Anxiety (Student) (1) PDF

Anxiety Generalized Anxiety Disorder, Post-Traumatic Stress Disorder, Somatic Disorders  What is Anxiety? A universal human experience and a basic emotion! A feeling of uneasiness, apprehension, uncertainty, or dread deriving from a real or perceived threat. Anxiety i...

Anxiety Generalized Anxiety Disorder, Post-Traumatic Stress Disorder, Somatic Disorders  What is Anxiety? A universal human experience and a basic emotion! A feeling of uneasiness, apprehension, uncertainty, or dread deriving from a real or perceived threat. Anxiety is typically FUTURE-ORIENTED Often confused with fear, however, fear is a reaction to a specific danger or circumstance  Anxiety Disorders 20 % Of the general population is affected by an anxiety disorder in which anxiety impairs individual functioning (the most common mental health dx in 3-5 adults) % Of children/adolescents have a diagnosed anxiety disorder  Risk Factors Female sex (2:1) Stressful/traumatic life events Family history of anxiety disorders Childhood adversity Support systems Alcohol or illicit drug use Other psychiatric or chronic health issues Personality factors Traumatic brain injury  Fight or Flight Symptoms Remember the body is HIGH from Autonomic NS/HPA axis activation. Vitals are increased Dilated pupils Hyperglycemia Dilated bronchioles Peripheral vasoconstriction  Spectrum of Anxiety Mild Moderate Severe Panic Increased motivation Decreased Concentration Complete lack of concentration progressively focus Can work effectively narrowed towards a goal Decreased problem Marked change in solving Severe impairment baseline behavior Heightened of attention awareness Muscular tension Marked functional Restlessness Severe cognitive impairment Optimal functioning impairment Physical and emotional symptoms  Mild Example: taking a quiz This is a part of everyday life. Problem- solving becomes more effective in this state (I know I need to study, I make a plan) Physical symptoms may be restlessness, irritability, mild tension-relieving behaviours (nail-biting) Moderate Perceptual field narrows Selective inattention Ability to process information becoming impaired but can still problem-solve Physical symptoms may include pounding heart, high HR and RR, perspiration, mild somatic symptoms (GI upset, headache, urinary urgency)  Severe Anxiety Behaviour becomes automatic (wringing hands, pacing) May have headaches, nausea, dizziness, insomnia, trembling, tachycardia, hyperventilation, sense of dread Need help to refocus PANIC SENSE OF IMPENDING DOOM Borders on psychosis; may have hallucinations, disorganized or irrational reasoning. May feel like they are dying Can be the result of an unexpected, anxiety-inducing situation, or a panic disorder (needs a formal diagnosis) Panic attacks 1. Stay with the patient during a panic attack 2. Assist them into a quiet place 3. Speak calmly and with simple, clear words Panic attacks may occur suddenly with no warning, but usually build to a peak intensity in 10-15 minutes.  Case Study 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? A. Mild B. Moderate C. Severe D. Panic  Case Study What would be some appropriate interventions for the parent whose child is missing at the mall and is experiencing panic-level anxiety? What behaviours might this parent be exhibiting that would indicate panic-level anxiety? What are some physical signs? A 32-year-old female client visits her primary health care provider for her annual physical examination. On initial assessment by the nurse, the following data was recorded _____ VS within normal limits _____Height = 5ft, 7in (170.2cm) _____Weight = 126 lb. (57.2kg) _____History of migraines that are controlled by drug therapy (one to two headaches a month) _____History of depression as a teenager but currently not being treated for this problem _____States that she has been extremely worried most days for the past 7 to 8 months about day-to-day things and reports having difficulty controlling the worry. _____Married for 1 ½ years and is starting out her practice as a clinical psychologist _____Husband lost his job 6 months ago due to his company’s closure; remains unemployed _____Has student loans from graduate school and is having problems making payments _____Wants to get pregnant someday but feels too stressed to think about it now _____Is having problems sleeping – either getting to sleep or staying asleep _____has been taking melatonin to help her sleep but is finding it only slightly effective _____Denies using