Download to read offline
Psychiatric Nursing Anxiety Disorders.ppt
- 1. 18 January 2013 1.AnxietyDisorders a. Generalized Anxiety Disorder (GAD) b. Panic Disorder c. Agoraphobia d. Specific Phobia e. Social Phobia f. OCD g. PTSD
- 2. 2. Somatoform Disorders a.Somatization Disorders b. Pain Disorder c. Hypochondriasis d. Conversion Disoder
- 3. 3. Dissociative Disorders a.Pychogenic Amnesia b. Psychogenic Fuge c. Depersonalization d. Dissociative Identity Disorder/ Multiple Personality Disoder
- 4. WHAT’S UP FORTODAY?????? • Articulate the difference between anxiety and fear. • Discuss the ff. theories of Anxiety:Psychoanalytic ,Cognitive,Behavior, Biologic,Genetic, and Socio-cultural • Compare the different levels of Anxiety • Construct a list of the common symptoms of anxiety(Physio-E-B-C sx) • Distinguish the different Anxiety disorders
- 5. • Describe therole of the nurse providing care for a client with an anxiety disoder • Formulate nursing care plan for a client with anxiety disoder
- 6. LET’S LOOK INTOTHIS Deo and John,two college roomates, received probationary notices from Mrs.Ferraren because of failure to obtain a WPA of 80% in the course.Deo made an appointment to discuss his grades with his adviser,whereas John was unable to sleep and complained of a headache, lightheadedness and SOB and began to doubt his ability to continue in college.
- 7.
- 8. ANXIETY VS. FEAR Anxiety –Apprehension about a future threat Fear – Response to an immediate threat • Both involve physiological arousal • Both can be adaptive – Fear triggers “flight or fight” • May save life – Anxiety increases preparedness • Moderate levels improve performance
- 9. Developmentally Normal Fears AgeNormal Fear Birth- 6 Months Loud noises, loss of physical support, rapid position changes, rapidly approaching other objects 7-12 Months Strangers, looming objects, unexpected objects or unfamiliar people 1-5 Year Strangers, storms, animals, dark, separation from parents, objects, machines loud noises, the toilet 6-12 Year Supernatural, bodily injury, disease, burglars, failure, criticism, punishment 12-18 Performance in school, peer scrutiny, appearance, performance
- 11. Updates!Updates! Updates! • Anxietyis the most common psychiatric- mental disorder in the US. • Affects approximately 19.1m people between 18-54 yo • Children and teens can develop anxiety disorder.
- 12. FACTS and STATISICS DidYou Know? • Anxiety disorders are highly treatable, yet only about one-third of those suffering receive treatment. • Anxiety disorders cost the U.S. more than $42 billion a year, almost one-third of the country's $148 billion total mental health bill, according to "The Economic Burden of Anxiety Disorders," a study commissioned by ADAA (The Journal of Clinical Psychiatry, 60(7), July 1999). – More than $22.84 billion of those costs are associated with the repeated use of health care services; people with anxiety disorders seek relief for symptoms that mimic physical illnesses. • People with an anxiety disorder are three to five times more likely to go to the doctor and six times more likely to be hospitalized for psychiatric disorders than those who do not suffer from anxiety disorders. • Anxiety disorders develop from a complex set of risk factors, including genetics, brain
- 13. Defining Characteristics ofAnxiety • a threat to one’s self- esteem • an energy that can’t be observed directly • is contagious
- 14. 4 Levels ofAnxiety (Peplau) • Mild level-person is alert and perceptual field is increased; can motivate learning and produce personal growth. • Moderate level- person focuses only on immediate concerns; involves narrowing of the perceptual field. • Severe level- marked by a reduction in the perceptual field. The person focuses on a specific detail.
- 15. Levels of Anxiety(continued) • Panic level- associated with dread and terror. -Person is unable to do things even - Involves disorganization of the personality and can be life threatening. - Person is unable to communicate or function effectively.
