Medications such as anxiolytics, antidepressants, and alpha adrenergic agonsist.
Nursing process for panic disorder:
Assessment - signs and symptoms
Nursing diagnoses - Risk for injury, Anxiety, Fear, Social isolation, Disturbed Sleep, Altered nutrition
Goals - Injury prevention, Improved coping, Adequate sleep and nutrition
Nursing interventions for panic disorder:
Remain with the client
Display a calm demeanor
Mutual problem solving
Client and family teaching - avoid secondary gain behaviors.
Review breathing control and relaxation techniques
Discuss positive coping strategies
Medication and follow up
Time management and goal directed activities
Participation at the community level in support groups
Persistent, excessive, irrational fear of a particular object or situation that can lead to avoiding the feared object or situation.
Fear of the marketplace where one may avoid public places and in extreme cases may never leave home.
Irrational fear of an object or situation for at least 6 months in persons older than 18 years of age.
Broad categories of specific phobias:
Examples of specific phobias:
Acrophobia - fear of heights
Astrophobia - fear of thunderstorms
Claustrophobia - when confined
Glossophobia - of talking
Hematophobia - of blood
Hydrophobia - of water
Mysophobia - of germs
Pyrophobia - of fire
Zoophobia - of animals
How the DSM-IV defines "specific phobia":
Client has marked persistent excessive or unreasonable fear. Presence of the object/situation or "anticipation" can provoke fear.
Exposure causes market anxiety
Client recognizes their fear is irrational
Attempts to avoid or endure distress and disability to usual activities.
The client experiences severe anxiety, possibly panic when confronted with situations involving people such as making a presentation, eating out, meeting new people, or being the "center of attention".
Diagnosis or seriousness of phobias:
Based on how phobic behavior affects the client's lives.
Is there marked distress?
Does it present difficulties with interpersonal relationships or interfere with the client's occupation?
Behavior therapies such as desensitization, exposure treatment, flooding and cognitive restructuring.
Statistics about phobias:
Specific phobias more common among women
Men are more likely to experience social phobias
Peak onset is childhood to mid 20's
Specific phobias continue into adulthood and are life long in 80%.
The therapist progressively exposes the client to their phobic object in a safe setting and teachers relaxation strategies.
The complexity and intensity of the exposure is gradually increased Once the client's anxiety is manageable they are encouraged to confront the source of their phobia.
The therapist "floods" the patient with information that causes anxiety.
There is sort o "give and take" communication pattern.
The therapy is considered successful once the client doesn't react adversely to the information.
Client has intrusive thought of unrealistic obsessions and in an effort to control these thoughts they engage in compulsive behaviors.
Obsessive compulsive disorder (OCD)
Common types of obsessions:
Repeated thoughts about:
-Aggression or horrific impulse
Clinical examples of compulsions:
Checking rituals - is the door locked? is the coffee pot off?
Counting rituals - ceiling tiles, steps taken, desks in class
Praying or chanting
Touching, rubbing, or tapping
Ordering - vacuuming in one direction
Rigid performance - only dress one way
Aggressive urges - to harm one's spouse or child
When a person suffers from OCD, why do they do it, are they aware of what they are doing, how do they feel about their actions, how do they feel if they try to resist their urges.
Statistics about OCD:
Onset as young as childhood, commonly seen in 20's
Equal sex distribution
Gradualonset and maybe exacerbated by stress
Manageable in 80%
Treatment of OCD:
Combined behavior therapy and medication Medications include:
To confront the situations they have been deliberately avoiding.
Delaying or avoiding their rituals.
Empowerment of the client is to recognize that the anxiety will recede and they do not need to engage in their ritualistic behaviors.
Extensive assessment tool using 14 criteria examples such as: How much time do you spend having obsessive thoughts or performing compulsive behaviors? Range from none to greater than 8 hours a day.
