Unit 7.

Mental Health Problems and

Therapeutic Interventions




ANXIETY & ANXIETY DISORDERS

 Objectives
• Discuss the concept of anxiety
• Discuss physiological, perceptual, cognitive, and behavioral
effects of anxiety
• Discuss various dysfunctional anxiety responses [Generalized
anxiety disorder, Post traumatic stress disorder, Phobia,
Obsessive Compulsive disorder, Conversion reaction] and their
basis in etiology
• Demonstrate understanding of the principles of nursing and
psychosocial care, while caring for clients with dysfunctional
anxiety responses
 INTRODUCTION
• FEAR:
• Fear is an emotional response to a real or perceived threat
• Anxiety:
• Anxiety is a subjective feeling of fear and uneasiness to an
unknown threat or internal conflict.
• Anxiety is body's natural response to stress that causes
increased alertness, fear and physical signs.
 Anxiety as a response to stress
• Stress is the wear and tear of life that effect on the body( it
has physical and emotional effects on us and can create
positive or negative feelings).
• It occurs when a person has difficulty dealing with life
situations, problems, and goals.
 ETIOLOGY
• 1. Genetic factors.
• 2. Environmental factors (early childhood trauma,
traumatic social experience).
• 3. Known or unrecognized medical condition.
• 4. Substance-induced anxiety disorder (Over-the-counter
(OTC) medicines are those that can be sold directly to
people without a prescription) herbal medications,
substances of abuse.
Levels of Anxiety

