Chapter 10:
Anxiety and Anxiety
Disorders
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Anxiety
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Function to warn of impending threat, conflict,
or danger
State of tension, dread, or impending doom
External influences of threat
Subjective
No identifiable object
Exists on a continuum
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When person receives danger
signal….
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Fleeing
Controlling dangerous impulses
Freeze, do not act
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Defense Mechanisms
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Primary method the ego uses to manage
anxiety
Unconscious
Protect ego
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Defense Mechanisms, cont’d
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Humor
Sublimation
Suppression
Displacement
Dissociation
Repression
Devaluation
Denial
Projection
Splitting of self or image of others
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Stages of Anxiety
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Mild
Moderate
Severe
Panic
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Clinical Presentations
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Panic attack
Panic disorder
Phobias
Agoraphobia
Social phobia
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Posttraumatic stress
disorder
Acute stress
disorder
Generalized anxiety
disorder
Obsessive
compulsive disorder
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Humanistic Nursing Theory
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Basis: Existential theory, phenomenologic
method
An interactive process:
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The client calls; the nurse responds.
The nurse is a participant, fully available to the
client.
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Additional Treatment Modalities
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Biologic
Interventions
Pharmacologic
Interventions
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Psychotherapy
Behavioral therapy
Cognitive behavioral
therapy
Psychologic first aid
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Etiologic Models for Anxiety
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Biologic
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Genetic
Psychosocial
Psychodynamic
Social theories
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Epidemiology
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Prevalence
Age of onset
Cultural variance
Comorbidity
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Panic Attacks
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Sudden onset
Physical symptoms of anxiety
Dread/doom/fear of death
Occur with:
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Panic disorder
Social phobia
Simple phobia
Posttraumatic stress disorder (PTSD)
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Panic Disorder
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Recent unexpected panic attacks
Concern (1 month) about additional attacks
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Panic Disorder with Agoraphobia
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Anxiety about being where escape is difficult
Situations avoided/endured with anxiety
Not due to effects of a medical
condition/substance
Not better described by other mental disorder
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Specific Phobia
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Marked, persistent fear
Excessive and unreasonable
Cued by presence/anticipation of specific
object/situation
Avoided or endured with anxiety
Distressed about having the phobia
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Social Anxiety Disorder
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Marked, persistent fear of one or more social
or performance situations
Often exposes individual to scrutiny because
behavior may be embarrassing
Avoided or endured with anxiety
Treated with individual therapy and serotonin
selective reuptake inhibitors (SSRIs)
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Posttraumatic Stress Disorder
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Traumatic event preceding symptoms
Individual response: fear, horror,
helplessness
Client often re-experiences event
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Disturbing recollections
Feeling/acting as though event is reoccurring
Physiologic distress during reoccurrence
Physiologic reactivity to similar cues
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Posttraumatic Stress Disorder,
cont’d.
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Avoidance of stimuli associated with the trauma
Numbing of general responsiveness
Estrangement, detachment
Restricted affect
Symptoms of increased arousal
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Sleep disturbed
 Irritability
 Poor concentration
 Exaggerated startle response
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Acute Stress Disorder
Different from PTSD:
 Experiences these symptoms of dissociation:
numbing, detachment, dazed, derealization,
depersonalization, dissociative amnesia
 Shorter time frame of development
 Shorter duration of symptoms (2-30 days)
 Not able to pursue a necessary task
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Generalized Anxiety Disorder
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Excessive anxiety and worry
Occurring more days than not
At least 6 months duration
Presence of three of the following:
restlessness, edginess, fatigue, poor
concentration, irritability, muscle tension,
sleep disturbance
Anxiety and worry that interfere with normal
social and occupational functioning
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Obsessive Compulsive Disorder
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Obsessions
Compulsions
Cannot be suppressed/ignored
Recognized as unwanted/unreasonable
Interferes with normal functioning
Etiology: trauma to basal ganglia/cortical
connections
Treatment: SSRIs
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Assessment
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Eating and eliminating patterns
Tics, stuttering
Eye contact
Blushing
Affect related to roles/role problems in work,
finances, family, role strain
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Assessment, cont’d.
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Culture/values
Coping strategies
Physical disability/motor dysfunction
Mental status
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Orientation
 Memory
 Pain
 Fears
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Useful Nursing Diagnoses
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Anxiety
Ineffective coping
Interrupted family processes
Fatigue
Risk-prone health behavior
Risk for loneliness
Posttrauma syndrome
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Useful Nursing Diagnoses,
cont’d.
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Powerlessness
Rape-trauma syndrome
Ineffective role performance
Impaired memory
Chronic low self-esteem
Social isolation
Spiritual distress
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Outcomes
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Determined by client’s clinical manifestations
Clients will:
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Demonstrate effective coping skills
Identify increasing anxiety
Identify when to call therapist
Take medications as prescribed
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Planning
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Inpatient treatment being replaced by
outpatient treatment
Hospitalization: Client at risk for harm to self
or others
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Implementation
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Assess own level of anxiety.
Recognize use of relief behaviors.
Teach:
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To limit central nervous system (CNS) stimulants
To distinguish identifiable sources/
nonidentifiable anxiety-reducing strategies
Help build on familiar coping methods.
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Implementation, cont’d.
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Help identify support persons
Give brief, directive verbal interactions
Structure calm environment
Assess grief/depression/suicidal ideation
Teach about medication regimen
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Treatment Modalities
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Benzodiazepines
SSRIs
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Fluoxetine, fluvoxamine (OCD)
 Paroxetine (GAD, OCD, PTSD, social phobia,
panic disorder)
 Sertraline (OCD, panic disorder, PTSD)
 Venlafaxine (GAD)
 Clomipramine (body dysmorphic disorder)

ECT
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Treatment Modalities, cont’d.
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Psychotherapy
Behavioral therapy
Cognitive behavioral therapy
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31
Evaluation
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Measurable outcomes necessary
Rating scales
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Hamilton Anxiety Scale
Yale-Brown Obsessive-Compulsive Scale
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