Anxiety disorders 1 Panic disorder 2 PHOBIAS 3

Anxiety disorders 1. Panic disorder 2. PHOBIAS 3. Generalized Anxiety Disorder “GAD” 4. Obsessive Compulsive & Related Disorders 5. Trauma &Stressor Related Disorders Psychiatric and Mental Health Nursing 1

Anxiety disorders Anxiety: is a vague, subjective, nonspecific feeling of discomfort and apprehension. - Response to external or internal stimuli that can have psychological &physical symptoms. - Fear: afraid by a clearly identifiable, external stimulus that represents danger to the person. - Anxiety is considered normal when it is appropriate to situation and dissipates after situation resolved. * As anxiety increases: - Energy become available for problem solving. Psychiatric and Mental Health Nursing 2

* Levels of anxiety: - Mild anxiety “Optimal”: People generally functioning well. - Moderate anxiety: Cope with the pleasant or unpleasant stressful situations - Sever anxiety , Energy is focused in reducing the pain of anxiety, rather than on coping with environment. “Impaired client function, and he may be in need for help to reserve the situation. - Panic anxiety: Client is disorganized, increased motor activity, Psychiatric and Mental Health Nursing loss of rational thought, and decrease ability to 3

Anxiety disorders Group of conditions of excessive anxiety with behavioral, emotional, and physiologic responses. Major symptoms of anxiety disorder: “panic, fear, stress, worry and rituals: A- panic: - Panic attack: can occur in any anxiety disorders - Panic disorder with or without agoraphobia B- Fear: Agoraphobia, social phobia, & specific Psychiatric and Mental Health Nursing 4

Anxiety disorders. . Cont. C- Stress: - Adjustment disorder with anxiety(exogenous or situational) Acute stress disorder - Post-traumatic stress disorder - D- worry: - Generalized anxiety disorder - Obsessions and rituals (obsessive compulsive disorder). Psychiatric and Mental Health Nursing 5

Etiology of anxiety disorders No definitive cause, but there are some theories: 1 - Stress Theory: Hans Selye * Identified three stages of stress: - Alarm reaction. - Resistance: continues as 'flight or fight' reaction &may relax. - Exhaustion: may be unable to relax & deplete his resources (physiological and emotional ) Psychiatric and Mental Health Nursing 6

Etiology of anxiety disorders. . Cont. 2 - Biological Theories: * Genetic theory: - Increased incidence in first-degree relatives. - Monozygotic twins are greater than dizygotic five times. * Neurochemical theory: - GABA , Serotonin & noradrenaline associated with anxiety disorders. Psychiatric and Mental Health Nursing 7

Etiology of anxiety disorders. . Cont. 3 - Personality Theory: - Shy, inhibited temperament: the strongest predictor of development of anxiety disorder. 4 - Psychoanalytic Theory: Unacceptable thoughts and emotion which occupy the unconscious mind lead to anxiety disorder. Psychiatric and Mental Health Nursing 8

Etiology of anxiety disorders. . Cont. 5 - Interpersonal Theory: Sullivan - Insecure parents may transmit anxiety to their children. - Or when persons do not conform to social norms. 6 - Behavioral Theory: - Anxiety can be learned through experience e. g. : When dog bites you, you develop a fear of dogs. May develop fears by watching/ hearing Psychiatric and Mental Health Nursing 9

Panic attacks Abrupt surge of intense fear /discomfort reaches a peak within minutes. Four or more) of the following symptoms occur: 1. Palpitations, pounding heart, or increased heart rate. 2. Sweating. 3. Trembling or shaking. 4. Shortness of breath (SOB). 5. Feelings of choking. 6. Chest pain or discomfort. Psychiatric and Mental Health Nursing 10

Panic attacks. . Cont. 8. Feeling dizzy, unsteady, light-headed, or faint. 9. Chilis or heat sensations. 10. Paresthesias (numbness or tingling sensations). 11. Derealization (feelings of unreality) or depersonalization (being detached from oneself). 12. Fear of losing control or “going crazy. ” 13. Fear of dying. * Panic attack is not a mental disorder. - Panic attacks can occur in the context of any Psychiatric and Mental Health Nursing 11

Panic disorder Client must have experienced at least two panic attacks to be diagnosed panic disorder. ** Diagnostic criteria of panic disorder: - Recurrent unexpected panic attacks. - At least one attack followed by (1 month or more) of one or both of the following: 1. Worry about additional panic attacks or their consequences (e. g. , losing control, having a heart attack, “going crazy”). 2. Maladaptive change in behavior related to the attacks (designed to avoid having panic and Mental Health attacks, such as avoidance Psychiatric of exercise or. Nursing 12

Panic disorder. . cont. The disturbance not related to physiological or medical condition. (e. g. , hyperthyroidism, CPD). - The disturbance is not better explained by another mental disorder (response to feared social situations, response to obsessions, as in OCD or as a response to PTSD. - Psychiatric and Mental Health Nursing 13

Panic disorder. . cont. * Characteristics of panic disorder are: - Fear that attacks indicate the presence of an undiagnosed, life-threatening illness - Fear of going crazy or have a weak character - Development of avoidance behaviors - Fear of having another attack. * Treatment of Panic disorder : - CBT & relaxation techniques. - Medications as: as Alprazolam (Xanax), clonidine (Catapres) & propanolol Psychiatric and Mental Health Nursing 14