illicit drugs or other substances _____Reports always feeling tired and having problems concentrating at work _____Has no problems with appetite and states she eats healthily as much as she can Place a check mark next to the assessment findings that require follow-up by the nurse and health care team.  01 Generalized Anxiety Disorder (GAD) What is GAD A persistent and exaggerated apprehension and tension causing dysfunction WORRY is the major issue. Events are misinterpreted due to worry. More common in women  5% Of the population is diagnosed with GAD  Diagnosis with DSM-V Excessive Have 3 or more Hard to control anxiety for more symptoms (only anxiety (cannot days than not 1 symptom or self-soothe) over 6 months more in children) Not explained by Not better Causes medication, drug explained by impairment in abuse, or other another mental daily life medical condition disorder Symptoms DSM V Restlessness Sleep Being easily disturbances fatigued Muscle Difficulty tension concentrating Irritability Excessive Distorted physiologic cognitive Poor coping arousal process SOB Poor concentration Tachycardia. Palpitations Avoidance Dry mouth Sweating Unrealistic assessment of problems Nausea Procrastination Diarrhea Excessive worry over Muscle tension minor matters Irritability Poor problem-solving Fatigue/Insomnia skills Fear grave misfortune Headache Sleep May ruminate over (real or imagined) mistakes, events, problems, and future difficulties Lack of sleep contributes to worsening symptoms  Treatments (often a combination) CBT Biofeedback Behavioural Therapist guides to assist Becoming aware of and Modelling recognition of harmful ways of consciously controlling body Systematic desensitization thinking and analyzing and functions Flooding reinterpreting past and current Response prevention experiences to adopt positive Thought stopping behaviours and interactions We practice coping skills in response to a trigger https://youtu.be/q6aAQgXauQw  Medications Beta Blocker SSRI/SNRI Slow the SNS Help to boost mood Anxiolytic Can be sedating and slow vitals, higher risk of abuse and toxicity (ex: benzos)  Nursing Decrease stimuli Give brief directions: convey belief in the patient and help with poor concentration Ask questions to clarify and dispute illogical thinking List strengths Reframe situations in a positive light Since learning that he will have a trial pass to a new group home tomorrow, Bill’s behaviour has changed. He has started to pace rapidly, has become very distracted, and is breathing rapidly. He has trouble focusing on anything other than the group home issue and complains that he suddenly feels very nauseated. Which initial nursing response is most appropriate for Bill’s level of anxiety? A) “You seem anxious. Would you like to talk about how you are feeling?” B) “If you do not calm down, I will have to give you medicine to calm you.” C) “Bill, slow down. Listen to me. You are safe. Take a nice, deep breath.” D) “We can delay the visit to the group home if that would help you A 32-year-old female client visits her primary health care provider for her annual physical examination. At the end of her visit, the provider determined that the client has generalized anxiety disorder (GAD) and prescribes venlafaxine XR 37.5 mg orally once a day as an initial dose. The client returns today to the primary health care provider’s office for follow-up 6 weeks after beginning drug therapy. For each assessment finding, use an X to indicate whether the interventions were Effective (helped to meet expected outcomes), Ineffective (did not help meet expected outcomes), or Unrelated (not related to the expected outcomes). Assessment Finding Effective Ineffective Unrelated Unintentional weight loss of 10 lb. (4.5 kg) in the past 6 weeks. Sleeping patterns improving Feels less worried most of the time Participates in yoga class 3 to 4 days a week No longer eating red meat in her diet Husband starting new job next week after 6 months of unemployment Was able to pay her student loan payment last month  02 Post-Traumatic Stress Disorder (PTSD)  When is PTSD diagnosable? 4 weeks 4+ weeks 20% 3 months ASD PTSD Veterans Trauma Acute Stress Post-Traumatic Canadian armed Usually begins Disorder Stress Disorder force veterans within 3 months of have an operation trauma, May not stress injury be apparent right including PTSD away.  