Chapter 09 Anxiety Disorders Copyright 2011 Wolters Kluwer

Anxiety Defined • Vague, uneasy, emotional feeling normally experienced in response to perceived threat

Anxiety as a Symptom • Free-floating anxiety • Thoughts, feelings, behaviors • Automatic relief

Anxiety Disorders • Uncontrolled, overwhelming anxiety • Impaired functioning – Personal – Social –

Panic Disorder • Panic attack – Rapid heartbeat – Increased perspiration – Chilling/numbness –

Agoraphobia • Avoid places or situations that trigger panic attack • Restrict activities to

Phobias • Specific phobia – Excessive, persistent fear of object or situation – Anxiety

Obsessive-Compulsive Disorder • Obsession – Recurrent, persistent, unwanted thoughts or images causing intense anxiety

Posttraumatic Stress Disorder (PTSD) • Response to a situation involving actual death or threat

Generalized Anxiety Disorder • Chronic worry/anxiety • Negative self-talk • Fatigue • Difficulty falling/staying

Treatment of Anxiety Disorders • Focus is to reduce the anxiety level • Medications

Nursing Process Applied • Take steps to lower the anxiety level; encourage the client’s

Nursing Process Applied (Cont. ) • Nursing diagnoses • Expected outcomes Copyright © 2011

Nursing Process Applied (Cont. ) • Interventions – Consider how your own anxiety may

Nursing Process Applied (Cont. ) • Evaluation – Client’s ability to recognize and deal

Question • Tell whether the following statement is true or false. The obsession aspect

Answer • False • Rationale: Obsession refers to recurrent, persistent, unwanted thoughts or images

Question • Which disorder is characterized by mental reruns of an event, emotional numbness,

Answer • D. Posttraumatic stress disorder • Rationale: A person with posttraumatic stress disorder

Question • Tell whether the following statement is true or false. A person suffering

Answer • True • Rationale: A person with agoraphobia often chooses to remain in

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Anxiety as a Symptom • Free-floating anxiety • Thoughts, feelings, behaviors • Automatic relief behaviors • Unrelieved anxiety over time leads to disorder Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Panic Disorder • Panic attack – Rapid heartbeat – Increased perspiration – Chilling/numbness – Nausea – Feeling of suffocation – Chest pain/fear of heart attack – Fear of being out of control Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Agoraphobia • Avoid places or situations that trigger panic attack • Restrict activities to avoid recurrence of symptoms • Often homebound or restricted to home environment • Unemployment or school dropout common Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Phobias • Specific phobia – Excessive, persistent fear of object or situation – Anxiety with contact • Social phobia, also called social anxiety disorder – Excessive fear of social situations in which embarrassment is possible – Discomfort being watched or at risk of being judged by others – Anticipatory anxiety Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Obsessive-Compulsive Disorder • Obsession – Recurrent, persistent, unwanted thoughts or images causing intense anxiety • Compulsion – Repetitive behavior engaged in to reduce high level of anxiety Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Posttraumatic Stress Disorder (PTSD) • Response to a situation involving actual death or threat of injury • Intense feeling or fear following an event • Mental reruns of an event • Emotional numbness • Avoidance of people and places associated with an event • Insomnia, inability to concentrate, impaired social or work functioning Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Generalized Anxiety Disorder • Chronic worry/anxiety • Negative self-talk • Fatigue • Difficulty falling/staying asleep • Tension • Anticipating the “worst” • Irritability, headaches, tremors • Physical symptoms Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Treatment of Anxiety Disorders • Focus is to reduce the anxiety level • Medications – Antianxiety drugs – Greatest success in combination with psychotherapy • Psychotherapy – Cognitive-behavioral therapy – Anxiety support groups Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Nursing Process Applied • Take steps to lower the anxiety level; encourage the client’s trust • Assessment – Current feelings – What happened immediately prior to the onset of symptoms – Client’s perspective on the situation – Thought processes – Communication ability, thought blocking – Affect, expression, nonverbal behaviors Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Nursing Process Applied (Cont. ) • Interventions – Consider how your own anxiety may affect nursing care – Should be timely, client centered, and realistic (small steps) – Help the client try more adaptive coping strategies Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question • Tell whether the following statement is true or false. The obsession aspect of obsessive-compulsive disorder refers to repetitive behavior. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question • Which disorder is characterized by mental reruns of an event, emotional numbness, and/or avoidance of people and places associated with the event? A. Agoraphobia B. Obsessive-compulsive disorder C. Generalized anxiety disorder D. Posttraumatic stress disorder E. Panic disorder Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer • D. Posttraumatic stress disorder • Rationale: A person with posttraumatic stress disorder experiences mental reruns, numbness, and avoidance of people and places associated with an event; the disorder usually occurs following a situation that involves a death or a threat of a severe injury. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins