Anxiety Disorder Slideshow Transcript
Slide 1: Psychobiology, Anxiety Disorders, and Anti-anxiety Medications The mind body connection
Slide 2: Primary and Secondary Gain Primary Gain: the reduction of felt tension/anxiety through a neurotic symptom Secondary Gain: The “fringe benefits” derived from the expression of a neurotic symptom (eg pity, nurturance, sick role)
Slide 3: A little bit of pathophysiology
Slide 4: General Nursing Issues Easy to become frustrated with this client, b/c behaviors seem like they should be under voluntary control. Form therapeutic trust relationship with the PERSON, address unmet needs/issues Balance: not ignoring real symptoms but also not dwelling on them or reinforcing them
Slide 5: Generalized Anxiety Disorder: Frequently found in women Excessive, uncontrollable worrying x 6 mo. Motor tension symptoms—trembling, fatigue, etc Scanning behavior—trouble concentrating, insomnia, startle response Autonomic hyperreactivity—SOB, sweating, N/V, dry mouth Tx: antidepressants, therapy
Slide 6: Panic Disorder: affects about 1.2 million in US Recurrent panic attacks: unexpected, situation bound, or situation predisposed Concern/worry about future attacks, fear death or illness, feel crazy, fear loss of control Changes of behavior to protect from future attacks: avoidance, self medication Treated well with antidepressants
Slide 7: Specific Nursing Measures During P. Attack: remain calm, use short acting antianxiety med, NI that are for panic level anxiety Others: educate about illness and how treatable it is; teach ways to moderate anxiety before it escalates, cognitive reframing, systematic desensitization Medical: anti-depressants
Slide 8: Somatoform Disorders: Physical illness issues and anxiety Somatization disorder: multiple prolonged physical problems, multi system, not in line with actual observed symptoms Conversion disorder: pseudoneurological symptoms. Eg blindness, paralysis, seizure Hypochondriasis: preoccupation with and fear of being ill/disease Pain disorder: chronic pain with strong component of psychiatric factors.
Slide 9: Obsessive Compulsive Disorder Obsession: recurring intrusive thoughts, ego dystonic Compulsion: Recurring ritualistic behavior that lowers anxiety temporarily Themes: sex, violence, death, germs Treatable with behavior therapy, anti depressant therapy
Slide 10: Specific Nursing Interventions During compulsive episode, do not abruptly interrupt or stop client Work WITH client to establish target behaviors to gradually decrease compulsive behavior Teach alternative ways of coping with anxiety Through therapeutic relationship address underlying issues as client is ready Medical: antidepressant therapy, education re this
Slide 11: Dissociative Disorders Dissociation: impaired integration of different aspects of consciousness (may feel numb, unattached from body, etc) Dissociative amnesia: extensive gaps in memory involving personal life, often from a traumatic time period Dissociative fugue: Episode of sudden identity loss leading to travelling, wandering, etc. Depersonalization: feeling detached, spacey, unreal
Slide 12: Dissociative Identity Disorder:alias Multiple Personality disorder More than one distinct identity state alternately controls the consciousness of an individual. Develops as a response to severe trauma, as in childhood. States represent different periods in development Often called an adaptive response to an unmanageable situation. Treatable with long term therapy and support. Goal is often to integrate personality structures.
Slide 13: Not Anxiety Disorders: But Maladaptive Behavior, for sure Malingering: intentional production of false or very exaggerated symptoms motivated by secondary gains. Factitious Disorder (Munchausen’s): intentional production of physical symptoms through tampering with the body. Nurse: gather evidence and document. Confront only as a team, and not prematurely.
Slide 14: Antianxiety Meds: Benzodiazepines You will need to study: Valium, Klonopin, Librium, Xanax, and Ativan How they work:
Slide 15: Antianxiety Meds: Buspirone You will need to know Buspar. How it works:
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