety Types Post-Traumatic Stress Disorder Symptoms (continued) Changes in relationships & difficulty forming new relationships Irritability and outbursts of anger with seemingly no obvious reason Depression Chemical dependency: self-medicating

Anxiety Disorders Anxiety Types Post-Traumatic Stress Disorder Nursing Interventions Communication & listening skills Develop a working rapport First step is important: encourage the patient to express thoughts & feelings about the traumatic event Help to identify the source Validate the patient’s feelings

Anxiety Disorders Medical Treatment Psychopharmacology Antianxiety Medications Benzodiazepines Strong potential for dependency Antidepressants Selective serotonin reuptake inhibitors Monoamine oxidase inhibitors

Anxiety Disorders Antianxiety/Anxiolytic Medications Uses: Treatment of anxiety, stress, mild depression, ETOH withdrawal, muscle relaxation Action: Depress activities of the cerebral cortex (CNS Depressant) Benzodiazepines: largest sub-category of anxiolytics

Anxiety Disorders Anixolytics Benzodiazepines: 1) Chlordiazepoxide (Librium) 2) Lorazepam (Ativan) 3) Diazepam (Valium) 4) Alprazolam (Xanax)

Anxiety Disorders Benzodiazepines: Side effects & Precautions: Fatigue, drowsiness, postural hypotension & ataxia Potential for physical & psychological dependence Confusion in the elderly Sleep pattern disturbance Potentiates ETOH and other narcotics

Anxiety Disorders Medical Treatment Psychotherapy Individual treatment Group therapy Systematic desensitization Counseling: concentrate esteem needs & reality

Anxiety Disorders Alternative Interventions Biofeedback Form of behavior modification Promotes relaxation

Anxiety Disorders Alternative Interventions Hypnosis Is a licensed profession Needs to be done routinely to be effective

Anxiety Disorders Alternative Interventions Aromatherapy Essential oils: aid in relaxation

Anxiety Disorders Alternative Interventions Teaching deep breathing and other relaxation techniques provides an avenue for individuals with an opportunity to manage their anxiety independently

Anxiety Disorders Nursing Interventions Maintain a calm milieu Minimizing 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.

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.

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.

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.

Anxiety Disorders Closure Table 11-2 (p. 194): Review common anxiety disorders Test Questions (p. 197-199) What is a therapeutic Milieu? (p. 126: lets read together)