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Anxiety Disorders Class 3 Part II Fall 2014 Slide 2 Anxiety Disorders Slide 3 What is Anxiety Subjective Emotional Response to a stressor vs. Stress Multi-faceted Response to a stressor vs. Fear Cognitive Response to a stressor Slide 4 Anxiety Disorders When does anxiety go from normal to abnormal? How do we decide whats normal? Is it out of proportion? Dys-function Junction Slide 5 Types of Anxiety Disorders Its a GAD (Generalized Anxiety D/O)! Panic Disorder Agorophobia Phobias (Specific) Social Anxiety Disorder (Social Phobia) Substance/Medication Induces Anxiety D/O OCD and Related Disorders Separation Anxiety D/O (Covered with children) Slide 6 Trauma and Stress-Related Disorders Post-traumatic Stress Disorder In the DSN 5 PTSD is now in this new category of disorders, but we will include it with the anxiety disorders. Slide 7 Just the Facts Anxiety is the most common form of psych disorder in US Co-morbidity-occurs simultaneously with major depression or substance use Women >2X more than men Slide 8 Phobias Persistent Irrational Fear Response Exposure/ Thinking about Phobic stimulus Agoraphobia Social Phobia Specific Phobia A (acrophobia) to Z (zoophobia) Goals of Nursing Interventions Decrease fear Increase ability to function Slide 9 Obsessive-Compulsive and Related Disorders OCD Body Dysmorphic D/O Hoarding D/O Tricotillomania D/O (hair pulling) Excoriation D/O (skin picking) Substance/Medication Induced OCD OCD due to another medical condition Slide 10 Oh say can you see the OCD Obsessions Compulsions Usually in it together Neurobiological Disturbances Nursing Interventions http://www.youtube.com/watch?v=Rn1OYlYzgm 8 Slide 11 Patient Goals Manageable level of Anxiety Perform ADLs Understands relationship between anxiety/ compulsions IDs situations that provoked anxiety Adaptive coping strategies Role-related responsibilities Slide 12 Its a GAD! Generalized anxiety disorder Chronic & Unrealistic Whats in Excess? Signs & Symptoms Can also be related to Medical Conditions Slide 13 Im so Panicked! (Panic Disorder) Unpredictable & Recurrent Attacks Feelings Intense Physical Symptoms Derealization Depersonalization Fears of ..? Slide 14 Nursing Interventions for GAD and Panic Disorder Relieve acute symptoms Assist client ID S/S of escalating anxiety Skills to manage anxiety Setting realistic goals Exercising control over own life ID and accept situations where they have no control Slide 15 Trauma and Stress-Related Disorders: Post-Traumatic Stress Disorder (PTSD) Occurs after exposure to an extreme traumatic stressor Stressor involves a personal threat to physical integrity of self or others Symptoms: Flashbacks Avoidance of anything associated with the trauma Numbing Hypervigilence Slide 16 PTSD Estimated 8% of Adult population in US have PTSD First recognized in Vietnam War Veterans http://www.youtube.com/watch?v=Ne3DOM3X tjI Slide 17 How do we assist our patients with anxiety disorders? Remain calm Reassure client R/T safety & security Enhance coping & self-esteem Provide hope Nonpharmacologic Measures Relaxation therapy Slide 18 Treatment Modalities for Anxiety Disorders Individual Psychotherapy Cognitive Therapy Behavior Therapy Group/ Family Therapy Psychopharmacology Slide 19 Antidepressants SSRIs TCAs MAOIs SNRIs Anxiolytics Benzos are the Best BUT And then there are the other medications Slide 20 Slide 21 Anxiolytics A void abrupt D/C after prolonged use N ot given if B/P is elevated, renal/ hepatic dysfunction or drug abuse X anax, Ativan are examples Increases the 3 Ds Drowsy, Dizzy, Decreased B/P E nhanced action of GABA (Inhibitory transmitter) T each to rise slowly from supine Y es Avoid Alcohol! Slide 22 Pharmacotherapy GAD & Panic D/Os and Phobic D/Os Anxiolytics, Antidepressants, Anti-hypertensive agents OCD & PTSD OCD- Antidepressants PTSD- Antidepressants, Anxiolytics, Other drugs for severe symptoms Slide 23 Coming in Class 4 Bipolar & Related Disorders Depressive Disorders Schizophrenia Spectrum Non-pharmacological & Pharmacological Management of these Disorders