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Anxiety and Anxiety Disorders

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Rebecca Sposato MS, RN A collection unpleasant emotions stemming from a real or perceived threat/stressor Often instinctual, necessary for survival and social order ... – PowerPoint PPT presentation

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Title: Anxiety and Anxiety Disorders


1
Anxiety and Anxiety Disorders
  • Rebecca Sposato MS, RN

2
Anxiety
  • A collection unpleasant emotions stemming from a
    real or perceived threat/stressor
  • Often instinctual, necessary for survival and
    social order
  • Increases when one is unable to deal with threat
  • May present as fear, dread, nervousness,
    uneasiness or apprehension
  • May be the primary syndrome or present as a
    symptom of another disorder
  • Many behaviors emerge to counteract anxiety
  • Comorbid w/ depression, substance abuse etc.

3
Theories
  • Biological genetic and neuro-chemical
    abnormalities
  • Psychodynamic Internal and interpersonal
    conflict
  • Behavioral learned response to a stressor
  • Cognitive distorted and negative thinking

4
Anxiety Diagram
Effective Medication
Ineffective Mediation
Reduced stressor Decreased anxiety
Stressor remains present Extreme coping
behaviors Increased Anxiety
5
Levels of Anxiety
  • Mild Adaptive heightened awareness to everyday
    living
  • Greater focus and process additional sensory data
  • Slight physiological arousal
  • Moderate No longer normal
  • impaired perceiving and processing sensory data
  • Impaired reasoning and problem-solving
  • Measurable physiological arousal

6
Levels of Anxiety
  • Severe Anxiety dominates experience
  • Distorted perceiving and processing sensory data
  • Impaired memory, reasoning, problem-solving
  • Marked physiological changes
  • Panic Terror dominates experience
  • Disorganized perceiving and processing sensory
    data
  • Unable to purposefully interact with other
    persons or environment
  • Out of control physical behavior and movements
  • Exaggerated physiological changes

7
Panic Attacks
  • Acute episode of marked anxiety and physiological
    changes
  • Exaggerated for perceived threat
  • Can be confused with heart attack
  • Expected (cued) response to known trigger
  • Unexpected (uncued) no known association
  • DSM-IV Not a stand-alone disease, no numeric
    code,
  • Must of 4 of the following tachycardia,
    diaphoresis, tremors, dyspnea, angina, nausea,
    de-realization, dizzy, fear of losing control,
    fear of dying, paresthesia, chills/hot flashes

8
Panic Disorders
  • Recurrent panic episodes with persistent concern
    lasting over 1 month and avoiding behaviors
  • 1-2 one year prevalence in population
  • Variable onset and duration, typical onset
    between adolescence and age 30.
  • Chronic course w/ wax-wane pattern
  • Often comorbid w/ agoraphobia

9
Phobia
  • Excessive fear, with a marked physiological
    response, to a specific thing or situation
  • Predisposing event
  • Acute onset
  • 6 lifetime prevalence in population
  • Often have childhood onset,
  • 21 female to male
  • Subtype categories animal, environment,
    blood/injury, situation

10
Social Anxiety Disorder (SAD)
  • Social phobia exaggerated concern over being
    embarrassed, ridiculed or judged in the presence
    of others
  • Causes physical symptoms of anxiety
  • Deters normal daily, social and occupational
    functioning
  • May be general or specific to public performances
    or social gatherings (parties)
  • Can be acute or chronic

11
General Anxiety Disorder
  • Persistent symptoms of anxiety not attached to
    specific triggers, lasting over 6 months
  • Focus of worry is out of proportion to source
  • Person may not insight into source of anxiety
  • 5 lifetime prevalence, slightly more female
  • DSM-IV a) excessive concern, b) difficult to
    control, c) 3 physical symptoms, d) not due to
    another Axis 1 condition, e) distress impairs
    functioning, f) the physical symptoms are not due
    to another condition

12
Obsessive Compulsive Disorder
  • OCD recurrent and time-consuming, often
    ritualized, behaviors causing significant
    impairment in daily function
  • Often an exaggerated natural behavior (grooming,
    nesting, hoarding for winter)
  • Often ego-dystonic, person may or may not have
    self insight into abnormality
  • 2 lifetime prevalence
  • Obsession persistent and anxiety producing
    ideas, impulses and images that something is
    wrong
  • Compulsion the action extending from the
    obsession, to temporarily fix the anxiety

13
Acute Stress Disorder Post Traumatic Stress
Disorder
  • A normal response to an abnormal event
  • Physiological arousal or emotionally numb,
    dissociation, amnesia or flashbacks, aversion or
    obsession with trigger,
  • Triggered by an extreme life stressor/threat-
  • A recipient or witness to violence, unnatural
    death, catastrophe perceived as threat to self
    and life
  • Acute- Within one month of the event
  • PTSD- Symptoms present 3 months after event, may
    last years
  • 8 lifetime prevalence

14
Interventions
  • Pharmacological benzodiazepines, Buspirone,
    SSRI
  • Milieu Therapy- supportive environment
  • Therapy psych, REBT, CBT, DBT, relaxation
    training,
  • Modeling- person watches anothers normal reation
  • Systematic Desensitization- repeated increasing
    exposure to trigger to grow tolerance
  • Flooding- excessive exposure to trigger to
    extinguish fear
  • Not as popular as desensitization

15
Nursing Care
  • Symptom management and control
  • Promote and support adaptation and coping
  • Promote and support daily function
  • Health teaching
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