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3-Generalized Anxiety Disorder( GAD )

3-Generalized Anxiety Disorder( GAD ). ** Characterized by: Excessive anxiety and worry, about some events/activities (work or school performance) Difficult to control their worry.  May expect the worst even when there is no apparent reason for concern.

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3-Generalized Anxiety Disorder( GAD )

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  1. 3-Generalized Anxiety Disorder(GAD) ** Characterized by: • Excessive anxiety and worry, about some events/activities (work or school performance) • Difficult to control their worry.  • May expect the worst even when there is no apparent reason for concern. • They anticipatedisaster and may be overly concerned about money, health, family, work, or other issues. Psychiatric and Mental Health Nursing

  2. Generalized Anxiety Disorder ..cont. • Diagnostic criteria GAD. - Anxiety/worry associated with “3 or more” of the following six symptoms: (more days than not for the past 6 months) 1. Restlessness feeling. 2. Being easily fatigued. 3. Difficulty concentrating or mind going blank. 4. Irritability. 5. Muscle tension. 6. Sleep disturbance (difficulty falling, or restless unsatisfying sleep). Psychiatric and Mental Health Nursing

  3. 3-Generalized Anxiety Disorder(GAD) diagnostic criteria ..con. • Impairment in social, occupational, or other areas of functioning. • The disturbance is not related to other physiological or medical condition. • The disturbance is not better explained by another mental disorder. • Typical worries in GAD about everyday routineevents like job responsibilities, finances, health of family members and household tasks. • Client may shift from one worrytoanother. NB. Medical condition associated with Anxiety disorder is due to pheochromocytoma “PCC” Psychiatric and Mental Health Nursing

  4. 3-Generalized Anxiety Disorder(GAD) diagnostic criteria ..con. • Associated Features support the diagnostic criteria of GAD: • Trembling –Twitching – Feeling shaky – Muscle aches – Soreness – Sweating – Nausea – Diarrhea – Exaggerated - startle response. • Treatment: - Anxiolytics asBuspirone (BuSpar) - SSRI “e.g. Prozac”antidepressants are the most effective treatment. - CBT (Cognitive Behavioral Therapy) Psychiatric and Mental Health Nursing

  5. 4-Obsessive-Compulsive & Related Disorders I-Obsessive Compulsive Disorder “OCD” II- Body Dysmorphic Disorder “BDD” III- Trichotillomania (Hair-Pulling Disorder) “HPD” I-Obsessive Compulsive Disorder OCD: Diagnostic Criteria OCD: • Presence of obsessions, compulsions, orboth: *Obsessions are defined by: 1. Recurrent & persistent unwantedthoughts/images experienced causing marked distress. 2. Individual attempts to ignore/suppressorneutralize thoughts/ images, with other action (i.e., by compulsion). Psychiatric and Mental Health Nursing

  6. I-Obsessive Compulsive Disorder OCD .. Cont. * Compulsions are defined by: 1. Repetitivebehaviors (e.g., hand washing, ordering, checking) or mentalacts(e.g., praying, counting, repeating words) “perform in response to obsession” . 2. The behaviors/mental acts aimed at preventing or reducinganxiety/distress; “not realistic & clearly excessive. Psychiatric and Mental Health Nursing

  7. I-Obsessive Compulsive Disorder OCD .. Cont. • Obsessions or compulsions are time consuming. • Impairment in social, occupational, or other important areas of functioning. • Notrelated to physiological or medical condition. • Not better explained by the symptoms of anothermentaldisorder. Psychiatric and Mental Health Nursing

  8. I-Obsessive Compulsive Disorder OCD .. Cont. • Development and Course: OCD • Prevalence of OCD (1%-2%) • Mean age at onset of OCD is 19.5 years but may occur on 14years • The onset of symptoms is typically gradual. • Clients with OCD have higher rates of major depression. • Clients with excessivewashing may have concurrent dermatitis. Psychiatric and Mental Health Nursing

  9. II- Body DysmorphicDisorder BDD • Diagnostic Criteria BDD: * Preoccupation with perceiveddefects in physical appearance , but not observable to others. * Individual has performedrepetitivebehaviors (e.g., mirror checking, excessive grooming,) Ormentalacts (e.g., comparing his appearance with others). Psychiatric and Mental Health Nursing

