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Anxiety
a vague feeling of dread that is unwarranted by the situation. Is a state of feeling apprehensive over a perceived threat that is not reality based
Anxiety vs Fear
both may coexist. Ansiety is the emotional response to an Unknown threat. Fear is the cognitive response, something specific to a real identifiable threat.
Levels of Anxiety 1. Mild
present in our day to day living; something that motivates which allows one to learn and grow and develop new problem-solving skills
Levels of Anxiety 2. Moderate
narrows perceptual field and focus in on the immediate concern; there is agitation because one knows there is something wrong
Levels of Anxiety 3. Severe
focus is on specific details, person is sure that a threat exists. Learning ability is impaired almost going to a distressed point and may use primitive skills to adapt thus no longer using intellectual (cognitive) skills; basically just for survival
Levels of Anxiety 4. Panic
highest level of anxiety; may last from minutes to an hour; person loosing control; disintegration of personality; if unresolved may develop psycho physiological disorders (some may lose minds, others develop severe stress ulcers
Types of Anxiety 1. Signal Anxiety
develop in response to anticipated events (ie response to a loved one who is anticipated to die)
Types of Anxiety 2. Anxiety Trait
a part of ones personality that has been present for a long period of time and is manifested by responding negatively to non-stressful events
Types of Anxiety 3. Anxiety state
when faced with a stressful situation, one loses control; one becomes hysterical
Types of Anxiety 4. Free floating anxiety
anxiety with a feeling of dread which is always present; ritualistic behaviors in nature
Theories r/t causes of anxiety 1. Psychodynamic theory
the unconscious conflicts of childhood is the focus Freud: unresolved conflicts during childhood will eventually haunt you as you grow older. Anxiety central to personality development
Theories r/t causes of anxiety 2. Biological theory
anxiety is the result of stress on the body's wear and tear principle. The role of neurotransmitters is being explored
Theories r/t causes of anxiety 3. Behavioral theory
an individual's response to a stressful event is often times a learned behavior; environmental influences must be considered
Theories r/t causes of anxiety 4. Socio-Cultural influence
Asians- stoic to pain Hispanic - express when in pain Caucasians - intellectualize pain
S/S of Anxiety 1. Physiological
varies from person to person. Includes: diaphoresis, hypertension, trembling, inc HR, inc BP, pupils dilate, hyperventilate.
S/S of Anxiety 2. Psychosocial and Emotional
crying, irritability, isolation, depression, hostile, withdrawal, emotionally labile
S/S of Anxiety 3. Intellectual and Cognitive
lack of concentration or no focus, ruminace (obsession with ideas)
Anxiety Disorders (worse than anxiety conditions)
When anxiety becomes long term or permeates a major portion of a persons life and leads to maladaptive behavior and emotional instability, they suffer from anxiety disorder. Most common mental disorder in US
Causative Factors of Anxiety Disorders 1. Biological - Genetic
1st degree relations are likely to get it more than general population
Causative Factors of Anxiety Disorders 1. Biological - Neurochemical
GABA (natural anti-anxiety agent) is decreased, the body must have sufficient amounts of GABA to counteract the effects of NE
Causative Factors of Anxiety Disorders 2. Psychodynamic - Cognitive
the result of distorted thinking pattern leading to maladaptive behaviors and emotional problems
Causative Factors of Anxiety Disorders 2. Psychodynamic - Interpersonal - Interpersonal
r/t lack of nurturing specially the dysfunctional family that could lead to altered coping mechanism
Causative Factors of Anxiety Disorders 2. Psychodynamic - Behavioral - Behavioral
the basis for this theory is believing that all behaviors are learned, including mental disorders
Phobic Disorders
an intense anxiety reaction to an object or situation. Specific pahtological fear which is out of proportion to the stimulus and interferes with the normal fxn of individual
Forms of Phobia
Social "performance anxiety"
Specific Phobias
agoraphobia - public places unable to escape danger Androphobia - men Gamophobia - marriage
Panic d/o with or without agoraphobia
highest level of anxiety characterized by recurrent panic attacks of intense fear which may not be associated with situation consciously perceived as anxiety provoked by pt
Characteristics of Panic attacks
chest pain, palpitations, choking sensations, disorganized thinking, difficulty breathing (mimics heart attack)
Generalized anxiety disorder (GAD)
Characterized by urealistic anxiety that lasts for 6 months or longer. No organic pathology. Not accompanied by phobias & No panic attack.
Generalized anxiety disorder & cortisol
because it lasts for 6 months or longer the cortisol levels increase (endocrine imbalance) which decreases immune system
Obsessive Compulsive Disorder (OCD)
essential feature is recurring obsessions and compulsions severe enough to be time consuming; can last from 1 hour to several hours; is very distressing. Cannot break ritual once pt started & Do not remind them
OCD Obsessions
Undesired persistent ideas, thoughts, impulses or images experienced as intrusive which leads to severe anxiety
OCD Compulsive
Repetitive behavior the goal of which is to alleviate anxiety and not for pleasure
Post Traumatic Stress Disorder (PTSD)
develops after exposure to a traumatic event; Flashbacks of traumatic events such as earthquakes, war experiences, etc,; symptoms occur within first 3 months after event
Acute Stress disorder (short anxiety d/o)
similar to PTSD but response is more dissociate in nature during or immediately after the distressing event. Symptoms must be resolved in 1 month, otherwise the dx is changed to PTSD if other criteria are met
Atypical anxiety d/o
the prominent anxiety and phobic features do not meet the DSM - IV TR criteria
Substance induced anxiety
usually come with dual dx
Anxiety d/o r/t medical problems
such as cancer, hypo/hyperthyroidism, DM (ketoacidosis)
General Moment and Nursing Care for Anxiety D/o
Rule out medical problems Anxiolytics - minor tranquilizers; benzodiasepines Psychotherapy, Therapeutic Milieu, Education
Somatoform d/o
characterized by the presence of unconscious or unintentional physical symptoms with no organic pathology
Types of Somatoform d/o 1. Somatization
multiple somatic complaints secondary to underlying psychological problems
Types of Somatoform d/o 2. Undifferentiated somatoform d/o
unexplained physical complaints that lasts at least 6 months
Types of Somatoform d/o 3. Conversion d/o (pseudoneurological)
the loss and changes in bodily function r/t psychological problem; most of the problems are neurological in nature but non-existent
Types of Somatoform d/o 4. Pain d/o
pain is the predominant focus with strong psychological emphasis
Types of Somatoform d/o 5. Hypochondriasis
pre-occupied with having severe illness with exaggerated unrealistic symptoms
Types of Somatoform d/o 6. Body Dismorphic d/o
pre-occupation with exaggerated physical imperfection r/t unresolved conflicts; is very difficult to treat
Factitious d/o
unreal
Manchausen syndrome
when a person assumes a sick role to gain attention; they purposely develop symptoms of a disease in order to gain attention; most chronic and severe from of factitious d/o
Manchausen syndrome by Proxy (MSBP)
person inflcits harm on others and saves his/her life for recognition; not even considered a mental disorder by APA, but a criminal behavior; vulnurable ones are children and elderly
Malingering
symptoms are similar to factitious but done for financial gain; ie calling in sick when not actually sick but to get paid for the day
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