Anxiety DisordersAnxiety Disorders

Trisha EconomidisTrisha Economidis

Fall, 2014Fall, 2014

Anxiety DisordersAnxiety Disorders

• Anxiety is a normal response to Anxiety is a normal response to stressstress

• Problematic when it produces Problematic when it produces dysfunctional behavior or becomes dysfunctional behavior or becomes intolerable.intolerable.

• Use behaviors to control anxiety: Use behaviors to control anxiety: rigid, repetitive, ineffectiverigid, repetitive, ineffective

Anxiety FactsAnxiety Facts

• Most common form of psych d/o Most common form of psych d/o in the U.S.in the U.S.

• Co-morbidity – occurs Co-morbidity – occurs simultaneously with major simultaneously with major depression and substance abusedepression and substance abuse

• More common in women than More common in women than menmen

Types of Anxiety Types of Anxiety DisordersDisorders

• Phobias (specific, social)Phobias (specific, social)• Generalized Anxiety Disorder (GAD)Generalized Anxiety Disorder (GAD)• Panic DisorderPanic Disorder• AgoraphobiaAgoraphobia• Social Anxiety DisorderSocial Anxiety Disorder• Substance/Medication Induced Anxiety Substance/Medication Induced Anxiety

DisorderDisorder• Separation Anxiety Disorder (will cover Separation Anxiety Disorder (will cover

with childrenwith children

PhobiasPhobias

• Irrational fear that persists even Irrational fear that persists even when aware that it is irrationalwhen aware that it is irrational

• AgoraphobiaAgoraphobia• Social PhobiaSocial Phobia• Specific phobiaSpecific phobia• Nursing Interventions aimed at Nursing Interventions aimed at

decreasing fear and increasing decreasing fear and increasing ability to functionability to function

Generalized Anxiety Generalized Anxiety DisorderDisorder

• Chronic, unrealistic & excessive Chronic, unrealistic & excessive anxiety & worryanxiety & worry

• RestlessnessRestlessness• FatigueFatigue• Concentration issuesConcentration issues• IrritabilityIrritability• Muscle tensionMuscle tension

Panic DisorderPanic Disorder

• Recurrent panic attacks, unpredictableRecurrent panic attacks, unpredictable• Feelings of impending doom along Feelings of impending doom along

with physical discomfortwith physical discomfort• Palpitations, racing heartPalpitations, racing heart• Sweating, shakingSweating, shaking• Nausea, abdominal painNausea, abdominal pain• De-realization or DepersonalizationDe-realization or Depersonalization• Fear of going crazy or dyingFear of going crazy or dying

GAD & Panic DisorderGAD & Panic Disorder

• Nursing InterventionsNursing Interventions– Aimed at relieving acute Aimed at relieving acute

symptomssymptoms– Assist client in taking control Assist client in taking control

of own life and accepting of own life and accepting situations over which he or she situations over which he or she have no controlhave no control

Obsessive-Compulsive Obsessive-Compulsive and Related Disordersand Related Disorders

• Obsessive-Compulsive DisorderObsessive-Compulsive Disorder• Body Dysmorphic DisorderBody Dysmorphic Disorder• Hoarding DisorderHoarding Disorder• Tricotillomania (hair-pulling)Tricotillomania (hair-pulling)• Excoriation (skin picking)Excoriation (skin picking)• Substance/medication-induced OCDSubstance/medication-induced OCD• OCD due to another medical OCD due to another medical

conditioncondition

Obsessive-Compulsive Obsessive-Compulsive DisorderDisorder

• Obsessions – unwanted thoughts that Obsessions – unwanted thoughts that cycle repeatedlycycle repeatedly

• Compulsions – unwanted, ritualistic Compulsions – unwanted, ritualistic actionsactions

• Usually obsessions & compulsions Usually obsessions & compulsions occur togetheroccur together

• Nursing Intervention – help the client Nursing Intervention – help the client maintain anxiety at a manageable level maintain anxiety at a manageable level without ritualistic behaviorswithout ritualistic behaviors

• Obsessions – unwanted thoughts Obsessions – unwanted thoughts that cycle repeatedlythat cycle repeatedly

• Compulsions – unwanted, ritualistic Compulsions – unwanted, ritualistic actionsactions

