anxiety disorders.pptx

8/18/2019 Anxiety disorders.pptx

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Anxiety disorders


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Anxiety disorders

• Most common anxiety disorders inthe US

• 19.1 million individuals in the US

• 13.3% of US population betweenaes 1!"#$ yrs. ld

•

&o occur with depressive disorders'eatin or substance abuse (inordinate morbidity 'use of carefacilities ( functional impairment


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Anxiety disorders• A)*+,- +S A /A0U, ,,2+)0 of dread or apprehension it is a

response to external or internal stimuli that can have behavioral'emotional' conitive' and physical symptoms.

• Anxiety is distinuished from fear, which is feelin afraid orthreatened by a clearly identi4able external stimulus thatrepresents daner to the person.

• Anxiety is unavoidable in life and can serve many positive functionssuch as motivatin the person to ta5e action to solve a problem orto resolve a crisis.

• +t is considered normal when it is appropriate to the situation anddissipates when the situation has been resolved.

•

A 4ht or 6iht decision is made by the person in an attempt toovercome con6ict 'stress 'trauma or frustration

• 7acob 8a &osta described a chronic cardiac syndrome that includedmany psycholoical ( somatic symptoms exhibited by soldiers

• Simund reud 4rst introduced the concept of anxiety in the 19 (referred to as a daner sinal that a person exhibits in response tothe perception of physical pain or daner.


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Several terms are used to describe

anxiety

1. Sinal Anxiety :response to anticipated event

;hen a mother exhibits tachycardia ( di


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,tioloy of Anxiety1.0enetic theory

• Some enetic component contributes to the development of anxiety

disorders Sadoc5 ( Sadoc5 =3 B• 0ene causes a 3"$% diCerence in the deree of anxiety or tension

the sub@ects experienced

• &hromosomes 9 maybe lin5ed to the development of panicdisorderDchromosomes 13? maybe lin5ed to a potential subtype ofpanic disorder called panic syndrome

• &hromosomes1 for panic disorder &hromosomes 3 for aorophobia

=. Eioloic -heory

Studies lin5ed between anxiety ( the followin D&atecholamines'neurotransmitters such as serotonin 'y amino butyric acid 0AEAB(cholecystenin ( autonomic reactivity 'neuroendocrine measures

)eurotransmitters studies have revealed that serotonin plays a role incausin anxiety

Studies shown the corrrelation between anxiety ( heart disease.Fawachi 'Sparrow '/o5onas ( ;eiss 199$ Bther is a stron

bassociation between symptoms of anxiety ( presence of coronaryartery disease.


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,tioloy of Anxiety$. Gsychoanalytic -hery :

Unresolved 'unconscious con6icts between impulses fro aressive orlibidinal rati4cation ( the eo Hs reconition of the external damae (could result from rati4cation

Unconscious con6icts such as fear of losin a parent Hs love as a result infeelin of discomfort ( anxiety in childhood 'adolescent orearly

childhood Ioein'1999B#. &onitive behavior theory developed by Aaron Eec5 :anxiety is a

learned or conditioned response to a stressful event or percieveddaner

"conceptuali


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DSM-IV-TR DIAGNOSTIC CRITERIA:Symptoms of Anxiety Disorders

• Panic disorder is characterized by recurrent,

unexpected panic attac5s that cause constant concern.

• Panic attack is the sudden

onset of intense apprehension' fearfulness' or terrorassociated with feelins of impendin doom

• Specic phobia is characterized by signicant

• anxiety provo5ed by a speci4c feared ob@ect

or situation' which often leads to avoidance behavior

•

Social phobia is characterized by anxietyprovoked

• by certain types of social or performance situations'which often leads to avoidance behavior


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DSM-IV-TR DIAGNOSTIC CRITERIA:Symptoms of Anxiety Disorders

• Obsessive–compulsive disorder involves obsessions

• thouhts' impulses' or imaesB that cause mar5ed anxiety andLorcompulsion repetitive behaviors or mental actsB that attempt toneutrali


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SMG-MS• Avoids bein outside alone or at home alone avoids travelin in

vehicles• impaired ability to wor5

• diKculty meetin daily responsibilities

e..' rocery shoppin or oin to appointmentsB

Fnows response is extreme

• discrete episode of panic lastin 1# to 3 minutes with four or more• of the followinD palpitations' sweatin' tremblin or sha5in'

• shortness of breath' cho5in or smotherin sensation' chest pain or

• discomfort' nausea' dereali


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SMG-MS

• ear of embarrassment or inability toperform avoidance or dreadedendurance of behavior or situation

• reconition that response is irrational orexcessive

• belief that others are @udin him or herneatively

• sini4cant distress or impairment inrelationships' wor5' or social lifeanxiety can be severe or panic level


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SMG-MS

• ,xposure to traumatic event causin intensefear' helplessness' or horror

• mar5ed anxiety symptoms or increased arousalsini4cant distress or impaired functioninpersistent re"experiencin of the event

• three of the followin symptomsD sense ofemotional numbin or detachment' feelinda


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Psychodynamic "heories• Intrapsycic ! "sycoana#ytic Teories

• reud 193JB saw a person>s innate anxiety as the stimulus forbehavior.

• e described defense mechanisms as the human>s attempt tocontrol awareness of and to reduce anxiety

• #efense mechanisms are cognitive distortions that aperson uses unconsciously to maintain a sense of bein incontrol of a situation' to lessen discomfort' and to deal withstress. Eecause defense mechanisms arise from theunconscious' the person is unaware of usin them.

