Anxiety Disorders

1. ADICHUNCHANAGIRI COLLEGE OF NURSING ANXIETY DISORDER Mr. Dipankar Maiti ACN

2. Neurotic Disorder • Definition: Neurotic(Neurosis) is a less severe form of psychiatric disorder where, parents show either excessive or prolonged emotional reaction to any given stress. • These disorders are not caused by organic disease of the brain &,however severe, do not involve Hallucination&Delusions.

3. Anxiety • Anxiety can be described as an uncomfortable feeling of vague fear or apprehension by characteristic physical sensations. • Anxiety can produce uncomfortable & potentially debilitating psychological(e.gworry or feeling of threat) & physiological arousal(e.g, tachycardia or shortness of breath)

4. Anxiety Disorders • Definition:- Anxiety disorders are a group of mental disorders characterized by exaggerated feelings of anxiety and fear responses. • These feelings may cause physical symptoms, such as a fast heart rate and shakiness.

5. Epidemiology

6. Common Etiology • Stress at work • Stress from school • Stress in a personal relationship such as marriage • Financial stress • Stress from an emotional trauma such as the death of a loved one • Stress from a serious medical illness • Side effect of medication • Use of an illicit drug, such as cocaine • Symptom of a medical illness (such as heart attack, heat stroke, hypoglycemia) • Lack of oxygen in circumstances as diverse as high altitude sickness, emphysema, or pulmonary embolism(a blood clot in the vessels of the lung)

7. Types of Anxiety Disorders(DSM-5) Cont…

9. 1.Separation Anxiety Disorder • The individual is fearful or anxious about separation from attachment figures to a degree . • There is persistent fear or anxiety about harm coming to attachment & reluctance to go away from attachment figure, as well as nightmares & physical symptoms of distress. • Although the symptoms often develop in childhood, they can be expressed throughout adulthood as well.

10. 2.Selective Mutism • It is characterized by a consistent failure to speak in social situations in which there is an exception to speak(e.g school)even through the individual speaks in other situation. • The failure to speak has significant consequences on achievement in academic or occupational settings r otherwise interferes with normal social communication.

11. Symptoms • Excessive shyness. • Social isolation. • Fear of embarrassment in front of a group. • Clinging to caregivers. • Temper tantrums. • Oppositional behavior. • Compulsive traits. • Negativity.

12. 3.Specific Phobia • Individual with specific phobia are fearful or anxious about or avoidant of circumscribed objects or situations. • There are various types of specific phobia: Animal, Natural Environment, Blood-Injection-inury, Situational Phobias etc. • Examples:- • Aerophobia-Fear of flying • Nyctophobia-Far of the dark • Xenophobia-Fear of strangers • Insectophobia-Far of insects • Emetophobia-Fear of vomiting • Tachophobia-Fear of speed • Ymophobia-Fear of contrariety

13. Symptoms • Feeling of imminent danger or doom • Need to escape • Heart palpitations • Sweating • Trembling • Shortness of breath or a smothering feeling • Feeling of choking • Chest pain or discomfort • Nausea or abdominal discomfort • Feeling faint, dizzy or lightheaded • A sense of things being unreal, depersonalization • A fear of losing control or “going crazy” • A fear of dying • Tingling sensation • Chills or heat flush

16. 4.Social Anxiety Disorder • The individual is fearful or anxious about or avoidant of social interactions & situations that involve the possibility of being scrutinized. • These include social interactions such as meeting unfamiliar people, situations in which the individual may be observed eating or drinking,& situation in which the individual performs in front of others. • The cognitive ideation is being negatively evaluated by others, by being embarrassed , humiliated, or rejected, or offending others.

17. Symptoms • Hyperventilation • Sweating • Cold & clammy hands • Blushing • Palpitations • Confusion • Gastrointestinal Symptoms • Trembling hands & voice • Urinary urgency • Muscle tension • Anticipatory anxiety

18. 5.Panic Disorder • Panic attacks are abrupt surges of intense fear or intense discomfort that reach a peak within minutes, accompanied by physical &/or cognitive symptoms. • The individual experiences recurrent unexpected panic attacks & is persistently concerned or worried about having more panic attacks or changes his or her behavior in maladaptive ways because of panic attacks (e,g avoidance of exercise or of unfamiliar locations)

