Anxiety Disorders

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Generalized Anxiety Disorder

Excessive anxiety and worry occurring more days than not for at least 6
months.

Symptoms include:
restlessness
feeling on the edge
easily fatigued with sleep disturbance
Difficulty concentrating
Irritability and muscle tension

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Goal
To reduce level of anxiety
1. Administer anti-anxiety agent
2. Teach anxiety-reducing techniques
3. Reduce pressure and anxiety-provoking situations
around client.
4. Divert attention from symptoms

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Panic Disorders
Intense anxiety with sympathetic
arousal.

Shortness of breath, dizziness,

diaphoresis, palpitations, chest pain, and
paresthesias, sense of doom,
depersonalization, may be with fear of
being in open space

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Panic Disorder without agoraphobia

characterized by recurrent panic attacks followed by at

least 1 month of persistent concern about having
another attack, worry about possible implications or
consequences of the attack, or a significant behavioral
change related to the attack.

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Panic with agoraphobia
anxiety about being in places or situations from which
escape might be difficult or embarassing, or in which
help may not be available in the event of having panic-
like symptoms.

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Goal
To reduce panic level anxiety feelings by reinterpreting
the feelings correctly
1. Anticipate administration of TCA
2. Reduce amount of caffeine in diet

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B.Obsessive Compulsive disorder

The essential features are recurrent obsessions or

compulsions that are severe enough to be the time
consuming, cause marked distress, or lead to significant
impairment in functioning.

The disorder begins in childhood and adolescence

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Characteristics

Obsessions and compulsions commonly occur together

Aware of the unrealistic, intrusive and inappropriate nature of
obsessions and compulsions
Attempt to resist obsessive thought or compulsive behavior
causes individual to experience increased anxiety
Indulgence in obsessive thought and performance of compulsive
behaviors causes temporary anxiety relief

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Goal
To assist in coping with the compulsive behavior
1. Accept rituals and avoid punishment or criticism; do not
interrupt ritual because this will increase anxiety.
2. Plan for extra time because of slowness and clients need for
perfection.
3. Prevent physical deterioration or harm, and set limits only to
prevent harmful acts (such as hand washing excessively that
removes the skin from the hand surface).

10
Phobic Disorder

Irrational fear of a specific object, activity or event.

Etiology
1. genetic susceptibility
2. conditioned response

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Characteristics

Irrational fear accompanied by persistent avoidance of

object, person, or situation.
Individual recognizes the fear as irrational and
inappropriate but feels powerless to control it
Simple phobia fear of specific things
Social phobia fear of potentially embarassing social
situations.

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Goal
To reduce phobic behavior
1. Do not force client to come in contact with the feared
object or source of anxiety.
2. Have client focus on awareness of self
3. Distract clients attention from phobia

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Post-traumatic Stress Disorder

Recurrent thoughts and feelings associated with severe,

specific trauma
can be acute or delayed response. Can also become chronic

Etiology
1. Direct relationship between trauma and risk of PTSD.
2. Psychosocial risk factors
.

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Symptoms

Exaggerated startle response, sleep disorders, guilt,

nightmares, flashbacks, anger with numbing of other
emotions.
Affected individuals often use drugs, alcohol, or both to
self-medicate for distressful symptoms.

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Goal
To determine precipitating stress factor in clients
reaction.
1. Reduce and prevent chronic disability
2. Encourage verbalization of the traumatic event.

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Goal
To maintain personal integrity
1. Provide physical, social, or occupational rehabilitation
2. Somatic therapies are used to decrease anxiety (e.g.
anti-anxiety agents, etc.)

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Dissociative disorders

Alteration in conscious awareness, which includes

periods of forgetfulness, memory loss, for past stressful
events, feeling disconnected from daily events, or
emergence of distinctly different personalities.

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Symptoms can include:
headaches and other body pains
distortion or loss of subjective time
depersonalization
amnesia
depression

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 Patients may experience an extremely broad array of
other symptoms that resemble epilepsy, schizophrenia,
anxiety, Mood disorders, posttraumatic stress,
personality, and eating disorders, with frequent
misdiagnoses and ineffective treatment.

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 Patients may experience auditory hallucinations of the
various alters conversing, and may be misdiagnosed as
psychotic as a result.
Changes in identity, loss of memory, and awaking in
unexplained locations and situations often leads to
chaotic personal lives.

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Dissociative Amnesia: This disorder is characterized
by a blocking out of critical personal information,
usually of a traumatic or stressful nature.

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Localized amnesia
is present in an individual who has no memory of
specific events that took place, usually traumatic. The
loss of memory is localized with a specific window of
time
For example, a survivor of a car wreck who has no
memory of the experience until two days later is
experiencing localized amnesia.

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Selective amnesia happens when a person can recall only small
parts of events that took place in a defined period of time. For
example, an abuse victim may recall only some parts of the
series of events around the abuse.

Generalized amnesia is diagnosed when a person's amnesia

encompasses his or her entire life.

