ANXIETY DISORDERS

MR. DEEGBE, David Atsu

[RMN/ BSc/ MPhil/ FWACN]
 ANXIETY
Feeling of uncertainty, uneasiness, apprehension or
tension in response to an unknown object or
situation.
Anxiety is the body’s natural response to danger.
In moderation, anxiety is useful for forming healthy
responses.
Constant, overwhelming anxiety interferes with
relationships and activities and becomes a disorder.
 ANXIETY Cont’d
 Anxiety is a normal and adaptive response which
prepares an individual to take on tasks that require
extra effort
 Eg. prior to interviews, examinations, and
appointments, meeting one’s lover for the first time,
admission to hospital etc.
 In all these situations, one experiences some level of
anxiety that keeps one alert or awake, a little keyed-
up to be able to face the “impending” danger more
appropriately.
 ANXIETY Cont’d
 Although anxiety is a normal phenomenon,
yet, in some cases anxiety gets out of control
by the person and becomes morbid (disease
causing).

 This is a condition in which a patient shows

prolonged and exaggerated or excessive
anxiety with physiological changes.
 ANXIETY Cont’d
In anxiety disorders, the anxiety experienced is;
 More intense
 Lasts longer (may persist for months)
 Threat is unidentified
 Leads to phobias
CAUSES OF ANXIETY DISORDERS
 Hereditary: Some genetic components
contribute to the development of anxiety
disorders (It is tailored in families).
 First degree relatives of clients with increased
anxiety have a higher rate of developing
anxiety,
 Obsessive-compulsive disorder and
serotonin hypothesis: People with
obsessive-compulsive disorder have
decreased serotonin levels in the brain
CAUSES Cont’d
Generalized anxiety disorder and GABA

hypothesis: It is suggested that insufficient

amounts of GABA is responsible for

generalized anxiety disorders

Significant personal loss such as divorce,

death, loss of job, financial losses

CAUSES Cont’d
 Behavioural theorist view anxiety as being
learned through experiences.

 Conversely, people can change or “unlearn”

behaviours through new experiences.

 Behaviourist contend that disturbing behaviours

that develop and interfere with a persons life can
be extinguished or unlearned by repeated
experiences guided by a trained therapist
CAUSES Cont’d
 Psychoanalytic Theory: Sigmund Freud
(1936) viewed a persons innate anxiety as the
stimulus for behaviour
 He views anxiety as a defence against the
anxiety experienced by the ego as it mediates
between the id impulses and those of the
super-ego.
CAUSES Cont’d
 Stability of the Environment: Threats of
civil war, insecurity, earthquake, etc.

 Change in Role Function: E.g. loosing an

election or being demoted to a junior rank
or being promoted to a higher or more
demanding positions.
CAUSES Cont’d
 Personality (anxious): Timid; Uncertain;
apprehensive; easily embarrassed; afraid of
others.

 Other precipitating causes include changing

from adolescence to adulthood, situational
crises, sudden bereavement etc.
CAUSES Cont’d
 Medical conditions that can cause anxiety
disorders
◦ CVS/ Respiratory: Asthma/ Congestive heart
failure/ Hypertension
◦ Neurological: Epilepsy/ cerebral tumours
◦ Endocrine disorders: Pituitary dysfunction/ thyroid
dysfunction/ adrenal dysfunction
◦ Toxic conditions: Acute reaction to caffeine,
cannabis and amphetamines/ withdrawal from
alcohol and sedatives
CAUSES Cont’d
 Childhood circumstances
◦ Parents communicating overly cautious view of
the world to children

◦ Parents setting excessively high and unrealistic

standards to their children

◦ Emotional insecurity due to neglect, rejection,

separation and abuse during childhood

◦ Suppression of assertiveness in children

SIGNS & SYMPTOMS
Physiological symptoms
 Cardiovascular system: Palpitation,
Increased blood pressure
 Genitourinary system: Frequency of
urination, abnormal menstrual cycle
 Gastro-Intestinal tract: Dryness of throat
and mouth, diarrhoea/ constipation, anorexia
(loss of appetite), heartburns
 Skin: sweating
SIGNS & SYMPTOMS Cont’d
Psychological/ Emotional symptoms
 Frequent lapses in memory/ forgetfulness
 Poor concentration
 Confusion
 Worrying and feelings of despair
 Apathy
 Irritability
 Frequent nightmares
 SIGNS & SYMPTOMS Cont’d
Behavioural signs  Teeth grinding
 Frequent nail biting  Insomnia
 Accident-prone  Complaints of body
behaviour pains
 Social withdrawal  Increased consumption
 Startle reaction of alcohol/ tobacco
 Loss of libido (sexual
drive)
 LEVELS OF ANXIETY
 Anxiety has both healthy and harmful aspects
depending on its degree and duration as well
as on how well the person copes with it.
 There are four (4) levels:
◦ Mild anxiety
◦ Moderate anxiety
◦ Severe anxiety
◦ Panic state
 LEVELS OF ANXIETY Cont’d
 MILD ANXIETY
 Is a sensation that something is different and warrants
special attention.
 Sensory stimulation increases and helps the person
focus attention to learn solve problems, think, act feel
and protect himself.
 Mild anxiety often motivates people to make changes
or to engage in goal directed activity.
 E.g. it helps students to focus on studying for an exam.
 LEVELS OF ANXIETY Cont’d
 MODERATE ANXIETY

