Download Anxiety Disorders

King Saud University
College of nursing
Psychiatric nursing department
Course No.
521
Master program
Under supervision by \
Prepared by \
At the end of the session the student will be
able to :
• Distinguish anxiety versus fear.
• Differentiate between normal & psychoneurotic
anxiety.
• Illustrate causes of anxiety.
• Discuss level of anxiety
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Compare manifestations of anxiety.
Formulate nursing diagnoses and outcome
Criteria for clients with anxiety.
Applied nursing management for
Patient's suffering from anxiety.
• Evaluate nursing care of clients with
anxiety
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Definition of anxiety.
Theories of anxiety
Normal versus abnormal anxiety.
Psychodynamics of anxiety.
Causes of anxiety.
Manifestation of anxiety.
Types of anxiety
Levels of anxiety.
Nursing intervention
Individuals face anxiety
on a daily basis.
Anxiety, which
provides the motivation
for achievement, is a
necessary force for
survival.
If we feel absolutely no anxiety, we might
be poorly motivated to study, to work
out difficulties, to look for solutions to
the problems that cause anxiety.
The term anxiety is often used
interchangeably with the word stress;
however, they are not the same.
Freud first introduced the term anxiety
neurosis in 1895.
Freud wrote, “I call this syndrome ‘anxiety
neurosis’ because all its components can
be grouped round the chief symptom of
anxiety” (Freud, 1959)
• This notion attempted to negate the
previous concept of the problem as
strictly physical, although it was so
many times before physicians of
internal medicine were ready to accept
the psychological implications for the
symptoms.
• A state of apprehension, uncertainty or
fear, resulting from the anticipation of
a realistic or imaginary threatening
event or situation.
• May have emotional, behavioural,
cognitive and physical components
Anxiety
Fear
Emotional process
Cognitive process
Response
to
a objective
subjective
Threat-external
or internal danger
danger- (e.g. fear of
dogs)
Involves
the involves
the
emotional response
intellectual appraisal
to
intellectual
appraisal
Which you & I would call fear.
Actually Freud did, too, in German. But
his translators thought "fear" too
mundane! Nevertheless, if I throw
you into a pit of poisonous snakes,
you might experience realistic
anxiety.
This is what we feel when the threat
comes not from the outer, physical
world, but from the internalized
social world of the superego.
It is, in fact, just another word for
feelings like shame and guilt and the
fear of punishment.
.
This is the fear of being overwhelmed by impulses
from the Id.
If you have ever felt like you were about to "lose
it," lose control, your temper, your rationality,
or even your mind, you have felt neurotic
anxiety.
Neurotic is actually the Latin word for nervous,
so this is nervous anxiety.
The psychodynamic view focuses
on the inability of the ego to
intervene when conflict occurs
between the Id and the
superego, producing anxiety.
The main thesis of the cognitive view is
that faulty, distorted, or
counterproductive thinking patterns
accompany or precede maladaptive
behaviors and emotional disorders
(Sadock & Sadock, 2003).
Modern theory on the physiology of
emotional states places the key in the
lower brain centers, including the
limbic system, the diencephalons
(thalamus and hypothalamus), and the
reticular formation.
Abnormal elevations of blood lactate have
been noted in clients with anxiety.
Likewise, infusion of sodium lactate into
clients with anxiety neuroses produced
symptoms of anxiety.
Stronger evidence exists for the involvement
of the neurotransmitter norepinephrine in the
etiology of anxiety (Daniels & Yerkes, 2006).
Structural brain imaging studies in
patients with panic disorder have
implicated pathological involvement in
the temporal lobes, particularly the
hippocampus (Sadock & Sadock,
2003).
Norepinephrine is known to mediate arousal,
and it causes hyperarousal and anxiety.
This fact has been demonstrated by a
notable increase in anxiety following
the administration of drugs that increase
the synaptic availability of
norepinephrine, such as yohimbine
Other causes are
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Threat to biological integrity
Unmet expectation
Unmet needs
Anticipated disapproval
Inability to gain self-respect, or
recognition by others
• Guilt, or discrepancy between selfview and actual behavior
1-State anxiety (acute)
2-Trait anxiety (chronic)
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Effects of sympathetic stimulation
Mediated through noradrenaline and adrenaline
Increased heart rate and contractility
Increased respiratory rate
Sweating
Increased glucose availability
Shunting of blood to muscles
Increased muscle tension
Enhanced blood clotting
-Urinary frequency.
