Transcript Anxiety In-service - Harvest Health Care!

Anxiety Overview
October 2011
Introduction to Harvest Healthcare
• Experience. Education. Excellence.
• Harvest is a leading full-service behavioral health provider,
specializing in the delivery of progressive and innovative
consultative behavioral health services for patients and
residents residing in skilled nursing, rehabilitation, and
assisted living facilities. Our multidisciplinary team of highly
skilled professionals work together to offer a broad menu
of services including but not limited to 24-hour prescriber
on-call services and hospitalization support, comprehensive
cognitive assessments, documentation review, OBRA
compliance support and customized educational programs
designed for the individual needs of your facility.
Objectives
• This presentation on anxiety was developed
for the continuing education of healthcare
providers.
• At the conclusion of this presentation,
participants will have a basic understanding of
anxiety including symptoms and management.
• Mental health professionals should be
consulted for management of patients with
anxiety.
Introduction to Anxiety
• Anxiety is also known as’ angst’ or ‘worry’
• It is a psychological and physiological state
characterized by somatic, emotional, cognitive
and behavioral components.
• Anxiety can create feelings of fear, worry,
uneasiness, and dread.
• Anxiety is considered a normal reaction to a
stressor and can help by motivating action but
when it becomes excessive it may become an
anxiety disorder.
Description
• Anxiety is a generalized mood condition that can
often occur without an identifiable trigger.
• Anxiety is related to situations perceived as
uncontrollable or unavoidable.
• Anxiety and fear differ: fear is short lived,
present focused, geared toward a specific threat
and facilitation escape from threat. Anxiety is
long acting, future focused, broadly focused
towards a diffuse threat and promoting caution
while approaching a potential threat.
Physical Effects
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Heart palpitations
Muscle weakness
Tension
Fatigue
Nausea
Chest Pain
Shortness of Breath
Stomach Aches
• Headaches
• Increased Blood
Pressure and Pulse
• Sweating
• Pale skin
• Trembling
• Pupillary Dilation
Panic Attacks
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The most intense form of anxiety.
Often thought of as heart attack.
Sense of dread or panic may exist
Panic attacks usually come without warning
with irrational fear and a perception of danger
that is very real to the person.
• A person experiencing a panic attack will often
feel as if he or she is about to die or pass out.
Emotional Effects of Panic
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Feelings of apprehension or dread
Trouble concentrating
Feeling tense or jumpy
Anticipating the worst
Irritability
Restlessness
Watching (and waiting) for signs (and occurrences) of danger
Feeling like your mind’s gone blank
Nightmares/bad dreams
Obsessions about sensations
Déjà vu
A trapped in your mind feeling
Feeling like everything is scary
Cognitive Effects of Panic
• Thoughts about suspected danger
– Such as fear of dying: “may fear that chest pains
(sign of anxiety) are a deadly heart attack or the
shooting pains in your head (another physical
symptom of anxiety) are the result of a tumor or
aneurysm.
– May feel an intense fear of dying or more frequent
thoughts that won’t go away
Behavioral Effects of Panic
• Withdrawal from situations where unpleasant
effects of anxiety have been experienced
• Changes in sleeping patterns
• Nail biting
• Increased motor tension, such as foot tapping
Causes of Anxiety
• The exact cause is not fully known, but a factors such
as genetics, brain chemistry and environmental factors
contribute.
• Genetics: some research suggests that family history
plays a role in the development of anxiety.
• Brain chemistry: abnormal levels of certain
neurotransmitters in the brain. Neurotransmitters are
special chemical messengers that help move
information from nerve cell to nerve cell. If the
neurotransmitters are out of balance, messages cannot
get through the brain properly. This can alter the way
the brain reacts in certain situations, leading to anxiety.
Causes of Anxiety
• Trauma and stressful events, such as abuse,
the death of a loved one, divorce, changing
jobs or schools, may lead to anxiety.
• Anxiety also may become worse during
periods of stress.
• The use of and withdrawal from addictive
substances, including alcohol, caffeine, and
nicotine, can also worsen anxiety.
Types of Anxiety: DSM IV
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Panic disorder with agoraphobia
Panic disorder without agoraphobia
Obsessive-compulsive disorder (OCD)
Phobias
Post-traumatic stress disorder
Acute Stress disorder
Generalized anxiety disorder (GAD)
Anxiety Disorder not otherwise specified
Anxiety Disorder due to known physical causes
Diagnostic Criteria for GAD
• A. At least 6 months of "excessive anxiety and worry" about a variety of
events and situations. Generally, "excessive" can be interpreted as more
than would be expected for a particular situation or event.
• B. There is significant difficulty in controlling the anxiety and worry. If
someone has a very difficult struggle to regain control, relax, or cope with
the anxiety and worry, then this requirement is met.
• C. The presence for most days over the previous six months of 3 or more
of the following symptoms:
1. Feeling wound-up, tense, or restless
2. Easily becoming fatigued or worn-out
3. Concentration problems
4. Irritability
5. Significant tension in muscles
6. Difficulty with sleep
Diagnostic Criteria for GAD
• D. The symptoms are not part of another mental
disorder.
• E. The symptoms cause "clinically significant distress"
or problems functioning in daily life.
• F. The condition is not due to a substance or medical
issue
• Mental health care provider will collect history and
current medical information
• Blood and other diagnostic tests may be ordered to
rule out medical causes of symptoms
• History may be obtained from family or caregivers
• Anxiety scales may be used
Treatment of Anxiety
• In general anxiety disorders are treated with
medication, specific types of psychotherapy or
both
• Treatment choices depend on the problem
and the person’s preference
• Before treatment begins, a careful diagnostic
evaluation needs to be done to determine
whether a person’s symptoms are caused by
an anxiety disorder or a physical problem.
Treatment of Anxiety
• If an anxiety disorder is diagnosed, the type of
disorder or the combination of disorders that are
present must be identified.
• Coexisting conditions:
– depression
– substance abuse.
• Sometimes alcoholism, depression, or other coexisting
conditions have such a strong effect on the individual that
treating the anxiety disorder must wait until the
coexisting conditions are brought under control.
Medication
• Medication will not cure anxiety disorders, but it
can keep them under control while the person
receives psychotherapy.
• Medication should be prescribed by mental
health specialists, who can either offer
psychotherapy themselves or work as a team
with psychologists, social workers, or counselors
who provide psychotherapy.
• The principal medications used for anxiety
disorders are antidepressants, anti-anxiety drugs,
and beta-blockers to control some of the physical
symptoms.
Psychotherapy
• Psychotherapy involves talking with a trained
mental health professional, such as a psychiatrist,
psychologist, social worker, or counselor, to
discover what caused an anxiety disorder and
how to deal with its symptoms.
• Cognitive-behavioral therapy (CBT) is very useful
in treating anxiety disorders. The cognitive part
helps people change the thinking patterns that
support their fears, and the behavioral part helps
people change the way they react to anxietyprovoking situations.
Thought Provoking Questions
• Can you describe the difference between
generalized anxiety and panic?
• When a patient is presenting with acute
anxiety, what should you do?
• How can you refer a patient for a
psychiatric evaluation?