ASDN 253 Mental Health Nursing

Anxiety, Somatoform, & Dissociative Disorders

Anxiety Disorders

Core concept: “1– frequent experience of anxiety, worry and apprehension that is more intense and lasts for a longer time than for that of an average person in everyday life, 2– frequent development of avoidance, ritual acts, or repetitive thoughts as a means of protecting the sufferer from experiencing the anxiety”

Physiologic response to stress – autonomic & sympathetic systems charge

the body for “fight or flight” - ^pulse, ^BP, ^O2 intake, decreased digestion

parasympathetic system reverses

Bronchioles dilate, HR increases, eyes dilate, GI tract slows, diaphoresis

Levels of Anxiety (Table 13-1, p 271)

Mild – sharpens senses

Moderate – short sentences

Severe – stay with patient

Panic – keep talking, maintain calm manner, reduce stimulation,

assure patient that he is safe

Panic Disorder – episodes of spontaneous panic (s stimulus)

Panic Attacks can last 15-30 minutes

Phobias

Agoraphobia

Specific Phobias

Social Phobia

PTSD – 3 symptom clusters, occurs 3 months or more p incident

1. Reliving event – memories, dreams, flashbacks, reactions to triggers

2. Avoiding reminders –

3. Hyper-vigilance (hyper-arousal) – insomnia, irritability

Acute Stress Disorder is same but within first month p incident

OCD – Obsessions (thoughts) and Compulsions (repetitive acts)

Subconscious coping mechanism to reduce anxiety

Generalized Anxiety Disorder – chronic excessive worry

Etiology: genetic link possible, neurochemical imbalances, psychosocial

Treatment/Therapy: combination of meds & psychotherapy

Meds – anxiolytics (esp. benzodiazepines & Buspar),

antidepressants, antihypertensives (Table 13-4, p 277)

Psychotherapy – cognitive restructuring techniques

“positive reframing”, “decatastrophizing” (thought

stopping and distraction techniques), “assertiveness training”, “desensitization” (gradual confrontation with phobia, flooding)

Nursing Interventions:

Panic & Phobias (Care Plan on p 273) -

Stay with patient, decrease stimulation (quiet area), remain calm, short & simple statements, don’t ask for decisions, relaxation techniques, prn meds

OCD (p 289) –

Give encouragement, expose & discuss feelings that cause anxiety, don’t interrupt ritual, gradually reduce time allowed for ritual, relaxation techniques

Somatoform Disorders

Core concept: “1- persistent or recurring c/o physical symptoms that are not supported by actual physical findings, 2- persistent worry about having an illness that is not supported by actual physical findings, 3- exaggerated concern about minor or imagined defects in an otherwise normal appearing person.”

Conversion Reaction – sudden unexplained sensory or motor deficits, ie.

blindness, paralysis

Somatization – over period of several years, beginning before age 30, has

multiple physical complaints that are not medically supported, and are not intentionally produced. Must include pain in multiple sites, and include non-pain symptoms that are gastrointestinal, sexual, and pseudoneurologic.

Hypochondriasis – persistent fear of having or getting a serious illness

May be due to misinterpretation of body signals

Dysmorphic Disorder – preoccupation with an imagined defect or

overconcern about a minor body anomaly

Etiology: internalization of stress and feelings

Treatment/Therapy: Medication (antidepressants) & group therapy

Nursing Interventions:

Healthy lifestyle teaching, allow to express feelings, improve coping

skills, limit primary and secondary gains

Do not assume all complaints have no medical basis

Factitious Disorders – fake symptoms or self-inflict injury in order to gain

attention (Munchausen’s Syndrome), or inflict injury on another in order to “save” them (Munchausen’s by proxy)

Dissociative Disorders –

Core concept: “ temporary disruption in the normally integrated functions of memory, identity, or consciousness, leading to amnesia, feelings of depersonalization, or multiple personalities in the same individual”

Response to physical or emotional trauma, can occur during or p incident

Amnesia – can’t remember personal info, confusion, disorientation

Fugue – may leave town, new identity – no confusion or

disorientation

Identity Disorder (DID) - Multiple Personality

usually results from severe childhood emotional trauma

Depersonalization (Out of Body)

Treatment/Therapy: Group & Individual Psychotherapy, Meds

(antidepressants, anxiolytics)

Nursing Interventions:

Promote safety (suicide precautions), do not force movement

during dissociative or flashback experience, promote relaxation techniques, promote self-esteem (Summary Box, p 228)