Ncm117 Anxiety Trans

Psychiatric Nursing
NCM 117/ LECTURE/ ANXIETY / PPT BASED FROM PROF. ROLANDO FAUSTO
ANXIETY
➢ Anxiety Behaviours
• Avoiding people or places
• Not going out
• Going to certain places at certain times, e.g.
shopping at smaller shops, at less busy times
• Only going with someone else
• Escape, leave early
➢ Safety Behaviours:
• Go to the feared situation, but use coping
behaviours to get you through, such as:
holding a drink, smoking more, fiddling
with clothes or handbag, avoiding eye
contact with others, having an escape
plan, taking medication. THE VISCIOUS CYCLE OF ANXIETY
➢ Safety behaviours can also help to keep your
anxiety going.
CALLISTA STYLES 1
Psychiatric Nursing
BREATHING
➢ Breathing exercises take only a few seconds, no
matter where you are.
TIPS TO HELP YOU COPE ➢ It is particularly helpful at stressful times, and also
➢ Remember Anxiety is something we all practise it at regular intervals throughout the day.
experience to varying degrees and is something ➢ When learning the techniques it is a good idea to
you can learn to cope with once you have the try it when you are feeling calm. NB: Need to take
correct skills. time to learn the skill before you can use it when
➢ These can include; stressed.
• Challenging Unhelpful Thinking A.P.P.L.E
• Breathing ➢ ACKNOWLEDGE - Notice and acknowledge the
• Using APPLE uncertainty as it comes to mind.
CHALLENGE UNHELPFUL THINKING ➢ PAUSE - Don't react as you normally do. Don't
➢ We can all be prone to ‘distorted thinking’ at times. react at all. Just pause, and breathe.
➢ When we are stressed our ‘distorted thinking’ or ➢ PULL BACK - Tell yourself this is just the anxiety or
‘unhelpful thinking styles’ become more depression talking, and this thought or feeling is
exaggerated. This is something that happens only a thought or feeling. Don't believe everything
you think! Thoughts are not statements of fact.
outside our awareness and can become an
➢ LET GO - Let go of the thought or feeling. It will
automatic habit.
pass. You don't have to respond to them. You
➢ Examples (see handout):
might imagine them floating away in a bubble or
cloud.
➢ EXPLORE - Explore the present moment, because
right now, in this moment, all is well. Notice your
breathing, and the sensations of breathing. Notice
the ground beneath you. Look around and notice
what you see, what you hear, what you can touch,
what you can smell. Right NOW. Then, SHIFT
CALLISTA STYLES 2
Psychiatric Nursing
YOUR FOCUS OF ATTENTION to something else - Increased physical

on what you need to do, on what you were doing discomfort
before you noticed the worry, or do something else • All behavior is
- mindfully, with your full attention. aimed at relieving
SEEKING SUPPORT anxiety direction is
➢ If you feel anxious all the time, for several weeks needed to focus
or if it feels like your anxiety is taking over your attention
life, then it’s a good idea to ask for help. Your • Awe, dread and
GP should be your first point of contact. If in terror
distress or out of office hours you can contact • Unable to see the
the A&E dept. of your local hospital. whole situation or
➢ Helpful Contacts; reality distortion of
PANIC perception
• Samaritans Ireland; FreePhone: 116 123
• Disorganization of
jo@samaritans.org www.samaritans.org
the personality
• Your Mental Health
• A frightening and
www.yourmentalhealth.ie
paralyzing
• Social Anxiety Ireland 01 803 2919
experience
www.socialanxietyireland.com
• Mental Help www.mentalhelp.ie INTERVENTIONS FOR MILD TO MODERATE LEVELS
ANXIETY
PEPLAU’S LEVEL OF ANXIETY
➢ Assist the client in identifying anxiety.
• Associated with the Anticipate anxiety provoking situations.
tension of day-today ➢ Use nonverbal language to demonstrate interest
MILD living perceptual ➢ Encourage the client to talk about his or her
field increased feelings.
• More alert than ➢ Avoid closing off avenues of communication
usual adaptive (refrain from offering advice or changing the
topic)
• Narrowed
➢ Encourage problem-solving
perception
➢ Explore past and present coping behaviors
• Difficulty focusing
Provide outlets for working off excess energy.
• Selective inattention
MODERATE • Mild somatic INTERVENTIONS FOR SEVERE TO PANIC LEVELS
complaints: ANXIETY
stomach ache and ➢ Maintain a calm manner. Remain with the
butterflies in the person. Minimize environmental stimuli.
stomach Reinforce reality.
• Very narrowed ➢ Listen for themes in communication.
SEVERE ➢ Attend to physical safety and medical needs
perception
first. Physical limits may need to be set.
• Unable to focus on
➢ Provide opportunities for exercising.
problem solving
CALLISTA STYLES 3
Psychiatric Nursing
➢ Assess the person’s need for medication or • Psychogenic pain

