psycho pathology of anxiety
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Mr. Terry CampbellMr. Terry Campbell
The University of Technology, JamaicaThe University of Technology, Jamaica
College of Health SciencesCollege of Health SciencesSchool of Allied Health & NursingSchool of Allied Health & Nursing
October 26, 2010October 26, 2010
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At the end of this lecture-discussion,students will be able to:
Conceptualize a definition for anxietyand anxiety disorders.
Describe the differences between
anxiety and fear.
Differentiate normal anxiety responses
from those suggestive of an anxietydisorder.
OBJECTIVES
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Identify specific types of anxiety
disorders.
Discuss the epidemiology, etiology,symptomatology, and treatment ofselected anxiety disorders.
Utilize the nursing process in developinga plan of care for persons with anxietydisorders.
OBJECTIVES
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Systematic desensitization Implosive therapy
Agoraphobia Exposure therapy
Depersonalization Distraction
Flooding Interoceptiveconditioning
Phobia Panic attacks
Positive self-talk Thought Stopping
Key Terms
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What is
Anxiety?
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Anxiety is an uncomfortable feeling of
apprehension or dread occurring inresponse to stimuli (internal orexternal) resulting in cognitive,physical, emotional and behavioral
symptoms.
Boyd, 2008
Overview
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Anxiety is a state wherein an
individual feels a strong sense ofdread frequently accompanied byphysical symptoms, withouthaving a specific source or reasonfor the emotions
Frisch & Frisch, 2006
Overview
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Anxiety is a normal alerting
response that is universal andintegral to human existence.
Some anxietys are necessary toenhance performance.
Overview
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Anxiety disorders are a group of
disorders characterized by the
presence of anxiety symptoms,avoidance reaction, and possibleinterference in functioning.
Patterns of symptoms and behavior inwhich anxiety is either the primary
disturbance or the secondaryr l m.
Overview
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Fear is a state wherein an
individual feels a strong sense ofdread with autonomic systemresponses that are focused on aspecific object or event.
Frisch & Frisch, 2006
Overview
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Both fear and anxiety are common
experiences, and it seems likelythat no matter how distressingthe experience is- appropriate fearis necessary for individual and
species survival.
Overview
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Stages of Anxiety
MILD
MODERAT
E
SEVERE
PANIC
(awe,uncanniness, terror,horror)
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MILD
Normal Vital Signs
Pupils constricted
Feeling of comfort & safety
Person relaxed and calm
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MODERATE
Vital signs normal or slightly elevated
May be tense or elated
Person is alert
Optimum state for problem solving
Feeling of readiness
Engage in competitive activities
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SEVERE
Fight/flight response
ANS is excessively stimulated
Vital signs increase Excessive sweating
Urinary urgency & frequency
Diarrhea
Dry mouth
Decreased appetite
Person feels threatened
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PANIC(awe,
uncannines
s, terror,horror)
As in severe but they escalate and person maybecome pale
Blood pressure reduced Person feels helpless
Person feels out of control
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Categories of
Anxiety Disorder(DSM-IV-TR)
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ANXIETYDISORDER
S
ACUTESTRESS
DISORDER
GENERALIZED
ANXIETYDISORDER
OBSESSIVE
COMPULSIVEDISORDER
PHOBIAS
POST-TRAUMATIC
STRESSDISORDER
PANICDISORDER
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Generalized Anxiety
DisorderPersistent chronic, excessive,
unrealistic worry or anxiety over twoor more situations in an individualslife.
Symptoms (3 or > of the following):
Restlessness, easy fatigue, difficultyconcentrating, muscle tension and
sleep disturbance.
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Obsessive Compulsive
DisorderRecurrent thought and behavior that are
extremely distressing and interferes with
normal life pattern.
Obsession - (see handout)
Compulsion (see handout)
The affected often knows that the feelingsare irrational
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Post-Traumatic Stress
DisorderDevelopment of anxiety symptoms
following an excessively distressinglife event that is experienced withterror, fear or helplessness forexample post-disaster, war,
witnessing a murder.
Refer to Page 2 of handout for otherdefining characteristics.
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Response to the exposure must
have been one of fear or
helplessness and the event needsto be persistently re-experiencedthrough recurrent recollections,
dreams, or hallucinatory-likeflashbacks.
