1. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. Chapter 12 Anxiety and Anxiety Disorders

2. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 2 Anxiety Anxiety – apprehension, uneasiness, uncertainty, or dread from real or perceived threatAnxiety – apprehension, uneasiness, uncertainty, or dread from real or perceived threat Fear – reaction to specific dangerFear – reaction to specific danger Normal anxiety – necessary for survivalNormal anxiety – necessary for survival

3. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 3 Levels of Anxiety Mild anxietyMild anxiety Moderate anxietyModerate anxiety Severe anxietySevere anxiety PanicPanic

4. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 4 A parent is shopping with a 5-year-old child in a large, busy urban mall. The parent suddenly realizes the child is missing. Which level of anxiety would likely result?A parent is shopping with a 5-year-old child in a large, busy urban mall. The parent suddenly realizes the child is missing. Which level of anxiety would likely result?

5. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 5 a.Mild b.Moderate c.Severe d.Panic

6. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 6 Defenses Against Anxiety Defense mechanismsDefense mechanisms –Automatic coping styles –Protect people from anxiety –Maintain self-image by blocking feelingsfeelings conflicts andconflicts and memoriesmemories –Can be healthy or unhealthy

7. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 7 Anxiety Disorders Clinical pictureClinical picture EpidemiologyEpidemiology ComorbidityComorbidity EtiologyEtiology –Biological GeneticsGenetics –Neurobiological

8. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 8 Psychological Theories Psychodynamic theoriesPsychodynamic theories –Sigmund Freud –Harry Stack Sullivan –Behavior theories –Cognitive theories Cultural considerationsCultural considerations

9. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 9 Panic Disorders (PD) Panic attackPanic attack Panic disorder without agoraphobiaPanic disorder without agoraphobia Panic disorder with agoraphobiaPanic disorder with agoraphobia Simple agoraphobiaSimple agoraphobia

10. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 10 Phobias Specific phobiasSpecific phobias Social phobia or social anxiety disorder (SAD)Social phobia or social anxiety disorder (SAD)

11. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 11 Obsessive-Compulsive Disorder (OCD) ObsessionsObsessions –Thoughts, impulses, or images that persist and recur, so that they cannot be dismissed from the mind CompulsionsCompulsions –Ritualistic behaviors an individual feels driven to perform in an attempt to reduce anxiety

12. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 12 Generalized Anxiety Disorder (GAD) Excessive anxiety or worry about numerous thingsExcessive anxiety or worry about numerous things Lasts for 6 months or longerLasts for 6 months or longer

13. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 13 Posttraumatic Stress Disorder (PTSD) FlashbacksFlashbacks Avoidance of stimuli associated with traumaAvoidance of stimuli associated with trauma Experience of persistent numbing of responsesExperience of persistent numbing of responses Persistent symptoms of increased arousalPersistent symptoms of increased arousal

14. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 14 Acute Stress Disorder Occurs within 1 month after exposure to highly traumatic eventOccurs within 1 month after exposure to highly traumatic event Must display at least 3 dissociative symptoms – during or after eventMust display at least 3 dissociative symptoms – during or after event Resolves within 4 weeksResolves within 4 weeks

15. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 15 Substance-Induced Anxiety Disorder Symptoms of anxiety, panic attacks, obsessions, and compulsionsSymptoms of anxiety, panic attacks, obsessions, and compulsions Develop with the use of a substance or within a month of stopping use of the substanceDevelop with the use of a substance or within a month of stopping use of the substance

16. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 16 Anxiety Due to Medical Conditions Symptoms of anxiety are direct physiological result of a medical conditionSymptoms of anxiety are direct physiological result of a medical condition

17. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 17 Application of the Nursing Process AssessmentAssessment –General assessment of symptoms –Self-assessment –Assessment guidelines: anxiety disorders Nursing DiagnosisNursing Diagnosis Outcomes IdentificationOutcomes Identification PlanningPlanning

18. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 18 Application of the Nursing Process Continued ImplementationImplementation –Mild to moderate levels of anxiety –Severe to panic levels of anxiety

19. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 19 Basic Level Nursing Interventions CounselingCounseling Milieu therapyMilieu therapy Promotion of self-care activitiesPromotion of self-care activities Pharmacological interventionsPharmacological interventions Health teachingHealth teaching

20. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 20 Advanced Practice Interventions Advanced Practice Interventions Cognitive therapyCognitive therapy Behavioral therapyBehavioral therapy –Relaxation training –Modeling –Systematic desensitization

21. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 21 Advanced Practice Interventions Continued Behavioral therapy, continuedBehavioral therapy, continued –Flooding –Response prevention –Thought stopping Cognitive-behavioral therapyCognitive-behavioral therapy