焦慮患者的管理

焦慮患者的管理“全民焦慮時代”來了？

Whatisanxiety？焦慮是人們遇到某些事情、挑戰(zhàn)、困難或危險時出現(xiàn)的一種指向未來的情緒反應(yīng)。正常焦慮：一般情況有明確誘因，適度的焦慮，屬于正常焦慮。病態(tài)焦慮：指不適當(dāng)?shù)慕箲]表現(xiàn)，多沒有明確的致焦慮因素，或有明確致焦慮因素，但反應(yīng)程度、持續(xù)時間與致焦慮因素不相稱，是“非同尋常”的一類焦慮反應(yīng)。

焦慮正常焦慮異常焦慮持續(xù)時間短程度較淺焦慮原因解除或因其他活動影響焦慮可減輕或消除持續(xù)時間長程度較重焦慮原因解除或因其他活動影響，焦慮不減輕，或慮減輕之后又復(fù)發(fā)，難以消除

兩者之間可以是一個連續(xù)過程，沒有絕對的界限

焦慮與恐懼的區(qū)別焦慮指向未來，恐懼指向現(xiàn)在。大多數(shù)情況下，這種說法是對的。但這是一個充分不必要條件焦慮和恐懼的區(qū)別在于強(qiáng)度，焦慮比較輕，恐懼比較強(qiáng)烈.焦慮是個人內(nèi)在意思的感覺，是一種不愉快的情緒體檢，所擔(dān)心的事情可能不確定；恐懼是一種認(rèn)知過程，有具體的外在刺激，所表現(xiàn)的是對現(xiàn)實(shí)的客觀威脅的一種情緒反應(yīng)，且這種情緒情緒反應(yīng)與現(xiàn)實(shí)威脅適應(yīng)，理智的估計，并隨著威脅的消失而消失。焦慮和恐懼的區(qū)別不在于對象、時態(tài)和強(qiáng)度，而在方向。焦慮是“趨”，恐懼是“避”。焦慮的原因應(yīng)激因素-壓力是導(dǎo)致焦慮最主要的原因失業(yè)的壓力失戀的壓力失學(xué)的壓力晉升的壓力人際關(guān)系的壓力發(fā)財?shù)膲毫】档膲毫Νh(huán)境的壓力…焦慮的原因焦慮的素質(zhì)因素童年經(jīng)歷態(tài)度悲觀歸因樂觀歸因人格堅韌幽默焦慮分類ThreecategoriesnormalacutechronicFourlevels

mildmoderateseverepanicDefensesAgainstAnxiety

MosthealthydefensesIntermediatedefensesImmaturedefensesAltruism利他主義Sublimation升華作用

HumorSuppression壓制Repression壓抑cornerstonedefensemechanismDisplacementReactionformation反作用形成

Somatization軀體化Undoing抵消RationalizationPassiveaggressionActing-outbehavior潛意顯現(xiàn)行為Dissociation分裂Devaluation貶低

IdealizationSplitting隔離ProjectionDenial輕度的焦慮有益于人的思維發(fā)散對人是一種激勵過度的焦慮便會演化為焦慮癥，從而給人帶來影響和傷害焦慮癥是以廣泛性焦慮癥和發(fā)作性驚恐狀態(tài)為主要臨床表現(xiàn)，常伴有頭暈、胸悶、心悸、呼吸困難、口干、尿急、尿頻，震顫和運(yùn)動性不安等癥，其焦慮并非由實(shí)際威脅所引起，或其緊張驚恐度與現(xiàn)實(shí)情況很不相稱病因遺傳因素大量研究表明焦慮障礙傾向家庭聚集神經(jīng)化學(xué)因素去甲腎上腺素理論，GABA理論,乳酸心理學(xué)理論行為理論認(rèn)為焦慮是學(xué)習(xí)而得的反應(yīng)；認(rèn)知行為理論認(rèn)為驚恐發(fā)作是不正常的一種害怕Freud心理分析理論認(rèn)為焦慮與早期發(fā)展有關(guān)，驚恐障礙是由于對潛意識沖突不成功防御的結(jié)果Sullivan焦慮的傳遞學(xué)說文化因素軀體癥狀vs認(rèn)知癥狀A(yù)nxietyprevalence

InUnitedStates,13.3%adultpopulation，majorinwomen$22billionperyear90%peoplewithanxietydevelopanotherpsychiatricdisorderDepressionandsubstanceabusehavenegativeimpactontreatmentAnxietyDisordersPanicdisorder驚恐性障礙Phobias恐怖癥Generalizedanxietydisorder(GAD)Obsessive-compulsivedisorder(OCD)Posttraumaticstressdisorder(PTSD)AcutestressdisorderAnxietyduetosubstanceAnxietyduetomedicalconditionsAnxietynototherwisespecified

