2. OBJECTIVES:
At the end of the class, the students will be able to :
To explain the meaning of the anxiety, fear and stress .
Enlist the ICD 10 classification of anxiety disorders.
To explain about various types of causes responsible for anxiety
disorders.
To explain phobic anxiety disorder in detail.
To explain about generalized anxiety disorder I detail
To explain about panic anxiety disorder in detail.
To describe the role of nurse in anxiety disorders
3. Fear :
A feeling of doom,
unease, or
apprehensiveness in
response to imminent
danger.
5. Anxiety:
A feeling of doom,
unease or
apprehensiveness
when no danger is
imminently present
6.
7. When does anxiety become a disorder?
Anxiety is a normal human response to objects,
situations or events that are threatening
Anxiety is different from fear due to its cognitive
component (i.e. fear of the future)
Anxiety can be helpful and adaptive (e.g. anxiety about
giving lectures!)
Anxiety becomes a disorder when out of proportion or
when it significantly interferes with life.
8. INTRODUCTION
Anxiety disorders are a category of mental
disorders characterized by feelings of anxiety and fear,
where anxiety is a worry about future events and fear is a
reaction to current events and these feelings may cause
physical symptoms, such as a racing heart beat
,shakiness, sweating
10. F40: Phobic Anxiety Disorders .
F41: Other Anxiety Disorder.
F42: OCD.
F43: Reaction to severe stress, adjustment
Disorder.
11. Sensory Input
2. Amygdala
registers
danger
3. Amygdala
triggers fast
response
4. More considered
response based on
cortical processing
1. Thalamus
receives stimulus
and sends to both
amygdala and
cortex
• Parts of the brain involved in fear response = thalamus, amygdale, hypothalamus, which
then instruct the endocrine glands and autonomic nerv.sys.
• Evolved fear module (pink) versus considered response (green) = “fight or flight”
versus “feel the fear and do it anyway (or do it differently)”!
14. GENERALIZED AND PANIC DISORDERS
Psychodynamic theory :
It focuses on the inability of the ego to intervene when conflict
occurs between the id and superego, producing anxiety .For
various reasons (unsatisfactory parent child relationship,
conditional love, ego development is delayed.
Neuroanatomical theory:
Structural brain imaging studies in patients with panic disorder
have implicated pathological involvement in the temporal lobe,
particularly the hippocampus
15. Cognitive theory:
According to this theory, anxiety is related to cognitive
distortions and negative thoughts. When there is a
disturbance in central mechanism of cognition, there is
disturbance in feeling and behavior
Genetic theory:
Anxiety disorder is most common in close relatives and risk
of this disorder is 10% to 20%,and the concordance rate in
monozygotic twins of patients with panic disorder is 80%.
16. Biochemical theory :
Abnormal elevation of blood lactate levels have been noted in
client with panic disorders.
Neurochemical theory :
Nor epinephrine neurotransmitter is involved in the aetiology of
panic anxiety disorder.
18. COGNITIVE THEORY
Anxiety is the product of faulty cognitions or anxiety –inducing
self instructions, Cognitive theorists believe that some individuals
engage in negative and irrational thinking that produce anxiety
reactions.
The individual begins to seek out avoidance behaviours to
prevent the anxiety reactions and phobia result
20. DRUGS
Anxiety can be caused by alcohol abuse ,Caffeine,
organic solvents and benzodiazepine , which in most cases
improves with prolonged abstinence .
Dependence on these drugs can worsen or cause anxiety
and panic attacks. Painting, varnishing and carpet-laying
are some of the jobs in which significant exposure to
organic solvents may occur. Cannabis use is associated
with anxiety disorders
21. STRESS
Anxiety disorders can arise in response to life stresses such as
financial worries or chronic physical illness. Anxiety among
adolescents and young adults is common due to the stresses of
social interaction, evaluation, and body image.
22. GENETICS
While anxiety arose as an adaptation, in modern times it is almost
always thought of negatively in the context of anxiety disorders.
People with these disorders have highly sensitive systems; hence,
their systems tend to overreact to seemingly harmless stimuli.
23. PERSISTENCE OF ANXIETY
At a low level, anxiety is not a bad thing. In fact, the
hormonal response to anxiety has evolved as a benefit, as it
helps humans react to dangers.
24. PHOBIA
A phobia is a irrational fear that produces conscious
avoidance of the feared subject, activity ,or situation.
25. PHOBIC ANXIETY DISORDER
The single largest category of anxiety disorders is that of phobic
disorders, which includes all cases in which fear and anxiety are
triggered by a specific stimulus or situation.
Between 5% and 12% of the population worldwide suffer from
phobic disorders.