seclusion ➢ Dissociative Disorders
ANTI-ANXIETY DRUGS • Dissociative amnesia
➢ VALIUM • Dissociative fugue
➢ LIBRIUM • Depersonalization
➢ ATIVAN • Dissociative Identity Disorder / Multiple
➢ SERAX Identity Disorder
➢ TRANXENE
BASIC ANXIETY DISORDER
➢ MILTOWN
➢ EQUANIL
• Excessive worry and
➢ VISTARIL
anxiety for days but
➢ ATARAX
not more than 6
➢ INDERAL
months
➢ XANAX
• Difficulty in
➢ BUSPAR
controlling the worry
➢ Used only in a short time (1-2 weeks) • Anxiety and worry
➢ Tolerance (after 7 days) and dependence (after 1 are evident by 3 or
MONTH) more of the following
➢ Liver function test o Restlessness,
➢ Monitor for side effects. Keyed up
➢ Avoid machines, activities needing concentration Fatigue and
➢ Z tract if given parenterally irritability
Generalized Anxiety
➢ Avoid mixing with alcohol, antihistamines, o Decreased
Disorder
antipsychotic ability to
➢ Don’t stop abruptly but gradually for 2-6 weeks concentrate
➢ Avoid caffeine Muscle tension
Note: Should be taken in an empty stomach, food o Disturbed sleep
may alter the action of the drug. • Anxiety or worry
CATEGORIES OF ANXIETY DISORDER causes significant
➢ Basic Anxiety impairment in
• Generalized Anxiety Disorder
interpersonal
• Panic
relationship or
• Phobia
activities of daily
• PTSD
living
• Obsessive Compulsive
➢ Disorders Somatoform Disorders • Disturbing pattern of
• Body Dysmorphic Disorder behavior occurring
• Somatization after a traumatic
• Conversion Disorders event that is outside
• Hypochondriasis
CALLISTA STYLES 4
Psychiatric Nursing
the range of usual TREATMENT

experience. • Systematic
• Characteristics are Desensitization,
o Persistent re- Flooding.
experiencing of
the trauma DEFENSE MECHANISMS
through • Repression and
recurrent displacement
intrusive
MAJOR TYPE OF
recollections of
PHOBIAS
the event,
POST TRAUMATIC through dreams • Agoraphobia
STRESS DISORDER or flashbacks • Comes from the
(PTSD) o Persistent
Greek word
avoidance of the
“Agora”
stimuli
Meaning
o Feeling of
“market place”
detachment of
estrangement • Fear of being
from others alone in open or
o Chemical abuse public spaces
to relieve • Social Phobia
anxiety • Fear of
DEFINITION situations where
• Persistent, one might be
irrational fear of seen and
a specific object, embarrassed or
activity or
criticized
situation that
• Specific Phobias
leads to a desire
• Fear of a single
for avoidance or
object, situation
actual
or activity that
PHOBIAS avoidance of the
cannot be
object of fear
avoided
SPECIFIC PHOBIA
Obsessions
• Experience of
Obsessive Compulsive • Preoccupation
high level of
Disorder with persistent
anxiety or fear
intrusive
provided by a
thoughts,
specific object or
situation
CALLISTA STYLES 5
Psychiatric Nursing
impulses or ➢ Encourage verbalizations of feelings, especially

