焦虑患者的管理

焦虑患者的管理“全民焦虑时代”来了？

Whatisanxiety？焦虑是人们遇到某些事情、挑战、困难或危险时出现的一种指向未来的情绪反应。正常焦虑：一般情况有明确诱因，适度的焦虑，属于正常焦虑。病态焦虑：指不适当的焦虑表现，多没有明确的致焦虑因素，或有明确致焦虑因素，但反应程度、持续时间与致焦虑因素不相称，是“非同寻常”的一类焦虑反应。

焦虑正常焦虑异常焦虑持续时间短程度较浅焦虑原因解除或因其他活动影响焦虑可减轻或消除持续时间长程度较重焦虑原因解除或因其他活动影响，焦虑不减轻，或虑减轻之后又复发，难以消除

两者之间可以是一个连续过程，没有绝对的界限

焦虑与恐惧的区别焦虑指向未来，恐惧指向现在。大多数情况下，这种说法是对的。但这是一个充分不必要条件焦虑和恐惧的区别在于强度，焦虑比较轻，恐惧比较强烈.焦虑是个人内在意思的感觉，是一种不愉快的情绪体检，所担心的事情可能不确定；恐惧是一种认知过程，有具体的外在刺激，所表现的是对现实的客观威胁的一种情绪反应，且这种情绪情绪反应与现实威胁适应，理智的估计，并随着威胁的消失而消失。焦虑和恐惧的区别不在于对象、时态和强度，而在方向。焦虑是“趋”，恐惧是“避”。焦虑的原因应激因素-压力是导致焦虑最主要的原因失业的压力失恋的压力失学的压力晋升的压力人际关系的压力发财的压力健康的压力环境的压力…焦虑的原因焦虑的素质因素童年经历态度悲观归因乐观归因人格坚韧幽默焦虑分类ThreecategoriesnormalacutechronicFourlevels

mildmoderateseverepanicDefensesAgainstAnxiety

MosthealthydefensesIntermediatedefensesImmaturedefensesAltruism利他主义Sublimation升华作用

HumorSuppression压制Repression压抑cornerstonedefensemechanismDisplacementReactionformation反作用形成

Somatization躯体化Undoing抵消RationalizationPassiveaggressionActing-outbehavior潜意显现行为Dissociation分裂Devaluation贬低

IdealizationSplitting隔离ProjectionDenial轻度的焦虑有益于人的思维发散对人是一种激励过度的焦虑便会演化为焦虑症，从而给人带来影响和伤害焦虑症是以广泛性焦虑症和发作性惊恐状态为主要临床表现，常伴有头晕、胸闷、心悸、呼吸困难、口干、尿急、尿频，震颤和运动性不安等症，其焦虑并非由实际威胁所引起，或其紧张惊恐度与现实情况很不相称病因遗传因素大量研究表明焦虑障碍倾向家庭聚集神经化学因素去甲肾上腺素理论，GABA理论,乳酸心理学理论行为理论认为焦虑是学习而得的反应；认知行为理论认为惊恐发作是不正常的一种害怕Freud心理分析理论认为焦虑与早期发展有关，惊恐障碍是由于对潜意识冲突不成功防御的结果Sullivan焦虑的传递学说文化因素躯体症状vs认知症状Anxietyprevalence

InUnitedStates,13.3%adultpopulation，majorinwomen$22billionperyear90%peoplewithanxietydevelopanotherpsychiatricdisorderDepressionandsubstanceabusehavenegativeimpactontreatmentAnxietyDisordersPanicdisorder惊恐性障碍Phobias恐怖症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过敏，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强迫意念Compulsions强迫行为“Everythingmustbeinitsplace”

istherecurrentthought.Manrepeatedlyhasthethought“Ishouldkillher”whenheseesablondewoman

ThefeaturesofPTSDReexperiencingofthetraumathroughintrusiverecollectionsoftheeventsthroughdreamsandthroughflashbacksAvoidanceofstimuliwiththetraumaAfterthetrauma,experienceofnumbinggeneralresponsiveness,feelingestrangedfromothersAfterthetrauma,experienceofpersistencesymptomsofincreasedarousal.difficultysleeping,hypervigilance

AcutestressdisorderSymptomsafter1monthafterthehighlytraumaticeventSubjectivesenseofnumbing,detachment,orabsenceofemotionalresponsivenessAreductioninawarenessofsurroundingsDerealization现实感丧失Depersonalization人格解体，人性丧失Dissociativeamnesia健忘症Diagnosismusthaveatleastthreedissociativesymptoms,resolveswithin4weeksSubstance-inducedanxietydisorderischaracterizedbysymptomsofanxiety,panicattacks,obsessions,andcompulsionsthatdevelopwiththeuseofasubstanceorwithinamonthofstoppinguseofthesubstanceThesymptomsofAnxietyduetomedicalconditionsareadirectphysiologicalresultofamedicalcondition，suchashyperthyroidism甲亢AnxietydisordernototherwisespecifiedisadiagnosisusedfordisordersinwhichanxietyorphobicavoidancepredominatesbutthesymptomsdonotmeetfulldiagnosticcriteriaforaspecificanxietydisorderAssessmentDiagnosesOutcomecriteriaPlanningInterventionEvaluationApplicationOfTheNursing

ProcessOverallsymptomsofanxietyDefensesusedinanxietydisordersSelf-assessmentOCDclientscannotaccomplishtaskswithagiventimeandcommunicateeffectiveBehavioralchangeofphobicclientsisoftenaccomplishedslowlyNursesexperiencesincreasedtensionandfatiguefrommentalstrainwhenworkingwithanxietyclientsNoteculture心理量表在焦虑评定中的应用

焦虑自评量表（SAS）由Zung于1971年编制汉密顿焦虑量表（HAMA）由Hamilton于1959年编制测验焦虑量表（TAI）由美国佛罗里达州大学的著名临床心理学家施皮尔伯格于1980年编制完成，是目前国际上最有效且应用最广泛的考试焦虑量表。显性焦虑量表（MAS）贝克焦虑量表（BAI）由美国阿隆贝克（AaronT.Beck）等于1985年编制综合性医院焦虑抑郁量表（HAD）由Zigmondas与SnaithRP于1983年创制交往焦虑量表(IAS)：社交回避及苦恼量表(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