Anxiety Disorder Panic Disorder with Agorophobia

Curious things to know Phobias begin early in life and are experienced as often by as men as by women. The two peak times for the onset are between ages 15-20 yrs and then again between 30-40 yrs.

Cause Triggered by stress.

Assessment/sympto ms Recurrent and persistent thoughts that causes anxiety or distress. Recurrent episodes panic attacks.

Nursing Intervention Reassure client you will stay and panic attacks will subside. Loosen any tight clothing. Instruct and demonstrate deep, slow breathing. Decrease environmental stimuli and interactions with other people.

Treatment Individual/ group therapy: Individual: therapists helps client identify current life situations that set off anxiety. Group: Can lead to greater understanding and resolutions of important issues. Clients prepare themselves to focus on the present rather than the past. Cognitive behavioral therapy: (best option) Teaches practical thoughtmanagement techniques and prevention. Learn to cope with anxiety. Anger management. Alcohol or drug relapse prevention. Relaxation techniques Transcedetal meditation. Progressive muscle

Preferred Drugs/Medications Anxiety agents: BusPar (buspirone): GAD, panic disorder, agoraphobia,PTSD MAOIs Phenelzine (Nardil) Social phobia, agoraphobia Tricyclic Antidepressant: Imipramine (Tofranil) GAD, agoraphobia SSIRs (first line of medication to treat panic disorders) Citalopram(Celexa) Escitalopram(Lexap ro) Fluoxetine(Prozac) Fluvoxamine(Luvox ) Paroxetine(Paxil) Sertraline(Zoloft) Panic disorder, OCD,GAD, dysmorphic disorder, social phobia, PTSD

The person recognizes that the obessions are product of his/her mind. A person with agoraphobia will avoid groups of people. At least one of the panic episodes has been followed by 1 month or more of: (a)Worry about the implications of the panic attack e.g losing control, going crazy.(b) significant changes in behavior related to attacks. (c) persistent concerns of having additional

attacks.

They may become housebound.

relaxation. Yoga. Exercise. Hobbies/arts/crafts. Prayer. Assertiveness Helps people resolve conflicts without resorting to manipulative or aggressive behavior. Training/Communi cation skill trainings.

Panic Disorder w/o Agoraphobia

Phobias begin early in life and are experienced as often by as men as by women. The two peak times for the onset are between ages 15-20 yrs and then again between 30-40 yrs.

Triggered by stress. Recurrent unexpected panic attacks At least one of the panic episodes has been followed by 1 month or more of: (a)Worry about the implications of the panic attack e.g losing control, going crazy.(b) significant changes in behavior related to attacks. (c) persistent concerns of having additional attacks.

Reassure client you will stay and panic attacks will subside. Loosen any tight clothing. Instruct and demonstrate deep, slow breathing. Decrease environmental stimuli and interactions with other people.

Individual/ group therapy: Individual: therapists helps client identify current life situations that set off anxiety. Group: Can lead to greater understanding and resolutions of important issues. Clients prepare themselves to focus on the present rather than the past. Cognitive behavioral therapy: (best option)

Anxiety agents: BusPar (buspirone): GAD, panic disorder, agoraphobia,PTSD MAOIs Phenelzine (Nardil) Social phobia, agoraphobia Tricyclic Antidepressant: Imipramine (Tofranil) GAD, agoraphobia SSIRs (first line of medication to treat panic disorders) Citalopram(Celexa)

Specific Phobia The client has a fear of specific objects, such as spiders, snakes, strangers. The client has a fear of specific experiences, such as flying, being in the dark, riding in an

Marked and persistent fear that is excessive or unreasonable, cue by the presence or anticipation of a specific object or situation. The person recognizes the fear

Avoid implying that symtoms are imaginary. Teach the use of positive energy such as sitting quietly on a beach. Teach calming techniques such as

Teaches practical thoughtmanagement techniques and prevention. Learn to cope with anxiety. Anger management. Alcohol or drug relapse prevention. Relaxation techniques Transcedetal meditation. Progressive muscle relaxation. Yoga. Exercise. Hobbies/arts/crafts. Prayer. Assertiveness Helps people resolve conflicts without resorting to manipulative or aggressive behavior. Training/Communi cation skill trainings. Individual/ group therapy: Individual: therapists helps client identify current life situations that set off anxiety. Group: Can lead to greater