- 16. Coping Mechanisms forMild Anxiety • Crying • Sleeping • Smoking • Exercise • Drinking • Limited self-disclosure
- 17. Coping Mechanisms (continued) Moderate,severe, and panic levels of anxiety require more energy to cope with the threat. These coping mechanisms are categorized as task oriented and ego- oriented reactions.
- 18. Task-Oriented Reactions • Attackbehavior: can be destructive hostility or constructive problem-solving
- 19. Task-Oriented Reactions cont. •Withdrawal behavior: this can be physical or psychological withdrawal
- 20. Task-Oriented Reactions (continued) •Compromise: involves changing usual ways of operating, substituting goals, and sacrificing aspects of personal needs
- 21. Ego-Oriented Reactions • Defensemechanisms are used to protect the self. They are the first line of psychic defense and operate at an unconscious level. They involve a degree of self-deception and reality distortion. • One must evaluate if the defense mechanism is adaptive or maladaptive..
- 22. Anxiety and PhysiologicalChanges • ↑BP,PR,RR • Dyspnea • Diaphoresis --(palms) • Anorexia,N & V • Headache • Vertigo • insomia
- 23. Behavioral Responses • pacing •Inability to sit still • Fingering hair continuously • hypervigilance
- 24. Cognitive Responses • Impairedattention • Poor concentration • Forgetfulness • Confusion • Nightmares • Errors in judgment • Fear of losing control
- 25. Affective Responses • Nervousness •Tension • Fear • depression • Terror • crying • Helplessness
- 26. Practice Guidelines (Severe &PanicLevels of Anxiety) • Establishing a trusting relationship • Be aware of your own feelings of anxiety, as a nurse. These can interfere with the therapeutic process. • Protecting the patient. Do not force severely anxious patients into situations they are not able to handle. • Do not ask “why” questions. Patients don’t understand why their symptoms have developed.
- 27. Cont’n • Modifying theenvironment- identify anxiety- producing situations and attempt to reduce them.Assume a quiet,calm manner and decrease environmental stimulation. Limiting the patient’s interaction with other patients will minimize the contagious aspects of anxiety. • Supportive measures include warm baths, massages, and whirlpool baths. • Encouraging patient’s interest in activities.(walking, hobbies, physical exercise)
- 28. Cognitive Behavioral Therapy •Involves 3 therapeutic strategies: • Anxiety reduction: relaxation, biofeedback, systematic desensitization. • Cognitive Restructuring: monitor thoughts and feelings, examining alternatives, reframing. • Learning new behavior: role-modeling, role playing, social skills training, learning new ways of coping with stress.
- 29. Promote the RelaxationResponse • It’s in the scope of nursing practice • It requires no special equipment • It does not need a physician’s supervision • Patient can practice techniques on their own • It can be implemented in various settings.
- 30. Theories of anxiety •Psychoanalytic (Freud) • Interpersonal (Sullivan) • Genetic – possiblity of defective genes that regulate specific neurotransmitters - chromosome 9 – Panic disorder • Biological basis - family studies show up to 25% have an immediate family member with an anxiety disorder
- 31. - Neurotransmitters • norepinephrine(NE) – concentrated in locus ceruleus • serotonin • dopamine in social phobia and OCD •GABA
- 32. • Psychological factor↗Cognitive theory ↘Behavioral theory
- 33. RISK FACTORS • Beingfemale • Childhood trauma • Stress due to an illness • Stress buildup. for example, ongoing worry about finances or a death in the family. • Personality- borderline personality disorder, may be linked to anxiety disorders. • Family hx of AD • Drugs or alcohol
- 34. Types of AnxietyDisorders • Panic Disorder • Obsessive-Compulsive Disorder • Post-Traumatic Stress Disorder • Phobias • Generalized Anxiety Disorder
- 35. 1. Panic Disorder •The abrupt onset of an episode of intense fear or discomfort, which peaks in approximately 10 minutes, and includes at least four of the following symptoms: • A feeling of imminent danger or doom • The need to escape • Palpitations • Sweating • Trembling • Shortness of breath or a smothering feeling • A feeling of choking • Chest pain or discomfort • Nausea or abdominal discomfort • Dizziness or lightheadedness • A sense of things being unreal, depersonalization • A fear of losing control or "going crazy" • A fear of dying • Tingling sensations • Chills or hot flushes
- 36. Panic attacks • Episodeof intense fear that something horrible is about to happen
- 37. Panic Disorder There arethree types of Panic Attacks: 1. Unexpected - the attack "comes out of the blue" without warning and for no discernable reason. 2. Situational - situations in which an individual always has an attack, for example, upon entering a tunnel. 3. Situationally Predisposed - situations in which an individual is likely to have a Panic Attack, but does not always have one. An example of this would be an individual who sometimes has attacks while driving.
