Mild Anxiety

can be productive and does not require intervention

Depersonalization

A sense that things are not real

an individual experiencing panic attacks can also experience depersonalization

Obsessions

ritualistic or repetitive behaviors or mental acts that a person carries out continuously in an attempt to neutralize anxiety

Positive Reframing

involves turning negative messages into positive messages

Selye's General Adaptation Syndrome

Exhaustion Phase

the body has responded negatively to anxiety and stress and is depleted physically and emotionally

Defense mechanisms

cognitive distortions that a person uses unconsciously to maintain a sense of control of a situation, and to deal with the stress

Phobia

is an illogical intense persistent fear of a specific object or a social situation that caused extreme distress and interferes with normal functioning

Exposure

a treatment used for obsessive compulsive disorder in which the client is assisted in deliberately confronting the situation and stimuli that the individual usually avoids

Automatisms

are automatic, unconscious mannerisms that a person with panic disorder may exhibit

Anti-anxiety Agents

Chemical Class 

Benzodiazepines (end in "am") - they are addicting, short acting and effect the seizure threshold

alprazolam (Xanax)

clonazepam (Klonipin) (a little longer acting than others)

diazepam (Valium)

lorazepam (Ativan) po, IM, IV

oxazepam (Serax)

Misc. (not a benzo)

buspirone (BuSpar) (not a CNS depressant, uses neurotransmitters, not addicting, takes 2wks to work, longer acting than benzo's)

Anti-anxiety Agents

Benzo's & Buspar

Indications

for the treatment of anxiety d/o and anxiety symptoms

to treat alcohol withdrawl

to skeletal muscle spasms

to treat convulsive d/o status epilepticus and preoperative sedation

Anti-anxiety Agents

Benzo's & Buspar

Actions

Short acting / half life 4 hours

depress subcortical levels of the CNS

potentiates the effects of the powerful inhibitory neurotrasmitter GABA in the brain, producing a calming effect

all levels of CNS depression can be effected, from mild sedation to coma

**Exception - Buspar does not depress the CNS and produces desired effects through interactions w/ serotonin, dopamine, & other neurotransmitters

Anti-anxiety Agents

Benzo's & Buspar

Contraindications

Contraindicated in the following:

pts w/ known hypersensitivity to any drugs w/in the classification

do not take in combination w/ other CNS depressants

do not take in pregnancy, lactation, narrow-angle glaucoma, shock, coma

cautious use in hepatic or renal dysfunction, elderly or debilitated

cautious use in pt w/ hx of drug abuse, addiction, depressed or suicidal (CNS can exacerbate symptoms of depression)

do not take w/ alcohol (benzo's strongly enhance effects of alcohol CNS depressant)

Anti-anxiety Agents

Benzo's & Buspar

Nursing

Monitor s/e

drowsiness, confusion, letharfy (most common), ↓ coordination, impaired memory, tolerance - physical & psychological dependence, orthostatic hypotension, dry mouth

exaggerates symptoms of depression

Considerations

abrupt w/drawl can be life threatening, do not take w/ other CNS depressants, benzo's can cause dependence

withdrawl sx include: depression, insomnia, increased anxiety, abd & musc cramps, tremors, vomiting, sweating, seizures

Anti-anxiety Agents

Benzo's & Buspar

Patient Teaching

anti-anxiety agents releive sx, but DO NOT treat underlying problems causing anxiety

Benzo's potentiate alcohol

decreased response time, slower reflexes, & sedative effects (when driving/working)

Benzo's can bot be stopped abruptly / can be life threatening

do not operate dangerous machinery

Agoraphobia

fear of being outside

Anxiety

a vague feeling of dread or apprehension; a response to external or internal stimuli that can have behavioral, emotional, cognitive, & physical symptoms

Anxiolytic

a type of drug used to treat anxiety, insomnia, OCD, Depression, PTSD and alcohol w/drawl

compulsion

ritualistic or repetitive behavior or mental act that a person carries out continuously in an attempt to neutralize anxiety

Generalized Anxiety D/O (GAD)

person worries excessively and feels highly anxious at least 50% of time for 6 months or more

Levels of Anxiety

Mild -  sensation that warrants special attention, can motivate in goal directed activity, sensory stimulation increases

Moderate - a disturbing feeling that something is definitely wrong, person is nervous and agitated

Severe - trouble thinking and reasoning, is restless, irritable, and angry

Panic - fight, flight or freeze  Adrenaline surge ^VS, cognitive process focuses on persons' defense

Panic Disorder

composed of discreet episodes of panic attacks, that is 15-30 minutes of rapid, intense, escalating anxiety in which a person experiences great emotional fear as well as physiologic discomfort

Post Traumatic Stress Disorder (PTSD)

a disturbing pattern of behavior demonstrated by someone who has experienced a traumatic event, begins three months or more following the trauma

Stress

the wear and tear that life causes on the body

Treatment for anxiety disorders

involve medication (anxiolytics, SSRI and tricyclic antidepressants, and clonidine and propranolol) and therapy

Cognitive Behavioral Techniques

positive reframing, decatastrophizing, thought stopping, and distraction

Behavioral Techniques for OCD

exposure and response prevention

mental health

state of well being in which individuals function well in society and are generally satisfied with their lives

Mental Disorder

a disturbance in thoughts or mood that causes maladaptive behavior, inability to cope with normal stresses, and/or impaired functioning

Stress Response & physical symptoms

3 phases occur w/in 10 minutes of a stressful event

1. Alarm

2. Resistance

3. Exhaustion

SNS - blood shunted to central, ^HR, narrow vision, ^temp, fingers/toes tingle

Working with Anxious Clients

be aware of own anxiety level

assess pt anxiety level

speak in short, simple sentences

lower pt anxiety level to moderate or mild before proceeding 

talk to pt in low, calm, and soothing voice

walk while talking if pt cannot remain still

ensure safety during panic level anxiety

remain w./ pt until panic recedes

short term use of anxiolytics

Cultural considerations for pts w/ anxiety D/O

Asian cultures express anxiety through somatic symptoms (h/a, backaches, fatigue, dizziness, and stomach problems)

Hispanics express high anxiety as sadness, agitation, weight loss, weakness, and HR changes (the symptoms are believed to occur b/c supernatural spirits or bad air from dangerous places or cemeteries invade the body)

Elder Considerations

late-life anxiety d/o are often ass'd w/ another condition (depression, dementia, physical illness, medication toxicity or w/drawl)

phobias (agoraphobia & GAD) are the most common late life anxiety d/o

treatment in elderly = SSRI antidepressants