Download Anxiety, Obsessive-Compulsive, and Related Disorders

Anxiety, ObsessiveCompulsive, and
Related Disorders
DR. ARNEL BANAGA SALGADO,
Ed.D., D.Sc., RN, MA, B.Sc, Cert .Ed, MAT (Psychology)
27
Chapter
of the
required textbook
5/4/2017
Learning Objectives
1.Identify the different levels of anxiety
2.List the different psychodynamic
factors that contribute to the
development of anxiety disorders.
3.Assess clients with anxiety disorders
4.Design a Nursing Care Plan
appropriate for clients with anxiety
disorders.
Anxiety Disorders
• Introduction
– Anxiety is an emotional response to
anticipation of danger, the source of
which is largely unknown or
unrecognized.
– Anxiety is a necessary force for survival.
It is not the same as stress or fear
(cognitive).
Historical Aspects
• Freud was the first to associate anxiety with
neurotic behaviors.
• For many years, anxiety disorders were
viewed as purely psychological or purely
biological in nature.
Epidemiological Statistics
• Anxiety disorders are the most common of
all psychiatric illnesses.
• They are more common in women than
men.
• Minority children and children from low
socioeconomic environments are at risk.
• A familial predisposition probably exists.
How Much Is Too Much?
• When anxiety is out of proportion to the
situation that is creating it
• When anxiety interferes
with social, occupational,
or other important
areas of functioning
Anxiety exists on a continuum
1. Mild
• Associated with the tension of everyday life
• The person is alert, the perceptual field is
increased, and learning is facilitated
• Physiological responses are within normal limits
• The effect is positive
www.arnels
2. Moderate
• Focus is on immediate concerns
• The perceptual field is narrowed
• Low-level sympathetic arousal occurs
• Tension and fear are experienced
3. Severe
• Focus is on specific details and behavior is
directed toward relieving anxiety
• The perceptual field is significantly reduced,
and learning cannot occur
• The SNS is aroused
• Severe emotional distressed is aroused
4. Panic Disorder
– Characterized by recurrent panic attacks the
onset of which is unpredictable and manifested
by intense apprehension, fear, or terror, often
associated with feelings of impending doom
and accompanied by intense physical
discomfort
– May or may not be accompanied by
agoraphobia.
Application of Nursing Process
• Symptoms of Panic Attack
– Sweating, trembling, shaking
– Shortness of breath, chest pain or discomfort
– Nausea or abdominal distress
– Dizziness, chills, or hot flashes
– Numbness or tingling sensations
– Derealization or depersonalization
– Fear of losing control or “going crazy”
– Fear of dying
Application of Nursing Process
• Generalized Anxiety Disorder
– Characterized by chronic, unrealistic, and
excessive anxiety and worry
Predisposing Factors
• Panic and Generalized Anxiety
Disorders
– Psychodynamic theory
• Ego unable to intervene
between id and superego
• Overuse or ineffective
use of ego defense
mechanisms results in
maladaptive responses
to anxiety.
S. Freud
Phobias
• Agoraphobia
– Fear of being in places or situations from which
escape might be difficult or in which help might not
be available in the event of panic-like symptoms or
other incapacitating symptoms
– Examples:
•
•
•
•
•
Traveling in public transportation
Being in open spaces
Being in shops, theaters, or cinemas
Standing in line or being in a crowd
Being outside of the home alone in other situations
Phobias (cont.)
• Social Anxiety Disorder (Social Phobia)
– Excessive fear of situations in which the
affected person might do something
embarrassing or be evaluated negatively by
others
Phobias (cont.)
• Specific Phobia
– Fear of specific objects or situations that
could conceivably cause harm but the
person’s reaction to them is excessive,
unreasonable, and inappropriate.
– Exposure to the phobic object produces
overwhelming symptoms of panic,
including palpitations, sweating, dizziness,
and difficulty breathing.
Phobias (cont.)
• Specific Phobia (cont.)
– Type specifiers
•
•
•
•
•
Animal
Natural environment type
Blood-injection-injury type
Situational type
Other type
Phobias (cont.)
• Predisposing Factors to Phobias
– Psychoanalytical theory:
Unconscious fears may
be expressed in a
symbolic manner as phobia.
S. Freud
Phobias (cont.)
