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SRINIVASAN A

Introduction

Anxiety disorders are a group of conditions marked


by extreme or pathological anxiety or fear. In India
anxiety disorders are the most common of the
psychiatric disorders, with one in four people
experiencing an anxiety disorder at some time in
their life.
Anxiety disorders have the potential to interfere with
a persons work, family and social life. They tend to
be persistent and can be disabling.

Cont

Anxiety is a normal response to a threatening


situation and can motivate us in a positive way, such
as in sport or study.
However, anxiety becomes a problem when it
interferes with normal functions, is unrelated to an
actual threat, causes physical symptoms and
becomes intolerable to the person

Psychopathophysiolgy

A person with phobic disorders may use


compensatory mechanism when he or she begins to
panic. The precipitating factors of such phobic
disorders may be pointed out as early exposures to
pressured decision-making about lifestyle issues.
Unconsciously, the anxiety can be transferred to
objects which may symbolize the event or the
previous situation that creates the fear to the person.

Panic disorder

Episodes typically last 15 to 30 min.


Four or more of the following
symptoms are present.
Palpitations
Shortness of breath
Choking or smothering sensation
Chest pain
Nausea

Cont

Feelings of depersonalization
Fear of dying or insanity
Chills or hot flashes
The client may experience behaviour changes and/or
persistent worries about when the next attack will occur.
The client may begin to experience agoraphobia due to a
fear of being in places where previous panic attacks
occurred. For example, if previous attacks occurred while
driving, the client may stop driving.
If attacks continue while walking or taking alternative
transportation, client may stay home.

Phobias The client fears a specific object or


situation to an unreasonable
level

Phobias include:
Social phobia The client has a fear of
embarrassment, is unable to perform in front of others,
has a dread of social situations, believes that others are
judging him negatively, and has impaired relationships.
Agoraphobia The client avoids being outside and
has an impaired ability to work or perform duties.
Specific phobias- The client has a fear of specific
objects (e.g., spiders, snakes, or strangers).
The client has a fear of specific experiences (e.g., flying,
being in the dark, riding in an elevator, being in an
enclosed space).

Obsessive-compulsive
disorder (OCD)

The client has intrusive thoughts of


unrealistic obsessions and tries to control
these thoughts with compulsive behaviours
(e.g., repetitive cleaning of a particular
object or washing of hands).

Clients who engage in constant ritualistic behaviours may


have difficulty meeting self-care needs (e.g., personal
hygiene, grooming, nutrition, fluid intake, elimination,
sleep).
If rituals include constant hand washing or cleaning, skin
damage and infection may occur.

Generalized anxiety
disorder (GAD)

More than 6 months of uncontrollable, excessive worry.


GAD causes significant impairment in one or more areas
of functioning, such as work-related duties.
At least three of the following physical symptoms are
present.
Fatigue
Restlessness
Problems with concentration
Irritability
Increased muscle tension
Sleep disturbances

Stress-related disorders
include

Acute stress disorder Exposure to a traumatic event


causes numbing, detachment, and amnesia about the
event for not more than 4 weeks following the event.

Posttraumatic stress disorder (PTSD)


Exposure to a traumatic event causes intense
fear, horror, flashbacks, feelings of
detachment and foreboding, restricted affect,
and impairment for longer than 1 month after
the event. Symptoms may last for years.

Medications used for the various types of anxiety


disorders generally include

Selective serotonin reuptake inhibitors (SSRIs).


Tricyclic antidepressants.
Monoamine oxidase inhibitors (MAOIs).
Benzodiazepines.
Beta blockers.
Anti-epileptic medications, including carbamazepine (Tegretol),
gabapentin (Neurontin), and valproic acid (Depakote).
These medications are used as mood stabilizers for the client who is
anxious.
When the anxiety has passed, help the client to evaluate the coping
mechanisms that work and do not work for controlling the anxiety.
Instil hope for positive outcomes (but avoid false reassurance).
Enhance self-esteem by encouraging positive statements and discussion of
past achievements.

NURSING DIAGNOSIS

Anxiety
Ineffective coping
Post-trauma syndrome
Powerlessness
Ineffective role performance Bathing/hygiene or
toileting
Chronic or situational low self-esteem
Disturbed sleep pattern

Nursing management

Provide safety and comfort to the client during the crisis


period of these disorders. Remain with the client during
the worst of the anxiety to provide reassurance.
Sit and talk to the client using therapeutic
communication skills to help the client express the
feelings of anxiety.
Use relaxation techniques with the client as needed for
symptoms of pain, muscle tension, and feelings of
anxiety.
Teach the client about prescribed medications for anxiety
as needed.

Points

Postpone health teaching until after acute anxiety


subsides. Clients with panic attack or severe anxiety are
unable to concentrate or learn.
Advanced practice nurses may be trained in other
therapies to treat anxiety disorder, including:
Cognitive behavioural therapy, such as cognitive
reframing.
Behavioural therapy, such as systemic desensitization
and thought stopping (distraction used by client to
interrupt negative or ritualistic thoughts).
Group and family therapy, for clients with PTSD.

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