Panic anxiety

This PPT useful for Nursing students

1. PRESENTATION ON PANIC ANXIETY DISORDER PRESENTED BY: Ms. RUCHI RANA

2. INTRODUCTION Panic anxiety disorders refers to sudden and repeated panic attacks (episodes of intense fear and discomfort that reach a peak with a few minutes) And person experiences severe physical symptoms such as chest pain , heart palpitations, breathlessness etc. (DSM-5)

3. Definition According to American Psychiatric Association,2014 Panic disorder is a fear or discomfort that abruptly arises and peaks in less that 10 minutes , can be triggered by stress , fear or even exercise , the specific cause is not always apparent.

4. CLINICAL FEATURES Physical symptoms Motoric symptoms : Tremors , restlessness, muscle twitches , fearful facial expression Autonomic symptoms : Palpitations, sweating, flushes,dyspnea,hyperventilation,dry mouth,dizziness,diarrhea

5. CLINICAL FEATURES Psychological Symptoms Cognitive Symptoms-Poor concentration, distractibility Perceptual Symptoms- Derealization , Depersonalization Affective Symptoms- fearfulness,Inability to relax, irritability Other symptoms - Insomnia,increase sensitivity to noise.

6. ETIOLOGY Family theory- It is believes that panic attacks runs in families and having higher incidence among first degree relatives. Socio-cultural factors -Major life transitions such as new job, getting married, child birth, loss of loved one, major failure etc are seems to be associated with the panic attack.

7. ETIOLOGY Personality factors- Person sensitive to anxiety, having personality traits of negative emotions may be at an increase risk. Childhood Trauma- Childhood physical and sexual abuse and seperation anxiety increase the risk of panic disorder.

8. PSYCHODYNAMICS OF PANIC DISORDER Childhood Experiences : Neurotic parents, unsatisfactory parent-child relationship Precipitating Factors : Loss of loved object or situational crises (real or imaginary) Primary ego defense mechanism repression used by the ego to repress the anxiety Failure of repression to control the anxiety Ego fails to activate the secondary ego defense mechanism to deal with the anxiety Leads to free floating anxiety (GAD, Panic)

9. DIAGNOSTIC CRITERIA According to DSM -5 Criteria for Panic disorder The experiencing of recurrent panic attacks, with one or more attacks followed by at least 1 month of fear of another panic attack or significant maladaptive behavior related to the attacks.

10. TREATMENT Medications Antidepressants such as fluoxetine , paroxetine Benzodiazepines such as Alprazolam , Diazepam , Lorazepam .

11. PHARMACOTHERAPY Benzodiazepines : Also called Minor transquillizers , Sedatives or hypnotics Used for treatment for anxiety Examples- Diazepam, Alprazolam , lorazepam

12. Contraindications Because to their muscle relaxant action, benzodiazepines may cause Respiratory Depression thus contraindicated for people having: Myasthenia gravis Sleep Apnea Bronchitis and COPD

13. Nurses Responsibilities for Benzodiazepines Caution is required when benzodiazepines are used in people with major depression Individual with a history of alcohol , opioid and and barbiturates abuse should avoid benzodiazepines, as there is a risk of life-threatening interactions with these drugs. Manage the side effects such as dizziness, drowsiness , poor coordination and feeling of depression. Educate patient that mixing alcohol with benzodiazepines can causing death.

14. Serotonin specific reuptake inhibitors (SSRIs) It increasing the level of active serotonin in synapses of the brain. Example- Dapoxetine ( Prillgy ) Fluxotine ( Oxactin ) Sertraline ( Lustral )

15. Side Effects Irregular heart rhythms Drowsiness Nausea Dizziness Insomnia

16. Nurses role in SSRIs Avoid SSRIs during 1 st trimester of pregnancy Monitor Vital signs of patient. Take medications with food. Use soft tooth brush Avoid Use of SSRIs with MAOI , because of the risk of serious adverse effect and even death. The combination has a high risk of Serotonin Syndrom

17. TREATMENT Cognitive Behavioral therapy

18. TREATMENT Exposure therapy

19. TREATMENT Stress management and Relaxation techniques

20. NURSING DIAGNOSIS 1.Anxiety related to acute or perceived threat to biological integrity as evidence by vague uneasy feeling of discomfort or fear accompanied by an autonomic response, restlessness and poor impulse control Expected outcome : Patient will be – Free from injury and reduce the level anxiety Discuss feeling of fear ,anxiety and so forth.

