Irene Dunn, MA,MSN,RNC. Physiological Responses to Anxiety Cardiovascular System Palpitations ...
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Transcript of Irene Dunn, MA,MSN,RNC. Physiological Responses to Anxiety Cardiovascular System Palpitations ...
Physiological Responses to Anxiety
Cardiovascular System
Palpitations Racing heart Increased blood
pressure Faintness*
Actual fainting* Decreased blood
pressure* Decreased pulse rate*
Physiological Responses to Anxiety
Respiratory System
Rapid breathing Shortness of breath Pressure on chest
Shallow breathing Lump in throat
Choking sensation Gasping
Physiological Responses to Anxiety
Gastrointestinal System Loss of appetite Revulsion toward
food Abdominal
discomfort
Abdominal pain* Nausea* Heartburn Diarrhea*
Physiological Responses to Anxiety
Neuromuscular System Increased reflexes Startle reaction
Eyelid twitching Insomnia Tremors Rigidity
Fidgeting Pacing Strained face Generalized
weakness Wobbly legs Clumsy movement
Physiological Responses to Anxiety
Skin
Flushed face
Localized sweating (palms)
Itching
Hot and cold spells Pale face Generalized
sweating
Physiological Responses to Anxiety
Urinary Tract Pressure to urinate* Frequent Urination* *Parasympathetic response
Behavioral Responses to Anxiety
Restlessness Physical tension Tremors Startle reaction Hypervigilance Rapid speech
Lack of coordination Accident proneness Interpersonal
withdrawal Inhibition Flight Avoidance Hyperventilation
Cognitive Responses to Anxiety
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
Affective Responses to Anxiety
Edginess Impatience Uneasiness Tension Nervousness Fear Fright Shame
Frustration Helplessness Alarm Terror Jitteriness Jumpiness Numbing Guilt
Medical Disorders Associated with Anxiety
Cardiovascular/Respiratory 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 Anxiety
Endocrinology
Carcinoid Cushing’s syndrome Hyperthyroidism Hypoglycemia Hypoparathyroidism
Hypothyroidism Menopause Pheochromocytoma Premenstrual
syndrome
Medical Disorders Associated with AnxietyNeurological
Collagen vascular disease
Epilepsy Huntington’s
disease
Multiple sclerosis Organic brain
syndrome Vestibular
dysfunction Wilson’s disease
Medical Disorders Associated with Anxiety
Substance Related Intoxications
Anticholinergic drugs
Aspirin Caffeine Cocaine
Hallucinogens including phencyclidine (angle dust)
Steroids Sympathomimetics THC
Panic Attack Criteria
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
Fear of losing control or going crazy Fear of dying Paresthesias (numbness or tingling
sensations) Chills or hot flashes
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.
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.
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.
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.
Differences Between Anxiety and Depression
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
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
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
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
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.
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 efficaciousThe benzodiazepines reduced the anxiety and worry symptoms of GADBuspirone appeared comparable to the benzodiazepines in alleviating GAD symptomsThe tricyclic antidepressants have been useful in the treatment of GAD
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%.
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
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.
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.
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.
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.
Antianxiety DrugsBenzodiazepines
Alprazolam (Xanax) Chloridazepoxide
(Librium) Clorezepate
(Tranxene) Diazepam (Valium)
Halazepam (Paxipam) Lorazepam (Ativan) Oxazepam (Serax) Prazepam (Centrax)
Antianxiety Drugs
Antihistamines– Diphenhydramine (Benadryl)– Hydroxyzine (Atarzx)
Beta-Adrenergic Blocker– Propranolol (Inderal)
Anxiolytic – Buspirone (BuSpar)
Antidepressant/Antianxiety Drugs
Citalopram (Celexa) Fluoxetine (Prozac) Fluvoxamine (Luvox) Paroxetine (Praxil) Sertraline (Zoloft)
Other Newer Antidepressants
Mirtazepine (Remerom) Nefazodone (Serzone) Reboxetine (Vestral) Trazodone (Desyrel) Venlafaxine (Effexor)
Tricyclics
Amitiptylene (Elavil) Desipramine (Norpramin) Clomipramine (Anafranil) Imipramine (Tofranil) Nortiptyline (Pamelor)
MAO’s Phenelzine (Nardil)
Cognitive Behavioral Treatment Strategies for Anxiety Disorders
Anxiety Reduction
Relaxation training Biofeedback Systematic
desensitation Interoceptive
exposure
Flooding Vestibular
desensitization training Response prevention Eyemovement
desensitization and reprocessing (EMDR)
Cognitive Restructuring
Monitoring thoughts and feelings
Questioning the evidence
Examining alternatives
Decatastrophizing Reframing Thought stopping