6. ANXIETY DISORDERS 1(1) BY VERO-1.pptx

condition in mental health

1. 1 ANXIETY DISORDERS BY V.N

2. Christine, is a 38 year-old divorced mother of two teenagers. She has had a successful, well-paying career for the past several years in upper-level management. Even though she has worked for the same, thriving company for over 6 years, she’s found herself worrying constantly about losing her job and being unable to provide for her children. This worry has been troubling her for the past 8 months. Despite her best efforts, she hasn’t been able to shake the negative thoughts. Ever since the worry started, Kristen has found herself feeling restless, tired, and tense. She often paces in her office when she’s there alone. She’s had several embarrassing moments in meetings where she has lost track of what she was trying to say. When she goes to bed at night, it’s as if her brain won’t shut off. She finds herself mentally rehearsing all the worse-case scenarios regarding losing her job, including ending up homeless. 2

3. Everyone has feelings of anxiety at some point in their life – for example, you may feel worried and anxious about sitting an exam, or having a medical test or job interview. During times like these, feeling anxious can be perfectly normal. However, some people find it hard to control their worries. Their feelings of anxiety are more constant and can often affect their daily lives. 3 Anxiety

4. Occasional anxiety is a normal part of life. You might feel anxious when faced with a problem at work, before taking a test, or making an important decision. But anxiety disorders involve more than temporary worry or fear. 4 Anxiety

5. Is a normal and often helpful emotion that alerts one to potential danger. Distinguished from fear in that it is vague, uneasy feeling the source of which is non specific or unknown. Fear is usually directed toward an external object or situation such as the fear of failing exam. 5 ANXIETY

6. Anxiety disorders are a group of mental disorders characterized by feelings of anxiety and fear. Anxiety is a worry about future events and fear is a reaction to current events. 6 Anxiety disorders

7. There are six major types of anxiety disorders, each with their own distinct symptom profile: Panic disorder ( anxiety attacks) – Social Phobia (Social Anxiety Disorder) Obsessive-compulsive disorder (OCD) Phobia Post-traumatic stress disorder (PTSD) Generalized anxiety disorder 7 Types of anxiety disorders

8. A Panic Attack is a period in which there is sudden onset (develop abruptly and reach a peak within 10 minutes ) of intense apprehension, fearfulness, or terror, often associated with feelings of impending doom. During these attacks, symptoms such as shortness of breath, palpitations, chest pain or discomfort, choking or smothering sensations, and fear of "going crazy" or losing control are present. 8 Panic Attack

9. Panic Disorder is characterized by recurrent unexpected Panic Attacks about which there is persistent concern with or without Agoraphobia. Agoraphobia is anxiety about, or avoidance of, places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having a Panic e.g being outside the home alone; being in a crowd or being on a bridge; and travelling in a bus, train. Agoraphobia is an extreme or irrational fear of entering open or crowded places, of leaving one's own home, or of being in places from which escape is difficult. 9 Panic Disorder

10. Unexpected ( uncued ) - the onset of the attack is not associated with a situational trigger and instead occurs "out of the blue“ Situationally bound - the panic attack almost invariably occurs immediately on exposure to, or in anticipation of, a situational trigger. Situationally predisposed - the panic attack is more likely to occur on exposure to a situational trigger but is not invariably associated with it. 10 Types

11. Shortness of breath, palpitations, chest pain or discomfort, choking or smothering sensations, and fear of "going crazy" or losing control are present. 11 Clinical features

12. Behavioural Treatments Exposure treatment - involve elimination of maladaptive anxiety by exposing the patient to the fear-producing stimuli (situation) (least feared to most feared or flooding ) either in vivo (in real life - method of choice ) or imaginary. Systematic desensitization - involves asking the patient to imagine anxiety-provoking scenes (least feared to most feared) while performing relaxation exercises. 12 Management