images anger.
➢ Encourage adaptive coping strategies and
Compulsions
techniques
• Repetitive
behaviors or ➢ Encourage patients to establish or reestablish
mental acts that relationships
the person ➢ Explore shattered assumptions. “I’m a good
feelds driven to person. This is a safe world”.
perform in order ➢ Promote discussion of possible meaning of the
t reduce distress events.
or prevent a
dreaded event SOMATO FORM DISORDER
or situation
Cues: • Body dysmorphic
• Ritualistic disorder (BDD), or
behavior body dysmorphia,
is a mental health
• Constant
condition where a
doubting if
person spends a lot
he/she has
of time worrying
performed the
about flaws in their
activity
appearance. These
Body dysmorphic flaws are often
disorder (BDD unnoticeable to
others. People of any
age can have BDD,
but it's most
common in
teenagers and young
adults. It affects both
men and women.
What are the symptoms
for body dysmorphic
disorder?
o Constantly
checking yourself
CARE STRATEGIES
in the mirror.
➢ Be nonjudgmental and honest; offer empathy and
o Avoiding mirrors.
support
o Trying to hide
➢ Help patient to recognize the connections between
your body part
the trauma experience and their current feelings, under a hat,
behaviors and problems.
CALLISTA STYLES 6
Psychiatric Nursing
scarf, or o Sexual
makeup. symptoms
o Constantly
exercising or Many people who have
grooming. SSD will also have
o Constantly an ANXIETY DISORDERS
comparing ➢ People with SSD are
yourself with not faking their
others. symptoms. The
o Always asking distress they
other people experience from pain
whether you look and other problems
OK. they experience are
real, regardless of
• Somatic symptom whether or not a
disorder physical explanation
(SSD) occurs when a can be found. And
person feels extreme, the distress from
exaggerated anxiety symptoms
about physical significantly affects
symptoms. The daily functioning.
person has such ➢ Doctors need to
intense thoughts, perform many tests
Somatic symptom
disorder (SSD) feelings, and to rule out other
behaviors related to possible causes
the symptoms, that before diagnosing
they feel they cannot SSD.
do some of the ➢ The diagnosis of SSD
activities of daily life. can create a lot of
• The symptoms can stress and frustration
involve one or more for patients. They
different organs and may feel unsatisfied
body systems, such if there's no better
as: physical explanation
o Pain for their symptoms
o Neurologic or if they are told
problems their level of distress
about a physical
o Gastrointestinal
illness is excessive.
complaints
Stress often leads
CALLISTA STYLES 7
Psychiatric Nursing
patients to become a concern they have

more worried about a serious disease.
their health, and this They may believe
creates a vicious that minor
cycle that can persist complaints are signs
for years.
of very serious
medical problems.
• (also called
For example, they
Functional
may believe that a
Neurological
common headache is
Symptom
a sign of a brain
Disorder). This
tumor.
condition is
diagnosed when DISSOCIATIVE DISORDER
people have
neurological • Characterized by
symptoms that can't the inability to recall
be traced back to a an extensive
medical cause. For amount of important
Dissociative amnesia personal information
example, patients
Conversion Disorder may have symptoms because of physical
such as: Weakness or psychological
or paralysis trauma
• Abnormal
• Localized amnesia
movements (such as
means that
tremor, unsteady
someone cannot
gait, or seizures)
• Blindness recall a specific
• Hearing loss event or series of
• Loss of sensation or events, which
numbness creates a gap in
• Seizures (called their memory.
Localized amnesia
nonepileptic seizures • These memory gaps
often relate to stress
and pseudoseizures)
or trauma. For
• Also known as example, someone
ILLNESS ANXIETY who experienced
Hypocondrias DISORDER childhood abuse
• People with this type may forget that
are preoccupied with entire chunk of time.
CALLISTA STYLES 8
Psychiatric Nursing
Those with localized when an individual