  10. II- Body Dysmorphic Disorder.. Cont. * Impairment in social, occupational, or other important areas of functioning. • Notrelated to other disorder e.g. ED • Development and Course: • Prevalence of body dysmorphic disorder, females 2.5% and males 2.2%. • The meanage onset is 16-17 years, gradualonset & chronic. Psychiatric and Mental Health Nursing

  11. III- Trichotillomania (Hair Pulling Disorder)HPD • Prevalence l-2%, Females more than males • Onset coincides with, or follows puberty. • HPD- Diagnostic Criteria. -Recurrentpulling out of hair, resulting in hair loss. -Repeated attempts to decrease or stop hair pulling. - Impairment in social, occupational, or other important areas of functioning. - Notrelated to another medical condition (e.g. dermatological condition). -Not explained by the symptoms of another mental disorder. Psychiatric and Mental Health Nursing

  12. III- Trichotillomania (Hair-Pulling Disorder): ..cont. • HPD- Diagnostic Features: - Most common hair(scalp, eyebrows, and eyelids) & less common (axillary, facial, pubic) - Hair pulling may occurbriefly but maycontinue for months or years. - Hair lossmay not be clearly visible (i.e., pulling single hairs from all over a site). - May attempt to conceal or camouflage hair loss (e.g., by using makeup, scarves, or wigs). - Repeatedattempts to decrease or stop hair pulling. Psychiatric and Mental Health Nursing

  13. Treatment of OCD: 1. Combines medication and behavior therapy. (Behavior therapy includes exposure &response prevention). 2. Exposure (flooding): assisting the client to confront the situations & stimuli that he usually avoids. 3. Responseprevention (systemic desensitization) focuses on delaying or avoidingperformance of rituals. - Learns to tolerateanxiety and to recognize that it will decreasewithout disastrous consequences Psychiatric and Mental Health Nursing

  14. 5-Trauma & Stressor Related Disorders: I- Posttraumatic Stress Disorder(PTSD): II- Acute Stress Disorder (ASD) : • Stress: Relationship between person &environment, appraised by him as exceeding his resources & endangering wellbeing. • Trauma: Sever suddenunexpectedoverwhelming event outside the range of human experience. I- Posttraumatic Stress Disorder PTSD • PTSD: development of characteristic symptomsfollowing exposure to extreme traumaticstressor. Psychiatric and Mental Health Nursing

  15. Prevalence: PTSD More prevalent among females than males across lifespan Diagnostic Criteria : A. Exposure to actualorthreatened death, serious injury, or sexual violence in (one or more) of the following ways: 1. Directlyexperiencing the traumatic event. 2. Witnessing the events as it occurred to others. 3. Traumatic eventsto a close familymemberorfriend. 4. Repeated exposure to aversive details of traumatic event e.g. (policeofficers, firefighters, emergency medical personnel). Psychiatric and Mental Health Nursing

  16. PTSD diagnostic criteria.. Cont. NB: “(Criteria B, C, D, E) is more than 1 month” B. Presence of (one or more) of the following intrusion symptoms: 1. Recurrent, involuntary, and intrusive distressing memories of traumatic event 2. Recurrentdistressingdreams related to traumatic event. 3. Individual feelsoractsas if the traumatic events were recurring. 4. Intense or prolonged distress at exposure to internal or external cuesresemble an aspect of traumatic event. Psychiatric and Mental Health Nursing

  17. PTSD diagnostic criteria.. Cont. C. Persistentavoidance of associated stimuli with traumatic events by following (one or both) : • Avoidance of distressingmemories & thoughts. • Avoidance of external remindersassociated with traumaticevents(people, places, conversations, situations.. etc.) Psychiatric and Mental Health Nursing

  18. PTSD diagnostic criteria.. Cont. D. Negative Alterations in cognitions and mood associated with traumatic events as following (two or more) : 1. Inability to remember an important aspect of traumaticevents due to dissociative amnesia. 2. Persistent negativebeliefs or expectations about oneself, others, or the world(e.g., “I am bad,” “No one can be trusted,” ‘world is completely dangerous,”) 3. Persistent, distortedcognitionsabout traumatic events lead to blame himself or others. Psychiatric and Mental Health Nursing

  19. PTSD diagnostic criteria.. Cont. 4. Persistent negativeemotional state (fear, horror, anger, guilt, shame). 5. Markedly diminishedparticipation in significant activities. 6. Feelings of detachmentfrom others. 7. Persistent inability to experiencepositiveemotions (e.g., inability to experience happiness, satisfaction, or loving feelings). Psychiatric and Mental Health Nursing