 Is the disturbing feeling that something is

definitely wrong - the person becomes
nervous or agitated.

 The person can still process information,

solve problems and learn new things with
assistance from others.
 LEVELS OF ANXIETY Cont’d
 MODERATE ANXIETY Cont’d

 He finds it difficult to concentrate but can be

redirected to the topic e.g., the nurse giving pre-
operative instructions to a client who is anxious about
the upcoming surgical procedure.

 As the nurse is teaching, the clients attention wanders

but the nurse can regain the clients attention and
direct him or her back to the task at hand.
 LEVELS OF ANXIETY Cont’d
 SEVERE ANXIETY
 A person with severe anxiety has trouble
thinking and reasoning. Muscles tighten and
vital signs increase.
 The person paces; is restless, irritable and
angry.
 LEVELS OF ANXIETY Cont’d
 PANIC STATE
 In panic the emotional-psychomotor realm
predominates with accompanying fight, flight
or freeze responses.
 Adrenalin surge greatly increases vital signs.
 Pupils enlarge to let in more light, and the
only cognitive process focuses on the
persons’ defence.
TYPES OF ANXIETY DISORDERS

 Panic disorder
 Phobia disorders
◦ Agoraphobia
◦ Social phobia
◦ Specific phobias
 Generalised anxiety disorder
 Obsessive- compulsive disorder
 Post-traumatic stress disorder (PTSD)
 PANIC DISORDER
 Sudden onset of acute apprehension that is
recurrent and unexpected and is accompanied
by a period of distress.
PANIC DISORDER Cont’d
It is characterised  Derealisation
by;  Depersonalisation
 Palpitations  Sweating
 Trembling/ shaking  Dyspnoea/ Shortness
 Chest pain of breath
 Fear of dying  Dizziness
 Chills  Fear of going crazy
 Parethesias
(numbness or tingling
sensations)
 PANIC DISORDER Cont’d
 It begins suddenly, reaches its peak within 10
minutes and may last for one hour. At least
four (4) of these symptoms are present in a
full blown panic attack.
 PANIC DISORDER Cont’d
Management:
 Benzodiazepines (diazepam, lorazepam,
alprazolam, clonazepam),
 Antidepressants if depression is present
(imipramine)
 Psychotherapy.
 Relaxation therapy
 PHOBIC DISORDERS
 An irrational fear of an object, activity or a
situation that is disproportionate to the
stimulus leading to avoidance of the object or
situation.
◦ Agoraphobia

◦ Social phobia

◦ Specific phobias
 PHOBIC DISORDERS Cont’d
Agoraphobia
 Fear of having panic attacks outside home.
Characterised by concerns of what others
might think about them when they have a
panic attack in public.
 Avoidance public places buses, shopping malls,
hair dressing salons, etc.
 PHOBIC DISORDERS Cont’d
Agoraphobia
 They end up remaining at home or leaving the
house only with someone accompanying
them.
 It can occur on its own or as a complication
of panic disorder.
 PHOBIC DISORDERS Cont’d
Specific phobias
 Excessive and irrational fear of certain
situations or objects leading to avoidance of
such objects or situations.
 For example: fear of height (acrophobia);
animals (zoonophobia); snakes
(ophicliophobia); …..
 PHOBIC DISORDERS Cont’d
Specific phobias
 Enclosed places (claustrophobia); crowd
(demophobia); night (nyctophobia); water
(hydrophobia), open place (agoraphobia);
corpse (neckrophobia); women (gynophobia);
sexual intercourse (coitophobia); rupophobia
(dirt); etc.
 PHOBIC DISORDERS Cont’d
Social phobia
 Fear of situations in which one is exposed to
scrutiny of others. It is usually so strong that
one avoids the situation entirely.
 PHOBIC DISORDERS Cont’d
Social phobia
Examples of social phobias are fear of;
 Speaking in public (laliophobia)
 Writing or signing a document in front of
others
 Performing practical examination
 Eating in public
Such persons are prone to abuse of alcohol and
drugs as means of decreasing anxiety.
 PHOBIC DISORDERS Cont’d
Management
 Desensitization
 Flooding
 Implosion
 Benzodiazepines as diazepam (Valium) in
Mono Amine Oxidase Inhibitors (MAOI) eg.
Isocarboxazid (Marplan).
GENERALISED ANXIETY DISORDER
Severe disproportionate worry about life issues
which persist for about 6 to 7 months but
unaccompanied by panic attacks, phobias and
obsessions.
The worry is usually related to;
 Family issues
 Finances
 Work
 Personal illness
GENERALISED ANXIETY DISORDER
Cont’d
It is characterised by
 Restlessness
 Irritability
 Muscle tension
 Easy fatigability
 Poor concentration
 Insomnia
Management: Relaxation techniques,
benzodiazepines (alprazolam)
OBSESSIVE-COMPULSIVE DISORDER
 A form of anxiety disorder characterised by
recurrent intrusive thoughts, ideas or
impulses (called obsession)
◦ whereby one is unable to resist causing marked
distress or anxiety and