• Usually obsessions & compulsions Usually obsessions & compulsions occur togetheroccur together

• Nursing Intervention – help the Nursing Intervention – help the client maintain anxiety at a client maintain anxiety at a manageable level without ritualistic manageable level without ritualistic behaviorsbehaviors

• http://www.youtube.com/watch?v=Rn1OYlYzgm8

Trauma and Stress-Related Trauma and Stress-Related Disorders:Disorders:

Post-Traumatic Stress Post-Traumatic Stress Disorder (PTSDDisorder (PTSD))• Occurs after exposure to an extreme Occurs after exposure to an extreme

traumatic stressortraumatic stressor• Stressor involves a personal threat to Stressor involves a personal threat to

physical integrity of self or othersphysical integrity of self or others• Symptoms: Symptoms:

– FlashbacksFlashbacks– Avoidance of anything associated with the Avoidance of anything associated with the

traumatrauma– NumbingNumbing– HypervigilenceHypervigilence

General Nursing General Nursing Interventions for Anxiety Interventions for Anxiety

Disorders, OCD, and Disorders, OCD, and Stress-Related D/OStress-Related D/O• Be calmBe calm

• Enhance copingEnhance coping• Instill hopeInstill hope• Enhance self-esteemEnhance self-esteem• Use relaxation therapyUse relaxation therapy

Treatment Modalities for Treatment Modalities for Anxiety, Obsessive-Anxiety, Obsessive-

Compulsive, and Compulsive, and Trauma/Stress-Related Trauma/Stress-Related

DisordersDisorders• Individual PsychotherapyIndividual Psychotherapy• Cognitive TherapyCognitive Therapy• Behavior TherapyBehavior Therapy• Group/Family TherapyGroup/Family Therapy• PsychopharmacologyPsychopharmacology

PsychopharmacologyPsychopharmacology

• AntidepressantsAntidepressants– SSRI’s (Selective Serotonin SSRI’s (Selective Serotonin

Reuptake Inibitors)Reuptake Inibitors)– TCA’s (Tricyclic Antidepressants)TCA’s (Tricyclic Antidepressants)– MAOI’s (Monoamine Oxidase MAOI’s (Monoamine Oxidase

Inhibitors)Inhibitors)– SNRI’s (Serotonin- Norepinephrine SNRI’s (Serotonin- Norepinephrine

Reuptake InhibitorsReuptake Inhibitors

Selective Serotonin Selective Serotonin Reuptake Inhibitors Reuptake Inhibitors

(SSRI’s)(SSRI’s)• Prozac, Paxil, Celexa, Zoloft, Prozac, Paxil, Celexa, Zoloft,

LexaproLexapro• Newer class of meds; less side Newer class of meds; less side

effectseffects• Some are sedatingSome are sedating• DO NOT MIX WITH ALCOHOLDO NOT MIX WITH ALCOHOL

Tricyclic Antidepressants Tricyclic Antidepressants (TCA’s)(TCA’s)

• Elavil, Tofranil, PamelorElavil, Tofranil, Pamelor• One of oldest classes, but One of oldest classes, but

effectiveeffective• Side effects: sedating, Side effects: sedating,

orthostatic hypotension, orthostatic hypotension, anticholinergic effect, weight anticholinergic effect, weight gain, sexual dysfunctiongain, sexual dysfunction

Monoamine oxidase Monoamine oxidase inhibitors (MAOI’s)inhibitors (MAOI’s)

• Nardil, EMSAM patchNardil, EMSAM patch• Serious side effect when taken with Serious side effect when taken with

tyramine – can cause hypertensive crisistyramine – can cause hypertensive crisis• Other side effects: orthostatic Other side effects: orthostatic

hypotension, tachycardia, sleep hypotension, tachycardia, sleep disturbances, impotencedisturbances, impotence

• ****Must be at least a 2 week washout Must be at least a 2 week washout period between MAOI’s and any other period between MAOI’s and any other antidepressant or any tyramine-rich antidepressant or any tyramine-rich foodsfoods

AnxiolyticsAnxiolytics

• Benzodiazepines – 1Benzodiazepines – 1stst line line medicationsmedications

• BusparBuspar• KavaKava• AntihistaminesAntihistamines• Beta BlockersBeta Blockers• AnticonvulsantsAnticonvulsants