1. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 19Anxiety Disorders

2. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Of chronic psychiatric disorders, anxiety disorders are the most prevalent. Despite effective treatment for anxiety, outpatient settings are failing to address anxiety and its associated symptoms appropriately, leading to increased use of emergency department (ED) visits and the incurrence of high health care costs. Pasic, Jagoda, & Zarkowski, 2008

3. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives After studying this chapter, you should be able to Articulate the difference between anxiety and fear Differentiate the following terms: signal anxiety, anxiety trait, anxiety state, and free-floating anxiety Explain the following theories of anxiety: psychoanalytic, cognitive behavior, biologic, genetic, and social–cultural (integrated) ‏ Analyze the different levels of anxiety Construct a list of the more common physiologic, psychological or emotional, behavioral, and intellectual or cognitive symptoms of anxiety

4. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives (cont.) ‏ Understand the clinical symptoms of panic disorder, agoraphobia, social phobia, specific phobia, generalized anxiety disorder, and obsessive–compulsive disorder Distinguish between posttraumatic stress disorder and acute stress disorder Integrate an understanding of cultural differences when assessing clients for clinical symptoms of an anxiety disorder Describe the role of the nurse providing care for a client with an anxiety disorder Create a nursing care plan for a client with clinical symptoms of generalized anxiety disorder

5. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Anxiety Disorder Statistics Anxiety disorders are the most common psychiatric–mental health disorder in the United States and in most other populations studied. They affect approximately 40 million individuals in the United States or 18% of the U.S. population between the ages of 18 and 54 years. Anxiety disorders frequently co-occur with depressive disorders, eating disorders, or substance abuse.

6. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Anxiety Overview Historical perspectives Related terminology –Anxiety –Fear –Signal anxiety –Anxiety trait –Anxiety state –Free-floating anxiety

7. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Etiology of Anxiety Genetic theory Biologic theory Psychoanalytic theory Cognitive–behavior theory Social–cultural theory (integrated theory)

8. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Levels of Anxiety NormalEuphoria Moderate Anxiety Severe Anxiety Panic State Mild Anxiety

9. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Clinical Symptoms and Diagnostic Characteristics Panic disorder, with or without agoraphobia Phobias Generalized anxiety disorder Obsessive–compulsive disorder Posttraumatic stress disorder Acute stress disorder Atypical anxiety disorder

10. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins The Nursing Process Assessment Screening tools and assessment scales General description and appearance Communication and cognitive ability Mood, affect, and feelings Behavior Transcultural considerations

11. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins The Nursing Process (cont.) Nursing Diagnoses Anxiety Impaired verbal communication Ineffective coping Posttrauma syndrome Powerlessness Disturbed sleep pattern Impaired social interaction

12. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins The Nursing Process (cont.) Outcome Identification Appropriate outcomes consider the following: –The client’s physical status and activity tolerance –Severity of clinical symptoms –Presence or absence of support systems –The clinical setting in which treatment occurs

13. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins The Nursing Process (cont.) Planning Areas of focus when planning interventions: –Acceptance that the experience of anxiety is natural and inevitable –Understanding that one’s level of anxiety may fluctuate –Understanding that shame is a self-imposed response to anxiety –Ability to learn and apply self-help techniques to reduce anxiety –Ability to remain calm in anxiety-producing situations –Development of problem-solving and coping skills

14. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins The Nursing Process (cont.) Implementation Assistance in meeting basic needs Medication management Interactive therapies Alternative and behavioral therapies/techniques Client education

15. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins The Nursing Process (cont.) Evaluation Clients will self-disclose an understanding of their clinical symptoms. Clients will identify causes of their clinical symptoms. Clients will exhibit coping skills to promote behavioral change. Clients will verbalize an understanding of medication.

16. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Key Terms Agoraphobia Anticipatory anxiety Anxiety Anxiety state Anxiety trait Compulsion Fear Free-floating anxiety Ideational compulsion Obsession Phobia Secondary traumatization Signal anxiety

17. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Reflection According to the chapter-opening quote, clients with anxiety disorders often present with various vague physical complaints. Develop a self-reporting assessment checklist for a client to completely rule out the possibility of an anxiety disorder. If the client identified several clinical symptoms of anxiety, what interventions would you propose? ?