1. Anxiety Disorders Class 3 Part II Fall 2014

2. Anxiety Disorders

3. What is… Anxiety Subjective Emotional Response to a stressor vs. Stress Multi-faceted Response to a stressor vs. Fear Cognitive Response to a stressor

4. Anxiety Disorders When does anxiety go from normal to abnormal? How do we decide what’s normal? Is it out of proportion? Dys-function Junction

5. Types of Anxiety Disorders It’s a GAD (Generalized Anxiety D/O)! Panic Disorder Agorophobia Phobias (Specific) Social Anxiety Disorder (Social Phobia) Substance/Medication Induces Anxiety D/O OCD and Related Disorders Separation Anxiety D/O (Covered with children)

6. Trauma and Stress-Related Disorders Post-traumatic Stress Disorder In the DSN 5 PTSD is now in this new category of disorders, but we will include it with the anxiety disorders.

7. Just the Facts Anxiety is the most common form of psych disorder in US Co-morbidity-occurs simultaneously with major depression or substance use Women >2X more than men

8. Phobias Persistent Irrational Fear Response – Exposure/ Thinking about Phobic stimulus Agoraphobia Social Phobia Specific Phobia – A (acrophobia) to Z (zoophobia) Goals of Nursing Interventions – Decrease fear – Increase ability to function

9. Obsessive-Compulsive and Related Disorders OCD Body Dysmorphic D/O Hoarding D/O Tricotillomania D/O (hair pulling) Excoriation D/O (skin picking) Substance/Medication Induced OCD OCD due to another medical condition

10. Oh say can you see the OCD Obsessions Compulsions Usually in it together Neurobiological Disturbances Nursing Interventions http://www.youtube.com/watch?v=Rn1OYlYzgm 8

11. Patient Goals Manageable level of Anxiety Perform ADLs Understands relationship between anxiety/ compulsions IDs situations that provoked anxiety Adaptive coping strategies Role-related responsibilities

12. It’s a GAD! Generalized anxiety disorder Chronic & Unrealistic What’s in Excess? Signs & Symptoms Can also be related to Medical Conditions

13. I’m so Panicked! (Panic Disorder) Unpredictable & Recurrent Attacks Feelings Intense Physical Symptoms Derealization Depersonalization Fears of …..?

14. Nursing Interventions for GAD and Panic Disorder Relieve acute symptoms Assist client – ID S/S of escalating anxiety – Skills to manage anxiety – Setting realistic goals – Exercising control over own life – ID and accept situations where they have no control

15. Trauma and Stress-Related Disorders: Post-Traumatic Stress Disorder (PTSD) Occurs after exposure to an extreme traumatic stressor Stressor involves a personal threat to physical integrity of self or others Symptoms: – Flashbacks – Avoidance of anything associated with the trauma – Numbing – Hypervigilence

16. PTSD Estimated 8% of Adult population in US have PTSD – First recognized in Vietnam War Veterans http://www.youtube.com/watch?v=Ne3DOM3X tjI

17. How do we assist our patients with anxiety disorders? Remain calm Reassure client R/T safety & security Enhance coping & self-esteem Provide hope Nonpharmacologic Measures – Relaxation therapy

18. Treatment Modalities for Anxiety Disorders Individual Psychotherapy Cognitive Therapy Behavior Therapy Group/ Family Therapy Psychopharmacology

19. Antidepressants – SSRIs – TCAs – MAOIs – SNRIs Anxiolytics – Benzos are the Best BUT… And then there are the other medications

21. Anxiolytics A void abrupt D/C after prolonged use N ot given if B/P is elevated, renal/ hepatic dysfunction or drug abuse X anax, Ativan are examples Increases the 3 D’s Drowsy, Dizzy, Decreased B/P E nhanced action of GABA (Inhibitory transmitter) T each to rise slowly from supine Y es Avoid Alcohol!

22. Pharmacotherapy GAD & Panic D/Os and Phobic D/Os Anxiolytics, Antidepressants, Anti-hypertensive agents OCD & PTSD OCD- Antidepressants PTSD- Antidepressants, Anxiolytics, Other drugs for severe symptoms

23. Coming in Class 4 Bipolar & Related Disorders Depressive Disorders Schizophrenia Spectrum Non-pharmacological & Pharmacological Management of these Disorders