ANXIETY-RELATED DISORDERS

DSM-IV-TR CRITERIA FOR GENERALIZED ANXIETY DISORDER

1. 2. 3.

Excessive worry and anxiety Difficulty in controlling the worry Anxiety and worry are evident in 3 or more of the following: - Restlessness -Decreased concentration -Fatigue -Muscle tension -Irritability -Disturbed sleep

PSYCHOTHERAPEUTIC MANAGEMENT
Nurse-Patient

Relationship 1. Reduce level of anxiety -Promote trust -Convey empathy 2. Assist patient to examine coping behavior Psychopharmacology >Antidepressants- (SSRI, SSNRI) >Benzodiazepine- Buspirone (Buspar) Milieu Management -Provide recreational activities (exercises, meditation, biofeedback) -CBT

DSM-IV-TR CRITERIA FOR PANIC DISORDER

1. 2.

3.

Recurrent, unexpected panic attacks Panic attacks followed by a month or more of worry about having additional attacks, worry about the results of the attacks, and behavior changes related to the attacks Panic disorder possibly accompanied by agoraphobia

CHARACTERISTICS
Develops

suddenly, unexpected Accompanied by intense fear or discomfort, and peaks within 10 mins Fear of losing control (going crazy, having a heart attack, or dying) Situationally bound

KEY NURSING INTERVENTIONS

Stay

with the patient Maintain a calm style and demeanor Speak in short, simple sentences, and give one direction at a time Provide a brown paper bag if hyperventilating Allow to pace or cry Reassure safety Reduce environmental stimuli Do not touch patient Allow to express fears

PSYCHOTHERAPEUTIC MANAGEMENT
Nurse-Patient

Relationship >Therapeutic Communication >Cognitive Restructuring Psychopharmacology >Antidepressants (SSRI) >Benzodiazepine- Clonazepam (Klonopin) Milieu Management >Gross motor activities (walking, jogging) >CBT

DSM-IV-TR CRITERIA FOR OBSESSIVE COMPULSIVE DISORDERS

A.

OBSESSIONS 1.Intrusive, inappropriate, recurrent, and persistent thoughts, impulses, or images that are distressful or produce anxiety. 2. Unsuccessful attempts to ignore or neutralize thoughts or impulses by other thoughts or actions 3. Recognition that obsessions are produced by own thoughts 4. Not simply excessive worry about real life problems

DSM-IV-TR CRITERIA FOR OBSESSIVE COMPULSIVE DISORDERS

B. COMPULSIONS 1. Repetitive behaviors, such as hand washing, or mental acts, such as counting, performed in response to an obsession 2. Excessive behaviors or mental acts used to reduce stress or prevent dreaded events C. Recognition that obsessions or compulsions are unreasonable or excessive D. Obsessions or compulsionscause distress, are time-consuming, and interfere with usual daily functioning

KEY NURSING INTERVENTIONS

Ensure

that basic needs are met PROVIDE TIME TO PERFORM RITUALS Explain expectations, routines and changes Be empathic Assist in connecting behaviors and feelings Structure simple activities, games or tasks Reinforce and recognize non ritualistic behaviors

PSYCHOTHERAPEUTIC MANAGEMENT
Nurse-Patient

Relationship >Promote Trust Psychopharmacology >Antidepressants- Clomipramine (Anafranil), Fluoxetine (Prozac), Sertraline (Zoloft) Milieu Management >CBT

PHOBIC DISORDER
In

phobic disorder, there is a specific places or things being feared In GAD, the source of anxiety is unspecified and anxiety is displaced or externalized outside of the body
AGORAPHOBIA W/O HISTORY OF PANIC DISORDER

SOCIAL PHOBIA SPECIFIC PHOBIA

SPECIFIC PHOBIAS
Acrophobia Ailurophobia Aquaphobia Claustrophobia Arachnophobia Cyanophobia Homophobia Thanatophobia Xenophobia Zoophobia Pyrophobia

Height Cats Water Closed space Spiders Dogs Homosexuality Death Strangers Animals Fire

KEY NURSING INTERVENTIONS

Accept patients and their fears w/ a noncritical attitude Provide activities that are non-threatening or non-anxiety provoking Ensure safety and needs Help patients recognize that their behavior is a method of coping w/ anxiety Assertiveness training and goal-setting group Social skills group and behavior therapy like desensitization, flooding, exposure etc.

ACUTE STRESS/POST TRUMATIC STRESS DISORDER

war, community violence, catastrophy, torture, fires

ACUTE STRESS DISORDER/ POST TRAUMATIC STRESS DISORDER

ASD

PTSD Onset : (Acute) within

Onset: within 4 weeks after the event Duration : 2 days to 4 weeks Symptoms: during or immediately after the event are: amnesia, depersonaliztion, derealization, numbing, detachment and or lack of emotion

6 months after the event or (Delayed) 6 months or more after the event Duration : (Acute) 1-3 months or (Chronic) 3 months or more

KEY NURSING INTERVENTIONS

Critical Incident Stress Debriefing A trusting N-P relationship Teaching dynamics of PTSD/ASD Assist in recognizing the relationship between current problems and the traumatic event Assist in reestablishing social support involve patient in problem solving