Anxiety disorders

Anxiety disorders are the commonest mental disorders affecting many people with mental illnesses.

1. Anxiety Disorders
Mr Mulundano

2. Introduction
•Anxietyisanormalreaction-asignaltothebody
thataspectsofitssystemsareunderstressorout
ofequilibrium
•Anxiety(neurotic)disordersaremorecommon
thananyotherclassofpsychiatricdisorderoften
notrecognizedandconsequentlynottreated
resultinginchronicity
•Anxietydisordersconstitute‘theapprehensive
anticipationoffuturedangerormisfortune
accompaniedbyafeelingofdysphoriaorsomatic
symptomsoftension(APA,1994;Kessleretal.,
2005).Fearbrings“FlightorFight”response
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3. •Define anxiety
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4. Definition
•Anxietyisanemotionalresponseto
anticipationofdanger,thesourceof
whichislargelyunknownor
unrecognized.
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5. •List 5 physical symptoms of anxiety
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6. Anxiety symptoms
•Psychological
•Fearfulanticipation,noisesensitivity,restlessness,
poorconcentrationandanxiouscognitions
•Physical
•GITdrymouth,swallowingproblem,frequentof
motions
•RSdifficultbreathing,hyperventilation,pinsand
needlesinextremitiesandmouth
•CVSpalpitations,chestdiscomfort,awarenessof
heartbeat
•GUTfrequencyofmicturition,sexualproblems,
andmenstrualproblems
•MSStremor,headache,achingmuscles
•SleepInsomnia,nightterrors
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7. •Mention 3 causes of anxiety
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8. Aetiology of Anxiety Related
Conditions
Both mental and physical factors are
involved
•Response to environmental stressors
(i.e. ending of a significant relationship
or exposure to a life-threatening
disaster
•Psychiatric disorders
•depression,
•anxiety disorders,
•eating disorders,
•avoidant personality disorders
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9. Aetiology of Anxiety Related
Conditions Contd.
•Some physical disorders directly
i.e.
•Hyperthyroidism
•Hyperadrenocorticism
•Heart failure
•Arrhythmias
•Asthma
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10. •Drugs:
•Bronchodilators,
•Psychostimulants
•Effectsofcorticosteroids,andeven
caffeinecanmimicanxietydisorders
•Withdrawalfromalcohol,sedatives,
andsomeillicitdrugscanalsocause
anxiety
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11. Etiological factors of anxiety
Canbeclassifiedas:
1.Biopsychosocial,orbiological
(relatedto physiological
processesinthebody),
2.Psychological(earlychildhood
experiences)and
3.Social(relatingtointeractionwith
otherpeopleandone’srankin
society).

12. Biological factors
•Genetic/Heritability:Thetendency
toanxietymaybeinheritedfrom
one’sparents.
•Biochemical: Imbalance of
serotoninandGamma-aminoButyric
Acid (GABA).These are
neurotransmitterswhichregulate
emotions.

13. Psychological factors
•Stressfuleventsandearly
childhood and current
experiences.
•Resultofabnormalcognitions–
focusonworryingthought,
anxious-avoidant personality
disorders.

14. Sociological factors
•Povertysuchaslackorabsence
ofmoneytoprovidefor,
accommodation,food,essential
serviceslikecleanrunningwater,
electricity,expensivetransport,
clothing;lowrankinginsociety,
belongingtothevulnerable
groupsofsocietyamongothers,
makesithardtomanagestress.

