Anxiety and Anxiety Disorders and associated notes.pptx

Anxiety and anxiety disorders with details

1. ANXIETY AND Anxiety Disorders BY TUGUME DANIEL

2. Introduction Anxiety is a part of everyday life and can be experienced to varying degrees from helpful to harmful. Anxiety is a universal human experience that includes feelings of apprehension, uneasiness, uncertainty, or dread / fear resulting from a real or perceived threat. Anxiety is a response to stress, whether the stressor is experienced as a positive or negative.

3. Positive stressors include upcoming wedding, exams, pregnancy etc and negative stressors include death of a spouse, injury, death of a family member etc. For example, mild anxiety can provide energy and concentration needed to complete important tasks or provide motivation to make healthy behavioral changes. However, excessive anxiety can cause distress and impair an individual’s functioning in social, educational, occupational, or other areas of functioning.

4. How Much Is Too Much? Anxiety is usually considered a normal reaction to a realistic danger or threat to biological integrity or self concept. Normal anxiety dissipates when the danger or threat is no longer present. Anxiety can be considered abnormal or pathological if: It is out of proportion to the situation that is creating it (see example 1. The anxiety interferes with social, occupational, or other important areas of functioning (see example 2.

5. examples Mrs. K. witnessed a serious automobile accident 4 weeks ago when she was out driving in her car, and since that time refuses to drive even to the grocery store a few miles from her house. When he is available, her husband must take her wherever she needs to go. Because of the anxiety associated with driving her car, Mrs. K. has been forced to quit her job in a downtown bank for lack of transportation.

6. Levels of Anxiety Hildegard Peplau, a psychiatric mental health nurse theorist, developed a model describing four levels of anxiety: mild , moderate , severe , and panic . Each level causes both physiologic and emotional changes in the person. Mild anxiety is a sensation that something is different and warrants special attention.

7. Sensory stimulation increases and helps the person focus attention to learn, solve problems, think, act, feel, and protect himself or herself. Mild anxiety often motivates people to make changes or to engage in goal-directed activity. For example, it helps students to focus on studying for an examination.

8. Moderate anxiety is the disturbing feeling that something is definitely wrong; the person becomes nervous or agitated. In moderate anxiety, the person can still process information, solve problems, and learn new things with assistance from others. He or she has difficulty concentrating independently, but can be redirected to the topic.

9. For example, the nurse might be giving preoperative instructions to a client who is anxious about the upcoming surgical procedure. As the nurse is teaching, the client’s attention wanders, but the nurse can regain the client’s attention and direct him or her back to the task at hand. Severe Anxiety The perceptual field of a person experiencing severe anxiety is greatly reduced.

10. They often have difficulty noticing what is going on in their environment, even if it is pointed out; they may appear dazed or confused with automatic behavior. Learning, problem-solving, and critical thinking are not possible at this level. Symptoms of the stress response intensify and may include hyperventilation, a pounding heart, insomnia, and a sense of impending doom.

11. Panic Panic is the most extreme level of anxiety that results in significantly dysregulated behavior. The individual is unable to process information from the environment and may lose touch with reality. They may demonstrate behavior such as pacing, running, shouting, screaming, or withdrawal, and hallucinations may occur. Acute panic can lead to exhaustion.

12. Anxiety disorders Anxiety disorders are diagnosed when anxiety no longer functions as a signal of danger or a motivation for needed change, but becomes chronic and permeates major portions of the person’s life, resulting in maladaptive behaviors and emotional disability. Anxiety disorders have many manifestations, but anxiety is the key feature of each. Types of anxiety disorders include the following: Agoraphobia, Panic disorder, Specific phobia, Social anxiety disorder (social phobia) and Generalized anxiety disorder (GAD)

13. Anxiety and fear-related disorders are characterized by excessive fear and anxiety and related behavioural disturbances, with symptoms that are severe enough to result in significant distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning. Fear and anxiety are closely related phenomena; fear represents a reaction to perceived imminent threat in the present, whereas anxiety is more future-oriented, referring to perceived anticipated threat.

14. Although the physical and emotional symptoms of anxiety are similar to “fear,” it differs from fear in that it is not a response to an overt danger, but rather an impending one. Both fear and anxiety are normal adaptive responses to a potentially dangerous environment. They make us better prepared to survive a danger, either through fight, flight, or freezing, as the situation may warrant.

15. Prevalence Worldwide, anxiety disorders are the sixth most significant contributor to nonfatal health loss globally, and they explain 10 percent of the disability-adjusted life years for all mental, neurologic, and substance use disorders, second only to major depression.

16. ETIOLOGY Genetic Theories Anxiety may have an inherited component because first-degree relatives of clients with increased anxiety have higher rates of developing anxiety. Neurochemical Theories Gamma-aminobutyric acid ( γ- aminobutyric acid [GABA]) is the amino acid neurotransmitter believed to be dysfunctional in anxiety disorders. GABA, an inhibitory neurotransmitter, functions as the body’s natural antianxiety agent by reducing cell excitability, thus decreasing the rate of neuronal firing.

