DR. CARL E. BALITA REVIEW CENTER TEL. NO. 735-4098/410-0250 - 1 -

ANXIETY AND ANXIETY DISORDERS ANXIETY • Amxiety is the feelings of uncertainty,

uneasiness and tension to an unknown object. • Fear is body’s physiologic response to a known

danger. • Signal anxiety- anticipated event • Anxiety trait- component of personality • Anxiety state- result of stressful situation • Free-floating anxiety- always present • Phases: normal, acute, chronic and panic • Level 1 (Mild): increase alertness, ability to

learn and challenged • Level 2 (Moderate): narrowing of perception

occurs. Pacing, tremors, increase verbalization • Level 3 (Severe): perception reduces.

Inappropriate verbalization, lack of determination

• Level 4 (Panic): Disintegration of personality occurs. Individual loses control

• Physiologic symptoms: elevated VS, diaphoresis, vertigo, sweaty palms, dilated pupils

• Psychologic symptoms: withdrawal, irritability, anger feelings of worthlessness, helplessness and apprehension

• Behavioral symptoms: pacing, inability to sit still, nervous habits

• Intellectual symptoms: decreased interest and productivity, nonresponsive, forgetful, rumination

ANXIETY DISORDERS • Panic Disorders: out of the blue, experiences

frightening and uncomfortable symptoms. • Lasts 1 minuite to I hour, onset begins late

teens or early twenties, more seen in women. • Symptoms of panic attack: palpitations

diaphoresis, tremors choking, vertigo, SOB • Phobic disorders: most common form of

anxiety disorder. • Phobia is the irrational fear of an object. • A person unconsciously displaces the source of

anxiety from an unpleasant childhood experience.

• Avoidance of the object allows the person to be free from anxiety.

• Agoraphobia (fear of public places); Social phobia (avoid situations); Specific phobia 5 subtypes: animal, natural environment, blood-injection injuries, situational, others such as sound, space and costumed characters.

Jeremiah 17:7 "But blessed is the man who trusts in the LORD, whose confidence is in him."

• Generalized Anxiety disorders: unrealistic or

excessive anxiety or worrying in a 6 month period.

• Associated restlessness, fatigue, irritability, impaired concentration, muscle tension and sleep disturbances

• Obssessive-Complusive Disorder: characterized by obsessions and compulsions

• Common obsessive thought involve religion, violence, symmetry and contamination

• Post-traumatic Stress Disorder: exposure to traumatic experiences such as rape, combat, crimes, violence, etc.

• Symptoms of PTSD: recollections, flashbacks, nightmares, avoidance, insomnia, exaggerated response, labile emotion

• Acute onset refers to symptoms less than 3 months; chronic if more than 3 months.

• Acute Stress Disorder: lasts for 2 days and either resolve within 4 weeks.

• Avoids stimuli that causes recollections of the trauma.

MOOD DISORDERS • Bipolar I: presence of one manic episode with

or without depression. • Bipolar II: presence of one hypomanic episode

and major depression • Cyclothymic Disorder: numerous episodes of

hypomania and depression for 2 years • Dysthymic Disorder: depressed mood for at

least 2 years for more days than not MANIA • Manic Episode: abnormal, persistent elevated

mood for 1 week. • Hypomanic episode: elevated mood for 4 days • Affective symptoms: elation, humorous, lack

of shame or guilt • Physiological symptoms: dehydrartion, poor

nutrition, little sleep time, weight loss • Cognitive symptoms: ambitious, deny danger,

illusions, lack judgment • Behavioral symptoms: aggressive, excessive

spending of money, hyperactive, argumentative

• Nursing management: provide safety, reduce external stimuli, avoid competitive activities, allow verbalization of feelings, limit setting, be firm and consistent.

NURSING FACTS IN BRIEFAnxiety, Anxiety Disorders, Psychosomatic

and Mood disorders

DR. CARL E. BALITA REVIEW CENTER TEL. NO. 735-4098/410-0250 - 2 -

DEPRESSION • Depression: lowered or saddened mood;

feeling of multiplied unhappiness for at least 1 week

• Major depression: symptoms that persist over a minimum period of 2 weeks.

• Symptoms: apathy, sadness, sleep disturbances, guilt, anger, hopelessness, helplessness, worthlessness, withdrawal, self-blame, ruminations, destructive thoughts, suicidal thoughts

• Women are more prone than men • Average onset is mid-20’s • Occurrence of depression in children and

adolescents can be more devastating than in adults.

• Nursing management: Provide safe environment, structured activities, listen to verbalization of feelings, divert attention, help build self-esteem.

SUICIDE • Suicide is the outcome of a person’s inability

to cope with catastrophic stress. • Ideation- person’s thought regarding suicide • Gestures- non-lethal acts to get attention • Threats- verbal statements to declare suicide • Attempt- actual implementation of ending

one’s life • Causes of suicide: mental disorder, personality

abnormalities, family history, physical disorders

• Suicide risk factors:anhedonia, hopeless, male, over 60 years old, adolescents (15-24), living alone, unemployed, prior suicide attempts, family history, substance abusers

• Nursing Management: recognize level of depression, observe behavioral cues, listen to verbalization, provide safe environment, supportive relationships, increase self-esteem, emotional and professional support.

SOMATOFORM DISORDERS • Somatization disorder: Briquet’s syndrome • Various physical complains over several years

usually appear before age 30. • Involves 4 different body functions: 2

gastrointestinal, 1 sexual symptom and 1 neurologic symptoms other than pain.

• Conversion disorder: one or more symptoms or deficits ( numbness or paralysis)

• Characterized by La Belle Indifference (little or no concern about disorder)

• Not intentionally produced – Malingering • Causes distress or impairment in social,

occupational or other important areas of functioning

• Pain disorder: pain is the major complaint for several months

• Pain is usually caused by stress or unconscious conflict.

• Body Dysmorphic Disorder: excessive concern of a perceived defect involving body image.

• Symptoms: compulsive mirror checking or inability to look at one’s reflection or image.

• Excessive grooming behaviors: combing hair, plucking eyebrows, shaving, etc.

• Obssession with plastic surgery. In obscure cases, patient perform surgeries themselves.

• Hypochondriasis: preoccupation of having a serious disease.

• “Doctor-shopping” or ”hospital-hopping” • Doctors reassurance does not calm the fears. • Might have had a serious illness as a child. DISSOCIATIVE DISORDERS • Dissociative disorder is a disruption of the

functions of consciousness, identity, momery or perception of the environment.

• Dissociative Amnesia: lossof memory in regards to important events.

• Classified as: Retrograde ( inability to recall remote past) Anterograde ( inability to recall immediate past)

• Dissociative Fugue: sudden, unexpected travel away from home and unable to recall the past.

• Client is unaware of the travel to another location.

• Dissociative Identity Disorder: formerly known as multiple personality disorder

• A person is domanted by one or two or more personalities which controls one’s behavior.

• Seen in adult women than men. • Depersonalizaton Disorder: strange alteration

in perception or experience of self-esteem with sense of unreality.

• Detachment from oneself, feeling of going crazy or insane.

• Cannot separate reality from fantasy • Feelings of being in a dream-like or movie-like

state, mechanical or bizarre appearance • Nursing management: Present reality, use

grounding techniques, reduce external stimuli, redirect attention away from self, avoid sympathizing with the client, increase socialization activites, provide therapies ( hypnosis, abreaction, cognitive and behavioral therapy). Administer drugs (anxiolytics and anti-depressants).

Notes: _________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________