Risk factors for PTSD Education Childhood Female sex Under 25 level Trauma Childhood Adverse life Psychiatric Genetics adversity events disorders Perceived Nature of HPA axis severity of trauma dysfunction trauma  Main features of PTSD Re-experiencing (flashbacks) Avoidance of stimuli associated with trauma Increased arousal Numbing of general responsiveness/Negative changes  Children Less likely to show distress, but this does not mean they don’t feel it Children often express memory through acting it out via play  Negative stress coping mechanisms in PTSD Denial Repression 01 Escaping unpleasant realities by ignoring 02 Excludes unpleasant experience from their existence consciousness  Patient Interview It is essential that the clinician conducts the diagnostic interview in a manner that acknowledges the patient’s worst fears and that provides an environment of sensitivity, safety, and trust. In the case of chronic PTSD, where protective layers have solidified for years or decades, the clinician must be patient and obtain the trauma history at a pace that the patient can tolerate.  Treatment Complicated as those with PTSD may be reluctant to engage in trauma thoughts, emotions, and conversations Exposure and group therapy shown to be beneficial Medications such as SSRI and SNRI may minimize flashbacks and nightmares Anxiolytics and sleep aids may be used to treat physiological arousal and sleep issues Risk Suicide risk Assess for self- harm thoughts and plans Substance Self-medication abuse Survivors May feel they deserve symptoms guilt The nurse is caring for a client who is a survivor of a disaster event. The client begins to display behaviors not demonstrated before. Which manifestations should indicate to the nurse that the client may be experiencing post-traumatic stress disorder (PTSD)? Select all that apply. A. Irritability and sleep disturbances B. Flashbacks or recollections of the disaster C. Regression to an earlier developmental stage D. A feeling of estrangement or detachment from others E. Consistent discussion and rationalizing as to why the disaster occurred F. Repression or the inability to remember an important aspect associated with the disaster  03 Somatic Disorders  Somatoform Disorders Symptoms are not intentional and are very real Co-occur with depressive, psychotic, or anxiety disorders High level of functional impairment; an extreme focus on symptoms which can lead to decreased quality of life  Somatic Symptoms Why does it Affects everyone happen? 25% of primary care clinic Anxiety, depression, and visits are for somatic trauma contribute to symptoms complex psychological and physical experiences Conversion disorder One or more symptoms of altered voluntary motor and sensory function inconsistent with condition Illness anxiety disorder Preoccupation with getting/having a serious medical disorder Psychological factors affecting other medical conditions A medical condition exists, but psychological factors negatively affect the condition Other specified somatic symptom Symptoms consistent with somatic disorder but do not meet full criteria above disorders Unspecified somatic symptom Symptoms consistent with somatic disorder, but do not meet criteria for any disorder. Insufficient information for specific disorder  Understanding Conversion Primary Gain Secondary Gain Relief of unconscious psychological Benefit that comes from conflict causing physical symptoms having the symptoms Anxiety threatens to emerge into Allows avoidance of difficult consciousness and is “converted” to situations and garners support physical symptoms or sympathy the person may Relieves pressure to deal with not otherwise receive anxiety source directly Risk Factors for Somatic Symptom Disorders Education Family Fewer years of Hx of chronic education illness in family SES Psychiatric Lower Existing psychiatric socioeconomic condition status Childhood Sex Hx of chronic Female sex childhood illness Somatic symptoms vary, most commonly include: GI 1 3 Sexual Dysfunction Pain 2 4 Persistent anxiety Interventions Limit the focus on illness and discussion of symptoms Promote insight by identifying stressors that intensify symptoms Introduce positive coping mechanisms to reduce stress A client was admitted to a medical unit with acute blindness. After extensive testing, there seems to be no organic reason why this client cannot see. The nurse later learns that the client became blind after witnessing a hit-and-run car accident in which a family of three was killed. The nurse suspects that the client's blindness supports which condition? A. Psychosis B. Repression C. Conversion disorder D. Dissociative disorder