ANXIETY DISORDERS

CAROLETTE BROWN MSc, RN

Anxiety is a state characterized by a feeling of dread and accompanied by somatic signs that indicate a hyperactive autonomic nervous system.It is an response to a threat that is unknown,vague or conflictual.

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 himself/herself. Often motivates people to make changes or to engage in goal-directed activity.

Moderate anxiety- is disturbing feeling that something is definitely wrong. The person becomes nervous or agitated. The person can still process information, solve problem and learn new things with the assistance of from others. Has difficulty concentrating Independently but can be redirected.

Sever anxiety- primitive survival skill take Over, defensive responses ensue and Cognitive skills decrease significantly. There is difficulty thinking and reasonining; V/S increase, pacing & restlessness, Irritability.

Epidemiology - make up the most common group of psychiatric disorders - women are more affected Etiology 1. Biological 2. Psychoanalytic 3. Learning theory 4. Genetic

Medical and neurological causes of anxiety 1. Neurological disorders: epilepsy, multiple sclerosis, migraine, cerebral trauma, encephalitis 2. Systemic conditions: hypoxia 3. Endocrine disturbance: pituitary dysfunction 4. Inflammatory: SLE, RA,

5. Deficiency state: vitamin B12 6. Miscellaneous conditions:hypoglycemia, PMS, febrile illness 7. Toxic condition: drug withdrawal, penicillin, mercury,aspirin, vasopressor agents

Types

. Panic disorder: characterized by panic attacks i.e. a discrete period period of intense fear/discomfort which develops abruptly and reach peak within 10 minutes.

. Agoraphobia: anxiety about being in places or situations from which escape might be difficult/embarrassing or which help may not be available in the event of having an unexpected situationally predisposed panic

attack or panic like symptoms. Fear involves situation that include being outside the home alone,being in crowd or standing in a line, being on a bridge,traveling in bus, train or car 3. Generalized anxiety disorders:Involves excessive worry about actual circumstances, events or conflicts.It accompanied by somatic symptoms and causes significant impairment in social occupational functioning

. Specific phobias: marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation

. Social phobia: fear of one or more social performance situations in which the person is exposed to unfamiliar people or possible scrutiny by others.The fear that they may act in a way that will be humiliating or embarrassing

6. Obsessive compulsive disorder: obsession is a recurrent and intrusive thought, feeling, idea, or sensation. A compulsion is a is a conscious, standardized,recurrent thought or behavior, such as counting, checking, or avoiding. Obsessions increase a persons anxiety, whereas carrying out compulsions reduces a persons anxiety. However, when a person resists carrying out a compulsion anxiety is increased.

. Posttraumatic stress disorder: Results from emotional stress that was of a magnitude that would be traumatic for almost anyone e.g. combat experience, rape. Disorder consists of- re-experiencing of trauma through dreams and waking thoughts; avoidance of reminders of the trauma; persistent hyperarousal. Common associations depression, anxiety. Symptoms must be for 1month or more

8. Acute stress disorders: Similar to PTSD but symptoms last for a minimum of 2 days and a maximum of 4 weeks 9. Anxiety due to medical condition 10. Substance induced anxiety 11. Mixed anxiety-depressive disorders 12. Other anxiety states

Signs and Symptoms of anxiety 1. Physical: Trembling, twitching, feeling shaky Backache,headache Muscle tension SOB, hyperventilation Fatigability Startle response

Autonomic hyperactivityflushing,pallor,sweating,dry mouth tachycardia, palpitation,cold hands urinary frequency Paraesthesia Difficulty swallowing

2. Psychological Feeling of dread Difficulty concentrating Hypervigilance Insomnia Decreased libido Lump in the throat Upset stomach

Treatment 1. Pharmacological 2. Psychological- supportive, insight oriented,behavior cognitive,group 3. Education

7. Post Traumatic Stress Disorder

-Etiology Evidence indicates a genetic predisposition for PTSD, which may be linked to the individual's temperament The incidence and course of PTSD depend on: the type and severity of trauma, The duration of the exposure the proximity to the stressor,

 Symptoms begin within 3 months after trauma (may be delayed for months, years) First reaction meets acute stress disorder criteria Symptoms vary based on the reexperience, avoidance and hyper arousal symptoms overtime Duration varies within 3 months to more than 12 months

In some cases the duration is characterized by diminishing or worsening symptoms Symptoms can resurface in response to reminders of the trauma, life stressors or new traumatic events.