amnesia often have completely forgets
more than one their own identity
episode of memory and life experiences.
loss. They can forget who
• Selective amnesia
they are, who they
involves losing only
spoke to, where they
some of one’s
went, what they did,
memory from a
and how they felt.
certain period. For
• Some people with
instance, this could generalized amnesia
Selective amnesia
mean forgetting may lose previously
some parts of a well-established
traumatic event, but skills.
not all of it. • This form of amnesia
• A person can have often occurs in
both selective and sexual assault
localized amnesia. survivors, combat
• In this type of veterans, and those
amnesia, a person experiencing
forgets each new extreme stress or
conflict.
event as it occurs. A
Continuous amnesia Dissociative fugue • The person suddenly
certain traumatic
and unexpectedly
event may trigger
leaves home or work
this continuous
and is unable to
forgetting.
recall the past
• Systematized
Symptoms of
amnesia is a loss of
dissociative fugue
memories related to
might include the
a specific category
following:
or individual. For
Systematized amnesia
example, someone • Sudden and
may forget all of unplanned travel
their memories away from home.
involving a • Inability to recall
particular person. past events or
important
Generalized amnesia • This rare form of information from the
amnesia occurs
person's life.
CALLISTA STYLES 9
Psychiatric Nursing
• Confusion or loss of their heads are

memory about their wrapped in cotton
identity, possibly • Feeling like you’re
assuming a new in a dream or
identity to make up dream
for the loss. world: Reality
doesn’t seem real,
• Feeling disconnected
and things may feel
or detached are the
blurry or incoherent
primary symptoms
like a dream
associated with
• Feeling like you’re
depersonalization.
a robot: It can seem
This sensation can
like you’re existing
occur at any time
on auto-pilot
and in any location,
without actual
although some
feelings or thoughts
people may be more
attached to what
likely to experience it
you do
during stressful
• Anxiety over feeling
times.
that something is
Symptoms of seriously
depersonalization may wrong: Because
Depersonalization include: you’re still grounded

in a sense of reality,
• Feeling cut off from
you may feel
reality: It may seem
panicked by your
like you are
own symptoms
observing your
• Feeling like you’re
thoughts or feelings
not in control of
from outside of
yourself: You may
yourself
worry that you will
• Distorted self-
lose control or that
image: There may
your speech and
be a sense that your
thoughts are not
limbs are distorted,
really your own
enlarged, or
• Worrying that your
shrunken. Some
memories are not
people also feel like
your own: You may
also doubt whether
CALLISTA STYLES 10
Psychiatric Nursing
your memories are • Bizarre behavior

valid or real • Affective flattening
• Anhedonia
• A mental health • Attention
condition, people NEGATIVE impairment
with dissociative • Asocial behavior
identity disorder • Anergia
(DID) have two or • Autism
more separate • Avolition
personalities. These DELUSIONS
identities control a • PERSECUTORY
Dissociative Identity
person’s behavior at • RELIGIOUS
Disorder (Multiple
different times. DID • GRANDEUR
Personality Disorder) can cause gaps in • IDEAS OF REFERENCE
memory and other DISTURBED THOUGHT PROCESSES
problems. Various • Looseness of Association
types of • Flight of Ideas
psychotherapy can • Ambivalence
help people manage • Magical Thinking
the symptoms of • Echolalia / Echopraxia
DID. • Word salad
PSYCHOSOMATIC DISORDER • Clang association
➢ True / unconscious because of hormonal and • Neologism
bodily changes • Thought blocking
➢ Increase anxiety may result to asthma, stress • Concrete association
ulcers or migraine. Bleuler’s Four A’s of Schizophrenia
SCHIZOPHRENIA ➢ Affective Disturbances
➢ A major form of psychotic disorder that affects a ➢ Autism
person’s thinking, language, emotions, social ➢ Associative looseness
behavior and ability to perceive reality ➢ Ambivalence
➢ At least 2 of 5 types of positive and negative ➢ Other A’s
symptoms • Attention defects
➢ Characteristic Symptoms • Disturbances of activities
➢ Social or occupational dysfunction • Auditory Hallucination
o IPR SCHIZOPHRENIA
o Self care Brief Psychotic Disorder • maybe seen when a
POSTIVE AND NEGATIVE SYMPTOMS person exhibits
POSITIVE • Hallucinations and clinical symptoms of
Illusions Delusions illogical thinking,
• Abnormal thought incoherent speech,
patterns or delusions, or
perceptions
CALLISTA STYLES 11
Psychiatric Nursing
disorganized ➢ Disorganized-absence of systematized