13. Pharmacotherapy Most antidepressants substantially reduce the frequency and severity of panic attacks and often prevent them altogether even if depression is not present. If resistant to antidepressant therapy, anxiolytics ; alternatively a benzodiazepine may be used as short-term adjunctive therapy at the start of antidepressant treatment to prevent the initial worsening of symptoms. 13 Management

14. A phobia is an overwhelming and debilitating fear of an object, place, situation, feeling or animal. Phobia is an extreme fear or dislike of a particular thing or situation, especially one that cannot be reasonably explained. Phobias are more pronounced than fears. They develop when a person has an exaggerated or unrealistic sense of danger about a situation or object. If a phobia becomes very severe, a person may organize their life around avoiding the thing that's causing them anxiety. As well as restricting their day-to-day life, it can also cause a lot of distress. 14 Phobia

15. Specific Phobia is characterized by clinically significant anxiety provoked by exposure to a specific feared object or situation, often leading to avoidance behaviour . Zoophobia Hydrophobia Ematophobia ( an abnormal and persistent fear of vomiting). Trypanophobia ( extreme fear of medical procedures involving injections or needles ). 15 Phobia Disorders

16. Behavioural Therapies ( treatment of choice ) Systematic desensitization Exposure therapy Participant modelling - Patients initially observe the therapist making contact with the stimulus they fear. Then they are encouraged to replicate the behaviour. Pharmacotherapy- benzodiazepines, beta blockers. 16 Management

17. Phobias can be successfully treated with a form of cognitive behavior therapy known as in vivo exposure therapy. This treatment may consist of flooding (rapid exposure to a feared situation or object) and/or systematic desensitization (gradual exposure). 17

18. Social Phobia is characterized by clinically significant anxiety provoked by exposure to certain types of social or performance situations, often leading to avoidance behaviour. Non-generalized type - the person fears public situations such as public speaking or performing on stage. Generalized type - most social interactions are feared. 18 Social Phobia

19. Social anxiety disorder (social phobia) is a mental illness. People with social anxiety disorder feel very nervous and uncomfortable in social situations like meeting new people. Social anxiety is the fear of social situations that involve interaction with other people. Social anxiety is the fear and anxiety of being negatively judged and evaluated by other people. 19 Social anxiety disorder

20. Agoraphobia is an anxiety disorder characterized by symptoms of anxiety in situations where the person perceives the environment to be unsafe with no easy way to get away. These situations can include open spaces, public transit, shopping malls, or simply being outside the home. Being in these situations may result in a panic attack. 20

21. Psychosocial therapies : Behavioural Therapies Social skills training designed to teach appropriate interpersonal behaviour based on the idea that persons with social phobia lack appropriate behavioural skills, both verbal (e.g., speech content) and nonverbal (e.g., eye contact, posture, gestures). Applied relaxation (AR) - The purpose of AR is to learn to recognize the early signs of their anxiety (i.e., physiological arousal) and to learn to cope with their anxiety rather than be overwhelmed by it. 21 Management

22. Exposure therapy Cognitive-behavioural group therapy (CBGT) - Involves development of a cognitive-behavioural understanding of social phobia & training of patients in the skills of identifying, analyzing, and disputing problematic cognitions through structured exercises Pharmacotherapy Benzodiazepines Beta-blockers MOA inhibiters 22

23. These symptoms are often severe and persistent enough to have a significant impact on the person’s day-to-day life. Recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress. 23 Obsessive-Compulsive Disorder

24. Repeated thoughts about contamination (e.g., becoming contaminated by shaking hands) Repeated doubts (e.g., wondering whether one has performed some act such as having hurt someone in a traffic accident or having left a door unlocked) A need to have things in a particular order (e.g., intense distress when objects are disordered or asymmetrical) 24 The most common obsessions

25. Repetitive behaviours (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession. The behaviours or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation. 25 Compulsions as defined;

26. Behavioural therapy - Effective behaviour therapy for OCD consists of exposure in vivo and response prevention. Pharmacotherapy - SSRIs have anti-obsessive-compulsive effects independent of their antidepressant properties. Electroconvulsive therapy-Electroconvulsive therapy is sometimes helpful. 26 Management