• Hildegard Peplau “Interpersonal Relations in Nursing

1952” identified Four stages of anxiety on a continuum
• Mild
• Moderate
• Severe
• Panic
 ASPECTS OF ANXIETY
• Anxiety has three aspects.
1. Physical: It includes headache, nausea, trembling, sweating,
and trigger the onset of disease, disorder, illness, accident, or
behavioral response.
Increase in heart rate etc., and may other physical symptoms.
2. Behavioral: It may include avoidance behavior, dependent
behaviour and agitated (disturb) behavior.
3. Cognitive: It may include worry, fear of losing control,
apprehension (fear) about future, confused thoughts, difficulty
concentration, and thinking about that things are getting out of
control
 SYMPTOMS OF ANXIETY
• Sensitivity of noise
• Dry mouth
• Difficulty in swallowing
• Palpitations
• Restlessness ,tremor
• Gastrointestinal discomfort
• Headache
• Insomnia.
• Constriction (tightening) in chest
• Poor concentration
 CLASSIFICATION
• Anxiety disorders are broadly divided into
• Generalized anxiety disorder
• Panic disorder
• Phobic disorder
• Post traumatic stress disorder
• Obsessive compulsive disorders
 Generalized anxiety disorder (GAD)
• Introduction
• Generalized anxiety disorder (GAD) is one of the most
common mental disorders.
• Up to 20% of adults are affected by anxiety disorders each
year.
• Generalized anxiety disorder produces fear, worry, and a
constant feeling of being overwhelmed.
• Generalized anxiety disorder is characterized by persistent,
excessive, and unrealistic worry about everyday things.
 GENERALIZED ANXIETY DISORDER
Chronic anxiety state associated with uncontrollable worry.
Patient with generalized anxiety disorder have persistent ,
excessive, unrealistic worry associated with muscles tension,
impaired concentration and insomnia
Complaints of shortness of breath , palpitation and tachycardia
are
relatively rare.
Alcohol abuse and dependence are common in generalized
anxiety disorder patient
 CLINICAL FEATURES OF GENERALIZED ANXIETY
DISORDER (GAD)
• Muscle tension
• Restlessness and fatigue
• Insomnia
• Anxiety related to personal safety
• Trembling, sweating, palpitations
• Difficulty controlling worry
• Avoid activity and events that can bring negative outcomes
• Poor personal , social and occupational functioning
 TYPES OF PHOBIC ANXIETY DISORDERS
• 1. Social Phobia
• 2. Specific Phobia
• 3. Agoraphobia
• SOCIAL PHOBIA (social anxiety disorder):
• Social phobia is fear of social situations where the person
may be examined closely , embarrassed or judged.
• The person is having negative ideation of being negatively
evaluated by others, embarrassed, humiliated, rejected or
insulted by others.
 SOCIAL PHOBIA (SOCIAL ANXIETY DISORDER)
• CLINICAL FEATURES
• strong persistent fear of an interpersonal situation.
• Fear of meeting unfamiliar peoples.
• Fear or avoidance of situations in which the person can be
observed eating or drinking.
• Fear of being criticized.
• Fear of public speaking or public performance.
• SPECIFIC PHOBIAS:
• Specific Phobias are characterized by unrealistic and
unreasonable fear related to a specific object or situation.
• Exposure to phobic stimulus provokes an immediate anxiety
response which may take form of a panic attack.
• Examples of Specific phobias are
• Acrophobia (The fear of heights)
• Hematophobia (Abnormal and persistent fear of blood),
• Claustrophobia (The fear of small spaces),
• Zoophobia (is an extreme fear of animals)etc
• AGORAPHOBIA :
• Agoraphobia is the fear of going out in public, either the fear
of open spaces or the fear of being in unfamiliar places.
• Many people with agoraphobia either never leave their home,
or do anything they can to avoid travelling anywhere other
than their home and office.
• Some people can go to the grocery store or other familiar
places, but otherwise experience intense, nearly debilitating
(making someone very weak )fear anywhere else.
• Many people (although not all) that have agoraphobia also
have panic disorder.
• That's because for many, agoraphobia is often caused by
panic attacks.
• People experience panic attacks in public places, so they start to
avoid more and more places in order to avoid panic attacks until
they are afraid to go outside.
• Some people experience agoraphobia after traumatic events as
well
• The person has a fear of being trapped and helpless.
• These may include:
–Enclosed spaces ( movie theaters, elevators, stores)
–Open spaces ( parking lots, bridges)
–Public transport( bus, aeroplane, train)
 What Causes Agoraphobia?
• Depression
• Other phobias, such as claustrophobia and social phobia
• Another type of anxiety disorder, such as generalized anxiety
disorder or obsessive compulsive disorder
• A history of physical or sexual abuse
• A substance abuse problem
• A family history of agoraphobia
 PANIC ANXIETY DISORDERS
• Panic A sudden uncontrolled fear or anxiety related to a
perceived threat or danger usually accompanied by behavioral,
cognitive and physiological signs.
• Panic anxiety disorder is characterized by recurring ,
unexpected , intense fear that brings on a panic attack.
• Panic attacks begin abruptly , and reach a peak within about
10 minutes.
• These panic attacks are accompanied by somatic symptoms
and are usually short lived (<1 hour)
 Diagnosis/clinical presentation
• • A panic attack usually peaks in 10 mins and lasts no longer
than 30 minutes.
• A patient is diagnosed with a panic disorder when that
individual experiences repeated unexpected panic attacks and
these attacks are followed by a 1-month period of one or more
 CLINICAL FEATURES OF PANIC ANXIETY
DISORDERS
• Symptoms may include:
• Sweating
• Shortness of breath
• Chest pain
• Palpitations
• Trembling
• Sensation of choking or having a heart attack.
• Fear of dying
• Altered reality
 POST TRAUMATIC STRESS DISORDERS
• Patients with stress disorders are at risk for the development of
other disorders related to anxiety, mood and substance abuse
(especially alcohol)
• As a human being, there are always risks that put there life in
danger.
• Most people are lucky enough to avoid these dangers and live a
nice and safe life.
• But in some cases, person may have experience a life trauma
either physically or emotionally and this can cause an anxiety
problem known as post-traumatic stress disorder.
• PTSD affects people both psychologically and physically.
• Post Traumatic Stress Disorder (PTSD)
• Symptoms :
• Nightmares,
• Negative thinking and mood,
• Unwanted distressing memories of the traumatic event
• Symptoms usually begin early, within 3 months of the
traumatic incident, but sometimes they begin years afterward.
• Symptoms must last more than a month
• Symptoms Reliving the Trauma,
• Which consists of:
• Flashbacks, in which it feels as if the event is occurring over and
over
• Intrusive, vivid memories of the event frequent nightmares about
the event mental or physical discomfort when reminded of the
event
• Avoidance, which includes:
• Emotional apathy
• Detachment from or lack of interest in daily activities
• Amnesia (memory loss) about the actual event
• Inability to express feelings
• Avoidance of people or situations that are reminders of the event
 OBSESSIVE-COMPULSIVE DISORDER
• Obsessive Compulsive Disorder is characterized by obsessive
thoughts and compulsive behaviors that impair everyday
functioning.
• Fears of contamination and germs are common as are hand
washing, counting behaviors and having check and recheck the
actions like whether a door is locked.
• What Causes Obsessive-Compulsive Disorder?
• Biological Causes : OCD may be caused by genetic
abnormalities. People with OCD often have a close relative that
has the disorder.
• Environmental Causes: OCD may develop as a result of
behaviors that have been learned over time.
• Insufficient Levels of Serotonin : OCD may occur if levels of
serotonin in brain decrease.
• Serotonin is a chemical that can help to regulate emotions.
• Symptoms
• A fear of germs, illness, or disease
• A fear of hurting oneself or others
• Violent thoughts of a sexual nature
• A fear that you will lose things that are important to you.
• A focus on preciseness and order
• A focus on superstitions
• Strict devotion to religious beliefs
• Compulsions (forces , pressures) are behaviors and while
behavior will vary for each person with OCD, there are some
common compulsions. These include:
• Checking and rechecking tasks that have already been
completed
• Continually calling friends and family to see if they are safe
counting or repeating words
• Excessive cleaning or washing
• Ordering things
• Excessive praying
• Accumulating trash that has no value or worth
 CONVERSION DISORDER
• Conversion disorder, also called functional neurological
symptom disorder, is a medical problem involving the
function of the nervous system; specifically, the brain and
body’s nerves are unable to send and receive signals properly.