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Systematized amnesia is characterized by a loss of
memory for a specific category of information. A person
with this disorder might, for example, be missing all
memories about one specific family member

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Dissociative Fugue
is a rare disorder. An individual with dissociative fugue suddenly
and unexpectedly takes physical leave of his or her surroundings
and sets off on a journey of some kind.
These journeys can last hours, or even several days or months
An individual in a fugue state is unaware of or confused about his
identity, and in some cases will assume a new identity ( although
this is the exception ).

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Dissociative Identity Disorder ( DID )

which has been known as multiple personality disorder,

is the most famous of the dissociative disorders. An
individual suffering from DID has more than one distinct
identity or personality state that surfaces in the
individual on a recurring basis.

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 This disorder is also marked by differences in memory
which vary with the individual's alters, or other
personalities.

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Depersonalization Disorder
is marked by a feeling of detachment or distance from
one's own experience, body, or self. These feelings of
depersonalization are recurrent.
Of the dissociative disorders, depersonalization is the
one most easily identified with by the general public;
one can easily relate to feeling as they in a dream, or
being spaced out.

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 An individual with depersonalization disorder has this
experience so frequently and so severely that it
interrupts his or her functioning and experience.

A person's experience with depersonalization can be so

severe that he or she believes the external world is
unreal or distorted.

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Contributing Factors
Trauma
Abuse
Sexual and physical abuse in early childhood
Gender
OCD
Sensory Deprivation
Severe stress such as military combat, violent crime, or
other traumatic events.
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Assessment Findings
Anxiety Symptoms
Depressive symptoms
Disturbance in sense of time
Fear of going insane
Impaired occupational functioning
Impaired social functioning
Low self-esteem
Persistent or recurring feelings of detachment from mind and
body.

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Diagnostic Test
Standard Dissociative disorder Test demonstrate high
degree of dissociation. These include:
Diagnostic drawing series
Dissociative experience scale
Dissociative interview schedule
Structured clinical interview for dissociative disorders.

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 Impaired memory
Posttrauma response
Sensory or perceptual alterations

Free Template from www.brainybetty.com 34

 Combination of the following treatments could be used for clients
with anxiety disorders. There is no standard single approach to
deal with anxiety disorders

NAME GOAL HOW IT WORKS BENEFITS DRAWBACKS

Behavior Therapy Modify and gain control Learning to cope with Person actively involved Can take time to achieve
over unwanted behavior difficult situations, often in recovery skills that are results
through controlled useful for a lifetime
exposure to them

Cognitive Therapy Change unproductive Examine feelings and Person actively involved Can take time to achieve
thought patterns learn to separate realistic in recovery skills that are results
from unrealistic thoughts useful for a lifetime

Relaxation Techniques Help resolve stresses Breathing re- training, Person actively involved Can take time to achieve
that can contribute to exercise and other skills in recovery skills that are results
anxiety useful for a lifetime

Medication Resolve symptoms Help restore chemical Effective for many Most medications have
imbalances that lead to people, enables other side effects
symptoms treatment to move
forward
 DRUG NAME CLASSIFICATION TO TREAT

Aldrazolam Benzodiazepine Anxiety, panic, OCD, Social and

Agoraphobia.
Buspirone Nonbenzodiazepine anxiolytic Anxiety, OCD, socal phobia, GAD

Chlordiazepoxide Benzodiazepine Anxiety

Clomidramine Tricyclic antidepressant OCD

Clonazepam Benzodiazepine Anxiety, panic, OCD

Clonidine Beta-blocker Anxiety, panic

Chlorazepate Benzodiazepine Anxiety

Diazepam Benzodiazepine Anxiety, panic

Fluoxetine SSRI anti depressant Panic, OCD, GAD

Fluvoxamine SSRI anti depressant OCD

Hydoxyzine Antihistamine Anxiety

Imipramine Tricyclic antidepressant Anxiety, panic, agoraphobia

Meprobamate Nonbenzodiazepine anxiolytic Anxiety

Oxazepam Benzodiazepine Anxiety

Paroxetine SSRI antidepressant Social phobia, GAD

Propanolol Alpha-adrenergic agonist Anxiety, panic disorder, GAD

Sertraline SSRI antidepressant Panic, OCD, social phobia, GAD

Common Nursing Diagnosis:

Ineffective Coping
Impaired Decision Making
Breathing pattern, ineffective
Individual coping, ineffective
Verbal communication, Impaired
Anxiety
Powerlessness
Fear
Nursing Care:

Remain with the client at all times when levels of anxiety are
high
Move the client to a quiet area with minimal or decreased
stimuli using a small room or seclusion area may be indicated.
Remain calm in your approach to the client.
Avoid asking or forcing the client to make choices.
Encourages the clients participation in relaxation
techniques/exercise.
Help the client to see mild anxiety as a positive catalyst for
change.
Collaboration for the administration of antianxiety drugs to
reduce the symptoms of severe anxiety.- Collaboration of
antianxiety drugs & observe the side effects of drugs.