17. Because GABA reduces anxiety and norepinephrine increases it, researchers believe that a problem with the regulation of these neurotransmitters occurs in anxiety disorders. Others • Temperamental traits of shyness or behavioral inhibition in childhood • Exposure to traumatic life or environmental events in early childhood or adulthood • A history of anxiety or other mental health disorders in biological relatives

18. types of anxiety disorders Generalized Anxiety Disorder (GAD): The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines generalized anxiety disorder (GAD) as “excessive anxiety and worry, occurring on more days than not for at least six months, about a number of events or activities (such as work or school performance).” The individual finds it difficult to control the anxiety and worry, and it is associated with at least three of the following symptoms:

19. • Restless or feeling on edge •Being easily fatigued • Difficulty concentrating or going mentally blank •Irritability •Muscle tension • Sleep disturbance (difficulty falling or staying asleep or restless, unsatisfying sleep)

20. The symptoms result in significant distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning. The symptoms are not a manifestation of another health condition and are not due to the effects of a substance or medication on the central nervous system. The distinction between generalized anxiety disorder and normal anxiety is that the worry is excessive, difficult to control, and causes impairment.

21. The onset of GAD is insidious. GAD affects individuals of all ages. Diagnostic Criteria GAD is characterized by excessive worry and anxiety (apprehensive expectation) for at least 6 months. The anxiety does not usually pertain to a specific situation; rather, it concerns several real-life activities or events. Ultimately, excessive worry and anxiety cause great distress and interfere with the patient’s daily personal or social life.

22. Nursing Care Nursing care for the person with GAD is similar to the care of the individual with a panic disorder. In many instances, antidepressants and an antianxiety agent will be prescribed. Nursing interventions should focus on helping the person target specific areas of anxiety and reducing the impact of the anxiety.

23. Panic disorder Panic disorder is characterized by recurrent unexpected panic attacks that are not restricted to particular stimuli or situations. Panic attacks are a major finding in panic disorder. A panic attack is a sudden, discrete period of intense fear or discomfort that reaches its peak within a few minutes and is accompanied by significant physical discomfort and cognitive distress (APA, 2013). Panic attacks usually peak in about 10 minutes but can last as long as 30 minutes before returning to normal functioning.

24. In addition, panic disorder is characterized by persistent concern about the recurrence or significance of panic attacks, or behaviors intended to avoid their recurrence, that results in significant impairment in personal, family, social, educational, occupational, or other important areas of functioning. The symptoms are not a manifestation of another health condition and are not due to the effects of a substance or medication on the central nervous system. The DSM-5 defines a panic attack when four or more of the following symptoms occur:

25. • Palpitations, a pounding heartbeat, or an accelerated heart rate • Sweating • Trembling or shaking • Sensations of shortness of breath or smothering • Feelings of choking • Chest pain or discomfort • Nausea or abdominal distress • Feeling dizzy, unsteady, light-headed, or faint

26. • Chills or heat sensations • Paresthesia (numbness or tingling sensations) • Derealization (feelings of unreality) or depersonalization (being detached from oneself) • Feelings of losing control or “going crazy” • Fear of dying To be diagnosed as a panic disorder, at least one of the panic attacks has been followed by one month (or more) of one or both of the following characteristics.

27. • Persistent concern or worry about additional panic attacks or their consequences • A significant maladaptive change in behavior related to the attacks (such as avoiding unfamiliar situations) People with panic disorder often worry about when the next attack will happen and actively try to prevent future attacks by avoiding places, situations, or behaviors they associate with panic attacks. Worry about panic attacks and the effort spent trying to avoid attacks cause significant problems in various areas of the person’s life, including the potential development of agoraphobia.

28. Management of PD Systematic Desensitization Systematic desensitization, an exposure method used to desensitize patients, exposes the patient to a hierarchy of feared situations that the patient has rated from least to most feared. The patient is taught to use muscle relaxation as levels of anxiety increase through multi-situational exposure. Planning and implementing exposure therapy require special training.

29. Flooding is a technique used to desensitize the patient to the fear associated with a particular anxiety-provoking stimulus. Desensitizing is done by presenting feared objects or situations repeatedly without session breaks until the anxiety dissipates. For example, a patient with ophidiophobia (i.e., a morbid fear of snakes) might be presented with a real snake repeatedly until the patient’s anxiety decreases.

30. Implosive Therapy Implosive therapy is a provocative technique useful in treating panic disorder and agoraphobia in which the therapist identifies phobic stimuli for the patient and then presents highly anxiety-provoking imagery to the patient, describing the feared scene as dramatically and vividly as possible.

31. Exposure Therapy Many of the treatment approaches used for panic disorder are effective for phobias. Exposure therapy is the treatment of choice for phobias. The patient is repeatedly exposed to real or simulated anxiety-provoking situations until he or she becomes desensitized and anxiety subsides.