  20. PTSD diagnostic criteria.. Cont. E. Marked alterations in reactivity associated with traumatic events, (two or more) as: 1. Irritable and angry with little or noprovocation(verbal or physical aggression). 2. Reckless or self-destructive behavior. 3. Hypervigilance. 4. Exaggerated startle response. 5. Poorconcentration. 6. Sleepdisturbance(e.g. insomnia or restless sleep). Psychiatric and Mental Health Nursing

  21. PTSD diagnostic criteria.. Cont. • Impairment in social, occupational, or other important functioning areas . • Disturbance not related to another physiological/medical condition. • PTSD Development and Course: - PTSD can occur at any age. - Symptoms begin within first 3monthspost-trauma - Maybe delay of months, years, beforefull diagnostic criteriamet. (now called "delayed expression). Psychiatric and Mental Health Nursing

  22. II- Acute Stress Disorder (ASD) : *Transientresponse to severetrauma as (accident, natural disaster, crime, torture.. Etc.) • ASD- Diagnostic Criteria: A. Exposure to actual or threatened death, serious injury, or sexual violation in (one or more) of the following ways: 1. Directlyexperiencingtraumatic event. 2. Witnessing, in person, the event as it occurred to others 3. Learning of eventoccurred to a close familymember or friend. Psychiatric and Mental Health Nursing

  23. Acute Stress Disorder.. Cont. • Repeatedor extreme exposure to aversive details of traumaticevent( police officers, firefighters, emergency medical personnel). • Note: not include exposure to electronic media or pictures, unless this exposure is event related. B. Presence of (nine or more) of the following: from any of fivecategories of intrusion, negative mood, dissociation, avoidance, and arousal, (3 days to 1 month)beginning or worsening after traumatic events occurred: Psychiatric and Mental Health Nursing

  24. Acute Stress Disorder.. Cont. 1. Recurrent, involuntary, and distressingmemories of the traumaticevent 2. Recurrentdistressingdreamsrelated to the event. 3. Individual feels or acts as if traumatic event was recurring(e.g. flashbacks). 4. Intensepsychological or physiologicalresponse to cuesresemble aspect of traumatic event. 5. Persistent inability to experiencepositive emotions e.g. happiness, satisfaction. Psychiatric and Mental Health Nursing

  25. Acute Stress Disorder.. Cont. 6. Alteredsense of reality of oneself or surroundings (e.g., seeing oneself from another’s perspective). 7. Inability to remember an important aspect of traumaticevents(dissociative amnesia). 8. Efforts to avoid distressing memories, thoughts, or feelings about traumatic events. 9. Efforts to avoidexternalreminders (people, places,.. etc. related to traumatic events. 10. Sleepdisturbance (e.g. insomnia, restless sleep) Psychiatric and Mental Health Nursing

  26. Acute Stress Disorder.. Cont. 11. Irritable/angry behavior, verbal/nonverbal with little or no provocation. 12. Hypervigilance. 13. ConcentrationProblems. 14. Exaggerated startle response. D. Impairment in social, occupational, or other important functioning areas. E. Disturbance not related to another physiological or medical condition. Psychiatric and Mental Health Nursing

  27. Difference between PTSD and ASD Psychiatric and Mental Health Nursing

  28. Treatment:(Trauma- and Stressor-Related Disorders) 1- Debriefing: Helps the individual to gain a clearunderstanding of trauma, express his thoughts and reactions to trauma & to identify any stress related symptoms. 2- Cognitive Behavioral Therapy:CBT 3- In PTSD , client assisted to viewself as a survivorrather than a victim. Psychiatric and Mental Health Nursing

  29. Drugs used to treat anxiety disorders • Anxiolytic drugs: two groups: • Benzodiazepines: mayabuse or dependence, as Diazepam (Valium) & Alprazolam (Xanax). • Non-Benzodiazepines: doesn't depress CNS, as Buspirone (BuSpar). 2- Antihistamine drugs: hydroxyzine (Atarax) used to treat anxiety, panic disorder. 3- Antidepressants: (Prozac), (Tofranil). 4- Beta-blockers: propranolol (deralin). 5- Alpha-adrenergicagonist: Clonidine (Catapres). Psychiatric and Mental Health Nursing

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