Chapter 12 Anxiety and Anxiety Disorders Elsevier items

Chapter 12 Anxiety and Anxiety Disorders Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Anxiety • Anxiety – apprehension, uneasiness, uncertainty, or dread from real or perceived threat • Fear – reaction to specific danger • Normal anxiety – necessary for survival Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 2

Levels of Anxiety • Mild anxiety • Moderate anxiety • Severe anxiety • Panic Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 3

• A parent is shopping with a 5 -year-old child in a large, busy urban mall. The parent suddenly realizes the child is missing. Which level of anxiety would likely result? Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 4

a. Mild b. Moderate c. Severe d. Panic Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 5

Defenses Against Anxiety • Defense mechanisms – Automatic coping styles – Protect people from anxiety – Maintain self-image by blocking • feelings • conflicts and • memories – Can be healthy or unhealthy Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 6

Anxiety Disorders • Clinical picture • Epidemiology • Comorbidity • Etiology – Biological • Genetics – Neurobiological Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 7

Psychological Theories • Psychodynamic theories – Sigmund Freud – Harry Stack Sullivan – Behavior theories – Cognitive theories • Cultural considerations Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 8

Panic Disorders (PD) • Panic attack • Panic disorder without agoraphobia • Panic disorder with agoraphobia • Simple agoraphobia Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 9

Phobias • Specific phobias • Social phobia or social anxiety disorder (SAD) Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 10

Obsessive-Compulsive Disorder (OCD) • Obsessions – Thoughts, impulses, or images that persist and recur, so that they cannot be dismissed from the mind • Compulsions – Ritualistic behaviors an individual feels driven to perform in an attempt to reduce anxiety Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 11

Generalized Anxiety Disorder (GAD) • Excessive anxiety or worry about numerous things • Lasts for 6 months or longer Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 12

Posttraumatic Stress Disorder (PTSD) • Flashbacks • Avoidance of stimuli associated with trauma • Experience of persistent numbing of responses • Persistent symptoms of increased arousal Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 13

Acute Stress Disorder • Occurs within 1 month after exposure to highly traumatic event • Must display at least 3 dissociative symptoms – during or after event • Resolves within 4 weeks Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 14

Substance-Induced Anxiety Disorder • Symptoms of anxiety, panic attacks, obsessions, and compulsions • Develop with the use of a substance or within a month of stopping use of the substance Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 15

Anxiety Due to Medical Conditions • Symptoms of anxiety are direct physiological result of a medical condition Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 16

Application of the Nursing Process • Assessment – General assessment of symptoms – Self-assessment – Assessment guidelines: anxiety disorders • Nursing Diagnosis • Outcomes Identification • Planning Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 17

Application of the Nursing Process Continued • Implementation – Mild to moderate levels of anxiety – Severe to panic levels of anxiety Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 18

Basic Level Nursing Interventions • Counseling • Milieu therapy • Promotion of self-care activities • Pharmacological interventions • Health teaching Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 19

Advanced Practice Interventions • Cognitive therapy • Behavioral therapy – Relaxation training – Modeling – Systematic desensitization Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 20

Advanced Practice Interventions Continued • Behavioral therapy, continued – Flooding – Response prevention – Thought stopping • Cognitive-behavioral therapy Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 21