• Some people overuse defense mechanisms' which stops themfrom learnin a variety of appropriate methods to resolveanxiety"producin situations.

• -he dependence on one or two defense mechanisms also caninhibit emotional rowth' lead to poor problem"solvin s5ills'and create

• diKculty with relationships


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Psychodynamic "heories

• Interpersona# Teory • arry Stac5 Sullivan 19#=B viewed anxiety as

bein enerated from problems ininterpersonal relationships.

• &areivers can communicate anxiety toinfants or children throuh inade?uatenurturin' aitation when holdin or handlinthe child' and distorted messaes

• ildeard Geplau 19#=B understood thathumans exist in interpersonal and physioloicrealms' the nurse can better help the client to

achieve health by attendin to both areas.


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Geplau>s four levels of anxiety

• and developed nursin interventionsand interpersonal communicationtechni?ues based on Sullivan>sinterpersonal view of anxiety.

• )urses today use Geplau>sinterpersonal

therapeutic communication techni?ues

to develop and to nurture the nurse:client relationship and to apply thenursin process.


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Psychodynamic "heories• $ea%iora# Teory

• Eehavioral theorists view anxiety asbein learned throuh experiences.

• Geople can chane or NunlearnO

behaviors throuh new experiences.• Eehaviorists believe that people can

modify maladaptive behaviors

without ainin insiht into theircauses


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&ultural &onsideration• Geople from Asian cultures often express anxiety

throuh somatic symptoms such as headaches'

bac5aches' fatiue' di


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Anxiety as a response to stress

• Stress is the wear and tear that life causes on the bodySelye' 19#JB

• ans Selye 19#J' 19P$B' an endocrinoloist' identi4ed thephysioloic aspects of stress' which he labeled the generaladaptation syndrome

• e determined three staes of reaction to stressD

1.Alarm reaction stage, stress stimulates the body to send

messaes from the hypothalamus to the lands such as theadrenal land' to send out adrenaline and norepinephrine forfuelB and orans such as the liver' to reconvert lycoen storesto lucose for foodB to prepare for potential defense needs.

2.Resistance stage, the digestive system reduces function to shunt

blood to areas needed for defense.

-he luns ta5e in more air' and the heart beats faster and harder soit can circulate this hihly oxyenated and hihly nourished bloodto the muscles to defend the body by 4ht' 6iht' or free


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Anxiety as a response toStress


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Ghysioloic response

• G


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$evels of !nxiety%&'ild anxiety is a sensation that somethin is diCerent and warrants

special attention.

Sensory stimulation increases and helps theperson focus attention to learn'

solve problems' thin5' act' feel' and protect himself or herself

•. or example' it helps students to focus on studyin for an examination.

•. 'oderate anxiety is the disturbin feelin that somethin

•. is de4nitely wron the person becomes nervous or aitated.

•. +n moderate anxiety' the person can still process information' solve

problems' and learn new thins with assistance from•. or example' the nurse miht be ivin preoperative instructions to a

client who is anxious about the upcomin surical procedure. As the nurseis teachin' the client>s attention wanders but the nurse can

•. reain the client>s attention and direct him or her bac5 to the tas5 athand.

•. Severe anxiety and panic' more primitive survival s5ills ta5e over'defensive responses ensue' and conitive s5ills decrease sini4cantly.

•. A person with severe anxiety has trouble thin5in and reasonin.

•. Muscles tihten and vital sins increase.

•. Adrenaline sure reatly increases vital sins.

•. Gupils enlare to let in more liht' and the only conitive process focuseson the person>s defense.


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!nxiety $evel Psychological(esponses

Physiologic(esponses

Mild ;ide perceptual 4eldSharpened senses

+ncreased motivation,Cective problem"solvin+ncreased learninability+rritability

Iestlessnessidetin

0+ Nbutter6iesO8iKculty sleepinypersensitivity tonoise

Moderate Gerceptual 4eldnarrowed toimmediate tas5Selectively attentive&annot connectthouhts or eventsindependently+ncreased use ofautomatisms

Muscle tension8iaphoresisGoundin pulseeadache8ry mouthih voice pitchaster rate of speech0+ upsetre?uent urination


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!nxiety $evel Psychological(esponses


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-reatment

1.Medication and therapy. -his combination

produces better,. Antidepressants

=.&onitive:behavioral therapy is usedsuccessfully to treat anxiety disorders

• Positive reframing means turnin neativemessaes into positive messaes.

• -he therapist teaches the person to createpositive messaes for use durin panic episodes.

• or example' instead of thin5in'• NMy heart is poundin. + thin5 +>m oin to dieQO

the client thin5s' N+ can stand this. -his is @ustanxiety. +t will o away.O


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)ecatastrophizing

• involves the therapist>s use of ?uestions to more realisticallyappraise the situation.

• -he therapist may as5' N;hat is the worst thin that couldhappenR

• +s that li5elyR &ould you survive thatR +s that as bad as youimaineRO

• -he client uses thouht"stoppin and distraction

techni?ues to @olt himself or herself from focusin on neativethouhts

*& !ssertiveness training

helps the person ta5e more control over life situations. -echni?ueshelp the person neotiate interpersonal situations and foster self"

assurance.• -hey involve usin N+O statements to identify feelins and to

communicate concerns or needs to others.

• ,xamples include N+ feel anry when you turn your bac5 while +>m

tal5in'O

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