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Irene Dunn, MA,MSN,RNC

Irene Dunn, MA,MSN,RNC. Palpitations Racing heart Increased blood pressure Faintness*. Actual fainting* Decreased blood pressure* Decreased pulse rate*. Physiological Responses to Anxiety Cardiovascular System. Rapid breathing Shortness of breath

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Irene Dunn, MA,MSN,RNC

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  1. Irene Dunn, MA,MSN,RNC

  2. Palpitations Racing heart Increased blood pressure Faintness* Actual fainting* Decreased blood pressure* Decreased pulse rate* Physiological Responses to AnxietyCardiovascular System

  3. Rapid breathing Shortness of breath Pressure on chest Shallow breathing Lump in throat Choking sensation Gasping Physiological Responses to AnxietyRespiratory System

  4. Loss of appetite Revulsion toward food Abdominal discomfort Abdominal pain* Nausea* Heartburn Diarrhea* Physiological Responses to AnxietyGastrointestinal System

  5. Increased reflexes Startle reaction Eyelid twitching Insomnia Tremors Rigidity Fidgeting Pacing Strained face Generalized weakness Wobbly legs Clumsy movement Physiological Responses to AnxietyNeuromuscular System

  6. Physiological Responses to AnxietySkin Flushed face Localized sweating (palms) Itching Hot and cold spells Pale face Generalized sweating

  7. Physiological Responses to AnxietyUrinary Tract • Pressure to urinate* • Frequent Urination* • *Parasympathetic response

  8. Restlessness Physical tension Tremors Startle reaction Hypervigilance Rapid speech Lack of coordination Accident proneness Interpersonal withdrawal Inhibition Flight Avoidance Hyperventilation Behavioral Responses to Anxiety

  9. Impaired attention Poor concentration Forgetfulness Errors in judgment Preoccupation Blocking of thoughts Decreased perceptual filed Reduced creativity Diminished productivity Confusion Self-consciousness Loss of objectivity Fear of losing control Frightening visual images Fear of injury or death Flashbacks Nightmares Cognitive Responses to Anxiety

  10. Edginess Impatience Uneasiness Tension Nervousness Fear Fright Shame Frustration Helplessness Alarm Terror Jitteriness Jumpiness Numbing Guilt Affective Responses to Anxiety

  11. Medical Disorders Associated with Anxiety

  12. Asthma Cardiac arrhythmias Chronic obstructive pulmonary disease Congestive heart failure Coronary insufficiency Hyperfynamic beta-adrenergic state Hypertension Hyperventilation syndrome Hypoxia, embolus, infections Medical Disorders Associated with AnxietyCardiovascular/Respiratory

  13. Carcinoid Cushing’s syndrome Hyperthyroidism Hypoglycemia Hypoparathyroidism Hypothyroidism Menopause Pheochromocytoma Premenstrual syndrome Medical Disorders Associated with AnxietyEndocrinology

  14. Collagen vascular disease Epilepsy Huntington’s disease Multiple sclerosis Organic brain syndrome Vestibular dysfunction Wilson’s disease Medical Disorders Associated with AnxietyNeurological

  15. Anticholinergic drugs Aspirin Caffeine Cocaine Hallucinogens including phencyclidine (angle dust) Steroids Sympathomimetics THC Medical Disorders Associated with AnxietySubstance Related Intoxications

  16. Medical Disorders Associated with Anxiety Withdrawal Syndromes Alcohol Narcotics Sedative-hypnotics

  17. Palpitations, pounding heart, or accelerated heart rate Sweating 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 Derealization (feelings of unreality) or depersonalization (being detached from oneself) Panic Attack Criteria

  18. Panic Attack Criteria • Fear of losing control or going crazy • Fear of dying • Paresthesias (numbness or tingling sensations) • Chills or hot flashes

  19. Obsession and Compulsion Criteria • Obsession • Recurrent and persistent thoughts, impulses, or images are experienced during the disturbance as intrusive and inappropriate and cause marked anxiety or distress • The thoughts, impulses, or images are not simply excessive worries about real-life problems.

  20. Obsession and Compulsion Criteria • The person attempts to ignore or suppress such thoughts or impulses or to neutralize them with some other thought or action • The person recognizes that the obsessional thought impulses, or images are a product of one’s own mind.

  21. Obsession and Compulsion Criteria • Compulsion • The person feels driven to perform repetitive behaviors (such as hand washing, ordering, checking) or mental acts (such as praying, counting, repeating words silently) in response to an obsession or according to rules that must be applied rigidly.

