Anxiety Disorders
AB SALGADO
A.Anxiety. A state of apprehension, dread, uneasiness, or uncertainty generated by a real or perceived threat whose actual source is unidentifiable
1. Anxiety is an emotional, subjective response a. Anxiety is commonly experienced by all human beings b. Anxiety involves feelings of apprehension, worry, uneasiness or dread
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The Fear and Anxiety Response Patterns
Fear Panic Anxiety Anxiety Disorder
The Bell Curve
An Important Law- The Yerkes Dodson Law
Another Bell CurveCourtesy of Our Good Buddies Yerkes-Dodsen
B. Anxiety can be a healthy adaptive reaction when it alerts the person to impending threats C.Anxiety is considered pathological when it is disproportionate to the risk, continues after the threat is no longer existing. D. 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
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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
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4. Panic
Associated with dread and terror
Details are blown out of proportion, the personality is disorganized, and the person is unable to function
Physiological arousal interferes with more activities
Overwhelming emotions caused regression to primitive or childish behaviors
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F. Anxiety is related to how a person appraises
stressors 1. Events may be appraised as beneficial, benign or stressful 2. Primary appraisal is used to evaluate personal and environmental; factors or events 3. Secondary appraisal is used to determine how to cope with the anxiety generated by a stressful event.
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Anxiety as a Normal and an Abnormal Response
Some amount of anxiety is normal and is associated with optimal levels of functioning.
Only when anxiety begins to interfere with social or occupational functioning is it considered abnormal.
Phobic Disorders
1. 2. 3. Phobias Specific phobias Social phobia Agoraphobia
Specific Phobias
Specific Phobias
Psychosocial causal factors Genetic and temperamental causal factors Preparedness and the nonrandom distribution of fears and phobias Treating specific phobias
Social Phobia
General characteristics Fear of being in social situations in which one will be embarrassed or humiliated
Social Phobia
Interaction of psychosocial and biological causal factors
Social phobias as learned behavior Social fears and phobias in an evolutionary context Preparedness and social phobia
Social Phobia
Interaction of psychosocial and biological causal factors
Genetic and temperamental factors Perceptions of uncontrollability Cognitive variables
Panic Disorder With and Without Agoraphobia
Panic disorder Panic versus anxiety Agoraphobia Agoraphobia without panic
Panic Disorder
Prevalence and age of onset Comorbidity with other disorders Biological causal factors The role of Norepinephrine and Serotonin
Panic and the Brain
Panic Disorder
Genetic factors Cognitive and behavioral causal factors Interoceptive fears
Panic Disorder: The Cognitive Theory of Panic
Panic Disorder: The Cognitive Theory of Panic
Perceived control and safety Anxiety sensitivity as a vulnerability factor for panic Safety behaviors and the persistence of panic Cognitive biases and the maintenance of panic
Treating Panic Disorder and Agoraphobia
Medications Behavioral and cognitive-behavioral treatments
Generalized Anxiety Disorder
General characteristics Prevalence and age of onset Comorbidity with other disorders
Generalized Anxiety Disorder: Psychosocial Causal Factors
The psychoanalytic viewpoint Classical conditioning to many stimuli The role of unpredictable and uncontrollable events A sense of mastery: immunizing against anxiety
Generalized Anxiety Disorder: Biological Causal Factors
Genetic factors A functional deficiency of GABA Neurobiological differences between anxiety and panic
Obsessive-Compulsive Disorder
Obsessions- repetitive unwanted ideas that the person recognizes are irrational Compulsions- repetitive, often ritualized behavior whose behavior serves to diminish anxiety caused by obsessions
Obsessive-Compulsive Disorder
Prevalence and age of onset Characteristics of OCD Types of compulsions Comorbidity with other disorders
Obsessive-Compulsive Disorder: Psychosocial Causal Factors
Psychoanalytic viewpoint Behavioral viewpoint The role of memory Attempting to suppress obsessive thoughts
Obsessive-Compulsive Disorder: Biological Causal Factors
Genetic influences Abnormalities in brain function The role of serotonin
Post-Traumatic Stress Disorder
Critical Component
Symptoms occurs AFTER a traumatic stressor
Symptoms Categories
Intrusive
distressing recollections dreams flashbacks psychological trigger reactions physiological trigger reactions
Symptoms Categories
Avoidance
avoid thoughts, feelings or discussions avoid activities, places memory blocks anhedonia (without pleasure) numb alexithymia (emotions unknown) feeling of doom
Symptom Categories
Hyperarousal Symptoms
sleep disturbance anger problems concentration startle response on guard hypervigilence
Diagnoses
Acute Stress Disorder
new to DSM-IV (1994) symptoms 2 days to 4 weeks following traumatic event
PTSD
new to DSM-III (1980) symptoms beyond 4 weeks delayed onset
Who Is Vulnerable?
All ages Both genders Across Cultures and ethnic groups
Employment
60 50 40 30 20 10 0 Employed Umemployed Frequency
Depression
35 30 25 20 15 10 5 0 Total Group Severe PTSD Moderate PTSD Enter Exit
Types of Traumas
Natural
earthquakes floods fires
Human induces
war crimes of violence
Co-Morbid Diagnoses
Alcoholism
75% for Vietnam Veterans with PTSD
Depression
77% of firefighters with PTSD also have depression
Generalized Anxiety Panic Attacks
IV. Nursing Dx / Analysis A. Anxiety (panic) RELATED TO SITUATIONAL OR MATURATIONAL CRISS
B. Fear related to phobic stimulus
C. Ineffective individual ritualistic behaviors coping pattern related to
D. Powerlessness related to lifestyle of helplessness
E. Social isolation related to panic level of anxiety
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V. Planning and Implementation A. Coping Strategies B. Psychopharmacology
C. Individual and Group Therapy
D. Behavior Modification
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VI. Evaluation/Outcomes A. Complete remission of symptoms B. Evaluation should focus on changes
C. Standardized rating scale
D. Logging of daily experiences
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