36. SIGN AND SYMPTOMS
Irrational and persistent
fear of object or situation
Immediate anxiety on
contact with feared
object or situation
Loss of control, fainting,
or panic responses
Avoidance of activities
involving feared stimulus
Anxiety when thinking
about object
Impaired social or work
functioning
39. SOCIAL PHOBIA
It is an irrational fear of performing activities in
the presence of other people interacting with
others.
The patient is afraid of his own actions being
viewed by others
43. AGORAPHOBIA
Agoraphobia is the an irrational fear of being in places away
from the familiar setting of home ,in crowds, or in situation
specific anxiety about being in a place or situation where
escape is difficult or embarrassing or where help may be
unavailable.
Agoraphobia is strongly linked with panic disorder and is
often precipitated by the fear of having a panic attack.
44. For example, following a panic attack while
driving, someone suffering from agoraphobia may
develop anxiety over driving and will therefore
avoid driving.
45. For example, following a panic attack while
driving, someone suffering from agoraphobia may
develop anxiety over driving and will therefore
avoid driving.
46. SIGNS/SYMPTOMS
Overriding fear of open or public spaces
Deep concern that help might not be available in such
places
Avoidance of public places and confinement to home
When accompanied by panic disorder, fear that having
panic attack in public will lead to embarrassment.
COURSE
The onset is sudden without any cause and is usually
chronic.
49. Anxiolytics :
The benzodiazepines have
been used with success in
the treatment. Alprazolam,
lorazepam and clonazepam
have been particularly
effective in the treatment
Antidepressants
Several antidepressants are
effective as major anxiety
agents. The tricyclics
,clomipramine and
imipramine have been used.
The SSRI is also effective in
the treatment.
52. 1. SYSTEMATIC DESENSITIZATION
Using this method, the person is engaged in some type of
relaxation exercise and gradually exposed to an anxiety producing
stimulus, like an object or place.
56. DESENSITIZATION OF THE STIMULUS
This can be either be done in reality or through imagination .At
first, the lowest item in hierarchy is confrontation.
The patient is advised to signal whenever anxiety is produced
,with each signal he is asked to relax.
After a few trials, patient is able to control his anxiety
gradually.
57. 2. IMPLOSION THERAPY (FLOODING)
The patient is directly exposed
to the phobic stimulus, but
escape is made impossible. By
prolonged contact with the
phobic stimulus ,the therapist
guidance and encouragement
and his modeling behavior
reduce anxiety.
60. GENERALIZED ANXIETY DISORDER
Definition :
Generalized anxiety disorder is a common, chronic disorder
characterized by long-lasting anxiety that is not focused on any
one object or situation. Those suffering from generalized
anxiety disorder experience non-specific persistent fear and
worry, and become overly concerned with everyday matters.
61. SYMPTOMS :
These symptoms should have existed for 6 months or longer and
patient feels highly anxious at least 50% of the time in a day ,are
not attributed to any specific organic factors such as caffeine
intoxication or hyperthyroidism.
Chronic excessive worry and anxiety about number of events
that individual finds difficult to control and the course is
insidious in nature and is usually chronic
65. PHARMACOLOGY
Anxiolytics :
The benzodiazepines have
been used with success in the
treatment of generalized
disorder. Alprazolam,
lorazepam and clonazepam
have been particularly
effective in the treatment
Antidepressants
Several antidepressants are
effective as major anxiety
agents. The tricyclics
,clomipramine and imipramine
have been used
66. Beta blockers:
Beta-blockers, such
as propranolol, can treat some
of the physical symptoms of
anxiety, including a rapid
heartbeat, palpitations and a
tremor (shaking).
Other drugs:
Carbazepine ,Valproate and
Lithium carbonate have been
reported to alleviate anxiety
68. Behavior therapy :
Biofeedback is used to
decrease physical
symptoms of anxiety by
teaching the patient how
to become aware of and
then consciously control
various body functions
71. Cognitive therapy :
To reduce cognitive distortions by teaching the patient how to
reconstruct her thoughts and view her worries more
realistically.
Patient is taught to record the worries and list evidence that
justifies or contradicts each one.
Patients learn that worrying about worry maintains anxiety
avoidance are ineffective problem solving techniques.
75. PANIC ANXIETY DISORDER
Panic anxiety is characterized by anxiety, which is
intermittent and unrelated to particular circumstances .
Panic anxiety disorder is composed of sudden and discrete
episodes of panic attacks that is ,15-30 minutes of rapid
,intense anxiety in which person experiences great emotional
fear as well as physiologic discomfort.
76. With panic disorder, a person has brief attacks of intense
terror and apprehension, often marked by trembling, shaking,
confusion, dizziness, nausea, and/or difficulty breathing.
Attacks can be triggered by stress, fear, or even exercises.
These symptoms should have existed for 1 month or more.
