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Anxiety Disorders Nursing 201 Introduction – Anxiety provides the motivation for achievement, a necessary force for survival. – Anxiety is often used interchangeably with the word stress; however, they are not the same. – Anxiety may be differentiated from fear in that the former is an emotional process, whereas fear is cognitive. Epidemiological statistics – Anxiety disorders are the most common of all psychiatric illnesses – More common in women than men – Minority children and children from low socioeconomic environments 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. Assessment • Panic disorder • Generalized anxiety disorder • Panic disorder with agoraphobia Predisposing Factors • Psychodynamic theory • Cognitive Theory • Biological aspects • Transactional Model of Stress Adaptation Nursing Process • • • • • Assessment Nursing Diagnosis Planning/Implementation Outcomes Evaluation Phobias Assessment • Agoraphobia without history of panic disorder – Fear of being in places or situations from which escape might be difficult or in which help might not be available if a limitedsymptom attack or panic-like symptoms should occur • Social phobia – Excessive fear of situations in which the affected person might do something embarrassing or be evaluated negatively by other • Specific phobia – Marked, persistent, and excessive or unreasonable fear when in the presence of, or when anticipating an encounter with, a specific object or situation, Animal type, Natural environment type, Bloodinjection-injury type, Situational type Nursing Process • • • • • • Assessment Nursing Diagnosis Planning/Implementation Outcomes Evaluation Client/Family Education Obsessive-Compulsive Disorder (OCD) • Obsessions: Unwanted, intrusive, persistent ideas, thoughts, impulses, or images that cause marked anxiety or distress • Compulsions: Unwanted repetitive behavior patterns or mental acts that are intended to reduce anxiety, not to provide pleasure or gratification Nursing Process • • • • • • Assessment Nursing Diagnosis Planning/Implementation Outcomes Evaluation Client/Family Education Post-traumatic Stress Disorder (PTSD) – Development of characteristic symptoms following exposure to an extreme traumatic stressor involving a personal threat to physical integrity or to the physical integrity of others – Characteristic symptoms include reexperiencing the traumatic event, a sustained high level of anxiety or arousal, or a general numbing of responsiveness. Intrusive recollections or nightmares of the event are common. • Psychosocial theory – The traumatic experience • • • • • • Severity and duration of the stressor Extent of anticipatory preparation before onset Exposure to death Numbers affected by life threat Extent of control over recurrence Location where trauma was experienced – The individual • Degree of ego-strength • Effectiveness of coping resources • Presence of preexisting psychopathology – Outcomes of previous experiences with stress/trauma – Behavioral tendencies – Current psychosocial developmental stage – Demographic factors – The recovery environment • • • • Availability of social supports Cohesiveness and protectiveness of family and friends Attitudes of society regarding the experience Cultural and subcultural influences • Learning theory – Negative reinforcement as behavior that leads to a reduction in an aversive experience, thereby reinforcing and resulting in repetition of the behavior – Avoidance behaviors – Psychic numbing • Cognitive theory – A person is vulnerable to post-traumatic stress disorder when fundamental beliefs are invalidated by experiencing trauma that cannot be comprehended and when a sense of helplessness and hopelessness prevails. • Biological aspects – It has been suggested that a person who has experienced previous trauma is more likely to develop symptoms after a stressful life event. – Disregulation of the opioid, glutamatergic, noradrenergic, serotonergic, and neuroendocrine pathways may be involved in the pathophysiology of PTSD. • Transactional Model of Stress Adaptation – The etiology of PTSD is most likely influenced by multiple factors Nursing Process • • • • • • Assessment Nursing Diagnosis Planning/Implementation Outcomes Evaluation Client/Family Education Treatment Modalities • Psychopharmacology – PTSD • Antidepressants • Anxiolytics • Antihypertensives • Others