Yale - Brown Obsessive Compulsive Scale
Nursing process for OCD:
Diagnoses: Ineffective coping, fatigue, social isolation
Goals: Client will follow a daily routine, spend less time on rituals and or exhibit an improved communication pattern.
Nursing interventions for OCD:
Convey "acceptance" for the client.
Establish trust by:
allowing time for rituals
mutual goal setting - set limits
active listening - therapeutic communication
teach coping mechanisms
follow daily routine
Family education for OCD:
Supportive role of family
Medication and therapy compliance
Prognosis is good with early recognition and therapeutic intervention.
Client has worries or feels anxious 50% of the time for at least 6 months.
Exhibits at least three of the following symptoms: uneasy irritable muscle tension fatigue difficulty thinking sleep disturbances
Generalized Anxiety Disorder
Often seen by non-psychiatrist providers.
Tenders to diminish client's quality of life and that is the rationale for treatment.
Cognitive therapy improves the results and outcomes of pharmacology treatment.
Generalized anxiety disorder
A subconscious effort to regain control over a traumatic situation - allowing the m id to remove the painful even from it's memory.
Underlying causes of dissociative disorders:
Trauma - person may separate themselves from the memory
Abuse- especially during childhood
Effect of early abuse - may cause poor neurodevelopment (limbic, left brain)
Gender - 3-9 times more common among women
May occur both during and after the event. Onset may be sudden or gradual transient or chronic Rare in the general population.
Cannot remember important personal information
Leaves their current setting of home or work and relocates elsewhere unable to remember past identity.
Displays two or more distinct identities - yet, doesn't know important personal information - "multiple personalities" formerly described this disorder
"Detached" from their body or mental processes yet in touch with reality.
Cannot recall details about a traumatic event for a certain amount of time - such as after an MVA.
Local and selective amnesia
Has no recollection of their former life.
Cannot recall events that occurred before a certain time.
Categorical or speciic to a certain person or place.
A disturbing pattern of coping demonstrated by an individual who has experienced a traumatic event, combat, natural disaster, assault, etc.
Cardinal symptoms of PTSD:
Symptoms of PTSD:
Reliving the event
Avoiding reminds of the event
Being on guard or experiencing hyperarousal
Cues in the environment remind the brain of the original trauma
The cues result in fight or flight responses.
Mnemonic for PTSD
Intense memories of event, thrashing in sleep, diaphoresis upon awakening, reliving the trauma, flashbacks, intense distress with memory.
Outbursts of anger, cannot tolerate crowds or public transportation, poor concentration, exaggerated startle response, hyperawareness of surroundings
Avoidance of thoughts, feelings people, and places associated with trauma, general lack of interest, emotional numbness and detachment from life, unable to have strong emotional reactions, and a sense of a foreshortened future.
Numbing and avoidance
Statistics about PTSD:
Can occur at any age
Those with a past history of combat, victims of violence, or experiencing a natural disaster have a 60% risk factor.
Treatment of PTSD:
Cognitive behavior therapy
-Putting conscious back together with dissociative disorders
Encourage patient to talk about the event and use a system of gradual re-exposure.
May use inpatient setting and or medications such as anxiolytics or antidepressants.
Interventions for PTSD
For clients experiencing flashbacks or other forms or temporary loss of
touch with reality such as PTSD and dissociative disorders.
Safety for PTSD:
Client management while promoting self-care. Use of a "safe haven" when self - destructive thoughts or impulses are present.
Focus on the "here and now" using nursing techniques that are clam and reassuring.
Grounding "in the person"
Encourage the client to move out of a fetal position into one of increased control such as walking or standing.
Techniques that assist with coping:
Deep breathing, relaxation
Distractions such as physical activity, music, conversations, hobbies
Assess for and discourage the use of drugs or alcohol as coping techniques
Journaling to identify triggers.
Symptoms occur withing first month after traumatic even but do not persist longer than 4 weeks.
Acute stress disorder
Symptoms occur more than 3 months after the traumatic event
50% of persons with this have complete recovery within three months.