• As a result of this communication problem, patients with

conversion disorders may have difficulty moving their limbs
or have problems with one or more of their senses.
 CONVERSION DISODER
• MEANING :
• Anxiety is converted into physical symptoms
• Previously it is known as Hysteria
• Conversion disorder in which a person experiences blindness,
paralysis, or other symptoms affecting the nervous system that
cannot be explained solely by a physical illness or injury.
• EPIDERMOLOGY
• Conversion disorder can occur at any age.
• It tends to develop during adolescence to early adulthood.
• Conversion disorder is more common in women.
• About two-third of patients have evidence of psychiatric
disease, the most common being depression and trauma.
• Personality disorders are also commonly seen.
• ETIOLOGY
Genetic factor
Biochemical factor
Psychosocial factor
Family dynamics
 CLINICAL MANIFESTATION
• Motor symptoms or deficits:
• Impaired coordination or balance
• Weakness/paralysis of a limb or the entire body
• Impairment or loss of speech
• Difficulty swallowing or a sensation of a lump (swelling )in the
throat
• Urinary retention
• Psychogenic non-epileptic seizures or convulsions
• Tremor
• Gait problems
• Fainting
• Sensory symptoms
• Impaired vision
• Double vision
• Impaired hearing (deafness)
• Loss or disturbance of touch or pain sensation
• Numbness
• DIAGNOSTIC MEASURES
• Medical history and physical exam.
• CT and MRI scans:These tests provide detail on possible
head injuries, strokes, brain tumors and brain diseases that
may be causing symptoms.
• EEG (Electroencephalogram)This tests looks for evidence of
seizures or other electrical changes in the brain
• Too reduce Panic anxiety
• Stay with the patient and offer reassurance of safety and
security.
• Maintain a calm and non-threatening approach.
• Use simple words and brief messages, speak calmly and
clearly to explain hospital experiences.
• Keep immediate surrounding low in stimuli
• Provide reassurance and comfort measures.
• Encourage the client’s participation in relaxation exercises
such as deep breathing, progressive muscle relaxation,
guided imagery, and meditation
• To improve the coping abilities of client.
• Talk with the patient about his/her anxious behavior and
explore possible reasons for occurrence.
• Help the patient to recognize signs and symptoms of
increasing anxiety and ways to interrupt its progression (i.e.
relaxation techniques).
• Teach the client a step by step approach to solve problems, i.e.
identifying problems, exploring alternatives, evaluating
consequences of each alternative and making a decision
• Encourage the patient to evaluate the success of choosing
alternative and help the patient to choose alternatives.
• Give patient a positive feedback as patient learns to express
emotions and problem solving.
• To improve decision making abilities and problem solving
skills
• Allow the patient to take as much responsibility as possible for
self care practices.
• Allow the patient to establish own schedule for self care
activities.
• Provide patient with privacy as needed.
• Provide positive feedback for decisions made.
• Help the patient to identify areas of life situation that patient
can control.
• Help the patient to verbalize his/her feelings