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Transcript
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 • • • • 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 • • • • • • • • • 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 • • • • • 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) • • • • • • • • • 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 - Restlessness (Agitation). Physical tension. Tremors. Rapid speech. Lack of co-ordination. Accident proneness. - 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 • • • • • • • • • 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 • • • • • 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 tasting concentrated quinine and sugar solutions". J. 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.