15. •Mention 4 types of anxiety
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16. Types of Anxiety Disorders
•Types of anxiety related disorders
include:
•Generalized Anxiety Disorder
•Panic disorder
•Phobia
•Social phobia/Social Anxiety Disorder
•Obsessive-compulsive Disorder
•Somatoform disorder
•hypochondriasis
•Post-traumatic stress disorder and
•Acute Stress Disorders
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17. Generalized anxiety disorder
•Generalizedanxietydisorderis
anxietycharacterizedbychronic,
unrealistic,andexcessiveanxiety
andworrywithsymptomsexisting
for6monthsorlongerandcannot
beattributedtospecificorganic
factors,suchascaffeineintoxication
orhyperthyroidism.
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18. •PeoplewithGADmayanticipatedisaster
andmaybeoverlyconcernedabout
money,health,family,work,orother
issues.
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19. Generalized Anxiety
•Anxietyisanormalresponsetoan
unusualorstressfulevent,a
psychologicalcomponentofthefightand
flightresponseonlyconsidered
abnormalwhen
•Occursinabsenceofastressfulsituation
•Impairsphysical,occupationalorsocial
functioning
•Excessivelysevereorprolonged(6months
orlonger).
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20. Diagnosis
•DiagnosticCriteriaforGeneralized
AnxietyDisorder
•A.Excessiveanxietyandworry
(apprehensiveexpectation),occurring
moredaysthannotforatleast6months,
aboutanumberofeventsoractivities
(suchasworkorschoolperformance).
•B.Theindividualfindsitdifficulttocontrol
theworry.
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21. •C. The anxiety and worry are associated with three
(or more) of the following six symptoms (with at least
some symptoms having been present for more days
than not for the past 6 months):
•Note: Only one item is required in children.
•1. Restlessness or feeling keyed up or on edge.
•2. Being easily fatigued.
•3. Difficulty concentrating or mind going blank.
•4. Irritability.
•5. Muscle tension.
•6. Sleep disturbance (difficulty falling or staying
asleep, or restless, unsatisfying sleep).
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22. •D.Theanxiety,worry,orphysical
symptomscauseclinicallysignificant
distressorimpairmentinsocial,
occupational,orotherimportantareasof
functioning.
•E.Thedisturbanceisnotattributableto
thephysiologicaleffectsofasubstance
(e.g.,adrugofabuse,amedication)or
anothermedicalcondition(e.g.,
hyperthyroidism).
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23. •F.Thedisturbanceisnotbetterexplainedby
anothermentaldisorder
•(e.g.,anxietyorworryabouthavingpanicattacksinpanic
disorder,negativeevaluationinsocialanxietydisorder
[socialphobia],contaminationorotherobsessionsin
obsessive-compulsivedisorder,separationfromattachment
figuresinseparationanxietydisorder,remindersof
traumaticeventsinposttraumaticstressdisorder,gaining
weightinanorexianervosa,physicalcomplaintsinsomatic
symptomdisorder,perceivedappearanceflawsinbody
dysmorphicdisorder,havingaseriousillnessinillness
anxietydisorder,orthecontentofdelusionalbeliefsin
schizophreniaordelusionaldisorder).
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24. Clinical Features of GAD
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Physical signs Psychological signs
Drymouth,difficultyswallowing
Headache,dizziness
Muscletension
Backpain
Abdominalpain,loosemotions
Tremulousnessor―shakiness
Fatigue
Numbness
Shortnessofbreath
Palpitations
Sweating
Hyper-vigilant reflexes (easily startled;
―jumpy)
Parasthesiae
Menstrual problems
Erectile dysfunction
Feelingofdread
Poorconcentration
Impairedsleep
Impairedsexualdesire
Irritability
Sensitivitytonoise
Restlessness
Worryingthoughts
Insomnia
Nightmares
Depersonalisation
Derealisation

25. Management
•Immediate
•Support and information
•Problem solving
•Benzodiazepines: Diazepam 2-5mg for less
than 2 weeks
•Long term
•Drug treatment SSRIs if not available TCAs
•CBT
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26. Activity
•Identifyatleast5nursing
problemsofapatientwithGAD,
and writeyournursing
interventionsforeach.
Important!