21. NURSING MANAGEMENT Nursing Intervention Rationale Approach in calm , non-threatening manner with the client. Use therapeutic communication skills to establish a trusting relationship (listening , warmth , empathy etc) Remain with the client when levels if anxiety are high (severe or panic). Maintain a quiet environment with minimal stimuli Provide reassurance and comfort measures. Avoid asking or forcing the client to make choices. Client develops feeling of security. Therapeutic skills put the client at comfort The client’s safety is priority. Anxious behavior escalates by external stimuli. Helps relieve anxiety. The client may not make sound and appropriate decisions.

22. NURSING DIAGNOSIS 2. Panic anxiety related to actual or perceived threat as evidenced by restlessness , poor impulse control and hyperactivity. Expected outcome : Patient will be- Free and free from injury Free from anxiety attacks Recognize the triggers and symptoms of panic anxiety panic.

23. NURSING INTERVENTIONS RATIONALE Maintain in a calm, non threatening working environment with the patient Establish trusting relationship Remain with the client at all the time panic Maintain a calm and quiet environment with minimal stimuli. Provide reassurance and comfort measures. Avoid asking or forcing the client to make choices. Encourage the client’s participation in relaxation exercises such as deep breathing Teach signs and symptoms of increasing anxiety , and ways to stop its progression ( eg,relaxation techniques) Feeling of security among the patient. Put the client at comfort. Client should not be left alone as his anxiety will increase. Anxious behavior increases by external stimuli. Helps relieve anxiety. The client may not be able to make decisions. Effective to reduce anxiety. Gives confidence to patient of having control over his anxiety.

24. NURSING DIAGNOSIS 3.Powerlessness related to helplessness and cognitive distortion as evidenced by apathy, irritability, anger and verbal expressions of having no control. Expected Outcome- Client will participate in decision making regarding own care. Client will demonstrate problem-solving skills to manage his life situation.

25. Nursing Interventions Rationale Encourage the client to take responsibility of self –care. Help the client to set realistic goals. Help the patient to identify areas of life situation that he can control. Provide positive reinforcement for participation in self-care activities. To increase patient’s feelings of control. Unrealistic goals may leads to feelings of powerlessness. Client’s emotional condition prevents his ability to solve problems. It enhances self-esteem and encourages repetition of positive behaviors.

26. NURSING DIAGNOSIS 4. Self –care deficit related to disabling anxiety as evidenced by impaired ability to perform activities of daily living (ADL) independently. Expected Outcome- Client will be able to perform ADL and demonstrate a willingness to do so.

27. Nursing Interventions Rationale Encourage the client to perform normal ADL to his level of ability. Encourage independence and intervene only when the client is unable to perform. Offer positive reinforcement for independent accomplishments. Successful performance of independent activities enhances self-esteem. Safety and comfort of the client are nursing priorities. Positive reinforcement enhances self-esteem and encourages repetition of desired behaviors.

28. Basic Activities of Daily Living (ADLs) Activities of daily living (ADLs) are basic tasks that must be accomplished every day for an individual to thrive. Generally, ADLs can be broken down into the following categories: • Personal hygiene Bathing, grooming, oral, nail and hair care. • Continence management A person’s mental and physical ability to properly use the bathroom.

29. Cont.. Dressing A person’s ability to select and wear the proper clothes for different occasions. • Feeding Whether a person can feed themselves or needs assistance. • Ambulating The extent of a person’s ability to change from one position to the other and to walk independently.

30. Cont.. I f no supervision ,direction or personal assistance is required ,then 1 point is given to the function activity . If the client requires supervision ,direction , personal assistance or total care then a 0 is assigned to that functional activity. A total score of 6 indicates full function. 4 indicates moderate impairment 2 or less indicates severe functional impairment. The purpose of the KATZ ADL, is to monitor the prognosis and treatment of older adults and chronically ill people It takes less than five minutes to perform and requires training