ANXIETY DISORDERS ANXIETY According to authors Kaplan and Sadock, anxiety is a diffuse, unpleasant, vague sense of apprehension It is often

a response to an imprecise or unknown threat Anxiety is an alerting signal; it warns of impending danger and enables the individual to take measures to deal with threat. The response to a threat is unknown, internal, vague, or conflicting in origin LEVELS OF ANXIETY Mild (+1) Moderate (+2) Severe (+3) Panic (+4)

- Perceptual field is closed o Unable to solve problems o Safety and survival is the main focus o SUICIDAL - Hallucinations and delusions may occur Nursing Intervention o Reduce environmental stimuli o Provide safety o Stay with the client o Do not touch the client o GUIDE FIRMLY or Physically take control o RESTRAINTS if needed ETIOLOGY OF ANXIETY DISORDERS Genetic Biochemical Neuroanatomic Psychodynamic

MILD (normal tension of everyday life) - Physiologic Response o Slight discomfort o Restlessness o Tapping - Non-physiologic Response o Attentive o Impatient o Learning capacity increases o Alert o Perceptual field heightened o Excited o Irritable Nursing Intervention o Listen o Promote insight and problem solving o Accept mild anxiety as normal o Tolerate mild anxiety and benefit from it MODERATE (focuses and responds to immediate problem) - Physiologic (SNS) Response o Increases PR, RR, Shakiness, Stuttering - Selective inattention - Difficulty concentrating - Perceptual field decreased (narrowed) - Slow pacing - Only focuses on the problem without considering the surrounding - Starts perspiring and has gastric distress Nursing Intervention - Calm and rational discussion - Refocus attention - Relaxation techniques o Deep breathing o Crying o Music o Exercise o Yoga o Meditation o Guided Imagery o Tai Chi - ORAL ANXIOLYTICS if needed SEVERE (focus is on just part of a problem) - Physiologic (SNS) Response o Increases BP, Headaches, tremors, rigid posture, dry mouth, profuse sweating, hyperventilation - Prepares for fight or flight - May experience severe muscle tension - LIMITED (greatly reduced) perceptual field, very frantic - Focuses on part (details) of the problem ONLY - Cant decide - Very confused inability to think abstractly - RITUALISTIC BEHAVIOR (purposeless activities) Nursing Intervention - Listen - Encourage expression of feelings to reduce pressure - Reduce stimuli - Use kind, firm SIMPLE DIRECTIONS - Use TIMEOUT (seclusion) - INTRAMUSCULAR ANXIOLYTICS if needed PANIC (focuses on self) - Physiologic Response o Immobility or severe hyperactivity, cool, clammy skin, pallor, dilated pupils, severe shakiness o Actual fight, flight, or freeze - Out of control o Has an irrational behavior, hysterical or mute

CATEGORIES OF ANXIETY DISORDERS Panic Disorder Obsessive-Compulsive Disorder (OCD) Generalized Anxiety Disorder Phopic Disorder PTSD PANIC DISORDER Sudden onset of intense apprehension, fear or terror THAT LASTS FOR 15 to 30 MINUTES Findings: Intense fear Palpitations Increased heart rate SOB Choking sensation Paresthesia Depersonalization Derealization Nursing Interventions: Stay with the client Remove anxiety producing stimuli Intervene to protect client from acting out that may hurt himself or others, client is acting out because of fear. Brown Paper Bag for hyperventilation Anti-anxiety drugs PHOBIC DISORDER Persistent or irrational fear of specific objects, activities, or situation that leads to loss of sense of security. Types 1. Agoraphobia fear of being alone, or in public places 2. Social Phobia fear of public speaking in which public scrutiny may occur. 3. Specific Phobia fear of specific object, animal, or situation - Zoophbia animals - Nyctophobia dark - Genophobia dirt - Astraphobia storms, thunder & lightning - Acrophobia height - Claustrophobia enclosed places - Pyrophobia fire - Ochlophobia crowds Nursing Interventions - Gradually expose client to the feared object through SYSTEMATIC DESENSITIZATION - FLOODING is an abrupt exposure to the feared object. The goal is to rid the clients phobia in one or two sessions - Help client to describe her feelings prior to a response for a phobic object - Help the client identify alternative coping strategies o REFRAMING - Practice relaxation techniques with the client - Teach client about medications as part of the tx plan o ANXIOLYTICS OBSESSIVE-COMPULSIVE DISORDER (OCD) Is an anxiety disorder and is characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions) Repetitive behaviors are often performed with the hope of preventing obsessive thought or making them go away such as o Handwashing o Counting o Checking o Cleaning

Performing these so-called rituals, however, provides only temporary relief, and not performing them markedly increases anxiety.

