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Saturday, September 1, 2007

Anxiety Disorder

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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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