27. Panic Attack
•Panicattackhas4ormoresymptomsin1attack
•Fear,terrorandfeelingofimpendingdoom
accompaniedbysomeorallthefollowing
•Palpitations
•Shortnessofbreath
•Chokingsensation
•Dizziness
•Paresthesia
•Chestpain/discomfort
•Sweating
•Carpopedalspasm–involuntaryspasmsof
wristorankles
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28. •What is the differential diagnosis of panic
attacks?
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29. Differential Diagnosis
•Asthma
•Anaphylaxis
•Thyrotoxicosis
•Temporal lobe epilepsy
•Hypoglycaemia
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30. •Pins and needles in the palms and feet
are also called_____________________
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31. A client in panic feels dizzy, this is due
to________________________
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32. Management
•Talking down
•Explain nature of symptoms to the person
•Racing of heart is due to adrenaline produced by panic
•Paraesthesiae and feeling dizzy due to over-breathing
•Hence need to count breaths in and out gently
slowing breathing rate
•Rebreathing techniques
•Place a paper bag over the mouth and breath in
and out through the mouth
•This raises the partial pressure of carbon dioxide in
the blood and symptoms due to low CO2 resolve
(tetany, paraesthesiae, dizziness)
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33. •Whenpanicdisorderischronicinitial
diagnosisdependsonmorethan
____attacksin______weeks.
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34. Panic Disorder
•Panicattacksareverycommonbut
panicdisorderisuncommon
•Characterizedbyintensefeelingsof
apprehensionorimpendingdisaster
•Anxietybuildsupquicklyand
unexpectedlywithoutrecognizable
trigger
•Panicdisorderischronic,initial
diagnosisdependsonmorethan4
attacksin4weeksor1attackfollowed
bypersistentfearofhavinganother.
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35. Clinical picture
•Shortness of breath
•Choking
•Palpitations and accelerated heart rate
•Chest discomfort or pain
•Sweating
•Dizziness, unsteady feelings or faintness
•Nausea or abdominal pain
•Depersonalisation/ derealisation
•Numbness or tingling sensations
•Flushes or chills
•Trembling or shaking
•Fear of dying
•Fear of doing something crazy or uncontrolled
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36. Examination
•Obvious distress
•Sweating
•Tachycardia
•Hyperventilation
•Raised BP
•When the episode is over everything
becomes normal
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37. Management
•Psychological therapy CBT
•Medications
•SSRI
•TCA
•Review after 2 weeks on commencement of
treatment (then 4, 6 & 12 weeks)
•If need arises refer to specialist
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38. Phobias
•Definedasanextremeorirrationalfear
oforaversiontosomething.
•Phobiashavesimilarsymptomswith
generalizedanxietydisorderbutlimited
tospecificsituationsorobjects
•Features
•Avoidanceofcircumstancesthatprovoke
anxiety
•Anticipatoryanxietywhenthereisthe
prospect of encounteringthose
circumstances
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39. Define the following phobas
1.Agoraphobia–
2.Hydrophobia–
3.Astraphobia/brontophobia -
4.Claustrophobia-
5.Arachnophobia-
6.Ophidiophobia–
7.Zoophobia–
8.Haemophobia-
9.Aviophobia–
10.Acrophobia–
11.Cynophobia-
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40. Phobic Anxiety Disorder-
Specific
•Agoraphobia-fear of open places
•Hydrophobia-fear of water
•Astraphobia/brontophobia -fear of lightening/
storm
•Claustrophobia-fear of enclosed places
•Arachnophobia-fear of spiders
•Ophidiophobia-fear of snakes
•Zoophobia-fear of animals
•Haemophobia-fear of blood
•Aviophobia-fear of flying
•Acrophobia-fear of heights
•Cynophobia-fear of dogs
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41. Social phobia
•Intense fear of being scrutinized or
negatively evaluated by others causing
fear and avoidance of social situations
•This fear must be significantly disabling,
not simple shyness
•May be generalized (most social
situations) or specific (certain activities
only)
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42. Management
•Drug therapy
•SSRIs has to be continued for 12 or
more months if;
•Symptoms remain unresolved
•Comorbidity (depression, generalized
anxiety and panic disorders)
•History of relapse or early onset
•Psychological therapies
•CBT with or without Exposure
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43. 24/06/2021 MML@KCN 43

44. Obsessive Compulsive Disorder (OCD)
•Obsessionsarerecurrent,persistent,
intrusive,andunwantedthoughts,
images,orimpulsesthatcause
markedanxietyandinterferewith
interpersonal,social,oroccupational
function.
•Thepersonknowsthesethoughtsare
excessiveorunreasonablebutbelieves
heorshehasnocontroloverthem.