behavior after delusions; presence of incoherence &
psychological inappropriate affect
trauma o Inappropriate, flat affect
o Herbephrenic, flight of ideas
Induced Psychotic • develops in seconds
➢ Catatonic ECT
Disorder person as a result of
o Risk for suicide
a close relationship
o Catatonic stupor, rigidity
with a person who
o Waxy flexibility it is a posture that an
has psychosis
individual can stay for longer hours without
Delusional Psychotic • experiencing any discomfort
Disorder o Catatonic excitement
• Characterized ➢ Undifferentiated
depression or elation o Unclassified
Schizoaffective as the psychotic ➢ Residual
disorder symptoms of o No more positive symptoms but withdrawn
schizophrenia and
MDD (Major NURSING PROCESS
depressive d/o) ➢ Disturbed Thought
➢ Process Disturbed
• When a person ➢ Sensory Process
exhibits features of ➢ Risk for self-directed violence
Schizophreniform schizophrenia for ➢ Risk for other directed violence
more than one week ➢ Present safety
but less than 6 ➢ Present reality
months
ANTI- PSYCHOTIC
SUBTYPES ➢ Tara, look natin sina Stella, Mel, at Thor na nag
Paranoid-most common form of the illness mo-moulin rouge…. Sssh , alam nyo ba na ang trio
➢ Suspicious na yan na akala mo may halo ay mga closet
o Promote trust queens pala…, namen”
o Short interaction but frequent Food in
containers (sealed) Prepare food in front MEDICATIONS
of them o Taractan, Loxitane, Stelazine, Mellaril,
o Let them see preparation of drugs Thorazine, Molindone, Seroquel, Serlect,
➢ Violent Trilafon, Haloperidol, Clozapine, Navane
o Keep door open SCHIZOPHRENIA MEDICATION
o Position near door and with distance of 1 • STELAZINE
arm length (patient-nurse) • SERENTIL
o Don’t touch Maintain eye contact • THORAZINE
• TRILAFON
• CLOZARIL
CALLISTA STYLES 12
Psychiatric Nursing
• MILLARIL ➢ Constant state of movement, characterized by

o HALDOL restlessness, difficulty sitting still, or strong urges to
• LOXITANE move about.
• RISPERDOL ➢ Generally, occurs two weeks after treatment
• PROLIXIN begins
o decanoate ➢ Rule out anxiety or agitation before administration
o Modecate of an anticholinergic agent
o Long acting Acute Dystonic reactions
ANTI – PSYCHOTIC DRUGS ➢ Irregular, involuntary spastic muscle movement,
➢ Watch for side-effects wryneck or torticollis, facial grimacing, abnormal
o Decrease v/s Constipation / dry mouth eye movements, backward rolling of eyes in the
Postural hypotension sockets
o Photophobia / photosensitivity ➢ May occur anytime from a few minutes to several
o Drowsiness hours after first dose of antipsychotic drug
o Agranulocytosis ➢ Administer anticholinergic agent, have respiratory
o Extrapyramidal symptoms support equipment available
▪ Parkinson’s syndrome Tardive Dyskinesia
▪ Akathisia ➢ Most frequent serious side effect resulting from
▪ Akinesia loss of volunatary muscle termination of the drug, during reduction in
control dosage, or after long term high dose therapy.
▪ Dystonia – oculogyric crisis, Characterized by involuntary rhytmic, stereotyped
torticollosis, opistothonus movements, tongue protrusion, cheek puffing,
▪ Tardive dyskinesia involuntary movements of extremities and trunk
▪ NMS neuroleptic malignant ➢ Occurs in approximately 20-25% of patients taking
syndrome -lethal antipsychotics for over two years
UNDESIRABLE EFFECTS ➢ No treatment except discontinuation of the
➢ S-edation/sunlight sensitivity/sleepiness antipsychotic agent
➢ T-ardive dyskinesia Neuroleptic Malignant Syndrome
➢ A-nticholinergic/aganulocytosis/akathisia ➢ A potentially fatal syndrome
➢ N-euroleptic malignant syndrome ➢ May occur anytime during therapy
➢ C-cardiac effects (Orthostatic hypotension) ➢ Seen during the initiation of therapy, change of
➢ E-xtrapyramidal Syndrome EPS (dystonia) therapy, After a dosage increase or when a
Parkinsonism combination of meds is used.
➢ Motor retardation or akinesia characterized by ➢ Early sign: rigidity or mental status changes
mask-like appearance, rigidity, tremors, “pill- ➢ catatonia, tachycardia, tachypnea, labile blood
rolling”, salivation pressure, dysphagia, diaphoresis, incontinence,
➢ Generally occurs after 1st week of treatment or rigidity, myoclonus, tremors, low grade fevers
before second month ➢ Discontinue antipsychotic agent. Have
➢ Administer anticholinergic agent, anti- parkinson cardiopulmonary support available; administer
medication (Akineton) skeletal muscle relaxant (e.g. dantrolene) or
Akathisia
CALLISTA STYLES 13
Psychiatric Nursing
central acting dopamine agonist (e.g. Other Treatments

