SUMMARY OF PSYCHIATRIC DISORDERSANXIETY DISORDERS
Individuals experience a degree of anxiety that is so high that it interferes with personal, occupational, or social functioning. ANXIETY DISORDERS are
the most commonform of psychiatric Disorder
in the USA.
TYPES/SUBTYPESPANIC DISORDERGENERALIZED ANXIETYDISORDER (GAD)PHOBIASOBSESSIVE-COMPULSIVEDISORDER (OCD)POST-TRAUMATIC STRESS DIRORDER (PTSD)FEATURES1.The patient experiences
2. Episodes typically last 15-30 minutes3. Four or more of the following symptomsare present:-
Choking or SmotheringSensation,
Nausea, Feelings of Depersonalization,
Fear of Dying
, Chills or Hot Flashes, Fear of going crazy, Decreased perceptual and cognitive abilities4. Pt may experience Changes in Behavior and/or Persistent Worries about when the nextattack will occur 5. May experience Agoraphobia due to fear of being in places where previous panic attacksoccurred.*
MAY BE CONFUSED WITH A HEARTATTACK *DOES NOT NECESSARILY FOLLOWS ANSTRESSFUL, IDENTIFIABLE EVENT
1. More than 6 months of uncontrollable, excessive, unrealisticworries (inadequacy in interpersonalrelationships, job responsibilities,finances, health of family members,household chores, and lateness for appointments)2. GAD causes significant impairmentin one or more areas of functioning.3. At least 3 of the following symptomsare present:-Fatigue-Restlessness-Inability to Concentrate-Irritability-Muscle Tension-Sleep Disturbances4. Characterized by Remissions andexacerbations (no acute anxiety attack)1. The client fears aspecific object or situationto an unreasonable level.Phobias include:-SOCIAL PHOBIA-AGORAPHOBIA-SPECIFIC PHOBIAS:-Fear of specific objects(snakes, spiders,strangers)-Fear of specificexperiences (flying, beingin the dark, riding anelevator, being in anenclosed space)1. The client has intrusivethoughts of unrealisticobsessions and tries tocontrol these thoughts withcompulsive behaviors,which are repetitive – ritualistic--Clients who engage inconstant ritualistic behaviorsmay have difficulty meetingself-care needs-If ritualsinclude constanthandwashing or cleaning,skin damage and infectionmay occur.1. Exposure to a traumatic event causes intense fear,horror, flashbacks, feelings of detachment andforeboding, restricted affect, and impairment for longer than 1 month after the event. Symptoms may last for years.-ACUTE PTSD: Symptoms last less than 3 months-CHRONIC PTSD: Symptoms last more than 3 monthsSYMPTOMS:-Recurrent, intrusive recollection of event-Dreams or images-Reliving through flashbacks, illusions, or hallucinations-Irritability, difficulty with concentration, sleepdisturbances, avoidance of stimuli associated withtrauma, inability to show feelings.(it differs from Acute Stress Disorder in that ASD occursafter exposure to a traumatic event, causing numbing,detachment and amnesia about the event for NOT MOREthan 4 weeks following the event, with symptoms lastingfrom 2 days to 4 weeks)ASSESSMENT
Perform a thorough Physical and Neurological examination to help determine if anxiety is primary or is secondary to another psychiatric disorder, a medical condition, or substance use.
Assess Risk for Suicide
Perform psychosocial assessment (To help client identify the problem to be addressed by counseling (stressful marriage, recent loss, stressful job or school situation)4.Assess coping mechanisms5.Use a standardized assessment scale, such as Hamilton Rating Scale for Anxiety.EXPECTEDOUTCOMES
Client uses coping mechanisms to prevent panic anxiety when stressful situations occur.
Client verbalizes acceptance of life situations over which he or she has no control3.The client is able to recognize signs of anxiety and intervene to prevent panic levelsINTERVENTIONSIn General, Interventions for Anxiety disorders attempt to:1.Reduce Anxiety2.Increase Self Esteem3.Increase Reality Testing4.Enhance Coping Mechanisms5.Instill Hope6.Relaxation Therapy1.Ensure Safety
Stay with the client and provide support (Provide reassurance, use therapeutic communication skills, useopen-ended questions, encourage client to verbalize feelings)
Use relaxation breathing techniques as needed4.Reduce environmental stimuli5.Encourage physical activity like walking6.Administer medications as prescribed (SSRIs, TCAs, MAOIs, Benzodiazepines (anxiolytics), Beta Blockers,Mood stabilizers)7.Instill hope (but avoid false reassurance)8.Enhance Self Esteem by encouraging positive statements about self and discussion of past achievements.9.Postpone teaching until acute anxiety subsides: clients with panic attack or severe anxiety are unable to