45. •TheDSM-IV-TRdescribesobsessive–
compulsivedisorder(OCD)asrecurrent
obsessionsorcompulsionsthataresevere
enoughtobetimeconsumingortocause
markeddistressorsignificantimpairment
(APA,2000).
•Theindividualrecognizesthatthebehaviour
isexcessiveorunreasonablebut,because
ofthefeelingofrelieffromdiscomfortthatit
promotes,iscompelledtocontinuetheact.

46. Obsessive Compulsive
Disorder (OCD)
•Commonillnesscharacterizedbyrecurrent
obsessivethoughtsandcompulsiveacts
•Lifetimeprevalence2%thoughminor
obsessionalsymptomsarecommon
•Maletofemaleoccurrenceis2:3
•Theoristssuggestobsessionalthoughts
generateanxietypartlyrelievedbycertain
actions
•“anxietyreductionreinforcestheactions
developmentofcompulsions
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47. Clinical features
•Onsetmaybeacuteorinsidious
associatedwithaprecipitatingeventin
60%
•Obsessionalthinking-recurrent
persistentthoughts,impulsesand
imagescausinganxietyordistress
•Compulsivebehavior–repetitive
behaviors,ritualsormentalactsdoneto
preventorreduceanxiety
•Indecisivenessandinabilitytotakeaction
•Anxiety
•Depression
•Depersonalization
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48. Diagnosis
•Obsessivethoughts/compulsiveactionsbe
presentonmostdaysfor2ormoreweeks
•Patientrecognizesthatthoughtscome
fromwithinthemselves
•Obsessivethoughtsandcompulsiverituals
havebeenunsuccessfullyresistedinthe
past
•Thoughtsandactionsareunpleasant
•Differentialdiagnosis: depression,
schizophrenia,tourette’ssyndrome
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49. Common compulsions include the
following:
i.Checking rituals (repeatedly making
sure the door is locked or the coffee
pot is turned off)
ii.Counting rituals (each step taken,
ceiling tiles, concrete blocks, or desks
in a classroom)
iii.Washing and scrubbing until the
skin is raw
iv.Praying or chanting

50. i.Touching,rubbing,ortapping(feelingthe
textureofeachmaterialinaclothingstore;
touchingpeople,doors,walls,oroneself)
ii.Hoardingitems(forfearofthrowingaway
somethingimportant)
iii.Ordering(arrangingandrearranging
furnitureoritemsonadeskorshelfinto
perfectorder;vacuumingtherugpileinone
direction)
iv.Exhibitingrigidperformance(getting
dressedinanunvaryingpattern)
v.Havingaggressiveurges(forinstance,to
throwone’schildagainstawall).

51. Management
•Patienteducation
•SSRI’s
•CBT
•isatypeofpsychotherapeutictreatmentthat
helpspeoplelearnhowtoidentifyand
changedestructiveordisturbingthought
patternsthathaveanegativeinfluenceon
behaviourandemotions.
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52. Nursing Interventions for Obsessive
Compulsive Disorder (OCD)
•Offerencouragement,support,
and compassion through
therapeuticcommunication.
•Offering support and
encouragementtotheclientis
importanttohelphimorher
manageanxietyresponses.

53. •Acknowledgetheoverwhelming
feelingstheclientexperienceswhile
indicatingthebeliefthattheclient
canmakeneededchangesand
regainasenseofcontrol.
•Encouragestheclienttotalkabout
thefeelingsandtodescribethemin
asmuchdetailastheclientcan
tolerate.

