1. Anxiety Disorders Dr.Ali K Al-Juboori Ph.D. psych. Nursing

2. Anxiety: Is an uncomfortable feeling that occur in response to the fear of being hurt or losing something valued. The source of this uneasiness is not always known or recognized Anxiety disorders are a group of psychiatric conditions that involve excessive anxiety.

3. Most common mental illness in the U.S. with 19 million of the adult (ages 18-54) U.S. population affected. Anxiety disorders cost more than $42 billion a year. More than $22 billion are associated with the repeated use of healthcare services, as those with anxiety disorders seek relief for symptoms that cause physical illnesses. Anxiety is highly treatable (up to 90% of cases), but only one-third of those who suffer from it receive treatment People with an anxiety disorder are three-to-five times more likely to go to the doctor and six times more likely to be hospitalized for psychiatric disorders than non-sufferers. Depression often accompanies anxiety disorders

4.  Anxiety disorder is characterized by chronic anxiety symptoms such as tension, sweating, trembling, light-headedness and irritability.  These disorders are a serious problem for the entire society because of their interference with patients' work, schooling, and family life.  Anxiety disorders are an additional problem for health professionals because the physical symptoms of anxiety frequently bring people to primary care doctors or emergency rooms.

5. Peplau (1963) described 4 levels of anxiety 1. Mild Anxiety: Is associated with tension experienced in response to event of day to day living, it prepare people for action, it increase motivation for productivity. 2.Moderate Anxiety: As the level of anxiety increase, the extent of the perceptual field diminishes, the ability to concentrate is decreased, increase muscular tension and restless are evident. Assistant with problem solving may be required.

6. 3. Severe Anxiety: Attention span is extremely limited, much difficulty completing even the simplest tasks, headache, palpitation and insomnia may be evident. 4. Panic Anxiety: Is the most intense state of anxiety, inability to focus, and lose of contact with reality may occur (hallucinations and delusions may be experienced).

7. Fear: Is a feeling that arises from concrete real danger. Anxiety: Is a feeling that arises from an ambiguous, unspecific cause that is disproportionate to the danger. -------------------------------------------------------- Stressors: is an external pressure that is brought to bear on individual. Anxiety: is the subjective emotional response to those stressors ( Stress Anxiety and grief)

8. Coping mechanisms: Is a conscious attempt that people try to protect themselves from anxiety in stressful situations like sleeping, physical exercise, crying. It may be effective or in effective. When it ineffective the following behaviors may be used: physical flight, abusing substance, social withdrawal, inability to focusing on the situations.

9. Defense mechanisms: It is a conscious or un conscious attempt to manage mild to moderate anxiety, they often prevent people from being sensitive to anxiety (e.g. compensation, denial, regression, repression, projection).

10. Types of Anxiety Disorders Generalized Anxiety Disorder Panic Disorder Obsessive-Compulsive Disorder Phobias Post-Traumatic Stress Disorder

11. Generalized anxiety disorder Is a chronic disorder characterized by persistent unrealistic and excessive anxiety, the symptoms has existed for six months or longer and are not attributed to hyperthyroidism or other organic factors

12. General anxiety disorder (GAD) is a broad term covering several different forms of abnormal, pathological anxiety, fears, phobias and nervous conditions, which may have sudden onset or may occur gradually over a period of several years

13. Symptoms:  Being easily fatigue,  Restlessness,  difficulty concentrating,  Irritability,  Headache  Muscle aches  Difficulty swallowing  Twitching  Sweating  Nausea  Short of breath  Hot flashes  Difficulty in initiation of maintenance of sleep

14. Generalized Anxiety Disorder Treatment 1.SSRIs ( Selective serotonin re-uptake inhibitors) 2.Benzodiazepines 3. Cognitive Behavioral Therapy. 4. Psychotherapy 5. Self-help or support group 6. Stress management techniques 7. The family support

15. Panic Disorder Is the highest level of anxiety cc. by disorganized thinking, feeling of terror, and helplessness, and non purposeful behavior People behave that they will die, lose of control, or go crazy. Extended period of panic level may lead to schizophrenia, schizoaffective disorder, or delusional disorder.

16. The abrupt onset of an episode of intense fear or discomfort, which peaks in approximately 10 minutes, and includes at least four of the following symptoms: A feeling of imminent وشيك danger or doom الموت The need to escape Palpitations Sweating Trembling ارتعاش Shortness of breath or a smothering feeling A feeling of choking Chest pain or discomfort Nausea or abdominal discomfort Dizziness or lightheadedness A sense of things being unreal, depersonalization A fear of losing control or "going crazy" A fear of dying Tingling تنمل sensations

17. There are three types of Panic Attacks: 1. Unexpected - the attack "comes out of the blue" ياتي من فراغwithout warning and for no discernable reason. 2. Situational - situations in which an individual always has an attack, for example, upon entering a tunnelنفق. 3. Situational Predisposed - situations in which an individual is likely to have a Panic Attack, but does not always have one. An example of this would be an individual who sometimes has attacks while driving

18. The onset of panic attack is sudden and unexpected with intense symptoms lasting from few minutes to an hour it may progress to phobic behavior. Panic attack awaken the person and usually occur within one to four hours after falling to a sleep, usually non REM sleep.

19. Interventions / Treatments Solution Focused Approach Cognitive Behavioural Therapy Stop, Think, Go Group Therapy Relaxation / meditation Counselling (narrative, gestalt, client centred) Medications Antidepressants - SSRI’s, Tricyclics, MAOI’s Benzodiazepines - Diazepam Inositol – naturally occurring isomer of glucose, participates in the action of serotonin

20. Nursing in the moment: stay calm, regulate own breathing whatever the wish… resist the temptation to abandon the client work with the client to regulate their breathing (may have to demonstrate) talk in a calm, firm and reassuring tone (the client needs to be able to hear you and needs to have a sense that you know what you are doing and that you can contain their overwhelming fear/ terror)

21. Longer term... work with client to recognize their own strengths and resilience facilitate their self appreciation be clear about your boundary issues in terms of the clients capabilities work with the client to develop a hierarchy of symptoms and interventions

22. Exp.Care plan for client with panic disorder or GAD Outcome criteriaNsg interventionrationale Client will be able to recognize symptoms of onset of anxiety and to intervene before reaching panic level. Stay with client and offer assurance of safety & security The client may fear for his or her life. Maintain a calm non threatening. Client feel of security in the presence of a calm staff person. Keep surrounding low in stimuli. A stimulating environment may increase anxiety level Teach client ways of interrupt anxiety relax. Technique, exercise….. Relax. Tech. result in physiological response opposite that of anxiety Response.

23. Thanks for listening