• Life Experiences
– Early experiences may set the stage for
phobic reactions later in life.
Substance-Induced Anxiety Disorder
• May be associated with intoxication or
withdrawal from any of the following
substances:
– Alcohol, sedatives, hypnotics, or anxiolytics
– Amphetamines or cocaine
– Hallucinogens
– Caffeine
– Cannabis
– Others
Obsessive-Compulsive Disorder (OCD)
• Assessment Data
Recurrent obsessions or compulsions that
are severe enough to be time-consuming or
to cause marked distress or significant
impairment
Obsessive-Compulsive Disorder (OCD)
(cont.)
• Obsessions
Recurrent thoughts, impulses, or images
experienced as intrusive and stressful, and
unable to be expunged by logic or reasoning
Obsessive-Compulsive Disorder (OCD)
(cont.)
• Compulsions
Repetitive ritualistic behavior or thoughts,
the purpose of which is to prevent or reduce
distress or to prevent some dreaded event or
situation.
Body Dysmorphic Disorder
• Assessment
– Characterized by the exaggerated belief
that the body is deformed or defective in
some specific way
– If true defect is present, the person’s
concern is unrealistically exaggerated and
grossly excessive.
– Symptoms of depression and obsessivecompulsive personality are common.
Trichotillomania (Hair-Pulling Disorder)
• Assessment
– The recurrent pulling out of one’s own hair
that results in noticeable hair loss.
– Preceded by increasing tension and results
in sense of release or gratification
– The disorder is not common but occurs
more often in women than in men.
Hoarding Disorder
• Assessment
– There is persistent difficulty discarding or
parting with possessions, regardless of their
actual value.
– When there is a need for continual acquiring
of items, the symptom is identified by the
DSM-5 as “with excessive acquisition.”
– Virtually all surfaces within the home are
covered with clutter.
Predisposing Factors to OCD and
Related Disorders
–Psychoanalytic Theory
• Clients with OCD have weak,
underdeveloped egos.
• Aggressive impulses are
channeled into thoughts
and behaviors that prevent
the feelings of aggression
from surfacing and producing
intense anxiety fraught with
guilt.
S. Freud
Diagnosis/Outcome Identification
• Nursing diagnoses commonly associated with
anxiety, OCD, and related disorders:
– Panic anxiety (panic disorder and GAD)
– Powerlessness (panic disorder and GAD)
– Fear (phobias)
– Social isolation (agoraphobia)
Diagnosis/Outcome Identification
(cont.)
• Ineffective coping (OCD)
• Ineffective role performance (OCD)
• Disturbed body image (body dysmorphic
disorder)
• Ineffective impulse control (trichotillomania)
Outcomes
• The Client:
– Is able to recognize signs of escalating
anxiety and intervene before reaching panic
level (panic and GAD)
– Is able to maintain anxiety at a manageable
level and make independent decisions
about life situations (panic and GAD)
Outcomes (cont.)
• The Client:
– Functions adaptively in the presence of the
phobic object or situation without
experiencing panic anxiety (phobic
disorder)
– Verbalizes a future plan of action for
responding in the presence of the phobic
object or situation without developing
panic anxiety (phobic disorder)
Outcomes (cont.)
• The Client:
– Is able to maintain anxiety at a manageable
level without resorting to the use of
ritualistic behavior (OCD)
– Demonstrates more adaptive coping
strategies for dealing with anxiety than
ritualistic behaviors (OCD)
Outcomes (cont.)
• The Client:
– Verbalizes a realistic perception of his or
her appearance and expresses feelings
that reflect a positive body image (body
dysmorphic disorder)
– Verbalizes and demonstrates more
adaptive strategies for coping with
stressful situations (trichotillomania)
Planning/Implementation
• Interventions for individuals experiencing
panic disorder or GAD are aimed at:
– Relief of acute panic symptoms
– Helping the client to take control of his or
her own life situation and accept those
situations over which he or she has no
control
Planning/Implementation (cont.)
– Nursing interventions for the client
with phobias are aimed at:
• Decreasing the fear and increasing the
ability to function in the presence of the
phobic stimulus or situation without
experiencing panic anxiety
Treatment Modalities
• Individual Psychotherapy
• Cognitive Therapy
• Behavior Therapy
– Systematic desensitization
– Implosion therapy