PanicdisorderwithoutagoraphobiaSimpleagoraphobiaPanicdisorderwithagoraphobiaJimisa28-year-oldmanwhosuffersfrompanicattackswithagoraphobia.Heoncelivedaveryactivelife,oftenparticipatinginthrill-seekingactivitieslikebungeejumpingandskydiving.Jim’sfather,whohadseverecardiovasculardisease,died2yearspreviouslyonhiswaytowork.Sincethattime,Jimhasbecomeincreasinglyfearfuloftheoutdoors.Hehasgraduallystoppedleavingthefamilyhomebecauseheexperiencespanicattacks;hefearsthathewilldieifheleaveshome.SpecificphobiasAlcoholordrugsSocialphobiasTim,a22-year-oldmusictheatermajor,developafearofperformingonstage.Hesufferssevereanxietyattackswheneverheisscheduledtoappearinastudentproduction.Recently,hehasbecomeseverelyanxiouswhenheisfacedwithgivingclassroomreadingorsingingsoloinmusicclass.Heisthinkingaboutchanginghismajor.SymptomsRestlessnessFatiguePoorconcentrationTensionIrritability過敏，易怒SleepdisturbanceBackgroundGADhighprevalenceratesomaticcomplain,workplaceabsenteeismCBT(cognitive-behavioraltherapy)inthetreatmentofGADSubjectivestudies16experiments,2/3clientswerewomen,mean40years,mean7yearsdurationGAD,meantimeoftreatment11sessionsInterventionteachesclientsself-monitoringandobservetheiranxietytriggers,relaxationtraining,cognitivetherapy,rehearsalofcopingresponsesControllow-dosediazepamtherapy,placebo,supportivelistening,andnottreatmentResults6-monthand12-monthfollow-upCBTgroupsimprovedsignificantlybystandardizedanxietyquestionnairesImplicationsfornursingpracticeteachclientswithGAD,referclientstoappropriateresourcesinthecommunity,relaxationexercisesStudies

Obsessions強(qiáng)迫意念Compulsions強(qiáng)迫行為“Everythingmustbeinitsplace”

istherecurrentthought.Manrepeatedlyhasthethought“Ishouldkillher”whenheseesablondewoman

ThefeaturesofPTSDReexperiencingofthetraumathroughintrusiverecollectionsoftheeventsthroughdreamsandthroughflashbacksAvoidanceofstimuliwiththetraumaAfterthetrauma,experienceofnumbinggeneralresponsiveness,feelingestrangedfromothersAfterthetrauma,experienceofpersistencesymptomsofincreasedarousal.difficultysleeping,hypervigilance

AcutestressdisorderSymptomsafter1monthafterthehighlytraumaticeventSubjectivesenseofnumbing,detachment,orabsenceofemotionalresponsivenessAreductioninawarenessofsurroundingsDerealization現(xiàn)實(shí)感喪失Depersonalization人格解體，人性喪失Dissociativeamnesia健忘癥Diagnosismusthaveatleastthreedissociativesymptoms,resolveswithin4weeksSubstance-inducedanxietydisorderischaracterizedbysymptomsofanxiety,panicattacks,obsessions,andcompulsionsthatdevelopwiththeuseofasubstanceorwithinamonthofstoppinguseofthesubstanceThesymptomsofAnxietyduetomedicalconditionsareadirectphysiologicalresultofamedicalcondition，suchashyperthyroidism甲亢AnxietydisordernototherwisespecifiedisadiagnosisusedfordisordersinwhichanxietyorphobicavoidancepredominatesbutthesymptomsdonotmeetfulldiagnosticcriteriaforaspecificanxietydisorderAssessmentDiagnosesOutcomecriteriaPlanningInterventionEvaluationApplicationOfTheNursing

ProcessOverallsymptomsofanxietyDefensesusedinanxietydisordersSelf-assessmentOCDclientscannotaccomplishtaskswithagiventimeandcommunicateeffectiveBehavioralchangeofphobicclientsisoftenaccomplishedslowlyNursesexperiencesincreasedtensionandfatiguefrommentalstrainwhenworkingwithanxietyclientsNoteculture心理量表在焦慮評定中的應(yīng)用

焦慮自評量表（SAS）由Zung于1971年編制漢密頓焦慮量表（HAMA）由Hamilton于1959年編制測驗(yàn)焦慮量表（TAI）由美國佛羅里達(dá)州大學(xué)的著名臨床心理學(xué)家施皮爾伯格于1980年編制完成，是目前國際上最有效且應(yīng)用最廣泛的考試焦慮量表。顯性焦慮量表（MAS）貝克焦慮量表（BAI）由美國阿隆貝克（AaronT.Beck）等于1985年編制綜合性醫(yī)院焦慮抑郁量表（HAD）由Zigmondas與SnaithRP于1983年創(chuàng)制交往焦慮量表(IAS)：社交回避及苦惱量表(SAD)Anxiety(moderate,severe,panic)FearIneffectivecopingSocialisolationDisturbedthoughtprocessesPosttraumasyndromeDisturbedsleeppatternFatigueHopelessnessChroniclowself-esteemImpairedskinintegrityImbalancednutrition:less(more)thanbodyrequirementsself-caredeficitSpiritualdistressIneffectiveroleperformanceSomeoftheNOC-recommendedoutcomes

relatedtoanxietyincludethefollowing:Anxietyself-control:personalactionstoeliminateorreducefeelingsofapprehension,tension,oruneasinessfromanunidentifiablesourceCoping:personalactionstomanagestressorsthattaxanindividual’sresourceSelf-Esteem:personaljudgmentofself-worthKnowledge:diseaseprocess:extentofunderstandingconveyedaboutaspecificdiseaseprocess