PSYCHIA CHAPTER 14

• What is anxiety?

  • vague feeling of dread

  • a response of external or internal stimuli

  • different from fear

  • unavoidable and can be positive

  • normal when appropriate to the situation
• Anxiety disorders

  • a group of conditions demonstrating excessive anxiety

  • with unusual behaviors (e.g. panic without reason)

  • distress impairs daily routines and social lives
• Anxiety as response to stress

  Stress (Hans Selye, 1956)

  •The wear and tear that life causes in the body

  • Occurs when person has difficulty dealing with situation, problems, and goals.

  •Hans Selye identified the physiological aspects of stress labeled as the general adaptation syndrome
• General Adaptation Syndrome (Selye)

  • stimulates body to prepare for potential defense needs

  • counteract the physiological changes that happened during the alarm reaction stage

  • a negative response to the stress causing exhaustion and no longer equipped to fight it.
• Anxiety

  • Has both healthy and harmful aspects

  • Depends on degree, duration and how well the person copes

  •Has four stages / levels (mild, moderate, severe and panic)
• LEVELS OF ANXIETY:

  • Mild anxiety
  • Moderate anxiety
  • Severe anxiety
  • Panic
• Mild anxiety

  • Sensation of something that warrants attention

  • Sensory stimulation helps person to focus attention to learn, solve problems, etc.

  • Motivates people to make changes and engage in goal-direct activities

  • No direct intervention necessary
• Psychological Response of MILD ANXIETY

  • Wide perceptual field

  • Sharpened senses

  • Increased motivation

  • Effective problem solving

  • Increased learning ability

  • Irritability
• Physiologic response OF MILD ANXIETY

  • Restlessness

  • Fidgeting

  • GI “butterflies”

  • Difficulty sleeping

  • Hypersensitivity to noise
• Moderate anxiety

  • disturbing feeling that something is definitely wrong

  • becomes nervous or agitated

  • person can still process information

  • has difficulty concentrating and attention wanders

  • attention can be regained to refocus at task
• Psychological Responses OF MODERERATE ANXIETY

  • Perceptual field narrowed to immediate task

  • Selectively attentive

  • Cannot connect thoughts or events independently

  • Increased use of automatisms
• Physiological Responses OF MODERERATE ANXIETY

  • Muscle tension

  • Diaphoresis

  • Pounding pulse

  • Headache

  • Dry mouth

  • High voice pitch

  • Faster rate of speech

  • GI upset

  • Frequent urination
• MODERATE ANXIETY

  Interventions:

  • Speak in short, simple and easy-to-understand sentences

  • Ensure that client is taking in the information correctly

  • Redirect client back to the topic if attention wanders
• Severe anxiety

  • more primitive survival skills take over

  • defensive responses ensue and cognitive skills decrease

  • Has trouble reasoning and thinking

  • paces, restless, irritable and angry

  • vital signs increases

  • Can no longer pay attention or take in information
• Psychological Responses OF SEVERE ANXIETY

  • Perceptual field reduced to one detail or scattered details

  • Cannot complete tasks

  • Cannot solve problems or learn effectively

  • Behavior geared toward anxiety relief and is usually ineffective

  • Doesn’t respond to redirection

  • Feels awe, dread, or horror

  • Cries

  • Ritualistic behavior
• Physiological Responses OF SEVERE ANXIETY

  • Severe headache

  • Nausea, vomiting, and diarrhea

  • Trembling

  • Rigid stance

  • Vertigo

  • Pale

  • Tachycardia

  • Chest pain
• Intervention IN SEVERE ANXIETY

  Goal: lower anxiety

  • Remain with client

  • Talk in a low, calm and soothing voice

  • Help client take deep breaths to lower anxiety
• Panic

  • Emotional-psychomotor realm predominates

  • Adrenaline surge greatly increases vital signs

  • Pupils enlarge and cognitive process focuses on the person’s defense

  • Not indefinite and usually last 5 to 30 minutes
• Panic

  Psychological Responses

  • Perceptual field reduced to focus on self

  • Cannot process any environmental stimuli

  • Distorted perceptions

  • Loss of rational thought

  • Doesn’t recognize potential danger

  • Can’t communicate verbally

  • Possible delusions and hallucination

  • May be suicidal
• Panic

  Physiological Responses

  • May bolt and run Or

  • Totally immobile and mute

  • Dilated pupils

  • Increased blood pressure and pulse

  • Flight, fight, or freeze
• Intervention IN PANIC ANXIETY

  Goal: ensure safety and reduce anxiety

  • Talk in a comforting manner

  • Place client in a quiet, non stimulating environment
• Medications: Anxiolytic drugs