Nursing Intervention - Convey acceptance of the client, despite ritualistic behavior o Allow client time to perform rituals o Encourage limit setting on ritualistic behaviors as part of the established tx plan (DIVERSIONAL THERAPY) o Encourage expression of feelings - Keep a journal o Assist client in listing all of the objects and places that triggers anxiety as part of exposure-response prevention program - Teach client about medications as part of the tx plan o Anafranil and Luvox to control symptoms POST TRAUMATIC STRESS DISORDER (PTSD) Characterized by re-experiencing of an extremely traumatic event that is outside the range of usual human experience. Traumatic events is usually re-experienced as flashbacks, nightmares.

Insomnia OCD Depression post traumatic stress disorder Muscle spasms and seizures Alcohol withdrawal

ACTION - Action of the drug is to enhance the action of GABA, decrease the firing rate of neurons resulting in lowering of anxiety. BENZODIAZEPINE XANAx KloNOPIN VAlium LIBRIum SERAx TRANXene NONBENZODIAZEPINE BUSpar AMbien Buspirone Zoldipem Alprazolam Clonazepam Diazepam Chlordiazepoxide Oxazepam Clorazepam

Findings -

Feeling of isolation and detachment Difficulty in sleeping Depression Violent Outburst of anger

Nursing Intervention - Promote ct safety o Discuss self-harm thoughts o Develop plan with client to go to safe place when having destructive thoughts and impulse - Help cl to cope with stress and emotions o Use grounding techniques to help ct who is dissociating or experiencing flashbacks - Distraction techniques o Physical exercise o Listening to music o Talking with others o Engaging in a hobby o Make a list of activities and provide materials close at hand - Help ct promote self esteem o Refer client as survivor and not a victim o Make a list of people and activities in the community for client to contact when he/she needs help o Protect the ct from acting out violently with disregard for safety to self or others o Assist the ct in developing new adaptive coping skills. GENERALIZED ANXIETY DISORDER (GAD) Characterized by excessive, uncontrollable and often irrational worry about everyday things that is disproportionate to the actual source of worry. This excessive worry often interferes with daily functioning, as individuals suffering GAD typically anticipate disaster, and are overly concerned about everyday matters such as o Health issues o Money o Death o Family problem o Friend problems o Relationship problems o Word difficulties

Adverse Effects: 1. Diminished mental alertness 2. Dizziness 3. Drowsiness Caution about driving Caution about operating hazardous activity *Drop in BP of 20 mmHg (systolic) warrants withholding the drug and notifying the physician. Symptoms Acute/Common Drowsiness Ataxia Feelings of detachment Increase irritability and hostility Anterograde amnesia Rare Management

Help with activity caution when using machinery Caution with activity; prevent falls Discourage social isolation Observe carefully; offer support, Be alert for disinheriting of control over socially unacceptable impulse Inability to recall event that occur while the drugs is active

Increased appetite/ weight Weight control measure gain Nausea Dose with meals, decrease dose Headache Usually respond to mild analgesic Confusion Decrease dose Benzodiazepine Withdrawal Syndrome Mild symptoms 1. Insomnia 2. Dizziness 3. Headache 4. Tinnitus 5. Anorexia 6. Vertigo 7. Agitation 8. Anxiety Severe symptoms 1. Diarrhea 2. Hyperthermia 3. Seizure 4. Hypotension 5. Psychosis

Findings Fatigue Fidgeting Headache Nausea numbness in hands and feet Muscle tension Muscle aches Difficulty swallowing DOB Difficulty concentrating Trembling, twitching, irritability Sweating, insomnia Hot flashes and rashes *These symptoms must be consistent and ongoing, persisting at least 6 months Nursing Intervention SAME AS ANXIETY MANAGEMENT OF ANXIETY DISORDER Anxiolytics Psychotherapy ANTIANXIETY DRUGS USES - Anxiety

PSYCHOTHERAPY - Involves talking with a trained mental health professional to learn how to deal problems like anxiety disorders O Psychiatrist O Psychologist O Nurse therapist O Social worker O Counsellor 3 General Types of Psychotherapy - Cognitive therapy helps the patient to gain insight of their irrational thoughts or faulty belief system - Behavioral therapy thru systematic desensitization uses relaxation techniques and carefully planned exposure to the feared object or situation gradually to help individual overcome his fears and enable him to learn to control the anxious responses. - Cognitive behavioral therapy helps the patient understand the patterns of thinking so that they can react differently to situations that cause anxiety.