1. Rebecca Sposato MS, RN

2.  A collection unpleasant emotions stemming from a real or perceived threat/stressor ◦ Often instinctual, necessary for survival and social order ◦ Increases when one is unable to deal with threat ◦ May present as fear, dread, nervousness, uneasiness or apprehension  May be the primary syndrome or present as a symptom of another disorder ◦ Many behaviors emerge to counteract anxiety ◦ Comorbid w/ depression, substance abuse etc.

3.  Biological: genetic and neuro-chemical abnormalities  Psychodynamic: Internal and interpersonal conflict  Behavioral: learned response to a stressor  Cognitive: distorted and negative thinking

4. Stressor/threatAnxietyRelief Behavior Effective Medication Ineffective Mediation Reduced stressor Decreased anxiety Stressor remains present Extreme coping behaviors Increased Anxiety

5.  Mild: Adaptive heightened awareness to everyday living ◦ Greater focus and process additional sensory data ◦ Slight physiological arousal  Moderate: No longer normal ◦ impaired perceiving and processing sensory data ◦ Impaired reasoning and problem-solving ◦ Measurable physiological arousal

6.  Severe: Anxiety dominates experience ◦ Distorted perceiving and processing sensory data ◦ Impaired memory, reasoning, problem-solving ◦ Marked physiological changes  Panic: Terror dominates experience ◦ Disorganized perceiving and processing sensory data ◦ Unable to purposefully interact with other persons or environment ◦ Out of control physical behavior and movements ◦ Exaggerated physiological changes

7.  Acute episode of marked anxiety and physiological changes ◦ Exaggerated for perceived threat ◦ Can be confused with heart attack ◦ Expected (cued) – response to known trigger ◦ Unexpected (uncued) – no known association  DSM-IV: Not a stand-alone disease, no numeric code, ◦ Must of 4 of the following: tachycardia, diaphoresis, tremors, dyspnea, angina, nausea, de-realization, dizzy, fear of losing control, fear of dying, paresthesia, chills/hot flashes

8.  Recurrent panic episodes with persistent concern lasting over 1 month and avoiding behaviors  1-2% one year prevalence in population  Variable onset and duration, typical onset between adolescence and age 30. ◦ Chronic course w/ wax-wane pattern ◦ Often comorbid w/ agoraphobia

9.  Excessive fear, with a marked physiological response, to a specific thing or situation ◦ Predisposing event ◦ Acute onset  6% lifetime prevalence in population ◦ Often have childhood onset, ◦ 2:1 female to male ◦ Subtype categories: animal, environment, blood/injury, situation

10.  Social phobia: exaggerated concern over being embarrassed, ridiculed or judged in the presence of others ◦ Causes physical symptoms of anxiety ◦ Deters normal daily, social and occupational functioning ◦ May be general or specific to public performances or social gatherings (parties) ◦ Can be acute or chronic

11.  Persistent symptoms of anxiety not attached to specific triggers, lasting over 6 months ◦ Focus of worry is out of proportion to source ◦ Person may not insight into source of anxiety  5% lifetime prevalence, slightly more female  DSM-IV: a) excessive concern, b) difficult to control, c) 3 physical symptoms, d) not due to another Axis 1 condition, e) distress impairs functioning, f) the physical symptoms are not due to another condition

12.  OCD – recurrent and time-consuming, often ritualized, behaviors causing significant impairment in daily function ◦ Often an exaggerated natural behavior (grooming, nesting, hoarding for winter) ◦ Often ego-dystonic, person may or may not have self insight into abnormality ◦ 2% lifetime prevalence  Obsession – persistent and anxiety producing ideas, impulses and images that something is wrong  Compulsion – the action extending from the obsession, to temporarily fix the anxiety

13.  A normal response to an abnormal event ◦ Physiological arousal or emotionally numb, dissociation, amnesia or flashbacks, aversion or obsession with trigger,  Triggered by an extreme life stressor/threat- ◦ A recipient or witness to violence, unnatural death, catastrophe perceived as threat to self and life  Acute- Within one month of the event  PTSD- Symptoms present 3 months after event, may last years  8% lifetime prevalence

14.  Pharmacological – benzodiazepines, Buspirone, SSRI  Milieu Therapy- supportive environment  Therapy – psych, REBT, CBT, DBT, relaxation training, ◦ Modeling- person watches another’s normal reation ◦ Systematic Desensitization- repeated increasing exposure to trigger to grow tolerance ◦ Flooding- excessive exposure to trigger to extinguish fear  Not as popular as desensitization

15.  Symptom management and control  Promote and support adaptation and coping  Promote and support daily function  Health teaching