  • anti-anxiety medications (anxiolytics)

  • high potential for abuse and dependence

  • are generally Benzodiazepines

  • used short term and no longer than 4 to 6 weeks

  • does not cure anxiety but enables client to deal with situation
• ANXIOLYTIC DRUGS

  Benzodiazepines

  Diazepam (Valium) Fast 20-100 

  Alprazolam (Xanax) Intermediate 6-12

  Chlordiazepoxide (Librium) Intermediate 5-30

  Lorazepam (Ativan) Intermediate 10-20

  Clonazepam (Klonopin) Slow 18-50

  Oxazepam (Serax) Slow 4-15
• SIDE EFFECTS OF: BENZODIAZEPINES MEDS

  Dizziness, clumsiness, sedation, headache, fatigue, sexual dysfunction, blurred vision, dry throat and mouth, constipation, high potential for abuse and dependence
• NURSING IMPLICATIONS OF BENZODIAZEPINES MEDS

  Avoid other CNS depressants, such as antihistamines and alcohol. Avoid caffeine. Take care with potentially hazardous activities such as driving. Rise slowly from lying or sitting position. Use sugar-free beverages or hard candy. Drink adequate fluids. Take only as prescribed Do not stop taking the drug abruptly.
• NURSING IMPLICATIONS OF BENZODIAZEPINES MEDS

  Avoid other CNS depressants, such as antihistamines and alcohol. Avoid caffeine. Take care with potentially hazardous activities such as driving. Rise slowly from lying or sitting position. Use sugar-free beverages or hard candy. Drink adequate fluids. Take only as prescribed Do not stop taking the drug abruptly.
• Nonbenzodiazepines:

  Buspirone (BuSpar) Very slow

  Meprobamate (Miltown, Equanil) Rapid
• SIDE EFFECTS OF NONBENZODIAZEPINES MEDS

  Dizziness, restlessness, agitation, drowsiness, headache, weakness, nausea, vomiting, paradoxical excitement or euphoria
• NURSING IMPLICATIONS IN NONBENZODIAZEPINES MEDS

  Rise slowly from sitting position. Take care with potentially hazardous activities such as driving Take with food. Report persistent restlessness, agitation, excitement, or euphoria to physician.
• Anxiety disorders

  • 1 in 13 globally suffers from anxiety. The WHO reports that anxiety disorders are the most common mental disorders worldwide with specific phobia, major depressive disorder and social phobia being the most common anxiety disorders.
• Anxiety disorders

  • selective mutism observed in children

  • can be related to substance abuse or a medical condition (CHF, COPD)

  • medication and anxiety management techniques are required to treat disorder
• ETIOLOGY

  1. Biologic theories •Genetic theories: High and Moderate Heritability's •Neurochemical theories: GABA and Serotonin B.
  2. Psychodynamic •Psychoanalytic theories : Overuse of one or two Defense mechanisms • Interpersonal theories: Harry Stack Sullivan •Behavioral theory: anxiety as being learned through experiences
• Anxiety disorders: treatment

  Combination of medication and therapy

  Cognitive-Behavioral therapy

  • Positive reframing: Negative to Positive

  • Decatastrophizing

  • Assertiveness training: “I” statements
• Mental health promotion

  Look out for warning signs of anxiety and make changes
• Tips in managing stress / anxiety:

  • Keeping a positive attitude and believe in yourself

  • Accept events that are out of your control

  • Communicate assertively: talk about feelings

  • Relaxation techniques

  • Regular exercise

  • Well-balance diet

  • Enough sleep and rests

  • Set realistic goals and expectations

  • Learn stress management techniques, such as relaxation, guided imagery, and meditation; practice them as part of your daily routine.
• Types of ANXIETY DISORDERS

  • Panic disorders

  • Specific phobia

  • Agoraphobia

  •Social anxiety disorder (social phobia) •Generalized anxiety disorder
• Panic disorder

  • Recurrent, unexpected panic attacks followed by at least a month of persistent concern / worry

  • Composed of discreet episodes of Panic Attack
• Panic disorder

  Person has overwhelmingly intense anxiety and displays four or more of the following symptoms:

  Palpitations

  Nausea

  Sweating

  Abdominal distress

  Tremors

  Dizziness

  Shortness of breath

  Paresthesias

  Sense of suffocation

  Chills, or hot flashes Chest pain
• Clinical course

  • Prevalent in new graduates or single

  • May be suicidal

  • Occurs in late adolescence and mid-30s

  •Avoidance behavior
• Panic Disorder + Agoraphobia = Panic Attack