◦ resulting in ritualistic irrational behaviours

(known as compulsion) aimed at neutralising or
relieving the anxiety caused by the obsession.
OBSESSIVE-COMPULSIVE DISORDER
Cont’d
 The obsession commonly comes in the form
of religion, violence, sexuality, contamination
and doubts.
 The associated compulsion comes in the form
of repetitive behaviours (such as hand
washing, checking, touching) and moral acts
(such as praying, counting, repeating words
silently).
OBSESSIVE-COMPULSIVE DISORDER
Cont’d
 Management:
◦ Drugs to increase serotonin in blood (fluoxetine
[Prozac]);

◦ Thought stopping;

◦ Desensitization,

◦ etc.
POST-TRAUMATIC STRESS
DISORDER
Manifestation of psychological symptoms after
one has a severe traumatic event that is
considered to be outside usual human
experience. These include…
 Rape
 Assault
 Military combat
 Natural disasters
 Serious accidents
 Victim of violent crimes
POST-TRAUMATIC STRESS
DISORDER Cont’d
The victim persistently re-experiences the
traumatic event through
 Repetitive thoughts and images about the
event
 Recurrent nightmares about the event
 Dissociating states in which the event is re-
lived (acting as if the event is recurring).
 Intense psychological distress on exposure to
clues referring to the traumatic event
POST-TRAUMATIC STRESS
DISORDER Cont’d
In response to this, there is a persistent
avoidance of stimuli associated with that event
such as;
 Efforts to avoid thoughts, feelings, and
conversations related to the trauma
 Efforts to avoid activities, places or people
that arouse recollection of the event
 Inability to recall important aspects of the
trauma
 Feeling of detachment from others
 Restricted range of affect
POST-TRAUMATIC STRESS
DISORDER Cont’d
They also experience the following
 Insomnia
 Exaggerated startle reflex
 Hyper vigilance
 Poor concentration
POST-TRAUMATIC STRESS
DISORDER Cont’d
These symptoms begin immediately or shortly
after the event or about 6 months or even
several years after the event.
POST-TRAUMATIC STRESS
DISORDER Cont’d
Management:
 Family therapy,
 Support from friends,
 Behaviour therapy,
 Anti-depressants,
 Relaxation techniques (meditation, deep
breathing exercise, etc…)
 Systematic desensitization, etc.
MANAGEMENT OF ANXIETY
DISORDERS
General management
 Relaxation techniques: deep breathing exercise,
progressive muscle relaxation, meditation, etc
 Systematic desensitization
 Massage – soothing and helping to relax muscles
 Exercise
 Family therapy
 Group therapy
 Medications (anti-anxiety drugs and
antidepressants)
MANAGEMENT OF ANXIETY
DISORDERS
Nursing management
 Establish rapport to facilitation nursing care (Initiate
and maintain therapeutic nurse-patient relation)
 Reassure patient/family to allay anxiety and doubts.
 Remain with patient during the acute phase to prevent
patient feeling isolated.
 Provide safe and secure environment to ensure patient
of his safety.
MANAGEMENT OF ANXIETY
DISORDERS
Nursing management cont’d

 Nurse client in quiet and less stimulating environment

 Remain calm and avoid being anxious herself.

 Prevent injury from restlessness and possible sedation.

 Speak in short simple terms

 Engage client in purposive activities such as interesting

conversation, playing games, watching movies, reading
as a form of diversional therapy.
MANAGEMENT OF ANXIETY
DISORDERS
Nursing management cont’d
 Encourage client to verbalise feelings
 Listen to clients concerns but do not be judgemental
 Remain calm when dealing with client
 Teach client coping mechanisms (deep breathing
exercise, progressive muscle relaxation, meditation) to
relieve anxiety
 Administer prescribed anti-anxiety drugs
THANK

YOU!!!