Professional Documents
Culture Documents
COLLEGE OF NURSING
The First Nursing School in the Philippines, 1906
Iloilo City, Philippines 5000
Tel. No. (63-33) 3291971 to 79 Local 1037 / 2133
Website: http://www.cpu.edu.ph | Email: nursing@cpu.edu.ph
Lecture Notes on
NCM 3218
(Care of Clients with Maladaptive Patterns of Behavior-Acute/Chronic)
ANXIETY DISORDERS
ANXIETY
response to external or internal stimuli that can have behavioral, emotional, cognitive, and physical
symptoms
A vague sense of impending doom, an apprehension or a sense of dread, to the lay person it is
described as ‘nervousness’
Types:
1. Anticipatory – “what will happen next” fears
2. Signal – response to a perceived threat/danger
3. Anxiety Trait – component of personality that has been present over a long period
4. Anxiety state – result of a stressful situation in which the person loses control of his/her
emotions
5. Free-floating – always present and is accompanied by a feeling of dread
Classifications
ETIOLOGY
1. Genetic Factors
5-http gene
15%-20% OCD - immediate family
40% agoraphobia - relative
2. Biologic
GABA Deficiency
Serotonin Deficit/Imbalance
Over/Underactivated Norepinephrine
3. Cognitive Theory
Learned/conditioned response
4. Psychoanalytic
unresolved, unconscious conflicts
5. Sociocultural
Difficulty adapting to everyday social and cultural demands
I. ANXIETY DISORDERS
A. Panic Disorder
Discrete period of intense fear or discomfort in the absence of real danger
Sudden onset of symptoms, peaking within 10 minutes
Onset: late adolescence (20’s) and the mid-30’s
Triggers:
injury
illness
interpersonal conflicts
ingestión of stimulants
2|Anxiety Disorders – Prof. Borlado
Interventions:
Medications: Ativan 0.5mg IV; Benzodiazepines; SSRI, TCA, MAOI
CBT
Provide non-threatening, supportive environment
Educate on thought substitution, meds s/e, stress response & management
Reduce caffeine
Be empathetic and non-argumentative
C. Phobias
uncontrollable, persistent irrational fear of an object or situation that impairs normal functioning
of a person
Typically displays:
Anticipatory anxiety
Avoidance behavior
Categories:
Agoraphobia fear of being alone in public places
Specific Phobia marked, persistent fear that is excessive or unreasonable, cued by
the presence or anticipation of a specific object or situation
(1) natural environment
(2) blood-injcetion
(3) situational
(4) animal
(5) others
Social Phobia also referred to as social anxiety disorder, is a compelling desire to
avoid situations in which others may criticize a person
Treatment:
Psychotherapy:
- Behavioral therapy
- Systematic desensitization
- Flooding
- Psychodynamic (insight-oriented)
Medications:
- Panic Disorder -Benzodiazepines (Lorazepam)
- Social Phobia -Clonazepam
Patient Education
- Teach what anxiety is & helping client identify anxiety responses
- Teach relaxation techniques, goal setting
- Discuss methods to achieve goals, and help the client to visualize phobic
situation
Etiology
Genetic
Behavioral
Environmental
E. Obsessive-Compulsive Disorder
characterized by recurrent obsessions or compulsions or a combination of both, that interferes
with normal life
onset: 20 years old but can occur as early as 2 years old
Etiology:
Stress
Genetics
Interpersonal Relationship
Group A Streptococcal Infection
Treatment:
SSRI; Clomipramine
Behavior Therapy
- relaxation
- neurosurgery
- calm and supportive environment
Onset:
Acute – less tan 3 months after the event
Chronic - beyond 3 months
Delayed - 6 months or more
Duration:
Acute - 1 to 3 months
Chronic - 3 months or more
Clinical symptoms:
Behavioral: hyperalertness, tend to abuse drugs, isolation,triggering events create a
cycle of reminders
Affective: irritable, tense and restless, labile, guilt feelings numbing of emotions, feel
detached from others
Cognitive: memory of traumatic events may be relieved by amnesia, flashbacks,
nightmares, dreams, illusions
Interventions:
SRI (Sertraline); Beta blockers (Propanolol)
non-stimulating, calm/tranquil environment
hospitalization (suicidal/homicidal)
coping strategies, stress management, relaxation techniques
counselling
NO caffeine
empathetic, supportive & non-threatening home environment
J. General Interventions:
Coping Assistance
Behavior Therapy- Art, Music, Play (for children)
Psychological Support
Techniques to reduce anxiety
Medications- Benzodiazepines, Beta blockers
Encourage verbalization of feelings especially anger, shock, depression
Be non-judgmental and honest
Encourage writing a journal
Expressive Therapy
Sleep disturbance therapy
K. General Treatment:
Behavioral/CBT
Psychotherapy
Supportive Family
Stress Management Technique
ETIOLOGY
Genetic and Biologic
- chemical imbalances (serotonin & endorphins)
- 10% to 20% of female first-degree relatives of people with this disorder
Familial/Psychosocial Theory
- characteristics of dynamic family relationships, such as parental teaching, parental example,
and ethnic mores
Learning Theory
- person learns to produce a physiologic response to achieve a reward, attention, or some other
reinforcement
INTERVENTIONS:
Focus on Anxiety reduction
Diversional activity, anxiolytic medications
Do not reinforce the sick role by not being overly attentive
Explore possible links between the symptoms and the emotions, past experiences or evoking thoughts
Establish a written contract that will redirect client’s thoughts and feelings
Allow the person to discuss physical complaints
7|Anxiety Disorders – Prof. Borlado
Matter of fact attitude
Psychotherapy
Relaxation Training
Hypnotherapy
INTERVENTIONS
Assure patient that he is not to blame for behaviors that occur during dissociative states.
Assure that staff will remain with him during overwhelming anxiety.
Listen actively and help patient identify effective coping methods.
Assist patient to utilize alternative coping methods. (provide opportunities for patients to vent anger,
fear, shame, doubt. Engage patient in physical activities that require energy and concentration.
Encourage patient to write thoughts, feelings, fears in a diary.
Praise the patient for the use of effective coping.
Refrain from passing judgment on the patient, instead let the patient know he/she is worthwhile.