- 38. 2. Post TraumaticStress Disorder (PTSD) • Patients with PTSD have experienced a trauma and develop disabling symptoms in response to the event. • Symptoms usually begin within 3 months of the trauma • Syndrome can occur at any age
- 39. Definition of Trauma •The person experienced, witnessed or learned of an event that involved actual or threatened death, serious injury, or threat of harm to self or others • The person’s response involved intense fear, helplessness or horror
- 40. Types of Trauma •Sexual abuse • Rape • Physical abuse • Severe motor vehicle accidents • Robbery/mugging • Terrorist attack • Combat veteran • Natural disasters • Being diagnosed with a life threatening illness • Sudden unexpected death of family/friend • Witnessing violence (including domestic violence) • Learning one’s child has life threatening illness
- 41. Diagnosis of PTSD •Symptoms must be > one month duration and include: –Re-experiencing symptoms –Avoidance symptoms –Emotional numbing –Hyperarousal symptoms
- 42. Re-experiencing Symptoms • Thereare recurrent, intrusive thoughts of the event (can’t not think about it) • Dreams (nightmares) about the event • Acting or feeling the event is recurring, or sense of living the event (flashbacks) • Psychological or Physiological Distress upon exposure to reminders or cues of the event.
- 43. 3. Obsessive Compulsive Disorder(OCD) • Obsessions: recurrent, intrusive, unwanted thoughts (i.e. fear of contamination) • Compulsions: behaviors or rituals aimed at reducing distress or preventing a dreaded event (i.e. compulsive handwashing)
- 45. OCD Symptoms • Recurrentobsessions and/or compulsions are severe enough to consume more than one hour/day • Person recognizes the obsession as a “product of his/her own mind”, rather than imposed from the outside, and that they are unreasonable or excessive
- 46. Common Obsessions • Contamination •Repeated doubts • Order • Aggressive or horrific images • Sexual/pornographic imager
- 47. Obsessions and Common CompulsiveResponses • Contamination: cleaning, hand washing, showering • Repeated doubts: checking, requesting or demanding reassurances from others, counting • Order: checking, rituals, counting • Aggressive or horrific images, checking, prayers, rituals • Sexual/Pornographic imagery: prayer/rituals
- 48. 4. Generalized Anxiety Disorder(GAD) • Patients with GAD suffer from severe worry or anxiety that is out of proportion to situational factors. • Must last most days for at least 6 months • Described as “worriers” or “nervous”
- 49. GAD • Symptoms include: –Muscle tension – Restlessness – Insomnia – Difficulty concentrating – Easy fatigability – Irritability – Persistent anxiety (rather than discrete panic attacks)
- 50. GAD Diagnostic Criteria •Excessive anxiety and worry that occurs more days than not for 6 months • Difficult to control the worry • 3 out of 6 symptoms • Anxiety caused significant distress or impairment in function • Not attributed to another organic cause
- 51. 5. Social Phobia/Anxiety •Social anxiety disorder, also known as social phobia, is an intense fear of social situations. This fear arises when the individual believes that they may be judged, scrutinized or humiliated by others. • Individuals with the disorder are acutely aware of the physical signs of their anxiety and fear that others will notice, judge them, and think poorly of them. • In extreme cases this intense uneasiness can progress into a full blown panic attack.