 PTSD is more prominent in women than in men. Studies indicate that females tend to exhibit more internalizing e.g. anxiety, dissociation and avoidance while males tend to externalize e.g. aggression, impulsivity , inattention and hyperactivity.

 PTSD is more common among individuals in low socioeconomic groups and among those living in areas in which violence is endemic. PTSD occurs in people of all ages, but younger and elderly persons are the most vulnerable.

Cause of PTSD
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PTSD may be caused by exposure to a severe traumatic stress such as: Rape Sexual and physical abuse Car accidents Fires Experiencingwar Receiving a serious medical diagnosis Being subjected to invasive

 Numerous factors increase the likelihood that a child will develop PTSD in response to a given stress. These include: Lack of social and parental support Prior exposure to traumatic incidents A preexisting psychiatric disorder Repeated trauma Trauma caused by a person (especially if by a trusted caregiver) rather than resulting from an accident

 Parental reaction is a critical factor affecting the child's reaction. Parents' anxiety and difficulty coping with life as the result of the trauma may overwhelm a child, whereas parental ability to cope and to provide a safe haven for a child may markedly affect the child's ability to deal with the stressor or the propensity to develop prolonged PTSD.

Posttraumatic Stress Disorder

Diagnostic Criteria

Diagnostic Criteria
According to the DSM-IV-TR criteria,
A. The person should have been exposed to a traumatic event in which both of the following are present: The person experienced, witnessed or was confronted with an event that involved actual or threatened death, serious injury,or a threat to the physical integrity of self or others. The persons response involved

Diagnostic Criteria Contd

B. The traumatic event is persistently reexperienced in one (or more) of the following ways:

Recurrent and intrusive distressing recollections of the event,including images,thoughts or perceptions. In young children,repetitive play may occur in which themes or aspects of the trauma are expected. Recurrent distressing dreams of the event.In children, there may be frightening dreams without

Diagnostic Criteria Contd

Acting or feeling as if the traumatic event was recurring. In young children,trauma specific re-enactment may occur. Intense psychological distress at exposure to cues that represents an aspect of the traumatic event. Physiological reactivity on

Diagnostic Criteria Contd

C.Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma) as indicated by three or more of the following.
Efforts to avoid thoughts ,feelings,or conversations associated with the trauma Efforts to avoid activities,places,or people that arouse recollections of the trauma

Diagnostic Criteria Contd

Markedly diminished interest or participation in significant activities Feeling of detachment or estrangement from others Restricted range of effect (e.g. unable to have loving feeling) Sense of fore shortened future( e.g. does not expect to have a career ,marriage,children or normal life span)

Diagnostic Criteria Contd

D.Persistent symptoms of increased arousal(not present before the trauma) as indicated by two or more of the following: Difficulty falling or staying asleep Irritability or outbursts of anger Difficulty concentrating Hyper vigilance Exaggerated startle response

Diagnostic Criteria Contd

E. Duration of the disturbance(symptoms in Criteria B,C,and D)is more than 1 month F. The disturbance causes clinically significant distress or impairment in social,occupational,or other important areas of functioning

Diagnostic Criteria Contd

Acute: if duration of symptoms is less than 3 months Chronic: if duration of symptoms is 3 months or more With Delayed Onset: if onset of symptoms is at least 6 months after the stressor

Nursing Diagnosis Anxiety (specify level) Ineffective individual coping Sleep pattern disturbance Ineffective family coping Impaired social interaction Social interaction