Anxiety disorders & Substance abuse

Incidence
Most common emotional disorder in the U.S.
Prevalent in women; age <45

Physiologic responses
Flight or fight responses
Sympathetic fibers increase the vital signs
Adrenal glands release adrenalin which causes the body to:
o Take in more oxygen
o Dilate the pupils (brings more light into eyes; better vision)
o Increase the arterial blood pressure and heart rate
o Constrict peripheral vessels (makes skin cool and pale)
o Increase glycogenolysis to free glucose for fuel (glycogen is being broken
down in the liver)
o Shunt blood from GI and reproductive organs

Psychological response
Difficulty with logical thought
Increased agitation with motor activity
Increased vital signs
Client will try to change the feelings of discomfort by:

o Changing behavior by adaptation

o Changing behavior with defense mechanisms

Anxiety disorders
Panic disorder
Phobic disorder
Agoraphobia
Obsessive-compulsive
PTSD
Generalized anxiety
Anxiety related to medical conditions
Substance-induced anxiety disorder

Development of Anxiety Disorders

Predisposing factors
o Onset: Acute or insidious (builds up)
o Precipitating event
o Chronic stressors
o Unusual behavior
o Fears disproportionate to reality

Levels of anxiety

 Mild:
o Psychological: Wide perceptional field, sharpened senses, increased
motivation, effective problem solving, increased learning ability, irritability.
o Physiologic: Restlessness, fidgeting, butterflies, difficulty sleeping,
hypersensitivity to noise.
Moderate:
o Psychological: perceptual field narrowed to immediate task, selectively
attentive, cannot connect thoughts or events independently, increased use
of automatisms
o Physiologic: Muscle tension, diaphoresis, pounding pulse, HA, dry mouth,
high voice pitch, faster rate of speech, GI upset, frequent urination
Severe:
o Psychological: Perceptual field narrowed to one detail or scattered details;
cannot complete tasks; cannot solve problems or learn effectively;
behavior geared toward anxiety relief and is usually ineffective; doesnt
respond to redirection; feels awe, dread, or horror; cries; ritualistic
behavior.
o Physiologic: Severe HA, N/V, diarrhea, rigid stance, vertigo, pale,
tachycardia, chest pain.
Panic:
o Psychological: Perceptual field reduced to focus on self; cannot process
any environmental stimuli; distorted perceptions; loss of rational thought;
doesnt recognize potential danger; cant communicate verbally; possible
delusions or hallucinations; may be suicidal.
o Physiologic: May bolt and run OR totally immobile and mute; dilated
pupils, increased blood pressure and pulse; flight, fright, or freeze.

Seyle Response to stress

Alarm reaction

o Physiologic response
o Body prepares to defend itself
Resistance stage
o Body will defend by flight or fight
o If the stress is gone; body relaxes
Exhaustion stage
o Negative response to anxiety and stress
o Body stores are depleted

Panic disorders
An episode lasting 15-30 minutes in which a client experiences rapid, intense,
escalating anxiety; great emotional discomfort; and physiologic discomfort.
Defined as recurrent, unexpected panic attacks followed by a month of persistent
concern or worry about having another attack.
75% with panic disorder have spontaneous attacks with no triggers
Others have attacks stimulated by phobias or chemical changes within the body.

Treatment
Psychotherapy
o Positive reframing
o Assertiveness training
Psychopharmacology
o SSRIs

o Anxiolytics
o Antidepressants
o MAOIs

Phobias
An illogical, intense, persistent fear of a specific object or social situation that
causes extreme distress and interferes with having a normal life.
Treatment for phobias:
o Psychopharmacology
Anxiolytics
Benzodiazepines
SSRIs
Beta Blockers
o Psychotherapy
Behavioral therapy
Systemic desensitization
Flooding Getting rid of fear all at one time

Obsessive-Compulsive Disorder (OCD)

Obsessions: Recurrent thoughts, ideas, visualizations, or inappropriate impulses
that disturb a persons life; has no control over them.
Compulsions: Behaviors or rituals continuously carried out to get rid of the
obsessive thoughts and reduce anxiety.
Higher incidence with groups in higher economic status and with more education

 Nursing interventions:
o Remember, a lot of the time people feel guilty about their thoughts and
behaviors.
o Do not try to stop the act unless the act is harmful (dangerous)
o Talk to them! Use I statements
o If they are too down on themselveslimit your time with them. For
instance, I hate myself. No one cares about me. Im fat and ugly. The
nurse would then say, I am going to come back in 30 minutes. In that time
frame, I want you to think of your good qualities.
o Do not argue with OCD person.
o Inject reality. If a teenager thinks she is pregnant despite a negative
pregnancy test, tell her the TEST IS NEGATIVE. Take them back into
reality.
o If they repetitively do an act over and over again; help them set a goal. For
instance, Lets try to only wash your hands once every ten minutes.

Post Traumatic Stress disorder

Three clusters if symptoms are present
o Reliving the event
Memories, dreams, or flashbacks
o Avoiding reminders of the event
Staying away from any stimuli that could be associated with the
trauma.
o Being on guard (hyper-arousal)
Less responsive to stimuli
Insomnia, irritability, or angry outbursts

 At risk people include:

o Combat veterans
o Victims of violence
o Abused victims
o Children in traffic accident (and the parents)
Only 46% of parents sought help for their children. KIDS NEED
HELP.
Symptoms of PTSD occur 3 months or more after the trauma.
Some more signs of PTSD:
o Have issues with authority figures
o Their first emotions are anger, rage, and guilt
o Their guilt comes out as anger (violent behavior)
o Isolate themselves
o Cry
o Dont want to talk about it
o Drug and alcohol abuse
o Nightmares
o Manifests in physiological symptoms (HA, GI distress)
o Irritable
o Insomnia
Nursing interventions:
o Have specific staff members assigned to client to facilitate building trust
o Consistency is the key

o Be non-judgmental; encourage client to talk

o Help them acknowledge where grief is coming from
o Involve family
o Give positive feedback
Goals for PTSD:
o Short term: Safety, decrease insomnia, identify source, grieve!
o Long term: Accept the fact that the experience happened and live healthy.

Substance abuse
Im not going to go much into these notes; there wasnt much information in the
lecture that is not in the packet.
Overdose of alcohol:
o Alcohol is a depressant; decreased respirations and blood pressure,
vomiting may cause aspiration.
Overdose of benzodiazepines require a gastric lavage including instillation of
activated charcoal.
Stimulants
o Cocaine, amphetamines, and Ritalin
o Increases HR and BP; decreases cardiac output and oxygen
o Cocaine specifically causes MIs

Withdrawal
Two purposes:
o Safe withdrawal with medication

 Suppress symptoms of abstinence

Around the clock schedule and PRN
Never, ever go cold turkey.
o Prevent relapse
May need to go to AA for rest of life.