psycho pathology of anxiety

8/4/2019 Psycho Pathology of Anxiety

1/48

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


2/48

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


3/48

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


4/48

Systematic desensitization Implosive therapy

Agoraphobia Exposure therapy

Depersonalization Distraction

Flooding Interoceptiveconditioning

Phobia Panic attacks

Positive self-talk Thought Stopping

Key Terms


5/48

What is

Anxiety?


6/48

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


7/48

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


8/48

Anxiety is a normal alerting

response that is universal andintegral to human existence.

Some anxietys are necessary toenhance performance.

Overview


9/48

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


10/48

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


11/48

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


12/48

Stages of Anxiety

MILD

MODERAT

E

SEVERE

PANIC

(awe,uncanniness, terror,horror)


13/48

MILD

Normal Vital Signs

Pupils constricted

Feeling of comfort & safety

Person relaxed and calm


14/48

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


15/48

SEVERE

Fight/flight response

ANS is excessively stimulated

Vital signs increase Excessive sweating

Urinary urgency & frequency

Diarrhea

Dry mouth

Decreased appetite

Person feels threatened


16/48

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


17/48

Categories of

Anxiety Disorder(DSM-IV-TR)


18/48

ANXIETYDISORDER

S

ACUTESTRESS

DISORDER

GENERALIZED

ANXIETYDISORDER

OBSESSIVE

COMPULSIVEDISORDER

PHOBIAS

POST-TRAUMATIC

STRESSDISORDER

PANICDISORDER


19/48

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.


20/48

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


21/48

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.


22/48

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


23/48

Avoidance thoughts, feelings,

conversations

Repression

Grief

Difficulty concentrating

Intrusive thoughts

Enuresis in children

Intrusive dreams

Nightmares

Defining Characteristics-

PTSD


24/48

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


25/48

Phobias

Persistent fear of a specific object

or situation

Phobias are categorized as:

Social phobia (Social AnxietyDisorder)

Specific phobia


26/48

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


27/48

Ophidiophobia fear of snakes

Claustrophobia fear of closed

spaces

Hydrophobia fear of water

Zoophobia fear of animals

Common Phobias


28/48

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


29/48

Women are more affected than

men

Affects individuals at all ages

Overview


30/48

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


31/48

Causative Factors


32/48

Causative Factors

Genetics

Interpersonal

Neuro-physiological

Environmental

Behavioral


33/48

SYM

PTOMAT

OLOGY


34/48

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


35/48

Affective Symptoms

Fearful

Terrified

Apprehensive

Frightened

Scared

Jittery

Jumpy

Uneasy

Impatient


36/48

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


37/48

Inhibited

Flight

Avoidance

Speech dysfluency

Impaired coordination

Restlessness

Postural collapse

hyperventilation

Behavioral Symptoms


38/48

Treatment


39/48

Treatment

Pharmacotherapy

Behavior therapy Systematic desensitization

Flooding

PsychodramaThought stopping

Thought blocking


40/48

Treatment

Psychotherapy

Combination Therapy


41/48


42/48


43/48

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


44/48

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


45/48

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


46/48

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


47/48

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


48/48

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

psycho pathology of anxiety

Documents