-Diarrhea.
-Blood pressure.
-Heart rate.
- Dry mouth
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Restlessness (Agitation).
Physical tension.
Tremors.
Rapid speech.
Lack of co-ordination.
Accident proneness.
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Impaired attention.
Poor concentration.
Forgetfulness.
Poor judgment.
Preoccupation.
Blocking of thought.
Decreased perceptual field.
Reduced creativity.
Diminished productivity.
Confusion.
Items
Physiological
Cognitive
- Emotional
Mild
Tension of need
motivate behavior.
Attentive, alert,
perceptive to a variety
of stimuli
No intense feeling
Moderate Severe
Some symptoms may
present
Perceptual field narrows,
but respond to directions,
Selective inattention.
Problem solving limited
with directions & support.
- Impatient , irritable
Panic
Self concept
threatened sense of
helplessness.
Severe symptoms
of exhaustion
Selective
inattention
Perceptual field
narrows, unable
to follow
directions or
remember main
points
Unable to plan or
make decisionStimuli
distortedlearning and
problem solving
ineffective
Self concept
threatened, sense
of helplessness.
-Sensory ability
and attention
reduced so that
only objects of
anxiety noticed.
- Self-concept
overwhelmed
Severe symptoms
of exhaustion
Items
Physiological
Cognitive
- Emotional
Mild
Tension of need
motivate behavior.
Attentive, alert,
perceptive to a variety
of stimuli
No intense feeling
Moderate Severe
Some symptoms may
present
Perceptual field narrows,
but respond to directions,
Selective inattention.
Problem solving limited
with directions & support.
- Impatient , irritable
Panic
Self concept
threatened sense of
helplessness.
Severe symptoms
of exhaustion
Selective
inattention
Perceptual field
narrows, unable
to follow
directions or
remember main
points
Unable to plan or
make decisionStimuli
distortedlearning and
problem solving
ineffective
Self concept
threatened, sense
of helplessness.
-Sensory ability
and attention
reduced so that
only objects of
anxiety noticed.
- Self-concept
overwhelmed
Severe symptoms
of exhaustion
I must not get anxious!
Imagine you got wired up to a special polygraph machine
that measures anxiety. You are told that, if you get too
anxious, you will be shot. What will happen?
Illustration taken from http://www.acceptanceandcommitmenttherapy.com/resources/VisualAids.html
Try putting your fingers into both ends of the
Chinese finger trap. What happens? How can you
best get your fingers out? Can you see any parallel
with your psychological experience?
Illustration taken from http://www.acceptanceandcommitmenttherapy.com/resources/VisualAids.html
NURSING DIAGNOSIS: PANIC ANXIETY
RELATED TO: Real or perceived threat to biological integrity or self-concept
EVIDENCED BY: Any or all of the physical symptoms identified by the DSM-IV-TR
NURSING DIAGNOSIS: POWERLESSNESS
RELATED TO: Impaired cognition
EVIDENCED BY: Verbal expressions of no control over life situation
and nonparticipation in
decision-making related to own care or life situation.
Behavioural therapy
- Relaxation techniques
Cognitive behaviour therapy
- Education
- Recognition and change of negative
thoughts
Conclusion
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Fear is normal and healthy
Anxiety develops very naturally
Not all anxiety is bad or unproductive
Many anxieties would extinguish naturally
Escape and avoidance play a crucial role here
Problems develop when it appears that
anxiety prevents us from functioning
May be the case that anxiety is not nearly the
culprit that avoidance appears to be
Reference
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Seligman, M.E.P., Walker, E.F. & Rosenhan, D.L. (2001). Abnormal
psychology, (4th ed.) New York: W.W. Norton & Company, Inc
Zald, D.H.; Hagen, M.C. & Pardo, J.V. (2002). "Neural correlates of
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Neurophysiology 87 (2): 1068-75.
Ernst E. (2002). "The risk-benefit profile of commonly used herbal
therapies: Ginkgo, St. John's Wort, Ginseng, Echinacea, Saw
Palmetto, and Kava". Ann Intern Med. 136 (1): 42-53.
Bisson J, Andrew M. Psychological treatment of post-traumatic
stress disorder (PTSD). Cochrane Database Syst Rev. 2005.
Connolly SD, Bernstein GA,. Practice parameter for the
assessment and treatment of children and adolescents with
anxiety disorders. J Am Acad Child Adolesc
Psychiatry. Feb 2007;46(2):267-83.