54. •Becausemanyclientstrytohide
theirritualsandtokeepobsessions
secret,discussingthesethoughts,
behaviours,andresultingfeelings
withthenurseisanimportantstep.
•Doingsocanbegintorelievesome
ofthe‘burden’theclienthasbeen
keepingtohimselforherself.

55. •Beclearwiththeclientthatyou
believeheorshecanchange.
•Encouragetheclienttotalkabout
feelings,obsessions,andritualsin
detail.
•Graduallydecreasetimeforthe
clienttocarryoutritualistic
behaviours.

56. •Assistclienttouse
exposureandresponse
prevention behavioural
techniques.
•Encourageclienttouse
techniquestomanageand
tolerateanxietyresponses.

57. •Tomanageanxietyandritualistic
behaviours,abaselineoffrequency
anddurationisnecessary.
•Theclientcankeepadiaryto
chroniclesituationsthattrigger
obsessions,theintensityofthe
anxietythetimespentperforming
rituals,and theavoidance
behaviours.

58. •Thisrecordprovidesaclearpicture
forbothclientandnurse.
•Theclientthencanbegintouse
exposureandresponseprevention
behaviouraltechniques.
•Initially,theclientcandecreasethe
timeheorshespendsperforming
theritualordelayperformingthe
ritualwhileexperiencinganxiety.

59. •Eventually,theclientcaneliminate
theritualisticresponseordecreaseit
significantlytothepointthat
interferencewithdailylifeisminimal.
•Clientscan use relaxation
techniquestoassistthemin
managingandtoleratingtheanxiety
theyareexperiencing.

60. •Itisimportanttonotethatthe
clientmustbewillingtoengage
inexposureandresponse
prevention.
•Thesearenottechniquesthat
canbeforcedontheclient.

61. Teaching Relaxation and
BehaviouralTechniques
•Thenursecanteachtheclientabout
relaxationtechniquessuchasdeep
breathing,progressive muscle
relaxation.
•Thisinterventionshouldtakeplace
whentheclient’sanxietyislowsoheor
shecanlearnmoreeffectively.
•Initially,thenursecandemonstrateand
practicethetechniqueswiththeclient.

62. •Then,thenurseencouragestheclient
topracticethesetechniquesuntilheor
sheiscomfortabledoingthemalone.
•When theclienthasmastered
relaxationtechniques,heorshecan
begintousethemwhenanxiety
increases.
•Inadditiontodecreasinganxiety,the
clientgainsanincreasedsenseof
controlthatcanleadtoimprovedself-
esteem.

63. Completing a Daily Routine
•Assistclienttocompletedailyroutine
andactivitieswithinagreed-ontime
limits.
•Encouragetheclienttodevelopand
followawrittenschedulewith
specifiedtimesandactivities.
•Toaccomplishtasksefficiently,the
clientinitiallymayneedadditional
timetoallowforrituals.

64. •Forexample,ifbreakfastisat8:00
AMandtheclienthasa45-minute
ritualbeforeeating,thenursemust
planthattimeintotheclient’s
schedule.Itisimportantforthe
nursenottointerruptortoattemptto
stoptheritualbecausedoingsowill
escalatetheclient’sanxiety
dramatically.

65. •Again,theclientmustbewillingtomake
changesinhisorherbehaviour.
•Thenurseandclientcanagreeona
plantolimitthetimespentperforming
rituals.
•Theymaydecidetolimitthemorning
ritualto40minutes,thento35minutes,
andsoforth,takingcaretodecrease
thistimegraduallyataratetheclient
cantolerate.

66. •Whentheclienthascompletedtheritual
orthetimeallottedhaspassed,theclient
thenmustengageintheexpected
activity.
•Thismaycauseanxietyandisatime
whentheclientcanuserelaxationand
stressreductiontechniques.
•Athome,theclientcancontinuetofollow
adailyroutineorwrittenschedulethat
helpshimorhertostayontasksand
accomplishactivitiesandresponsibilities.