Escitalopram(Lexap ro) Fluoxetine(Prozac) Fluvoxamine(Luvox ) Paroxetine(Paxil) Sertraline(Zoloft) Panic disorder, OCD,GAD, dysmorphic disorder, social phobia, PTSD

SSIRs (first line of medication to treat panic disorders) Citalopram(Celexa) Escitalopram(Lexap ro) Fluoxetine(Prozac) Fluvoxamine(Luvox ) Paroxetine(Paxil)

elevator, being in an enclosed space.

is excessive or unreasonable. Disabling. Nursing assessments: What are your greatest fears in life? What situations or objects do you try to avoid in your life? Are your social or work activities limited to a geographic area? How often and in what circumstances are you able to leave home?

muscle relaxation. Help them focus on relaxing specific muscle groups: while taking a deep breath through the nose, inhaling to the count of 5.

understanding and resolutions of important issues. Clients prepare themselves to focus on the present rather than the past. Cognitive behavioral therapy: (best option) Teaches practical thoughtmanagement techniques and prevention. Learn to cope with anxiety. Anger management. Alcohol or drug relapse prevention. Relaxation techniques Transcedetal meditation. Progressive muscle relaxation. Yoga. Exercise. Hobbies/arts/crafts. Prayer. Assertiveness Helps people resolve conflicts without resorting to manipulative or aggressive behavior. Training/Communi cation skill

Sertraline(Zoloft) Panic disorder, OCD,GAD, dysmorphic disorder, social phobia, PTSD MAOIs Phenelzine (Nardil) Social phobia, agoraphobia Tricyclic Antidepressant: Imipramine (Tofranil) GAD, agoraphobia

trainings. ObsessiveCompulsive Disorder OCD It is unclear, but usually people who have OCD start at a young age. Affects 3% of the population. Males develop this disorder at a younger age (6 to 15 yrs) than females (20-29yrs) 20% of individuals with OCD have hoarding convulsions. Women w/ OCD 90% are compuslvie cleaners. Men w/ OCD are compulsive checking. Genetics Obsessivecompulsive thoughts and behaviors dominate a persons life. Thoughts are just not about the real life problems. The person recognizes that the thoughts, impulses or images are a product of his own mind. Clients who engage in constant ritualistic behaviors may have difficulty meeting self-care needs, such as personal hygiene, grooming, nutrition, fluid intake, elimination, sleep. Nursing assessments: What kinds of things do you feel a need to check or recheck frequently? How much during Point out that time spent worrying often has no impact on actual outcomes. Identify situations that trigger worries such as interpersonal conflict or uncertainty at work. Individual/ group therapy: Individual: therapists helps client identify current life situations that set off anxiety. Group: Can lead to greater understanding and resolutions of important issues. Clients prepare themselves to focus on the present rather than the past. Cognitive behavioral therapy: (not effective for hoarding symptoms.) Teaches practical thoughtmanagement techniques and prevention. Learn to cope with anxiety. Anger management. Alcohol or drug relapse prevention. Relaxation techniques Transcedetal SSRIs: Reduces symptoms by increasing serotonin Fluoxetine (Prozac) Sertraline (Zoloft), Fluvoxamine (Luvox), Citalopram (Celexa), Paroxetine (Paxil). 70% to 80% respond to these medications. Riluzole (Rilutek) may be used if SSRIs do not work. Compulsive hoarding does not respond to any medication.

the day do you spend on checking activities? Describe any movements youre forced to repeat? What kind of things do you count outloud? How much time a day do you spend doubting what you have done? If rituals include constant handwashing or cleaning, skin damage and infection may occur. Post Traumatic Stress Disorder The onset of symptoms is delayed at least 3 months from the precipitating event, and onset may not occur until years afterward. the client witnesses or experiences an actual event that threatens severe injury or death to the client or others. The client responds with fear, helplessness, or horror to the event. Symptoms of increased arousal, such as irritability, difficulty with concentration, sleep disturbance Avoidance of stimuli associated with trauma, such as avoiding people, inability to show feelings A structured environment for physical safety and predictability Monitoring for, and protection from, self-harm Daily activities that encourage the client to share and be cooperative Use of therapeutic communication

meditation. Progressive muscle relaxation. Yoga. Exercise. Hobbies/arts/crafts. Prayer. Assertiveness Helps people resolve conflicts without resorting to manipulative or aggressive behavior. Training/Communi cation skill trainings.