Duration > 1 month and causes
PTSD
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Avoidance thoughts, feelings,
conversations
Repression
Grief
Difficulty concentrating
Intrusive thoughts
Enuresis in children
Intrusive dreams
Nightmares
Defining Characteristics-
PTSD
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Inability to recall an important
aspect of the trauma.Feeling of detachment or
estrangement from others.
Unable to have loving feelingsSense of a foreshortened future.
Defining Characteristics-
PTSD
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Phobias
Persistent fear of a specific object
or situation
Phobias are categorized as:
Social phobia (Social AnxietyDisorder)
Specific phobia
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Common Phobias
Acrophobia fear of heights
Brontophobia fear of thunder
Nyctophobia fear of night or dark
places
Microphobia fear of germs
Arachnophobia fear of spiders
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Ophidiophobia fear of snakes
Claustrophobia fear of closed
spaces
Hydrophobia fear of water
Zoophobia fear of animals
Common Phobias
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Most common of the psychiatric
illnesses
Anxiety is a nearly universal experience
Symptoms can be found in healthyadults given particular circumstances.
More than 19 million people are
Overview
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Women are more affected than
men
Affects individuals at all ages
Overview
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High Risk Groups: Smokers
< 45 years
Separated or divorced
Survivors of abuse
Low SES
(Isensee, Wittchen, Stein, Hofler, & Lieb, 2003; Sheikh, Leskin, & Klein,2002 as cited in Boyd, 2008)
Overview
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Causative Factors
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Causative Factors
Genetics
Interpersonal
Neuro-physiological
Environmental
Behavioral
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SYM
PTOMAT
OLOGY
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Physical Symptoms
SOB Spasm
Dizziness Unsteadiness
Choking sensation Wobbly Legs
Palpitations Flushed face
Trembling Itching
Fidgeting Loss of Appetite
Pacing Abdominal Discomfort
Sweating Dilated pupils
Dry mouth Urinary frequency
Nausea Elevated blood pressure
Diarrhea
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Affective Symptoms
Fearful
Terrified
Apprehensive
Frightened
Scared
Jittery
Jumpy
Uneasy
Impatient
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Confusion
Difficulty recalling
Difficulty focusing & concentrating
Distractibility
Blocking
Fear of: losing control, not being able to cope,physical injury, death, mental disorder.
hypervigilance
Cognitive Symptoms
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Inhibited
Flight
Avoidance
Speech dysfluency
Impaired coordination
Restlessness
Postural collapse
hyperventilation
Behavioral Symptoms
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Treatment
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Treatment
Pharmacotherapy
Behavior therapy Systematic desensitization
Flooding
PsychodramaThought stopping
Thought blocking
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Treatment
Psychotherapy
Combination Therapy
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Anxiety r/t a subjective sense of
uneasiness and tension.
Fear r/t a specific object, for example, aphobis fear of heights.
Social isolation r/t restriction of travelaway from home or places felt to besafe
Nursing Diagnosis
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Powerlessness r/t feeling out of control
of ones own thoughts and behaviors.
Post-trauma syndrome r/t anxiety feltfollowing a significant, life threateningevent.
Dysfunctional grieving r/t inability tocope with grief following significant
losses associated with a significant life
Nursing Diagnosis
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At the end of therapy, patient will:
Express or verbalize a decrease inanxiety levels
Effectively employ learned relaxation
techniques
Be able to describe early warning signs
of anxiety
Patients Goals
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Assess the level of anxiety to provide
baseline data
Initiate supportive therapy to build trust
Teach skills of cognitive restructuring toassist client in controlling anxiousfeelings.
Interventions/Rational
es
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Provide information on medications to
aid compliance.
Encourage expression of thoughts andfeelings to set the context for
acceptance.
Teach problem solving techniques toassist the client find reasonablesolutions.
Interventions/Rationale
s
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American Psychiatric Association. (2000). Diagnostic &
Statistical Manual of Mental Disorders, 4th(Ed.).Text Revision. Washington, DC, American
Psychiatric Association.
Boyd, M. (2008). Psychiatric Nursing:Contemporary Practice 4th (Ed.). Lippincott Williams& Wilkins: USA.
Frisch, N., C., & Frisch, L., E. (2005). PsychiatricMental Health Nursing 3rd (Ed.).Thompson DelmarLearning: New York.
References
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