67. Providing Client and Family Education
•It is important for both the client
and the family to learn about
OCD.
•They often are relieved to find
the client is not ‘going crazy’ and
that the obsessions are
unwanted, rather than a
reflection of any ‘dark side’ to the
client’s personality.

68. •Helpingtheclientandfamilyto
talkopenly about the
obsessions,anxiety,andrituals
eliminatestheclient’sneedto
keepthesethingssecretandto
carrytheguiltyburdenalone.
•Familymembersalsocanbetter
givetheclientneededemotional
supportwhentheyarefully
informed.

69. Teaching about the importance of
medication compliance
•Theclientmayneedtotrydifferent
medicationsuntilhisorher
responseissatisfactory.
•ThechancesforimprovedOCD
symptomsareenhancedwhenthe
clienttakesmedicationanduses
behaviouraltechniques.

70. REVISION QUESTION
•Discussthemanagementofthe
followinganxietydisorders:[40
marks]
i.Generalizedanxietydisorder
ii.Phobicdisorder
iii.OCD
iv.Panicdisorders
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72. LEVELS OF ANXIETY
•Anxietyhasbothhealthyand
harmfulaspectsdependingonits
degreeanddurationaswellason
howwellthepersoncopeswithit.
•Anxietyhasfourlevels:mild,
moderate,severe,andpanic.
•Eachlevelcausesbothphysiologic
andemotionalchangesinthe
person.

73. Levels of Anxiety

74. Mild anxiety
•Thisisasensationthat
somethingisdifferentand
warrantsspecialattention.
•Sensorystimulationincreases
andhelpsthepersonfocus
attentiontolearn,solve
problems,think,act,feel,and
protecthimselforherself.

75. •Mildanxietyoftenmotivates
peopletomakechangesorto
engage ingoal-directed
activity.
•Forexample,ithelps
studentstofocusonstudying
foranexamination.

76. Moderate anxiety
•Thisisthedisturbingfeelingthat
somethingisdefinitelywrong;the
personbecomesnervousoragitated.In
moderateanxiety,thepersoncanstill
processinformation,solveproblems,
andlearnnewthingswithassistance
fromothers.Heorshehasdifficulty
concentratingindependentlybutcan
beredirectedtothetopic.

77. For example
•Thenursemightbegiving
preoperativeinstructionstoaclient
whoisanxiousabouttheupcoming
surgicalprocedure.
•Asthenurseisteaching,theclient’s
attentionwandersbutthenursecan
regaintheclient’sattentionand
directhimorherbacktothetaskat
hand.

78. •Asthepersonprogressesto
severeanxietyandpanic,more
primitivesurvivalskillstakeover,
defensiveresponsesensue,and
cognitiveskillsdecrease
significantly.

79. Severe anxiety
•Apersonwithsevereanxietyhas
troublethinkingandreasoning.
Musclestightenandvitalsigns
increase.
•Thepersonpaces;isrestless,
irritable,andangry;oruses
othersimilaremotional–
psychomotormeanstorelease
tension.

80. Panic
•The emotional–psychomotor realm
predominateswithaccompanying;
•fight,
•flight,or
•freezeresponses.
•increasesvitalsignsduetoAdrenalinesurge
greatly.
•Pupilsenlargetoletinmorelight,andthe
onlycognitiveprocessfocusesonthe
person’sdefense.

81. WORKING WITH ANXIOUS CLIENTS
•Nursesencounteranxiousclientsand
familiesinawidevarietyofsituations
suchasbeforesurgeryandin
emergencydepartments,intensivecare
units,offices,andclinics.
•Firstandforemost,thenursemust
assesstheperson’sanxietylevel
because thatdetermineswhat
interventionsarelikelytobeeffective.