PHOBIAS - Illogical, intense, persistent fear of a specific object or a social situation. - Extreme distress and interferes with normal functioning. - People with phobias understand their situation but cannot stop. - People develop anticipatory anxiety when thinking about phobic object or situation. - People engage in avoidance behavior which limits their lives Psychiatric and Mental Health Nursing 15

Types of phobia A- Specific phobia: Specific phobic object or situation. * Prevalence: - Around 5% in children & older clients - Around 16% in (13 -17 years). - Females more than males, 2: 1. * Predisposing factors to specific phobias: - Traumatic events as biting by a dog. - Observation of others undergoing trauma. - Repeated warnings of danger e. g. by parents or the media. Psychiatric and Mental Health Nursing 16

*Diagnostic criteria of Specific phobia: - Marked fear or anxiety about a specific object or situation (e. g. , flying, heights, animals, receiving an injection, seeing blood). (In children, may be expressed by crying, tantrums, freezing, or clinging). - Phobic situation provokes immediate fear or anxiety. - Phobic object or situation is actively avoided or endured with intense fear Psychiatric and Mental Health Nursing 17

*Diagnostic criteria of Specific phobia: . . Cont. - Fear/anxiety is more than actual danger of specific object or situation. - Fear/anxiety typically lasting for 6 months or more. - Impairment in social, occupational, or other areas of functioning. - Disturbance is not directly explained by another mental disorder, as panic disorder, OCD, or PTSD. Psychiatric and Mental Health Nursing 18

* Types of specific phobia: 1. Animals (zoophobia) , Insects (insectophobia) 2. Heights (acrophobia), Water (hydrophobia). 3. Electrical storms (astraphobia), 4. Darkness or night (nyctophobia) 5. Seeing blood (hematophobia), receiving an injection (injection phobia) 6. Closed places (claustrophobia), 7. Bridges (Gephyrophobia) 8. Elevator phobia. 9. Flying (aviation phobia). Psychiatric and Mental Health Nursing 19

Types of phobia. . cont. . B- Agoraphobia: Anxiety if being in open places or situations from which escape might be difficult (or embarrassing). * Diagnostic criteria of Agoraphobia: - Marked fear about (two or more) of the 5 situations: 1. Using public transportation (buses, trains, ships, planes). 2. Being in open spaces (e. g. , parking lots, marketplaces, bridges). 3. Being in enclosed places (e. g. , shops, theaters, cinemas). Psychiatric and Mental Health Nursing 20

* Diagnostic criteria of Agoraphobia: . . Cont. 4. Standing in line or being in a crowd. 5. Being outside of the home alone. Client avoids these situations because of thoughts that escape is difficult or help might not be available. - Agoraphobic situations always provoke fear/anxiety. - The fear or anxiety is inappropriate to the actual danger of phobic situations. - Fear/anxiety, or avoidance lasting for 6 months or more. - Psychiatric and Mental Health Nursing 21

* Diagnostic criteria of Agoraphobia: . . Cont. - Impairment in social, occupational, or other areas of functioning. - If another medical condition (e. g. , inflammatory bowel disease) is present, symptoms is excessive. Fear/anxiety, or avoidance is not better explained by another mental or physical disorder. * Two main types: panic disorder with agoraphobia (more prevalent), & agoraphobia without panic disorder. - Psychiatric and Mental Health Nursing 22

Types of phobia. . cont. . C- Social Anxiety Disorder (Social Phobia): *Diagnostic Criteria : * Marked fear/anxiety about one or more social situations: Examples - Social interaction (e. g. having conversation, meeting unfamiliar people) - Being observed (e. g. , eating or drinking , giving a speech). * Client fears that he will act in a way or show anxiety symptoms which is Psychiatric and Mental Health Nursing 23

*Diagnostic Criteria of social phobia: . . Cont. - Social situations avoided or endured with intense anxiety. Fear/anxiety is inappropriate to the actual social situation. Fearing typically lasting for 6 months or more. Impairment in social, occupational, or other areas of functioning. Fear/anxiety not related to another physiological or medical condition. Psychiatric and Mental Health Nursing 24

Features associated with social phobia - Hypersensitivity to criticism. - Fear of negative evaluation or rejection. - Difficulty in being assertive. - Low self-esteem, feelings of inferiority. - Avoiding eye contact when talking to a person. - Observable signs of anxiety tremor or shaky voice. - Underachievement school/work & decreased social networks. Psychiatric and Mental Health Nursing 25

Features associated with social phobia. . Cont. - In severe social phobia client is less likely to marry, & may have suicidal ideation • Social phobia begins in mid-teens and persists throughout a lifetime. Common conditions comorbid with social phobia include: - Depression, substance abuse, anorexia nervosa and avoidant • Psychiatric and Mental Health Nursing 26

Treatment: (anxiety associated with phobias). 1. Anxiolytic drugs 2. Behavioral therapy: - (relaxation techniques) - Systematic desensitization: (progressively exposes the client to threatening object until anxiety decreases) 3. Flooding: rapid desensitization (confronts client with phobic object, picture or actual) until anxiety Psychiatric and Mental Health Nursing 27