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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