82. Mild anxiety
•Thisisanassettotheclient
andrequiresnodirect
intervention.
•Peoplewithmildanxietycan
learnandsolveproblemsand
areeven eager for
information.

83. Nursing activity
•Teachingcanbevery
effective.

84. Moderate anxiety
•Clientsattentioncanwander,
andheorshe
•mayhavesomedifficulty
concentratingovertime.

85. Nursing activity
•In moderate anxiety, the nurse must
be certain that the client is following
what the nurse is saying.
•Speakinginshort,simple,andeasy
to-understandsentencesiseffective;
•thenursemuststoptoensurethat
theclientisstilltakingininformation
correctly.

86. •Thenursemayneedtoredirectthe
clientbacktothetopicifthe
clientgoesoffonanunrelated
tangent.

87. Severe Anxiety
•When anxietybecomes
severe,the
•Clientnolongercanpay
attentionortakein
information.

88. •Thenurse’sgoalmustbeto
lowertheperson’sanxiety
leveltomoderateormild
beforeproceedingwith
anythingelse.

89. •Itisalsoessentialtoremainwith
thepersonbecauseanxietyis
likelytoworsenifheorsheisleft
alone.
•Talkingtotheclientinalow,
calm,andsoothingvoicecan
help.

90. •Ifthepersoncannotsitstill,
walkingwithhimorherwhile
talkingcanbeeffective.
•Whatthenursetalksabout
matterslessthanhowheorshe
saysthewords.
•Helpingthepersontotakedeep
evenbreathscanhelplower
anxiety.

91. Panic-level anxiety
•Theperson’ssafetyisthe
primaryconcern.
•Cannotperceivepotentialharm
and
•mayhavenocapacityforrational
thought.

92. Nursing activity
•Keeptalkingtothepersonin
acomfortingmanner,even
thoughtheclientcannot
processwhatthenurseis
saying.

93. •Goingtoasmall,quiet,andnon-
stimulatingenvironmentmayhelpto
reduceanxiety.
•Thenursecanreassurethepersonthat
thisisanxiety,thatitwillpass,andthathe
orsheisinasafeplace.
•Thenurseshouldremainwiththeclient
untilthepanicrecedes.
•Panic-levelanxietyisnotsustained
indefinitelybutcanlastfrom5–30minutes.

94. Grief
•Grief is an oscillation between loss and
restoration
•focused on behaviour
•Demonstrated by swings of mood
•Thoughts and behaviour between
memories of the dead person and
•Getting on with life
•Avoidance or denial of loss is common
and part of the process
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95. REVISION
•Read and make notes on the grieving
process according to Kubler Ross and
management of abnormal grieving.
Please understand those stages of
grieving.
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96. Acute Stress Reaction
•Transient develops in response to physical and/or mental stress
and subsides within hours or days.
•This is an exaggeration of normal response
•Response to stress
•divorce,
•bereavement,
•terminal illness onset,
•having a handicapped child (emotional response),
•road accident,
•rape,
•Assault
•Then coping by use of a defence mechanism
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97. Acute Stress Reaction contd.
•Emotional response-anxiety symptoms, depressed
mood, poor concentration, physical symptoms of
anxiety such as palpitations and tremor. Social
functioning impaired.
•There can be an initial numbness feeling
•Depression when there is a loss event. Doesn’t meet
criteria for depressive disorder. No biological
symptoms.
•Coping can be problem solving and this reduces
anxiety. Talking through the stress can reduce anxiety
(basis of counselling).
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98. Acute Stress Reaction contd.
•Other people may avoid problem, deny,
repress or other defence mechanisms
•Maladaptive patterns of coping may be
alcohol, aggressiveness, anger
•Usually self-limited and people start to deal
with their stress
•May occur in up to a third of people after
stress. Significant number may go to have
post-traumatic stress disorder
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99. Acute Stress Reaction contd.
•Treatment
•Reduce stress and help coping, problem
solving
•Debriefing or recalling and talking through details
of stress unclear.
•Counselling.
•If severe an anxiety reducing drug can be
used for a short period e.g. diazepam 5-10
mgs. Or sleeping agent such as Diazepam 10
mgs or Temazepam 10 mgs night.
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100. Somatoform Disorders
•A Somatoform disorderis characterized by physical
symptoms that suggest physical illness or injury that
cannot be explained fully by a general medical
condition, direct effect of a substance, or attributable
to another mental disorder
•These range from
•Hypochondriasis,
•hysteria (conversion disorder),
•body dysmorphic disorder,
•somatization and
•pain disorder.
•Included among these disorders are false pregnancy
(pseudocyesis), psychogenic urinary retention, and
mass psychogenic illness (so-called mass hysteria).
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101. Hypochondriasis
•Hypochondriasis refers to a chronic preoccupation
with and fear of having a serious disease
•The preoccupation persists despite all reasonable
medical testing and reassurance; it may cover a
wide range of body functions and systems over
time as various evaluations demonstrate healthy
functioning.
•Also may occur in association with (co-morbid)
anxiety, depression, obsessive-compulsive
disorder, or psychotic disorders
•Occur at any age with a chronic course usually
waxing and waning symptoms and presentations
•Common in men and women and may be made
worse by the diagnosis of new medical problems
24/06/2021 MML@KCN 101

