COLLEGE OF NURSING

ANXIETY DISORDER





Submitted By:
Ayr Hershel D. Masenas
Flora Angeli D. Pastores
Bsn 3-1

Submitted to:
Mr Rolando P. Antonio, RN MAN


May, 2014

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Republic of the Philippines
CAVITE STATE UNIVERSITY
DON SEVERINO DELAS ALAS CAMPUS
Indang, Cavite
UNIVERSITY VISON
The Premier University in historic
Cavite recognized for excellence in
the development of globally
competitive and morally upright
individuals.

Anxiety Disorder comprise a group of condition that share a key feature of excessive
anxiety with ensuing behavioural, emotional, cognitive, and physiologic responses. Clients
suffering from anxiety disorders can demonstrate unusual behaviours such as panic without
reason, unwarranted fear of objects or life conditions, uncontrollable repetitive actions, re-
experiencing of traumatic events, or unexplainable or overwhelming worry. Anxiety is
distinguished from fear, which is feeling afraid or threatened by a clearly identifiable external
stimulus that represents danger to the person. Anxiety is unavoidable in life and can serve many
positive functions such as motivating the person to take action to solve a problem or to resolve a
crisis. Anxiety causes uncomfortable cognitive, psychomotor, and physiologic responses, such as
difficulty with logical thought, increasingly agitated motor activity, and elevated vital signs.
The condition often develops for no apparent reason. Various factors may play a part.
These are some of reason why anxiety disorder happens to a patient. Your genetic 'makeup' may
be important (the material inherited from your parents which controls various aspects of your
body). Some people have a tendency to have an anxious personality, which can run in families.
Childhood traumas such as abuse or death of a parent may make you more prone to anxiety when
you become older. A major stress in life may trigger the condition. For example, a family crisis
or a major civilian trauma such as a toxic chemical spill. But the symptoms then persist when
any trigger has gone. Common minor stresses in life, which you may otherwise have easily
coped with, may then keep the symptoms going once the condition has been triggered.



Levels of Anxiety
 Mild anxiety is a sensation that something is different and warrants special
attention. Sensory stimulation increases and helps the person focus attention to
learn, solve problems, think, act, feel, and protect him or her.
 Moderate anxiety is the disturbing feeling that something is definitely wrong; the
person becomes nervous or agitated.
 Severe anxiety - person with severe anxiety has trouble thinking and reasoning.
Muscles tighten and vital signs increase. The person paces; is restless, irritable,
and angry; or uses other similar emotional–psychomotor means to release tension.
 Panic the emotional–psychomotor realm predominates with accompanying fight,
flight, or freeze responses.
What Are the Symptoms of an Anxiety Disorder?
Symptoms vary depending on the type of anxiety disorder, but general symptoms include:
 Feelings of panic, fear, and uneasiness
 Uncontrollable, obsessive thoughts
 Repeated thoughts or flashbacks of traumatic experiences
 Nightmares
 Ritualistic behaviors, such as repeated hand washing
 Problems sleeping
 Cold or sweaty hands and/or feet
 Shortness of breath
 Palpitations
 An inability to be still and calm
 Dry mouth
 Numbness or tingling in the hands or feet
 Nausea
 Muscle tension
 Dizziness
What Causes Anxiety Disorders?
The exact cause of anxiety disorders is unknown; but anxiety disorders -- like other forms
of mental illness -- are not the result of personal weakness, a character flaw, or poor upbringing.
As scientists continue their research on mental illness, it is becoming clear that many of these
disorders are caused by a combination of factors, including changes in the brain and
environmental stress.
Like other brain illnesses, anxiety disorders may be caused by problems in the
functioning of brain circuits that regulate fear and other emotions. Studies have shown that
severe or long-lasting stress can change the way nerve cells within these circuits transmit
information from one region of the brain to another. Other studies have shown that people with
certain anxiety disorders have changes in certain brain structures that control memories linked
with strong emotions. In addition, studies have shown that anxiety disorders run in families,
which means that they can at least partly be inherited from one or both parents, like the risk for
heart disease or cancer. Moreover, certain environmental factors -- such as a trauma or
significant event -- may trigger an anxiety disorder in people who have an inherited susceptibility
to developing the disorder.

