Transcript Chapter 8

Chapter 8
Anxiety and Anxiety Disorders
Anxiety
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Definition
 Feeling
of apprehension, uneasiness, uncertainty or
dread resulting from a real or perceived threat,
whereas fear is reaction to a specific threat
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Types
 Normal:
healthy life force necessary for survival
 Acute: precipitated by imminent loss or change that
threatens one’s sense of security
 Chronic: anxiety that a person has lived with for a
long time
Levels of anxiety
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Mild
Occurs in normal experience of everyday living
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Moderate
Occurs as anxiety escalates, perceptual field narrows and details
are excluded from observation
Selective inattention: only certain things are seen and heard
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Severe
Perceptual field is greatly reduced. May focus on particular detail or
scattered details
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Panic
Most extreme form and results in markedly disturbed behavior
Anxiety interventions
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Mild to Moderate
-Use of specific communication techniques-open ended
questions, giving broad openings, exploring and
seeking clarification
-Be calm, recognize persons distress, listen
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Severe to Panic
-Quiet environment with minimal stimulation and
providing gross motor activities to drain some of the
tension
-Firm, short, and simple statements are useful
Defense mechanisms
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The degree of distortion of reality and disruption in
interpersonal relationships determines if the use of a
defense mechanism is adaptive (healthy) or maladaptive
(unhealthy) (Vaillant, 1994)
Defenses are major means of managing conflict and
affect
Defenses are relatively unconscious
Defenses are discrete from one another
Although defenses are hallmark of psychiatric
syndromes they are reversible
Defenses are adaptive as well as pathological
Healthy defenses
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Altruism
-Emotional conflicts and stressors are dealt with by
meeting the needs of others
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Sublimation
-Unconscious process substituting constructive and
socially acceptable activity for strong impulses that
are not acceptable in original form
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Humor
-Emphasizing the amusing or ironic aspects of conflict
or stressor
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Suppression
-Conscious denial of disturbing situation or feeling
Immediate defenses
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Repression: exclusion of unwanted experiences,
emotions or ideas from conscious awareness
Displacement: transfer of emotions associated with
person, object or situation to another
Reaction formation: unacceptable behavior or feelings
are kept out of awareness by developing opposite
behavior or emotion
Somatization: transforming anxiety unconsciously to
physical symptom
Undoing: Making up for act or communication
Rationalization: Justifying illogical ideas, actions by
developing acceptable explanations that satisfy both
Immature defenses
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Passive Aggression: indirect aggression toward others
Acting-Out Behavior: actions rather than feelings or reflections
Dissociation: integrating consciousness, memory, identity or perception
of environment
Devaluation: attributing negative qualities to others
Idealization: attributing exaggerated positive qualities to others
Splitting: inability to integrate positive & negative qualities of oneself into
cohesive image
Projection: reject unacceptable personal features & attributes them to
other people, objects or situations
Denial: escaping unpleasant reality by ignoring their existence
Anxiety disorders
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Refers to number of disorders including: panic
disorders, phobias, obsessions, compulsions,
and PTSH (post traumatic stress)
Prevalence and co-morbidity
 Most
prevalent lifetime psychiatric disorder in US
 1 in 4 will experience in lifetime
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Co-occurs with other psychiatric disorders
Theory
 Genetic,
Biological, Learning, & Cognitive
Cultural considerations
Data on incidence in cultures is sparse
 Some cultures express anxiety through
physical symptoms (somatic) while in
other cultures cognitive symptoms are
predominant
 Barrier for some cultural groups seeking
health care for anxiety is the stigma
associated with mental illness
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Types of anxiety disorders
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Panic Disorder
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Panic Disorder with Agoraphobia
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Combination of above symptoms and agoraphobia(intense phobic disorder)
excessive anxiety or fear about being in places from which escape might be
difficult or help unavailable
Phobias
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Sudden onset extreme apprehension or fear associated with impending
doom
Persistent, irrational fear of specific object, activity, or situation that leads to
desire fro avoidance of the object, activity or situation
Social anxiety disorder
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Severe anxiety or fear provoked by exposure to social or performance
situation
Types of anxiety disorders
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Obsessive-Compulsive Disorder
-Obsessions: thoughts, impulses or images that persist & recur and can’t be
dismissed from mind
-Compulsions: ritualistic behavior that person feels driven to perform in order to
reduce anxiety
-Obsessions and compulsions that occur together
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Generalized Anxiety Disorder
-Excessive anxiety or worry about numerous things that lasts for 6 months or longer
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Post Traumatic Stress Disorder (PTSD)
-Repeated re-experiencing of highly traumatic event that involved actual or
threatened death or serious injury to self or others
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Acute Stress Disorder
-Occurs 1 month after exposure to traumatic event
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Anxiety cause by Medical Conditions
-Anxiety caused by medical disorder (hyperthyroidism, cardiac, pulmonary embolus)
Applications of nursing process
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Assessment
-Symptoms of anxiety
-Defenses used in anxiety disorders
-Assessment guidelines
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Diagnosis
-NANDA
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Outcomes Identification
-NOC
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Planning
Implementation
-Follow psychiatric-mental health nursing: scope & standards of practice
-Communication guidelines
-Health teaching and health promotion
-Milieu therapy
-psychotherapy: CBT (Cognitive Behavioral Therapy)
Pharmacological, biological and
integrative therapies
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Antidepressants
-SSRI’s - 1st line treatment for anxiety
-Also treat co-morbid depressive disorders
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Anxiolytic
-Treat somatic and psychological symptoms of anxiety
-Can be addictive (Seroquel, Xanax)
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Other classes of medications
-Beta-blockers, antihistamines (Vistaril) & anticonvulsants
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Complementary interventions
-“Natural” substances include kava kava, gotu kola & St John’s
Wort
-Not subject to same rigorous testing as prescription medications