By: Mr.

Mohannad Ghazzawi, MSN, RN

Outline
Introduction
Anxiety disorders:

- Panic disorder
- Phobias

- Obsessive-Compulsive disorder (OCD)

- Post Traumatic Stress Disorder (PTSD)

Outline
Therapy
Nursing care

Introduction
Anxiety is an emotional response (e.g.,

apprehension, tension, uneasiness) to anticipation

of danger, the source of which is largely unknown

or unrecognized.
Individuals face anxiety on a daily basis. Anxiety is a necessary force for survival.

Introduction
Anxiety is different than stress. Stress, or more

properly, a stressor, is an external pressure that is brought to bear on the individual. Anxiety is the subjective emotional response to that stressor.
Anxiety may be distinguished from fear in that it is an

emotional process, whereas fear is a cognitive one.

Epidemiology
Anxiety disorders are the most common of all

psychiatric illnesses and result in considerable

functional impairment and distress.

Epidemiology
Prevalence rates for anxiety disorders within the

general population have been given at 3 to 5

percent for generalized anxiety disorder and panic

disorder, 2 to 3 percent for OCD, 8 percent for

PTSD, 13 percent for social anxiety disorder, and

25 percent for phobias.

Panic Disorder
Panic is a sudden overwhelming feeling of terror

or impending doom.
This most severe form of emotional anxiety is

usually accompanied by behavioral, cognitive, and

physiological signs and symptoms considered to

be outside the expected range of normalcy.

Panic Disorder
This disorder is characterized by recurrent panic

attacks.
At least four of the following symptoms must be

present to identify the presence of a panic attack:

- Palpitations, or accelerated heart rate
- Sweating

Panic Disorder
- Trembling or shaking
- Sensations of shortness of breath or smothering

- Feeling of choking
- Chest pain or discomfort

- Nausea or abdominal distress

- Feeling dizzy, unsteady, lightheaded, or faint

Panic Disorder
- Derealization (feelings of unreality) or depersonalization

(feelings of being detached from oneself)

- Fear of losing control or going crazy - Fear of dying - Paresthesias (numbness or tingling sensations) - Chills or hot flashes

Panic Disorder
The attacks usually last minutes, or more rarely,

hours.
The disorder may last for a few weeks or months

or for a number of years.

Panic Disorder
Etiology:
Genetics:

- Between identical twins is 30 percent, and in a

close relative is 10 to 20 percent.

Panic Disorder
Neurochemical:
- Increase in norepinephrine.

- Decrease in serotonin and GABA.

Nursing care
Panic Anxiety:
- Stay with client; offer reassurance of safety

- Remain calm
- Use simple explanations

- Low stimuli environment

Nursing care
- Tranquilizers, as ordered
- Encourage verbalization of current situation

- Teach ways to interrupt escalating anxiety

Phobia
Phobia is an irrational and excessive fear of an

object or situation.
Three major types of phobia: - Agoraphobia without history of panic disorder. - Social phobia. - Specific phobia.

Phobia
Agoraphobia without history of panic disorder:
- It is a fear of being in places or situations from

which escape might be difficult, or in which help

might not be available if a limited-symptom attack

or panic-like symptoms (rather than full panic

attacks) should occur.

- Most commonly occurs in the 20s and 30s and

persists for many years.

- More in women than in men.
- In extreme cases the individual is unable to leave

his or her home without being accompanied by a

friend or relative.

 Social phobia:
- It is an excessive fear of situations in which a person

might do something embarrassing or be evaluated

negatively by others.
- Examples may include fear of speaking or eating in a

public place, fear of using a public restroom, or fear of writing in the presence of others.

- It may involve general social situations, such as

saying things or answering questions in a manner that would provoke laughter on the part of others.
- Exposure to the phobic situation usually results in

feelings of panic anxiety, with sweating, tachycardia, and dyspnea.

 Specific phobia:
- It was formerly called simple phobia.

- The essential feature of this disorder is a marked,

persistent, and excessive or unreasonable fear

when in the presence of, or when anticipating an

encounter with, a specific object or situation.

Nursing care
Fear:
- Reassure client of safety - Encourage client to verbalize about fears - Discuss reality of the situation - Help client select alternative coping strategies - Help client face underlying feelings that may be

contributing to irrational fears

Nursing care
Social isolation:
- Convey acceptance and unconditional positive regard - Attend activities with client - Be cautious with touch - Discuss signs and symptoms of increasing anxiety and

ways to intervene
- Give recognition for voluntary interactions with others

Obsessive-Compulsive Disorder (OCD)

Obsessions are unwanted, intrusive, persistent

ideas, thoughts, impulses, or images that cause

marked anxiety or distress.

Compulsions are unwanted repetitive behavior

patterns or mental acts that are intended to reduce

anxiety, not to provide pleasure or gratification.

Obsessive-Compulsive Disorder (OCD)

OCD is characterized by recurrent obsessions or

compulsions that are severe enough to be time

consuming or to cause marked distress or

significant impairment.

Obsessive-Compulsive Disorder (OCD)

The most common compulsions involve washing

and cleaning, counting, checking, requesting or

demanding assurances, repeating actions, and

ordering.
Serotonin is increased in OCD.

Post-Traumatic Stress Disorder (PTSD)

It is defined as the development of characteristic

symptoms following exposure to an extreme

traumatic stressor involving a personal threat to

physical integrity or to the physical integrity of

others.

Post-Traumatic Stress Disorder (PTSD)

Examples of some experiences that may produce this

type of response include participation in military combat, experiencing violent personal assault, being kidnapped or taken hostage, being incarcerated as a prisoner of war, experiencing natural or man-made

disasters, surviving severe automobile accidents, or

being diagnosed with a life-threatening illness.

Post-Traumatic Stress Disorder (PTSD)

Sustained high level of anxiety or arousal, and

depression are common in PTSD.

Treatment
Individual psychotherapy
Cognitive therapy

Behavior therapy:
- Systematic Desensitization

- Implosion Therapy (Flooding)

Treatment
Systematic Desensitization:
- The client is gradually exposed to the phobic stimulus,

either in a real or imagined situation.

- It involve: 1. Training in relaxation techniques.

2. Progressive exposure to a hierarchy of fear stimuli

while in the relaxed state.

Treatment
- The patient is instructed to use relaxation

techniques he or she is exposed to the phobic

stimulus.
- It based on the fact that because relaxation is

antagonistic to anxiety, individuals cannot be

anxious and relaxed at the same time.

Treatment
Implosion Therapy (Flooding):
- It is a therapeutic process in which the client must

imagine situations or participate in real-life

situations that he or she finds extremely

frightening for a prolonged period of time.

- Relaxation training is not a part of this technique.

Treatment
Psychopharmacology:
- Use of antianxiety (anxiolytics) drugs

Any Questions?

Thanks