- 52. Social Phobia/Anxiety • Commonanxiety provoking social situations include: – public speaking – talking with people in authority – dating and developing close relationships – making a phone call or answering the phone – interviewing – attending and participating in class – speaking with strangers – meeting new people – eating, drinking, or writing in public – using public bathrooms – driving – shopping
- 53. Social Phobia: Treatment Cognitive-BehavioralTherapy Assess which social situations are problematic Assess their behavior in these situations Assess their thoughts in these situations Teaches more effective strategies Rehearse or role play feared social situations in a group setting Medication Tricyclic antidepressants Monoamine oxidase inhibitors SSRI (Paxil) approved for treatment Relapse is common with medications are discontinued
- 54. 6. PHOBIA • Aperson experiences sudden episodes of intense dread.
- 55. Phobias: Prevalence Fearsare very prevalent Phobias occur in about 11% of the population More common among women Tends to be chronic
- 56. Phobias are dividedinto three main categories: • Specific phobias • Social Phobia • Fear of open spaces (agoraphobia). Agoraphobia is a fear of a place, such as a mall, an elevator or a room full of people, with no easy means of escape if a panic attack should occur
- 57. • Social phobia.More than just shyness, social phobia involves a combination of excessive self- consciousness, a fear of public scrutiny or humiliation in common social situations, and a fear of negative evaluation by others. • Fear of open spaces (agoraphobia). Most people who have agoraphobia develop it after having one or more panic attacks. Agoraphobia is a fear of a place, such as a mall, an elevator or a room full of people, with no easy means of escape if a panic attack should occur.
- 58. List of Phobias •Agoraphobia - Fear of open spaces or crowds • Arachnophobia - Fear of spiders • Bacteriophobia - Fear of bacteria • Elurophobia - Fear of cats. • Hemophobia - Fear of blood. • Gamophobia - Fear of marriage. • Melanophobia - Fear of the color black • Claustrophobia - Fear of confined spaces • Necrophobia - Fear of death or dead things.
- 59. MEDICATIONS( Minor Tranquilizers) •To relieve sx r/t alcohol withdrawal,control convulsions, and produce muscle relaxation. • Action: depress the CNS including the thalamus, hypothalamus and the limbic system. This effect ↑ the action of GABA
- 60. Medications • Benzodiazepines: ie. Xanax,Librium, Valium, Ativan, Serax, Tranxene) • Anxiolytic: BuSpar • SSRI’s: Celexa, Prozac, Paxil, Zoloft • Tricyclics: Elavil, Norpramin, Anafranil, Tofranil, Pamelor • MAOI’s: Nardil
- 61. Side effects • Sedation •Blurring of vision • Headaches • Hypotension • Tremors • Urinary incontinence • constipation
- 62. Nursing Responsibilities • Shouldbe use for a short time – 1-2 wks • Drugs should not be stopped abruptly ( can cause seizures) • Avoid taking w/ antihistamine and alcohol ( increase the depressant effect) Avoid ingesting caffeine ( decrease the effect of the drug)
- 63. Formulating Nursing Diagnoses •Determine the quality & quantity of anxiety experience by the patient. • Is the patient’s response out of proportion to the threat?
- 64. Formulating Nursing Diagnoses (continued) •Explore how the patient is coping with the anxiety. • Is it constructive or destructive? • Determine the overall effect of the anxiety. Is it stimulating growth or interfering with effective living?
- 65. 4 Primary NANDANursing Diagnoses • Anxiety • Ineffective coping • Readiness for enhanced coping • Fear
- 66. Examples of ExpandedNANDA Diagnosis • Anxiety: moderate anxiety related to financial pressures, as evidenced by episodes of stomach pain and heartburn. • Ineffective coping: related to father’s death as evidenced by inability to concentrate and psychomotor agitation and depression. • Readiness for enhanced coping: related to mother moving in with daughter secondary to stroke related disability, as evidenced by modification of living environment.
