Anxiety and Obsessive-Compulsive Related Disorders Chapter 15 Anxiety and Obsessive-Compulsive Related Disorders Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Anxiety 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.

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

Question 1 A parent is shopping with a 5-year-old child in a large, busy urban mall. The parent suddenly realizes the child is missing. Which level of anxiety would likely result? Mild Moderate Severe Panic Answer: D Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Case Study What behaviors might this parent be exhibiting that would indicate panic-level anxiety? Behaviors that may be manifested are: Pacing Running Shouting Screaming Also, physical behavior may become: Erratic Uncoordinated Impulsive Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Defenses Against Anxiety 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.

Clinical Picture Separation anxiety disorder Panic disorder Developmentally inappropriate levels of concern over being away from a significant other Panic disorder Panic attacks Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Clinical Picture (Cont.) Agoraphobia Excessive anxiety or fear about being in places or situations from which escape might be difficult or embarrassing Specific phobias Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Clinical Picture (Cont.) Social anxiety disorder Severe anxiety or fear provoked by exposure to a social or a performance situation that will be evaluated negatively by others Generalized anxiety disorder Excessive worry that lasts for months Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Clinical Picture (Cont.) Other anxiety disorders Substance-induced anxiety disorder Anxiety due to a medical condition Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Obsessive-Compulsive Disorders 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.

Obsessive-Compulsive Disorders (Cont.) 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.

Anxiety Disorders Epidemiology Comorbidity Etiology Biological Genetics Neurobiological Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

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

Application of the Nursing Process 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.

Application of the Nursing Process (Cont.) 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.

Case Study (Cont.) What would be some appropriate interventions for the parent whose child is missing at the mall and is experiencing panic level anxiety? Maintain a calm manner Remain with the parent Minimize environmental stimuli if possible Move to a quieter setting if possible and stay with the parent Use clear, simple statements and repetition Use a low-pitched voice; speak slowly Recognize the anxious person's distress Being willing to listen Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Implementation 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.

Advanced Practice Interventions 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.

Audience Response Questions What is your usual level of anxiety on the day of a nursing exam? Mild Moderate Severe Panic ANS: Answers will vary.   Discuss the benefits of mild anxiety. REF: 279-280 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Audience Response Questions The television character “Monk” appears to have which anxiety problem? Panic disorder Generalized anxiety disorder Posttraumatic stress disorder Obsessive-compulsive disorder ANS: D   Identify some of Monk’s behaviors, including straightening his umbrellas and using tissues. Help students differentiate between obsessions and compulsions. REF: 287-288 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.