ANXIETY

STAGES OF ANXIETY  Persistent distress, reluctance to be away

 Physical pain
-Mild -Moderate -Severe -Panic
 Nightmares
 Increased alertness
Specific Phobia of Phobic Disorder
 Focus on central concerns Difficulty in concentration
 Inability to focus or solve problems (>6mos or more)
 SNS activated
 Always provoke out of proportion intense fear even
 Total inability to focus
just by thoughts
 Loss of ability to cope
 Eg. Snakes, injections, blood, height
 Fight or flight response
Clinical Treatments of Anxiety Disorders
Stages of Anxiety, Effects & Intervention
 CBT (Positive reframing, Decatastrophizing)
 Cognitive strategies
 Exposure Therapy or Systematic Desensitization
 Stress mgmt. educ
 Anti-anxiety medications
 Relax. techniques; coping strats; Promote catharsis
 Antidepressant (SSRIs preferred)
 Phys. activity to release
 Beta-blockers - relief of anx symptoms
 energy from SNS response
 Meds Anti-Anxiety Medication
 Stay with client Decrease stimuli; soft voice
Drug of choice: BENZODIAZEPINES ("ams")
Generalized anxiety disorder (GAD) (>6mos)
 Alprazolam (Xanax)
 Excessive worry with difficulty in concentrating  Chlordiazepoxide (Librium)
 Sleep disturbance  Clonazepam (Klonopin)
 Easy fatigability  Lorazepam (Ativan)
 Irritability
Mechanism of Action:
Social anxiety Disorder or Phobia (>6mos)
 Increase level of GABA which decreases stimulation
 Fears social interactions of limbic system = decrease anxiety
 Performing
 Humiliations OBSESSIVE- COMPULSIVE RELATED DISORDERS

Agoraphobia (>6mos) OC Related Disorders

-Hoarding Disorder
 Avoids open spaces or enclosed places
 Need to hide or escape a situation  "Can't let go
Panic Disorder or Panic Attack -Trichotillomania
-Recurrent, unexpected SNS hyperstimulation  Hair pulling
 Racing pulse -Excoriation Disorder
 Pounding HR
 Increased BP  Skin picking
 Sweating, flushing -Body Dysmorphic Disorder
-Feeling of losing control or dying OC Related Disorders
Separation Anxiety Disorder Nursing Diagnoses
4wks - kids
 Anxiety
6mos - Adults  Chronic low self-esteem
 Ineffective coping
 Impaired social interaction
Nursing Interventions

 Promote trust; catharsis

 Initially, allow time for compulsion, then gradually
set limits
 Thought stopping

Clinical Treatment of OCD

Disorder Psychotherapy Pharmacotheraphy

Body CBT (exposure SSRIs
dysmorphic and response
Disorder prevention)
Excoriation Habit reversal Limited studies on
Disorder theraphy pharmacotherapy
Hoarding Behavior No data to support
Disorder theraphy focuse pharmacotherapy
on removal of
hoarded items
and reduction in
accumulation of
new items
Trichotillomania Habit reversal Mixed to poor
Disorder theraphy response to SSRIs