1. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 09Anxiety Disorders

2. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Anxiety Defined Vague, uneasy, emotional feeling normally experienced in response to perceived threat or danger

3. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Anxiety as a Symptom Free-floating anxiety Thoughts, feelings, behaviors Automatic relief behaviors Unrelieved anxiety over time leads to disorder

4. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Anxiety Disorders Uncontrolled, overwhelming anxiety Impaired functioning –Personal –Social –Work

5. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Panic Disorder Panic attack –Rapid heartbeat –Increased perspiration –Chilling/numbness –Nausea –Feeling of suffocation –Chest pain/fear of heart attack –Fear of being out of control

6. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Agoraphobia Avoid places or situations that trigger panic attack Restrict activities to avoid recurrence of symptoms Often homebound or restricted to home environment Unemployment or school dropout common

7. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Phobias Specific phobia –Excessive, persistent fear of object or situation –Anxiety with contact Social phobia, also called social anxiety disorder –Excessive fear of social situations in which embarrassment is possible –Discomfort being watched or at risk of being judged by others –Anticipatory anxiety

8. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Obsessive-Compulsive Disorder Obsession –Recurrent, persistent, unwanted thoughts or images causing intense anxiety Compulsion –Repetitive behavior engaged in to reduce high level of anxiety

9. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Posttraumatic Stress Disorder (PTSD) Response to a situation involving actual death or threat of injury Intense feeling or fear following an event Mental reruns of an event Emotional numbness Avoidance of people and places associated with an event Insomnia, inability to concentrate, impaired social or work functioning

10. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Generalized Anxiety Disorder Chronic worry/anxiety Negative self-talk Fatigue Difficulty falling/staying asleep Tension Anticipating the “worst” Irritability, headaches, tremors Physical symptoms

11. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Treatment of Anxiety Disorders Focus is to reduce the anxiety level Medications –Antianxiety drugs –Greatest success in combination with psychotherapy Psychotherapy –Cognitive-behavioral therapy –Anxiety support groups

12. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process Applied Take steps to lower the anxiety level; encourage the client’s trust Assessment –Current feelings –What happened immediately prior to the onset of symptoms –Client’s perspective on the situation –Thought processes –Communication ability, thought blocking –Affect, expression, nonverbal behaviors

13. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process Applied (Cont.) Nursing diagnoses Expected outcomes

14. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process Applied (Cont.) Interventions –Consider how your own anxiety may affect nursing care –Should be timely, client centered, and realistic (small steps) –Help the client try more adaptive coping strategies

15. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process Applied (Cont.) Evaluation –Client’s ability to recognize and deal with the anxiety-producing factors

16. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false. The obsession aspect of obsessive-compulsive disorder refers to repetitive behavior.

17. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False Rationale: Obsession refers to recurrent, persistent, unwanted thoughts or images that cause intense anxiety.

18. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which disorder is characterized by mental reruns of an event, emotional numbness, and/or avoidance of people and places associated with the event? A. Agoraphobia B. Obsessive-compulsive disorder C. Generalized anxiety disorder D. Posttraumatic stress disorder E. Panic disorder

19. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer D. Posttraumatic stress disorder Rationale: A person with posttraumatic stress disorder experiences mental reruns, numbness, and avoidance of people and places associated with an event; the disorder usually occurs following a situation that involves a death or a threat of a severe injury.

20. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false. A person suffering from agoraphobia is often homebound.

21. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True Rationale: A person with agoraphobia often chooses to remain in familiar home surroundings.