77. SYMPTOMS
Difficulty breathing
Pounding heart or chest pain
Intense feeling of dread
Shortness of breadth
Sensation of choking or
smothering
Dizziness or feeling faint
Key symptom is persistent
fear of having future attacks
Trembling or shaking
,sweating
Nausea, stomachache
Tingling or numbness in the
fingers and toes
Chills or hot flashes
A fear that you are losing
control or are about to die
80. PHARMACOTHERAPY:
Anxiolytics :
The benzodiazepines have been used with success in the
treatment of generalized disorder. Alprazolam, lorazepam and
clonazepam have been particularly effective in the treatment
Antidepressants:
Several antidepressants are effective as major anxiety agents.
The tricyclics ,clomipramine and imipramine have been used
with success in clients experiencing panic disorder. The SSRI
sertraline (Zoloft), paroxetine (Paxil) are commonly used.
81.
82. Individual Psychotherapy
Most clients experience a marked lessening of anxiety when
given the opportunity to discuss their difficulties with a
concerned and sympathetic therapist.
The therapist uses logical and rational explanations to
increase the clients understanding about various situations
that create anxiety in his or her life.
83. Cognitive therapy
Teaches the patient to replace
negative thoughts with more
realistic ,positive ways of
viewing the attacks.
Helps the client to identify
possible triggers for attacks,
such as particular thought or
situation .
Helps the client to identify
and evaluate the thoughts that
proceeds the anxiety ,and
restructures them to gain more
realistic perception.
84. Sensation Thought Alternative Explanation
Tightness in
my throat
Light
headedness
Feeling of
unreality
My throat is tightening up, and
I won't be able to breathe
"I'm going to faint.“
What if I'm going to lose it and
go crazy
This is a harmless sensation of
anxiety and has nothing to do
with my breathing.
This is a symptom of anxiety or
hyperventilation, not fainting
This is just a harmless sensation
of anxiety, which will go away
when my anxiety subsides
85. Behavioral therapy
Relaxation techniques to help
the patient cope with a panic
attack by easing physical
symptoms and directing
attention elsewhere.
Deep breathing exercise
,which also reduce the risk of
hyperventilation
Listening of calm music
Positive verbalization in which
patient elicits peaceful mental
images promoting feelings of
relaxation.
86.
87. NURSING MANAGEMENT
Nursing assessment
Assessment focuses on physical symptoms, precipitating
factors, avoidance behavior associated with phobias, impact of
anxiety on physical functioning, normal coping ability, and
thought content and social support systems.
88. Nursing Diagnosis
Panic anxiety related to real or perceived threat to biological
integrity or self harm as evidenced by physical symptoms
Goal :Client will be able to recognize symptoms of onset of anxiety
and to intervene before reaching panic level
Interventions :
Stay with client.
Maintain calm environment and nonthreatening .
Use simple words and brief messages, spoken calmly to explain
hospital experiences.
Keep immediate surrounding low in stimuli
89. Nursing diagnosis
Powerlessness related to impaired cognition evidenced by verbal
expressions of no control over life situations
Goal
Client will be able to effectively solve the ways to control of life
situation, thereby decreasing feelings of powerlessness
Interventions :
Allow the client to take as much responsibility as possible for self
care practices .
90. Allow him to establish his own schedule for self care activities
Include client in setting goals of care
Provide client with privacy as need is determined
Provide positive feedback for decisions made.
Assist client to set realistic goals
Help identify areas of life situation that client can control
Help client identify areas of life situation that are not within his
or her ability to control.
91. SUMMARY
Today ,we have discussed about :
Meaning of the anxiety, fear and stress .
The ICD 10 classification of anxiety disorders.
Different causes responsible for anxiety disorders.
Description about phobic anxiety disorders.
Description about generalized anxiety disorders.
Description about panic anxiety disorders
The role of nurse in anxiety disorders.
92. CONCLUSION
Anxiety is necessary force for survival and has been
experienced by humanity throughout the ages .It was first
described as a physiological disorder and identified by its
physical symptoms .Anxiety is considered a normal reaction to
a realistic danger or threat to biological integrity or self concept
.
93. ASSIGNMENT
Description about panic anxiety disorder
RECAPTUALIZATION
What are the types of anxiety disorders?
What are the types of phobias?
94. BIBLIOGRAPHY
Mary C Townsend, Essentials of Psychiatric Mental Health
Nursing,3rd Edition ,F.A Davis Publications ;Page No:338-362
David A. Tomb, Psychiatry for the House Officer,2nd Edition,
Williams and Wilkins publications; Page No: 104-107
Sreevani R, A Guide to Mental Health and Psychiatric Nursing,
3rd Edition, Jaypee publishers; Page No: 171-17
Mary C Townsend, Psychiatric Mental Health Nursing,7th Edition
,F.A Davis Publications ;Page No:631-689
Niraj Ahuja, A Short Textbook of Mental Psychiatry,7th Edition,
Jaypee Publishers.;Page No: 189-197