bromocriptine) ➢ Psychotherapy-individual, group, behavioral,
NOTES on SCHIZOPHRENIA supportive or family therapy maybe used
➢ Distorted EGO depending on the clinical symptoms
➢ Disturbed thought process ➢ Milieu therapy- a structured environment to
➢ Disorganized personality minimize environmental and physical stress and to
➢ Dopamine – increase meet the individual needs of the patients until they
➢ Autism are able to assume responsibility for themselves
➢ Ambivalence Concepts & Principles of Hallucination
➢ Associative looseness ➢ Possible to replace hallucination with satisfying
➢ Affect – flat interactions
➢ Stimulation ➢ Can re-learn to focus attention on real things and
➢ Structure ➢ Can re-learn to focus attention on real things and
➢ Socialization people
➢ Support ➢ Hallucinations originate during extreme emotional
stress when the patient is unable to cope
Manifestations: ➢ Hallucinations are very real to the patient
➢ S-social isolation ➢ Patient will react as the situation is perceived
➢ C-catatonic behavior ➢ Concrete experiences, not argument on
➢ H-hallucinations
confrontation will correct sensory distortion
➢ I-Incoherence
➢ Hallucinations are a substitute for human relations
➢ Z-zero/lack of interest and initiative
➢ O-obvious failure in development
➢ P-peculiar behavior
➢ H-hygiene and grooming impaired
➢ R-recurrent illusions
➢ E-exacerbations and remissions
➢ N-no organic factor account S/S
➢ I-inability to return to functioning
➢ A-affect is inappropriate
ANTI-PARKINSONIAN DRUGS
➢ Dopaminergic Drugs
• To live (Levodopa), you need a car
(carbidopa) and a man (Amantidine) not
your brother
• (bromocriptine) per (pergolide) se
(selegiline)
➢ ANTI-CHOLENERGIC
• BACPAK (BENADRYL, ARTANE, COGENTIN,
PARSIDOL, AKINETON, KEMADRIN)
CALLISTA STYLES 14

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Ncm117 Anxiety Trans

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Psychiatric Nursing

YOUR FOCUS OF ATTENTION to something else - Increased physical

➢ Assess the person’s need for medication or • Psychogenic pain

the range of usual TREATMENT

impulses or ➢ Encourage verbalizations of feelings, especially

patients to become a concern they have

Those with localized when an individual

• Confusion or loss of their heads are

Depersonalization include: you’re still grounded

your memories are • Bizarre behavior

disorganized ➢ Disorganized-absence of systematized

• MILLARIL ➢ Constant state of movement, characterized by

central acting dopamine agonist (e.g. Other Treatments

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