Transcript Anxiety and Anxiety Disorders

Rebecca Sposato MS, RN
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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
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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.
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Biological: genetic and neuro-chemical
abnormalities
Psychodynamic: Internal and interpersonal
conflict
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Behavioral: learned response to a stressor
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Cognitive: distorted and negative thinking
Stressor/threat
Anxiety
Relief Behavior
Effective
Medication
Reduced stressor
Decreased anxiety
Ineffective
Mediation
Stressor remains present
Extreme coping behaviors
Increased Anxiety
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Mild: Adaptive heightened awareness to
everyday living
◦ Greater focus and process additional sensory data
◦ Slight physiological arousal
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Moderate: No longer normal
◦ impaired perceiving and processing sensory data
◦ Impaired reasoning and problem-solving
◦ Measurable physiological arousal
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Severe: Anxiety dominates experience
◦ Distorted perceiving and processing sensory data
◦ Impaired memory, reasoning, problem-solving
◦ Marked physiological changes
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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
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Acute episode of marked anxiety and
physiological changes
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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
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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
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Excessive fear, with a marked physiological
response, to a specific thing or situation
◦ Predisposing event
◦ Acute onset
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6% lifetime prevalence in population
◦ Often have childhood onset,
◦ 2:1 female to male
◦ Subtype categories: animal, environment,
blood/injury, situation
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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
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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
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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
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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
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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
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A normal response to an abnormal event
◦ Physiological arousal or emotionally numb,
dissociation, amnesia or flashbacks, aversion or
obsession with trigger,
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Triggered by an extreme life stressor/threat◦ A recipient or witness to violence, unnatural death,
catastrophe perceived as threat to self and life
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Acute- Within one month of the event
PTSD- Symptoms present 3 months after
event, may last years
8% lifetime prevalence
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Pharmacological – benzodiazepines,
Buspirone, SSRI
Milieu Therapy- supportive environment
Therapy – psych, REBT, CBT, DBT, relaxation
training,
◦ Modeling- person watches another’s 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
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Symptom management and control
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Promote and support adaptation and coping
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Promote and support daily function
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Health teaching