Group and family therapy, for clients with PTSD.

Antidepressants: It improves sleep and suppress intrusive thoughts, jumpingness and explosive anger. Sertraline (Zoloft) Parozetine (Paxil) are only FDA approved for PTSD.

Duration is more than a month. Exaggerated startle response. Hyperalertness May resort to abusing alcohol or drugs Guilt is common with PTSD Distress when reminded of the event Dreams or images Reliving through flashbacks . Dissociative symptoms, such as amnesia of the trauma event, absent emotional response, decreased awareness of surroundings, depersonalization Symptoms of severe anxiety,

skills, such as openended questions, to help the client express feelings of anxiety, and to validate and acknowledge those feelings Client participation in decision making regarding care

Acute stress disorder

Symptoms occur within 4 weeks of the traumatic event. Symptoms last from 2 days to 4 weeks.

People who experience or witness an extreme traumatic stressor.

Provide a structured interview to keep the client focused on the present. Provide safety and comfort to the client during the crisis period of these disorders, as clients in severe- to panic-level anxiety are unable to problem solve and focus. Remain with the client during the worst of the anxiety to provide reassurance.

Antidepressants: It improves sleep and suppress intrusive thoughts, jumpingness and explosive anger. Sertraline (Zoloft) Parozetine (Paxil) are only FDA approved for PTSD.

such as irritability, sleep disturbance Standardized Screening Tools

Provide a safe environment for other clients and staff. Provide milieu therapy that employs the following: A structured environment for physical safety and predictability Monitoring for, and protection from, self-harm Daily activities that encourage the client to share and be cooperative Use of therapeutic communication skills, such as openended questions, to help the client express feelings of anxiety, and to validate and acknowledge those feelings Client participation in decision making regarding care

I Generalized Anxiety Disorder Generalized anxiety disorder is characterized by worry of long duration and without cause. Excessive anxiety for more days than not for at least six months about a number of events or activities Person finds it difficult to control the worry. The anxiety is associated with 3 or more of the following: restlessness, fatigue, difficulty concentrating, muscle tension, insomnia. Use relaxation techniques with the client as needed for symptoms of pain, muscle tension, and feelings of anxiety. n GAD, therapeutic goal of antianxiety agents is to limit the unpleasant symtoms to help the person return to a high level of functioning. Venlafacine (Effexor) (SNRI) Escitalopram (Lexapro) (Antidepressant) Have FDA approval for treatment of GAD Buspirone (BuSpar) is also used for non addictive and non CNS depressant. Takes time to take effect. Imioramine (Tofranil) ________________ Administer Alprozolam: drug of choice for agoraphobia.

________________ ________________ ________________ Social Phobia ________________ Fear of: Speaking in public Eating in public Using public bathrooms ________________ A marked and persistent fear of one or more social or performance cituations in which a person is exposed to unfamiliar people or Discuss feelings of fear. Listen to clients concern. Provide opportunity for questions and answers honestly.

________________ Support system enhacement Emotional Support Family integration promotion Security enhacement Support system enhacement Spiritual support

Making phone calls Writing in front of others Performing specific tasks in front of other.

to possible scrutiny by others. The individual fears that he may act in a way that will be humiliating or embarrassing. Exposure to feared situation results in anxiety/panic attack.

Agoraphobia: most common and serious phobic disorder. Triggered by severe stress. 20% to 45% of the general population has some mild form of phobic behavior. Actual phobic disorders occur in only 5% to 10% of the population Stress stimulated the hypothalamus. Stress increases glucose levels, ADH, prolactin and endorphins are increased. Blood preassure increases. Blood viscosity increases. Calcium resorption increases and leads to loss of bone mass. Mobilization of store energy results in loss of muscle.

Hamilton Rating Scale for Anxiety The Hamilton Anxiety Scale (HAMA) is a rating scale developed to quantify the severity of anxiety symptomatology, often used in psychotropic drug evaluation. It consists of 14 items, each defined by a series of symptoms. Each item is rated on a 5-point scale, ranging from 0 (not present) to 4 (severe)

Modified Speilberger State Anxiety Scale Scores range from 20 to 80, with higher scores correlating with greater anxiety