  22. Obsession and Compulsion Criteria The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive.

  23. Anxiety Predominantly fear or apprehension Difficulty falling asleep (initial insomnia) Phobic avoidance behavior Rapid pulse and psychomotor hyperactivity Depression Predominantly sad or hopeless with feelings of despair Early morning awakening (late insomnia) or hypersomnia Diurnal variation (feels worse in the morning) Slowed speech and thought processes Differences Between Anxiety and Depression

  24. Anxiety Breathing disturbances Tremors and palpitations Sweating and hot or cold spells Faintness, lightheadedness, dizziness Depression Delayed response time Psychomotor retardation (agitation may also occur) Loss of interest in usual activities Inability to experience pleasure Differences Between Anxiety and Depression

  25. Anxiety Depersonalization (feeling that one’s environment is strange, unreal, or unfamiliar) Selective and specific negative appraisals that do not include all areas of life Depression Thoughts of death or suicide Negative appraisals are pervasive, global, and exclusive Sees the future as blank and has given up all hope Differences Between Anxiety and Depression

  26. Anxiety Sees some prospects for the future Does not regard defects or mistakes as irrevocable Uncertain in negative evaluation Predicts that only certain events may go badly Depression Regards mistakes as beyond redemption Absolute in negative evaluations Global view that nothing will turn out right Differences Between Anxiety and Depression

  27. Summarizing the Evidence on Anxiety Disorders Disorder: Generalized anxiety disorder Treatment: Most treatment outcome studies have shown active treatments to be superior to nondirective approaches, and uniformly superior to no treatment, however; most of these studies failed to demonstrate differential rates of efficacy among active treatments.

  28. Treatment: Generalized anxiety disorder Recent studies suggested cognitive-behavior therapy (combining relaxation exercises and cognitive therapy), with the goal of bring the worry process under control, to be most efficacious The benzodiazepines reduced the anxiety and worry symptoms of GAD Buspirone appeared comparable to the benzodiazepines in alleviating GAD symptoms The tricyclic antidepressants have been useful in the treatment of GAD

  29. Disorder:Obsessive compulsive disorder (OCD) • Treatment: Cognitive-behavioral therapy involving exposure and ritual prevention methods reduced or eliminated the obsessions and behavioral and mental ritual of OCD. • Approximately 40% to 60% of OCD patients respond to serotonergic reuptake inhibitors (SRI’s), including clomipramine, fluvoxamine, paroxetine, fluoxetine, and sertraline, with mean improvement in obsessions and compulsions of approximately 20% to 40%.

  30. Disorder: Panic disorder • Treatment: situational in vivo exposure substantially reduced symptoms of panic disorder with agoraphobia. • Cognitive-behavioral treatments that focused on education about the nature of anxiety and panic and provided some form of exposure and coping skills acquisition significantly reduced symptoms of panic disorder without agoraphobia

  31. Disorder: Panic disorder • Tricyclic antidepressants and monoamine oxidase inhibitors reduced the number of panic attacks and also reduced anticipatory anxiety and phobic avoidance, although side effects cause some patients to drop from clinical trials. • The benzodiazepines (e.g. Alprazolam) elinated panic attacks in 55% to 75% of patients.

  32. Disorder: Panic disorder • More recently, serotonin reuptake inhibitors (SRI’s), and selective serotonin reuptake inhibitors (SSRI’s) have produced reductions in panic frequency, generalized anxiety, disability and phobic avoidance.

  33. Disorder: Posttraumatic stress disorder • Treatment: Monoamine oxidase inhibitors (MAO’s) reduced intrusive thoughts, improved sleep, and moderated anxiety and depression in PTSD patients. • Tricyclic antidepressants reduced intrusive thoughts and obsessions and moderated depression in these patients.

  34. Disorder: Posttraumatic stress disorder • Selective serotonin reuptake inhibitors (SSR’s) markedly reduced intrusive thoughts, avoidance, and sleep problems. • Exposure therapies (systematic desensitization, flooding, prolonged exposure and implosive therapy) and , to a lesser extent, anxiety management techniques (using cognitive-behavioral strategies) reduced PTSD symptoms, including anxiety and depression, and increased social functioning.

  35. Alprazolam (Xanax) Chloridazepoxide (Librium) Clorezepate (Tranxene) Diazepam (Valium) Halazepam (Paxipam) Lorazepam (Ativan) Oxazepam (Serax) Prazepam (Centrax) Antianxiety DrugsBenzodiazepines

  36. Antianxiety Drugs Antihistamines Diphenhydramine (Benadryl) Hydroxyzine (Atarzx) Beta-Adrenergic Blocker Propranolol (Inderal) Anxiolytic Buspirone (BuSpar)

  37. Antidepressant/Antianxiety Drugs • Citalopram (Celexa) • Fluoxetine (Prozac) • Fluvoxamine (Luvox) • Paroxetine (Praxil) • Sertraline (Zoloft)

  38. Other Newer Antidepressants • Mirtazepine (Remerom) • Nefazodone (Serzone) • Reboxetine (Vestral) • Trazodone (Desyrel) • Venlafaxine (Effexor)

  39. Tricyclics • Amitiptylene (Elavil) • Desipramine (Norpramin) • Clomipramine (Anafranil) • Imipramine (Tofranil) • Nortiptyline (Pamelor) • MAO’s • Phenelzine (Nardil)

  40. Relaxation training Biofeedback Systematic desensitation Interoceptive exposure Flooding Vestibular desensitization training Response prevention Eyemovement desensitization and reprocessing (EMDR) Cognitive Behavioral Treatment Strategies for Anxiety DisordersAnxiety Reduction

  41. Monitoring thoughts and feelings Questioning the evidence Examining alternatives Decatastrophizing Reframing Thought stopping Cognitive Restructuring

  42. Modeling Shaping Token economy Role playing Social skills training Aversion therapy Contingency contracting Learning New Behavior

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