32. Cognitive Behavioral Therapy Cognitive behavioral therapy (CBT) is a highly effective tool for treating individuals with panic disorder. It has been considered the first-line treatment for those with panic and other anxiety disorders and is often used in conjunction with medications, including the selective serotonin reuptake inhibitors (SSRIs), in treating those with panic disorder. The goals of CBT include helping the patient to manage his or her anxiety and correcting anxiety-provoking thoughts through interventions, including cognitive restructuring, breathing training, and psychoeducation.

33. Agoraphobia Agoraphobia is characterized by marked and excessive fear or anxiety that occurs in response to multiple situations where escape might be difficult or help might not be available, such as using public transportation, being in crowds, being outside the home alone (e.g., in shops, theatres, standing in line). The individual is consistently anxious about these situations due to a fear of specific negative outcomes (e.g., panic attacks, other incapacitating or embarrassing physical symptoms).

34. The situations are actively avoided, entered only under specific circumstances such as in the presence of a trusted companion, or endured with intense fear or anxiety. The symptoms persist for least several months, and are sufficiently severe to result in significant distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning.

35. The DSM-5 defines agoraphobia as intense fear of two or more of the following situations: • Using public transportation • Being in open spaces (e.g., parking lots, marketplaces, or bridges) • Being in enclosed spaces (e.g., shops or theaters) • Standing in line or being in a crowd • Being outside of the home alone

36. People with agoraphobia often avoid these situations because they think it may be difficult or impossible to leave in the event they have a panic-like reaction or other embarrassing symptoms such as incontinence. In the most severe form of agoraphobia, the individual can become housebound. Agoraphobia can be diagnosed in an individual, in addition to the presence of a panic disorder.

37. Specific phobia The term phobia refers to excessive fear of a specific object, circumstance, or situation. A specific phobia is an intense, persisting fear of an object or situation, considered dangerous. The fear should be out of proportion to the actual threat. The diagnosis of specific phobia requires the development of intense anxiety, even to the point of panic, when exposed to the feared object. Persons with specific phobias may anticipate harm, such as being bitten by a dog, or may panic at the thought of losing control; for instance, if they fear elevators, they may also worry about fainting after the door closes.

38. There are many possible objects of the fear, including things (animals), environments (storms, dark rooms), situations (driving, flying, blood injections), and many other things that do not fit into these categories. What they have in common is the irrational fear that the object of one’s fear is harmful or dangerous. In each case, the anxiety usually occurs immediately after exposure to the object or situation. The result is either avoidance or painful endurance. It should last for at least 6 months.

39. Social anxiety disorder Social anxiety disorder was previously called social phobia. The DSM-5 defines social anxiety disorder as marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g., giving a speech).

40. The individual fears they will act in a way or show anxiety symptoms that will be negatively evaluated by others, so social situations are avoided or endured with intense fear or anxiety. This fear, anxiety, or avoidance is persistent and typically lasts for six months or more and is not related to a substance, another mental health disorder, or medical condition. It results in clinically significant impairment in social, occupational, or other important areas of functioning.

41. In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.

42. Selective Mutism Selective mutism is a rare disorder associated with anxiety. Selective mutism occurs when people fail to speak in specific social situations despite having normal language skills. Selective mutism usually occurs before the age of five and is often associated with extreme shyness and fear of social embarrassment. It can also be a symptom of post-traumatic stress syndrome.

43. Coping with Anxiety Individuals may use several strategies to cope with anxiety. Coping strategies are an action, a series of actions, or a thought process used to address a stressful or unpleasant situation or modify one’s reaction to such a situation. Coping strategies are classified as adaptive or maladaptive . Adaptive coping strategies include problem-focused coping and emotion-focused coping.

44. Problem-focused coping typically focuses on seeking treatment such as counseling or cognitive behavioral therapy. Emotion-focused coping includes strategies such as engaging in mindfulness, meditation, or yoga; using humor and jokes; seeking spiritual or religious pursuits; engaging in physical activity or breathing exercises; and seeking social support.

45. Maladaptive coping responses include responses such as avoidance of the stressful condition, withdrawal from a stressful environment, disengagement from stressful relationships, and misuse of alcohol or other substances. Defense mechanisms are reaction patterns used by individuals to protect themselves from anxiety that arises from stress and conflict. Adaptive use of defense mechanisms can help people achieve their goals, but excessive or maladaptive use of defense mechanisms can be unhealthy. Excessive use of defense mechanisms are associated with specific mental health disorders.

46. Treatments for Anxiety Anxiety disorders are generally treated with psychotherapy, medication, or a combination of both treatments. Medications do not cure anxiety disorders but tare used o help relieve symptoms of anxiety, panic attacks, extreme fear, and worry. The most common classes of medications used to combat anxiety disorders are antianxiety drugs (such as benzodiazepines), antidepressants, and beta-blockers.