102. Hypochondriasis Contd.
•Often leads to recurrent investigations
•illness worry, distress, medical help seeking
•Often persistent with anxiety and depression
•Examples are HIV, malaria preoccupation, tuberculosis
•Patient may go for multiple tests and feel reassured for a
short period before seeking another
•Prevalence of 5% in population
•Hypochondriacs frequently “doctor shop” when
dissatisfied by the responsivity of their current physician.
•“Doctor shopping” occur in response to failure to
diagnose a condition, but more commonly occurs when
a physician unwittingly becomes irritated by the patient’s
persistent complaints
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103. Treatment of Hypochondriasis
Treatment needs to set limits
•Treatment of the hypochondriac include careful
assessment and reassessment for co-morbid
psychiatric disorders and avoiding unnecessary
investigations
•Drugs
•if possible withdraw unnecessary drugs but treat any
depression, symptomatic anxiety and frank delusions, which
may worsen hypochondriacal complaints and/or occur in
response to the chronic fear of disease
•Psychological
•Cognitive Model
•stop reassurance
•examine cognitions
•CBT -collaborative, reattribution of symptoms
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104. Assignment
•DISCUSSTHEMANAGEMENT OFA
PATIENT ATEACH OF THE
FOLLOWINGLEVELOFANXIETY
i.Mild
ii.Moderate
iii.Severe
iv.Panic
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105. References
•Gelder, M., Harrison, P. & Cowen, P. (2006). Shorter Oxford
Textbook of Psychiatry5th Edition. Oxford: Oxford University
Press.
•Jacobson, J. L. & Jacobson, A. (2001). Psychiatric Secrets: The
Secret Series2nd Edition. Philadelphia: Hanley & Belfus Inc.
•Kendrick, T. & Simon, C. (2006). Mental Health. Oxford: Oxford
University Press.
•Kaplan & Sadock (2000). Textbook of Psychiatry7th Edition. New
York: Lippincott Williams & Wilkins Publishers.
•Robertson, B., Allwood, C. & Gagiano, C. (2001). Textbook of
Psychiatry for Southern Africa. Oxford: Oxford University Press
•Semple, D., Smyth, R., Burns, J., Darjee, R. & McIntosh, A.
(2005). Oxford Handbook of Psychiatry. Oxford: Oxford
University Press.
•Puri, B.K., Laking, P.J. &Treasaden, I.H. (2002). Textbook of
Psychiatry(2
nd
Edition). Edinburgh: Churchill Livingstone.
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106. Thank you for
attending
God bless you!
TAKE NOT OF ALL THE QUESTIONS IN
THIS PRESENTATION