ANXIETY & STRESS-RELATED DISORDERS

Anxiety-related disorders are the most common of all psychiatric disorders.

Three quarters of those with anxiety disorders have their first episode by age

21.5 years.

Symptoms of anxiety that negatively affect the persons ability to

function in work or interpersonal relationships are considered symptomatic of anxiety disorders.

Anxiety disorders may be associated with other mental & physical

illnesses such as respiratory, cardiac, and mood disorders

Panic attacks occur in many of the Anxiety Disorders. Patients with Panic Disorders are often seen in a number of

health care settings.

ETIOLOGY
Research points to a combination of biologic

and psychosocial factors that cause persistent anxiety. Other research demonstrates that personality traits may predispose an individual to anxiety. Low self-esteem and some negative family influences may contribute to development of anxiety disorders. In some cases, there may be a traumatic or stressful precipitating event.

ANXIETY DISORDERS
Panic Disorder Acute Stress Disorder Post Traumatic Stress Disorder Obsessive-Compulsive Disorder Generalized Anxiety Disorder

Phobias

PANIC DISORDER

Characterized by the appearance of disabling attacks of panic. Physical and psychological symptoms include:
Palpitations Sweating

Shaking
Shortness of breath or smothering sensation Sensation of choking Chest pain

Nausea & vomiting of abdominal distress

Dizziness Derealization or depersonalization Fear of going crazy or fear of dying

Chills or hot flashes

OBSESSIVE-COMPULSIVE DISORDER Obsessions are excessive, unwanted, intrusive and persistent thoughts, impulses or images that cause anxiety and distress. Compulsions are behaviors that are performed repeatedly in a ritualistic fashion with the goal of preventing or relieving anxiety & distress caused by obsessions.

GENERALIZED ANXIETY DISORDER

Excessive worry and anxiety that is unwarranted

more days than not.

Symptoms include uneasiness, irritability, muscle

tension, fatigue, difficulty thinking and sleep alteration.

Adults with GAD often worry about matters such

as their job, household finances, health of family or simple matters such as household chores or being late for appointments.

ACUTE & POSTTRAUMATIC STRESS DISORDERS

Develops after a traumatic event involving a personal

experience of threatened death, injury or perceived threat to physical integrity.

They are hypervigilent, they re-experience the event

through images, thoughts or nightmares and try to avoid people, places or things that are reminders of the event.
Examples of events are violent personal assault, rape,

military combat, natural disasters, terrorist attacks, incarceration as POW, torture, automobile accidents or being diagnosed with a life-threatening illness.

PHOBIAS
An Illogical, intense, persistent fear of a specific object or social situation that causes extreme distress and interferes with normal life functioning. Agoraphobia- fear of open spaces

Specific Phobia an irrational fear of an object or situation

Social Phobia- anxiety provoked by certain social or performance situations.

TREATMENT
Usually involves a combination of medication(anxiolytics & antidepressants) & therapy.
Cognitive Behavioral Therapy: Positive reframing Decatastrophizing Assertiveness training Desensitization Psychoeducation: Relaxation techniques Medication Education to understand disorders

PHARMACOLOGIC INTERVENTIONS
Selective Serotonin Reuptake Inhibitors (SSRIS) &

Tricyclic Antidepressants(TCAS) are the most effective treatment for clients with Anxiety Disorders.
Benzodiazepines are utilized short-term.

Tolerance Sedation Withdrawal

Buspirone (BuSpar) must be taken 3-4 weeks before

anxiolytic effects are experienced.

WORKING WITH ANXIOUS CLIENTS

Be aware of nurses own anxiety Assess the persons anxiety level Speak in short, simple, easy-to-understand

sentences Lower the persons anxiety level to moderate or mild before proceeding with anything else Speak to the client in a low, calm, and soothing voice Walk while talking, if the client cant sit still Ensure safety during panic level of anxiety Remain with the client until panic recedes Use Cue Cards to help client restructure thought patterns

SOMATIC SYMPTOM DISORDERS

DEFINITIONS
Somatization is the transference of mental experiences and states into bodily symptoms.

Somatic Symptom Disorders are the presence of physical symptoms that suggest a medical condition without a demonstrable organic basis to account fully for them.

ESSENTIAL FEATURES
Physical complaints suggest major medical

illness but have no demonstrable organic basis.

Psychological factors and conflicts seem

important in initiating, exacerbating and maintaining the symptoms.

Symptoms or magnified health concerns are

not under the clients conscious control.

COMPLEX SOMATIC SYMPTOM DISORDER

Is a reconfiguration of Somatization, Hypochondriasis

and Pain Disorder. Clients perceive themselves as being very sick and aspects of healthcare as poor. Common features of somatization and cognitive distortions. Nurses in Primary Care and MedicalSurgical settings more likely to encounter these persons. Symptoms tend to change, are diffuse and complex and move from one body system to another. Clients tend to move from one practitioner to the next. It is a chronic relapsing condition

TREATMENT
Provide health teaching Assist client to express emotion Teach coping strategies; emotion

focused & problem focused Use of antidepressants for depression Referral to pain clinic for Pain Disorder Family Education