Anxiety disorders What is anxiety?
Anxiety is the subjective emotional response to a stressor.
What is neurosis?
- Less severe form of psychiatric disorder
- Show either excessive or prolonged emotional reaction to any stress
- Not caused by organic disease
- Do not involve hallucinations and delusions
Neurotic, Stress Related and Somatoform Disorders ICD 10 classification
F40 phobic anxiety disorder
F41 other anxiety disorders
F42 obsessive compulsive disorders
F43 reaction to severe stress and adjustment disorder
F44 dissociative(conversion) disorders
F45 somatoform disorders
F48 other neurotic disorders
- Catecholamine levels
- Decreased GABA level
- Excessive serotonin activity in brain
- Neuroimaging studies : PET revealed increased metabolic activity and blood flow in brain (OCD)
- Laboratory studies : spontaneous panic attacks cause tripling of respiratory tidal volume
Strong association between symptoms of anxiety and presence of coronary artery disease
- 8 to 17 % risk in first degree relatives(panic disorder)
- 15 to 20 % OCD patients have an immediate family member with the same problem.
- 40% patients with agoraphobia have a relative with same problem.
Psychoanalytic or psychodynamic model
- Freud states that anxiety is the result of failure to repress painful experiences. In case of phobia displacement anxiety is transferred to a neutral object.
- Newer concepts : anxiety is an interaction between temperament and the environment
- Sullivan : symptoms are a result of expectations, insecurities, frustrations and conflicts between individuals and primary groups.
- According to him anxiety is the first great educative experience in life.
Cognitive behavioral model
- Developed by Aaron Beck : anxiety is a learned or conditioned response to a stressful event or perceived danger. Faulty thinking precede the development of anxiety.
Environmental model or social psychiatry
- anxiety and its manifestations result from the dynamic relationship between individual and the environment
- Individuals can behave adaptively or can develop the
CLINICAL SYMPTOMS Physiologic symptoms
- Elevated pulse, blood pressure and respiration
- Dyspnoea or hyperventilation
- Blurred vision
- Anorexia, nausea and vomiting
- Weakness or muscle tension
- Tightness in the chest
- Sweaty palms
- Dilated pupils
- Irritability, crying
- Lack of interest or apathy
- Feeling of worthlessness, apprehension or helplessness
- Inability to sit still
- Fingering hair continuously
- Hyper vigilance
Intellectual or cognitive symptoms
- Decreased interest
- Inability to concentrate
- Non responsiveness to external stimuli
- Decreased productivity
LEVELS OF ANXIETY
Normal : may feel uneasiness or apprehension. And the client take necessary step to prevent the threat.
Mild anxiety : increased alertness to the inner feelings or the environment.
Moderate anxiety : experiences a narrowing of the ability to concentrate, with the ability to focus on only one specific thing at a time
Severe anxiety : ability to perceive is further reduced and focus is on small or scattered details. -Inability to communicate clearly, occurs because of increased anxiety and decreased intellectual thought processes.
- Complete disruption of the ability to perceive takes place
- Difficulty in verbalization
- Unable to function normally
- Unable to focus on reality.
- Mood stabilisers
- Individual psychotherapy
- Cognitive therapy
- Behavioural therapy
- Group & family therapy
- Ineffective individual coping
- Ineffective breathing pattern
- Impaired verbal Communication
- Confusion, Acute
- Ineffective denial
- Risk for injury
- Chronic Low Self esteem
- Disturbed Sleep pattern
- Impaired Social interaction
- Ineffective tissue perfusion
- Interact with the client in a calm manner using a soft voice and reassuring approach
- Reduce distractions and stimuli in the environment
- Listen to the clients concerns
- Teach relaxation techniques
- Assist the client to identify factors that contribute to anxiety response
- Administer anti-anxiety medications
- Determine factors that increase anxiety such as caffeine,nicotine and teach techniques to avoid them
- Teach and encourage assertiveness techniques
- Help the client to solve his problem
- Monitor response to medications