- 67. Examples of NANDADiagnoses (cont.) • Fear: related to impending biopsy as evidenced by generalized hostility toward staff and family.
- 68. Allopathic Treatments • Medications(Drug Therapy) • Behavioral Therapy • Cognitive Behavioral Therapy • Psychodynamic Psychotherapy
- 69. Alternative Treatments • Acupuncture •Aromatherapy • Breathing Exercises • Exercise • Meditation • Nutrition and Diet Therapy • Vitamins • Self Love
- 70. A. Behavioral andCognitive Therapy • Teaches patient to react differently to situations and bodily sensations that trigger anxiety • Teaches patient to understand how thinking patterns that contribute to symptoms • Patients learn that by changing how they perceive feelings of anxiety, the less likely they are to have them • Examples: Hyperventilating, writing down list of top fears and doing one of them once a week, spinning in a chair until dizzy; after awhile patients learned to cope with the negative feelings associated with them and replace them with positive ones
- 71. B. Psychodynamic Psychotherapy •Psychodynamic therapy is a general name for therapeutic approaches which try to get the patient to bring to the surface their true feelings, so that they can experience them and understand them. • Psychodynamic Psychotherapy uses the basic assumption that everyone has feelings held in the subconscious which are too painful to be faced. We then come up with defenses (such as denial) to protect us knowing about these painful feelings.
- 72. C. Acupuncture • Causedby the imbalance of chi coming about by keeping emotions in for too long • Emotion effects the chi to move in an abnormal way: when fearful it goes to the floor, when angry the neck and shoulders tighten • Redirects the chi into a balanced flow, releases tension in the muscles, increases flow of blood, lymph, and nerve impulses to affected areas • Takes 10-12 weekly sessions
- 73. D. Aromatherapy • CalmingEffect: vanilla, orange blossom, rose, chamomile, and lavender • Reducing Stress: Lavender, sandalwood, and nutmeg • Uplifting Oils: Bergamot, geranium, juniper, and lavender • Essential Oil Combination: 3 parts lavender, 2 parts bergamot, and 1 part sandalwood
- 74. E. Exercise • Benefits:symbolic meaning of the activity, the distraction from worries, mastery of a sport, effects on self image, biochemical and physiological changes associated with exercise, symbolic meaning of the sport • Helps by expelling negative emotions and adrenaline out of your body in order to enter a more relaxed, calm state to deal with issues and conflicts
- 75. F . Meditation •Cultivates calmness to create a sense of control over life • Practice: Sit quietly in a position comfortable to you and take a few deep breaths to relax your muscles, next choose a calming phrase (such as “om” or that with great significance to you), silently repeat the word or phrase for 20 minutes
- 76. G. Nutrition andDiet Therapy • Foods to Eat: whole grains, bananas, asparagus, garlic, brown rice, green and leafy veggies, soy products, yogurt • Foods to Avoid: coffee, alcohol, sugar, strong spices, highly acidic foods, foods with white flour • Keep a diary of the foods you eat and your anxiety attacks; after awhile you may be able to see a correlation • East small, frequent meals
- 77. H. Vitamins • B-Vitaminsstabilize the body’s lactate levels which cause anxiety attacks (B-6, B-1, B-3) • Calcium (a natural tranquilizer) and magnesium relax the nervous system; taken in combination before bed improves sleep • Vitamin C taken in large doses also has a tranquilizing effect • Potassium helps with proper functioning of adrenal glands • Zinc has a calming effect on the nervous system
- 78. I. Self Love •The most important holistic treatment of all • Laugh: be able to laugh at yourself and with others; increases endorphin levels and decreases stress hormones • Let go of frustrations • Do not judge self harshly: don’t expect more from yourself than you do others • Accept your faults
- 79.