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Chapter 12. Anxiety and Anxiety Disorders. Anxiety. Anxiety – apprehension, uneasiness, uncertainty, or dread from real or perceived threat Fear – reaction to specific danger Normal anxiety – necessary for survival. Levels of Anxiety. Mild anxiety Moderate anxiety Severe anxiety Panic.

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Chapter 12

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Chapter 12

Anxiety and

Anxiety Disorders


Anxiety

  • Anxiety – apprehension, uneasiness, uncertainty, or dread from real or perceived threat

  • Fear – reaction to specific danger

  • Normal anxiety– necessary for survival


Levels of Anxiety

Mild anxiety

Moderate anxiety

Severe anxiety

Panic


A parent is shopping with a 5-year-old child in a large, busy urban mall. The parent suddenly realizes the child is missing. Which level of anxiety would likely result?


Mild

Moderate

Severe

Panic


Defenses Against Anxiety

  • Defense mechanisms

    • Automatic coping styles

    • Protect people from anxiety

    • Maintain self-image by blocking

      • feelings

      • conflicts and

      • memories

    • Can be healthy or unhealthy


Anxiety Disorders

  • Clinical picture

  • Epidemiology

  • Comorbidity

  • Etiology

    • Biological

      • Genetics

    • Neurobiological


Psychological Theories

  • Psychodynamic theories

    • Sigmund Freud

    • Harry Stack Sullivan

    • Behavior theories

    • Cognitive theories

  • Cultural considerations


Panic Disorders (PD)

  • Panic attack

  • Panic disorder without agoraphobia

  • Panic disorder with agoraphobia

  • Simple agoraphobia


Phobias

  • Specific phobias

  • Social phobia or social anxiety disorder (SAD)


Obsessive-Compulsive Disorder (OCD)

  • Obsessions

    • Thoughts, impulses, or images that persist and recur, so that they cannot be dismissed from the mind

  • Compulsions

    • Ritualistic behaviors an individual feels driven to perform in an attempt to reduce anxiety


Generalized Anxiety Disorder (GAD)

  • Excessive anxiety or worry about numerous things

  • Lasts for 6 months or longer


Posttraumatic Stress Disorder (PTSD)

  • Flashbacks

  • Avoidance of stimuli associated with trauma

  • Experience of persistent numbing of responses

  • Persistent symptoms of increased arousal


Acute Stress Disorder

Occurs within 1 month after exposure to highly traumatic event

Must display at least 3 dissociative symptoms – during or after event

Resolves within 4 weeks


Substance-InducedAnxiety Disorder

  • Symptoms of anxiety, panic attacks, obsessions, and compulsions

  • Develop with the use of a substance or within a month of stopping use of the substance


Anxiety Due toMedical Conditions

Symptoms of anxiety are direct physiological result of a medical condition


Application of the Nursing Process

  • Assessment

    • General assessment of symptoms

    • Self-assessment

    • Assessment guidelines: anxiety disorders

  • Nursing Diagnosis

  • Outcomes Identification

  • Planning


Application of the Nursing Process Continued

  • Implementation

    • Mild to moderate levels of anxiety

    • Severe to panic levels of anxiety


Basic Level Nursing Interventions

  • Counseling

  • Milieu therapy

  • Promotion of self-care activities

  • Pharmacological interventions

  • Health teaching


Advanced Practice Interventions

  • Cognitive therapy

  • Behavioral therapy

    • Relaxation training

    • Modeling

    • Systematic desensitization


Advanced Practice Interventions Continued

  • Behavioral therapy, continued

    • Flooding

    • Response prevention

    • Thought stopping

  • Cognitive-behavioral therapy


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