How Common Are Anxiety Disorders?
Anxiety disorders affect about 19 million adult Americans. Most anxiety disorders begin in
childhood, adolescence, and early adulthood. They occur slightly more often in women than in
men, and occur with equal frequency in whites, African-Americans, and Hispanics.
How Are Anxiety Disorders Diagnosed?
If symptoms of an anxiety disorder are present, the doctor will begin an evaluation by asking you
questions about your medical history and performing a physical exam. Although there are no lab
tests to specifically diagnose anxiety disorders, the doctor may use various tests to look for
physical illness as the cause of the symptoms.
If no physical illness is found, you may be referred to a psychiatrist, psychologist, or another
mental health professional who is specially trained to diagnose and treat mental illnesses.
Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate
a person for an anxiety disorder.
The doctor bases his or her diagnosis on the patient's report of the intensity and duration of
symptoms -- including any problems with daily functioning caused by the symptoms -- and the
doctor's observation of the patient's attitude and behavior. The doctor then determines if the
patient's symptoms and degree of dysfunction indicate a specific anxiety disorder.
How Are Anxiety Disorders Treated?
Fortunately, much progress has been made in the last two decades in the treatment of people with
mental illnesses, including anxiety disorders. Although the exact treatment approach depends on
the type of disorder, one or a combination of the following therapies may be used for most
anxiety disorders:
 Medication: Drugs used to reduce the symptoms of anxiety disorders include anti-
depressants and anxiety-reducing drugs.
 Psychotherapy: Psychotherapy (a type of counseling) addresses the emotional
response to mental illness. It is a process in which trained mental health professionals
help people by talking through strategies for understanding and dealing with their
disorder.
 Cognitive-behavioral therapy: This is a particular type of psychotherapy in which
the person learns to recognize and change thought patterns and behaviors that lead to
troublesome feelings.
 Dietary and lifestyle changes.
 Relaxation therapy.

Etiology
Some research suggests that GAD may run in families. It may also grow worse when a person is
under stress. Although the exact causes of GAD are unknown, it may be due to a chemical
imbalance in the brain. Serotonin and norepinephrine are 2 chemicals used by some nerve cells
to communicate. These chemicals, called neurotransmitters, are thought to be linked to GAD.
Therefore, medications that affect these neurotransmitters may play a role in treating GAD. Like
other complex medical illnesses such as heart disease and diabetes, the exact causes of
generalized anxiety disorder, or GAD, are difficult to explain. Research suggests that
environmental and genetic factors (eg, a family history of GAD) may make a person more likely
to develop the disorder.Experts also agree that GAD may be caused by an imbalance of certain
chemicals in the brain. In particular, 2 neurotransmitters (chemical message carriers) called
dopamine and serotonin, are believed to regulate mood and behavior. Depression and/or other
anxiety disorders are also common in people with GAD.
In people who develop GAD, anxiety symptoms often occur first during childhood or
adolescence, but they can also begin in adulthood. GAD affects people of all ages, and the
disorder is twice as likely to affect women as men. According to the National Institute of Mental
Health, approximately 19 million Americans suffer from depression and 4 million from GAD
each year.