27. John is a 27 year-old male who recently moved back in with his parents after his fiancée was killed by a drunk driver 3 months ago. His fiancée, a beautiful young woman he’d been dating for the past 4 years, was walking across a busy intersection to meet him for lunch one day. He still vividly remembers the horrific scene as the drunk driver ran the red light, plowing down his fiancée right before his eyes. He raced to her side, embracing her crumpled, bloody body as she died in his arms in the middle of the crosswalk. No matter how hard he tries to forget, he frequently finds himself reliving the entire incident as if it was happening all over. Since the accident, John has been plagued with nightmares about the accident almost every night. He had to quit his job because his office was located in the building right next to the little café where he was meeting his fiancée for lunch the day she died. The few times he attempted to return to work were unbearable for him. He has since avoided that entire area of town. Normally an outgoing, fun-loving guy, Josh has become increasingly withdrawn, “jumpy”, and irritable since his fiancé’s death. He’s stopped working out, playing his guitar, or playing basketball with his friends – all activities he once really enjoyed. His parents worry about how detached and emotionally flat he’s become. 27

28. Posttraumatic Stress Disorder is characterized by the re-experiencing of an extremely traumatic event accompanied by symptoms of increased arousal and by avoidance of stimuli associated with the trauma. Symptoms usually begin within the first 3 months after the trauma, although there may be a delay of months, or even years, before symptoms appear. 28 Posttraumatic Stress Disorder (PTSD)

29. Post-traumatic stress disorder (PTSD) is an anxiety disorder caused by very stressful, frightening or distressing events. Someone with PTSD often relives the traumatic event through nightmares and flashbacks, and may experience feelings of isolation, irritability and guilt. They may also have problems sleeping, such as insomnia, and find concentrating difficult. 29 Post-traumatic stress disorder (PTSD)

30. Presence of childhood trauma Those with inadequate support systems Genetic predisposition Recent stressful life changes Recent excessive alcohol/drug intake Certain personality traits - Paranoid, dependent, anti-social 30 Predisposing factors;

31. Intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behaviour The traumatic event is persistently re-experienced (flash backs) increased arousal 31

32. Pharmacotherapy - In general, the use of antidepressants, anticonvulsants, or mood stabilizers should be considered only when the PTSD symptoms have persisted for several weeks and the disorder has assumed a more chronic course. Psychosocial Interventions 32 Management of PTSD

33. Generalized Anxiety Disorder is characterized by at least 6 months of persistent and excessive anxiety and worry. Excessive anxiety and worry occurring more days than not for at least 6 months , about a number of events or activities (such as work or school performance). The person finds it difficult to control the worry. 33 Generalized Anxiety Disorder

34. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months). Restlessness or feeling keyed up or on edge Being easily fatigued Difficulty concentrating or mind going blank Irritability Muscle tension Sleep disturbance 34 Generalized Anxiety Disorder…

35. Cognitive-Behavioural Treatment Self-monitoring Relaxation techniques Exposure methods Cognitive therapy Pharmacotherapy Benzodiazepines Antipsychotics are sometimes used in severe anxiety 35   Management

36. Ms. lucy is a 24 year old female came into the outpatient office for follow up treatment for Generalized Anxiety Disorder. The symptoms she presented were that she could easily become fatigued, irritable, muscle tension, and sleep disturbance. She is currently on a SSRI and has been in therapy for the last month. She continues to have difficulty with the symptoms and the inability to sleep is interfering with her productivity at work. The nurse, recognizing the importance of a holistic focus, recommends working with the patient on progressive muscle relaxation and breathing techniques. 36 Case

37. Disturbed sleep pattern r/to Remembering traumatic events AEB fatigued, headache, swollen of eyes. Acute chest pain r/to the disease process AEB 37 Nursing Dx

38. Thank you 38 END