19. Symptoms • Palpitations • Sweating • Shaking or trembling • Feeling Shortness of breathor smothering • Sensation of choking • Chest pains or tightness • Nausea or gastrointestinal problems • Dizziness, light-headedness, or feeling faint • Feeling hot or cold • Numbness or tingling sensations (Paresthesia) • Feeling detached from oneself or reality, known as depersonalization and decreolization • Fear of “going crazy” or losing control • Fear of dying

22. 6.Agoraphobia • Individual with agoraphobia are fearful & anxious about two or more of the following situations: • Using public transportation • Being in open spaces • Being in enclosed places • Standing in line • Being in crowd • Being outside of the home alone

23. 6.Generalized Anxiety Disorder • Generalized anxiety disorder is an anxiety disorder that is characterized by excessive uncontrollable & irrational worry about everyday things. • GAD is common chronic disorder characterized by long-lasting anxiety that is not focused on any one objects or situation. • Risk factors:- • Family members with an anxiety disorder • Increase in stress • Exposure to physical or emotional trauma • Unemployment • Poverty • Drug Abuse

24. Symptoms • Nervousness, • Restlessness, • Being tense • Feelings of danger, panic, or dread • Rapid heart rate • Rapid breathing, or hyperventilation • Increased or heavy sweating • Trembling or muscle twitching • Weakness and lethargy • Difficulty focusing or thinking clearly • Insomnia • Digestive or Gastrointestinal Problems:- • Gas, • Constipation or Diarrhea • A strong desire to avoid the things that trigger your anxiety • Performing certain behaviors over and over again • Anxiety surrounding a particular life event or experience that has occurred in the past, especially indicative of post-traumatic stress disorder (PTSD)

25. 8.Substance/Medication-Induced Anxiety Disorder This disorder involves anxiety due to substance intoxication or withdrawalor to a medication treatment .

26. 9.Anxiety Disorder Due to Another Medical Condition • Patients feel anxiety due to other medical conditions. Like:- • Endocrine Disorder- • Hypothyroidism • Hypoglycemia etc. • Cardiovascular Disease- • Congestive Heart Failure • Arrhythmias • Pulmonary Embolism etc. • Respiratory Illness- • Asthma • Pneumonia etc. • Neurological Illness- • Neoplasm • Encephalitis • Seizure etc.

29. Pharmacotherapy • Benzodiazepines— • Alprazolam • Clonazepam • Lorazepam • Diazepam • Antidepressants— • Imipramine • Sertraline • Phenelzine • Anxiolytics— • Alprazolam • Antivan • Beta-blocker— • Propranolol

30. Behavior Therapy

31. Psychotherapy • SUPPORTIVE PSYCHOTHERAPY-Supportive psychotherapy is a dyadic treatment that uses direct measures to ameliorate symptoms and to maintain, restore, or improve self-esteem, ego functions, and adaptive skills.  • PSYCHODYNAMIC THERAPY-Psychodynamic psychotherapy or psychoanalytic psychotherapy is a form of depth psychology, the primary focus of which is to reveal the unconscious content of a client's psyche in an effort to alleviate psychic tension. • BEHAVIOUR THERAPY-the treatment of neurotic symptoms by training the patient's reactions to stimuli. • FAMILY AND MARITAL THERAPY-Marriage and Family Therapy (MFT) is a form of psychotherapy that addresses the behaviors of all family members and the way these behaviors affect not only individual family members, but also relationships between family members and the family unit as a whole. • COGNITIVE BEHAVIOUR THERAPY-a type of psychotherapy in which negative patterns of thought about the self and the world are challenged in order to alter unwanted behavior patterns or treat mood disorders such as depression.

32. Conclusion • Anxiety is the most common disorder especially in children & teen age group. • The vast majority of kids with significant anxiety develop symptoms during their grade school years(or earlier) & receive no treatment for their condition. • Kids with anxiety may be over represented among the student body at independent schools. • Cognitive behavior Therapy(CBT) & Medications are effective treatment for the children with Anxiety Disorder ……best response when CBT & Medications are used Together.

33. Bibliography: • R Sreevani, a guide to mental health and psychiatric nursing, • jaypeepublishers, • 3rd edition, pg.no:216-221 • Townsend c Mary, text book on “Psychiatric Mental HealthNursing.” • Jaypeepublications. • 5th edition, page240-245

34. Presented By Dipankar Maiti