Treatment options
Cognitive Behavioral Therapy
Cognitive-behavioral therapy (CBT) for generalized anxiety disorder can be very effective. CBT
examines distortions in our ways of looking at the world and ourselves. Negative thoughts lead
to negative emotions, so CBT aims to change those negative thoughts before they trigger
psychological difficulties. CBT for generalized anxiety disorder involves retraining the way you
think. You therapist will help you identify automatic negative thoughts that contribute to your
anxiety. For example, if you catastrophize—always imagining the worst possible outcome in any
given situation—you might challenge this tendency through questions such as, ―What is the
likelihood that this worst-case scenario will actually come true?‖ and ―What are some positive
outcomes that are more likely to happen?‖
According to the San Francisco Bay Area Center for Cognitive Therapy, Cognitive Behavioral
Therapy for GAD involves five components:
Education
CBT teaches you about the cognitive, physical, and behavioral processes involved in anxiety. It
also teaches you how to distinguish between helpful and unhelpful worry. An increased
understanding of your anxiety encourages a more accepting and proactive response to it.
Monitoring
Through CBT, you learn to monitor your anxiety, including what triggers it, the specific things
you worry about, and the severity and length of a particular episode. This data helps you get
perspective, as well as track your progress.
Physical Control Strategies
Deep breathing and progressive muscle relaxation help decrease the physical over-arousal of the
―fight or flight‖ response that maintains the state of fear and anxiety.
Cognitive Control Strategies
Through CBT, you are taught to realistically evaluate and alter the thinking patterns that
contribute to your anxiety. As you challenge these negative thoughts, your fears will begin to
subside. CBT also teaches you to test the beliefs you have about worry itself, such as ―Worry is
uncontrollable‖ or ―If I worry, bad things are less likely to happen.‖


Behavioral Strategies
Instead of avoiding situations you fear, CBT teaches you to tackle them head on. You may start
by imagining the thing you’re most afraid of. By focusing on your fears without trying to avoid
or escape them, you will begin to feel more in control and less anxious. Time management and
problem-solving skills are also effective behavioral techniques for GAD.
CBT for generalized anxiety disorder also involves training in relaxation techniques such as
guided imagery (visualizing a soothing place), progressive muscle relaxation (systematic tensing
and relaxing of the various muscle groups), and controlled breathing. Practice Your Breathing
Skills outlines three deep breathing techniques that can counteract anxiety. Biofeedback has also
been found to reduce symptoms in GAD.

Medication
Medication can be effective for generalized anxiety disorder. However, it is generally
recommended only as a temporary measure to relieve symptoms at the beginning of the
treatment process, with psychotherapy the key to long-term success. See Psych Central’s article
on treatment for GAD for a discussion of drug therapy vs. alternative non-drug treatments.
There are three types of medication prescribed for generalized anxiety disorder:
Buspirone – This anti-anxiety drug, known by the brand name Buspar, is generally considered to
be the safest drug for chronic anxiety. Unlike the benzodiazepines, buspirone isn’t sedating or
addictive. Although buspirone will take the edge off, it will not entirely eliminate anxiety.
Buspirone typically takes at least two weeks before it has a therapeutic effect.
Benzodiazepines – These anti-anxiety drugs act very quickly (usually within 30 minutes to an
hour). The rapid relief the benzodiazepines provide is a major benefit. But there are serious
drawbacks as well. Benzodiazepines are addictive, and both physical and psychological
dependence are common after more than a few weeks of continuous use. They are generally
recommended only for severe, paralyzing episodes of anxiety. Common brand names include
Xanax and Valium.
Antidepressants – A number of antidepressants are used in the treatment of GAD. Commonly
used brands include Effexor, Paxil, Prozac, Tofranil, and Lexapro. The relief antidepressants
provide for anxiety is not immediate, and the full effect isn’t felt for up to six weeks.
For an in-depth look at the medications used for generalized anxiety disorder and the pros and
cons of drug treatment, read Helpguide's Anxiety Medications: Benefits and Risks.

Other Generalized Anxiety Disorder Treatments
People with generalized anxiety disorder can adopt a number of effective self-help techniques.
Using ―self-talk‖ to intervene in your own anxious thoughts — forcing yourself to stop the cycle
of anxiety and replace worried self-dialogue with practical dialogue — can help you learn how
not to worry. Tips for learning how to ―worry well‖ include:
· Writing down and postponing worrisome matters until your body and mind are better able to
handle them.
· Challenging the thoughts brought on by anxiety.
· Being prepared for stressful situations.
· Discovering further relaxation techniques