ANXIETY-RELATED DISORDERS

Anxiety
- Existence of stressors perceived as life threatening or something negative.
- A vague feeling of dread or apprehension rises from a response to external or internal
stimuli (behavioral, emotional, cognitive, physical).
- Decrease in Gamma Amino Butyric Acid (GABA).
- Alert the person, protect the self from threat to mental security.
- Motivating defensive behaviors consciously or unconsciously aimed to reduce or
alleviate anxiety’s associated discomfort.

Predisposing factors (anxiety)

- Psychoanalytic view (Freud): the threat between id, ego, superego
o Primary anxiety: developmental stage
o Subsequent anxiety: related to different situations to everyday life
- Interpersonal view (Sullivan)
- Behavioral view
o Frustrations
o Conflict
- Family studies: genetics
- Biological studies: GABA
LEVELS OF ANXIETY
- Anticipatory anxiety
o Stressor/ event does not yet happen. But knows it might happen.
1. Mild anxiety
o Normal
o Sensation that something is different and warrants special attention
o Increase in sensory stimulation (alert, sees, hears, and grasps)
o Normal person – motivating forces to strive, produce growth and creativity
o Open sphere of awareness
o Example: cramming
o Best time where learning takes place
2. Moderate anxiety
o Considerably abnormal
o Disturbing feeling that something is definitely wrong
o Focuses only on immediate concern – narrowing of perceptual field
o Irritable, cannot concentrate
o Decrease in hear, sees, grasps of what is going on outside the sphere of
awareness
 o Can be directed through intervention of another individual
o Example: walking back and forth, staring at space

3. Severe anxiety
o Abnormal, free-floating anxiety (it depends on the situation)
o Hyphened feeling impending doom
 o Involuntary s/ sx
o Perceptual field is greatly reduced with scattered focus
o Behaviors are aimed to relieve anxiety
o Cannot function effectively

4. Panic
o Highest level leading to irrational behavior
 o Involuntary actions
o Emotional-psychomotor realm predominates with accompanying fight, flight or
freeze response
o Disorganized behavior (unable to do things even with direction of another)

TRIAD OF PSYCHOTIC vs NUEROTIC (3Ds of Psychosis):

- Dereism (fantasy)
- Disorganized personality
- Distorted reality
ANXIETY DISORDERS
- Feelings of fear and discomfort that is associate with stimulus
- An unresolved anxiety may become a pathologic anxiety disorder
- GAD, Panic disorder, Phobia, Obsessive compulsive, PTSD, Dissociative disorders

GENERALIZED ANXIETY DISORDER (GAD)

- Excessive chronic moderate anxiety and worry occurring at least 6 months (at least 50%
of the time)
- “excessive worrying”

CAUSES
- Assessment
o Abnormal levels of GABA, serotonin, and norepinephrine in the limbic system
(has something to do with memory), (limbic system is situated inside the
structure from the right and left hemisphere where corpus callosum is).
Interrelated to hypothalamus, thalamus, hippocampus, amygdala, striatal areas,
substantia nigra
o Condition co-exists with other psychopathologies (major depression, panic)
o More common to people with poor stress tolerance and ineffective coping
o Women > man

SIGNS AND SYMPTOMS

- At least three or more of the following:
o Uneasiness
o Irritability
o Muscle tension
o Fatigue
o Difficulty concentrating/ thinking
o Sleep alterations

PANIC DISORDER
- Uncontrollable reaction to stressor leading to panic attacks
- 15-30 minutes rapid, intense, escalating anxiety followed by at least 1 month of
persistent worry
CAUSES
- Assessment
o Lactate response (by product of sodium lactate) – 80% of patients have
sensitivity to lactate = panic attack
o Suffocation alarm theory – (+) hyperventilation interpreted by brain as sign of
suffocation and throwing the survival instinct into play
o Classical conditioning – catastrophic experiences (stimulus) = panic reaction

Types:
A. Panic with Agoraphobia
o Agoraphobia – fear of place where in there is a difficulty of a person to escape,
correlated to crowded places
B. Panic without Agoraphobia

SIGNS AND SYMPTOMS

- At least four or more of the following:
o Palpitations
o Sweating
o Tremors
o Shortness of breath (suffocation)
o Chest pain
o Nausea
o Abdominal distress
o Distress
o Paresthesia
 o Chills or hot flashes

PHOBIC DISORDER
- Illogical/ irrational, intense and persistent fear of a specific object or social situation
causing extreme distress and interferes with normal functioning
- Extreme but unreasonable fear over specific and attributable causes
- Irrational fear, fear without a definite cause

- behavioral in nature

CAUSES
- Assessment
o Genetics
o Classical conditioning – (+) traumatic experience = association to object stimulus
= phobia

Three Categories
A. Agoraphobia – places which is hard to escape
B. Specific phobia – particular object or a situation (example: height, snake, etc.)
C. Social phobia – social or performance situation (example: fear of public speaking)

