Anxiety Disorder Review

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Generalized Anxiety Disorder

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GAD is the most common form of anxiety disorder and frequently is accompanied by depression and somatization or the development of phobias. The client worries over everything, and the stress this creates eventually affects every aspect of life.

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Anxiety Disorders

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Are characterized by feelings of fear and apprehension accompanied by a sense of powerlessness. Examples are: Dissociative Identity disorder, generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, phobic disorder, post-traumatic disorder, somatoform disorder

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Post-Traumatic Stress Disorder

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PTSD develops after exposure to a clearly identifiable threat, the nature of the threat is so extreme that it overwhelms the person's usual means of coping.

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Acute PTSD

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Occurs within 6 months of the traumatic event

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Delayed PTSD

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Occurs 6 months or more after the traumatic event.

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Somatoform Disorder

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This disorder is characterized by the appearance of physical symptoms for which there is no apparent organic or physiological cause. The client seeks medical treatment for a physical complaint, even thought he has been told there is no evidence of physical illness.

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Somatoform Disorders Include...

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- Conversion Disorder
- Hypochondriasis
- Pain Disorder
- Somatization Disorder

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Panic Disorder

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This disorder is characterized by sudden attacks of intense fear or discomfort that peaks within 10 - 15 minutes. Clients with Panic Attacks might complain of not being able to breathe, or feeling they are having a heart attack, or that they are 'going crazy'.

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Phobic Disorder

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This is expressed as intense irrational fears of some object, situation, or activity. The client recognized that the fear is irrational, but the phobia still persists. When a person comes into contact with the situation or fear object, anxiety attacks will ensue.

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Three Major Categories of Phobic Disorders

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Agoraphobia
Social phobia
Specific phobia

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Obsessive-Compulsive Disorder

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OCD is characterized by the presence of recurrent persistent thoughts, ideas, or impulses and the repetitive rituals that are carried out in response to the obsession. Persons with OCD know that their actions are ridiculous; still they must carry them out to avoid overwhelming anxiety.

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Nursing interventions for the client with anxiety disorder

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Administer antidepressant medication, help the client become aware of situations that increase anxiety, help the client recognize the overuse of certain defense mechanisms, and teach cognitive-behavioral methods for reducing anxiety.

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A client taking Zoloft (an antidepressant) tells the nurse that she has also been taking St. John's wort. The nurse should report this information to the doctor because:

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The amount of the Zoloft may be reduced. RATIONALE: St. John's wort has an antidepressant effect so it might be necessary to reduce the current medication dosage.

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The nurse is preparing to discharge a client who is receiving Nardil, an MAOI. The nurse should tell the client to:

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Avoid medication containing pseudoephedrine. RATIONALE: Drug interactions between an MAOI and pseudoephedrine can result in hypertensive crisis.

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Nursing Process: The nurse can use this scale along with a detailed discussion to guide the assessment of the client with panic disorder

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The Hamilton Rating Scale for Anxiety

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Nursing process: What are the major areas of assessment of the client with a panic disorder?

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History, General appearance and motor behavior, Mood and affect, thought process and content, Intellectual process and orientation, Judgement and insight, self-concept, roles and relationships, physiologic problems such as sleeping and eating issues.

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What are some appropriate nursing diagnosis for a client with an anxiety disorder?

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Risk for injury - Anxiety - Situational low self esteem (panic attacks) - Ineffective coping - Powerlessness - Ineffective Role Performance - Disturbed Sleep pattern

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Identify outcomes for the client with anxiety/panic disorders.

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The client will be free from injury. The client will verbalize feelings. The client will demonstrated use of effective coping mechanisms. The client will demonstrate effective use of methods to manage anxiety response. The client sleep at least 6 hours per night.

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During a panic attack, the nurse's first concern is to...

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provide a safe environment and the client's privacy.

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Client and Family Teaching areas for the the panic disorder

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Review breathing control and relaxation techniques. Discuss positive coping strategies. Emphasize the importance of maintaining prescribed medication regimen and regular follow-up. Describe time management techniques such as creating 'to do' lists with realist deadlines for each activity. Learning to say 'no' to prevent feeling overwhelmed. Stress the importance of maintaining contact with community and supportive relationships.

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Nursing Process: The nurse can use the Yale-Brown Obsessive-compulsive Scale and which discussion areas to assess the client with OCD?

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History - has the compulsion become too overwhelming or interfering with daily life. General appearance - Clients with OCD often sense tense, anxious, worried, fretful, and nothing about their dress seems out of place. Thought Processes - Clients may report that the obsessions arise from nowhere during the middle of normal activities, and the more they try to stop, the more intense it becomes. Judgement - the client recognizes the obsession is irrational, but still engages in ritualistic behavior when the anxiety becomes overwhelming. Roles and relationships - is the client fulfilling life roles successfully?

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Nursing Process: What are some nursing interventions for clients with OCD?

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Offer encouragement, support, and compassion (using therapeutic communication).
Encourage client to talk about feelings, obsessions, and rituals.
Gradually decrease time for the client to carry out ritualistic behaviors.
Assist client to use exposure and response prevention behavioral techniques.
Encourage client to use techniques to manage and tolerate anxiety responses.
Assist client to complete daily routine and activities.
Provide client and family education.

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Category of pharmacological interventions commonly used for clients with anxiety disorders in the short-term setting (usually recommended to be used less than 6 weeks)

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Benzodiazepines
Examples: diazepam (Valium), chlorazepate (Tranzene), alprazolam (Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin), lorazepam (Ativan)

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Which of the four classes of medications used for panic disorder is considered the safest because of low incidence of side effects and lack of physiologic dependence?
a. Benzodiazepines
b. Tricyclics
C. Monoamine oxidase inhibitors
d. Selective serotonin reuptake inhibitors

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D. Selective Serotonin Reuptake Inhibitors
Examples: Prozac, Luvox, Celexa, Zoloft, Paxil, Lexapro