Examples:
- Ablutophobia – washing/ bathing
- Claustrophobia – enclosed places
- Erythrophobia – red
- Gynophobia – women
- Androphobia – men
 - Xenophobia – strangers
- Alektorophobia – chicken/ poultry
- Photophobia – light
- Cacophobia – ugly
- Haptephobia – touch
- Ombrophobia – rain
- Pyrophobia – fire
- Thanatophobia – death
- Tokophobia – pregnancy
- Arachnophobia – spiders

SIGNS AND SYMPTOMS

- Exposure to definite object, person, or place which fear is associated with
- Avoids identified causes
- Irrationality of fear
- Inability to control fear
- Exposure leads to panic and anxiety attack

MANAGEMENT
- Behavioral therapy
o Flooding (exposure to stimulus)
o Systematic desensitization (gradual exposure)
- With relaxation response

OBSESSIVE-COMPULSIVE DISORDER
- OCD
- Characterized by two factors: obsession, compulsion
o Feelings of compelling urges (obsession) to perform an act and perform it
repeatedly (compulsion) that disrupts ADL’s
- Disrupts daily living (OCD), does not disrupts (OCPD)
- OBSESSION: current persistent, intrusive, and unwanted thoughts, images, or impulses.
Known excessive/ unreasonable thoughts with no control
- COMPULSION: ritualistic or repetitive behaviors to attempt to neutralize anxiety
CAUSES
- Assessment
o Serotonin sensitivity
o Striatum malfunction theory
o Genetics
o Personality formation

SIGNS AND SYMPTMOS

- Obsession
o Safety
o Freedom from microbes
o Sexual urges
o Aggression
o Horrible aggression
- Compulsion
o Checkers
o Washers and cleaners
o Orderers, counters, arrangers
o Hoarders
o Violent thoughts
o Doubt and sinner – afraid of punishments

MANAGEMENT
- Cognitive behavioral therapy
o Exposure/ flooding (confronting)
 o Response prevention (delaying/ avoiding rituals): diversional activities
- With relaxation response

POST-TRAUMATIC STRESS DISORDER (PTSD)

- Disturbing pattern of behavior who has experienced, witnessed, or confronted a
traumatic event

CRITERIA
- At least two or more of the following:
o Experience a traumatic event that involved actual or threatened death or serious
injury
o Traumatic event is re-experienced in mind with intense fear, horror, or
helplessness
o Persistent avoidance of stimuli
o Persistent symptom of increased arousal
o Duration of disturbance: >1 month
o Disturbance causes distress and dysfunction (negative cognition or thoughts)

CAUSES
- Assessment
o Experience of severe trauma
o History of psychopathologies such as depression, anxiety

SIGNS AND SYMPTOMS

- Flashback – reminded of traumatic experience while awake
- Nightmares – suddenly wakes up from a bad dream r/ t traumatic experience
 - Guilt and anger
- Substance abuse in attempt to forget traumatic memory

MANAGEMENT
- Cognitive behavioral therapy
o Counseling therapy
o Self-help groups
o Exposure therapy – avoidance behavior by confrontation
o Adaptive disclosure – exposure therapy + empty chair technique (say anything)
o Cognitive processing therapy – examines beliefs that interfere with ADLs

DISSOCIATIVE DISORDERS
- “depersonalization disorder”
- “acute stress disorder”
- DISSOCIATION: subconscious defense mechanisms that helps a person protect his
emotional self from traumatic event
- Detachment from reality to escape the painful truth/ event

CAUSES
- Assessment
o Trauma – “splitting off”
o Abuse
o Gender: 3-9x women > men

SIGNS AND SYMPTOMS

- Dissociative amnesia: sudden inability to recall personal infection, thought process
disturbance
- Dissociative fugue: sudden unexpected flight from home, forgetting the past and
assumes new identity
- Dissociative identity (multiple personality disorder): two or more distinct identities or
personalities, interchanging
- Depersonalization: persistent, recurrent detachment from own mind/ body or being in a
foggy dream-like state (derealization)

DIAGNOSIS (Anxiety disorders)

- Moderate to panic anxiety
- Ineffective individual coping
- Low self-esteem
- Powerlessness
- Alteration in role performance
- Self-care deficit
- Sleep disturbance
- Risk for injury
INTERVENTIONS (Anxiety disorders)
Nursing Interventions
- Establish a trusting NP relationship
- Self-awareness/ insight into anxiety
- Emotional catharsis
- Safety/ protection of patients
- Modify environment (external control)
- Encourage activity
- Encourage relaxation techniques
- Attitude therapy
- Therapies: psychotherapy
Pharmacologic
- Anxiolytics: 4 to 6 weeks only (short term)
- Antidepressants (long term)
- Cardiovascular medications
o Clonidine (Catapres) – beta blocker
o Propranolol (Inderal) – alpha adrenergic agonist