Chapter 14 Schizophrenia Chapter 16 Personality Disorders
10458-13 UT4-CH13.qxd7/12/0711:18 AMPage 239Chapter 13 Anxiety andStress-Related IllnessChapter 14 SchizophreniaChapter 15 Mood DisordersChapter 16 Personality DisordersChapter 17 Substance AbuseChapter 18 Eating DisordersChapter 19 SomatoformDisordersChapter 20 Child and AdolescentDisordersChapter 21 Cognitive Disorders
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10458-13 UT4-CH13.qxd7/12/0711:18 AMPage 241Key TermsLearning Objectives agoraphobiaAfter reading this chapter, you should be able to anxiety1.Describe anxiety as a response to stress. anxiety disorders2.Describe the levels of anxiety with behavioral changes related to each level.3.Discuss the use of defense mechanisms by people with anxiety disorders.4.Describe the current theories regarding the etiologies of major anxietydisorders.5.Evaluate the effectiveness of treatment including medications for clientswith anxiety disorders.6.Apply the nursing process to the care of clients with anxiety and anxietydisorders.7.Provide teaching to clients, families, caregivers, and communities toincrease understanding of anxiety and stress-related disorders.8.Examine your feelings, beliefs, and attitudes regarding clients with anxietydisorders. assertiveness training automatisms avoidance behavior compulsions decatastrophizing defense mechanisms depersonalization derealization exposure fear flooding mild anxiety moderate anxiety obsessions panic anxiety panic attack panic disorder phobia positive reframing primary gain response prevention secondary gain severe anxiety stress systematic desensitizationVisithttp://thePoint.lww.com forNCLEX-style questions, journal articles, and more!241
10458-13 UT4-CH13.qxd2427/12/0711:18 AMPage 242UNIT 4 NURSING PRACTICE FOR PSYCHIATRIC DISORDERSAnxiety is a vague feeling of dread or apprehension; it isa response to external or internal stimuli that can havebehavioral, emotional, cognitive, and physical symptoms.Anxiety is distinguished from fear, which is feeling afraidor threatened by a clearly identifiable external stimulus thatrepresents danger to the person. Anxiety is unavoidablein life and can serve many positive functions such as motivating the person to take action to solve a problem or toresolve a crisis. It is considered normal when it is appropriate to the situation and dissipates when the situationhas been resolved.Anxiety disorders comprise a group of conditions thatshare a key feature of excessive anxiety with ensuingbehavioral, emotional, cognitive, and physiologic responses.Clients suffering from anxiety disorders can demonstrateunusual behaviors such as panic without reason, unwarranted fear of objects or life conditions, uncontrollablerepetitive actions, re-experiencing of traumatic events, orunexplainable or overwhelming worry. They experiencesignificant distress over time, and the disorder significantly impairs their daily routines, social lives, and occupational functioning.This chapter discusses anxiety as an expected responseto stress. It also explores anxiety disorders, with particular emphasis on panic disorder and obsessive-compulsivedisorder (OCD).ANXIETY AS A RESPONSE TO STRESSStress is the wear and tear that life causes on the body(Selye, 1956). It occurs when a person has difficulty dealingwith life situations, problems, and goals. Each person handles stress differently: One person can thrive in a situationthat creates great distress for another. For example, manypeople view public speaking as scary, but for teachers andactors, it is an everyday, enjoyable experience. Marriage,children, airplanes, snakes, a new job, a new school, andleaving home are examples of stress-causing events.Hans Selye (1956, 1974), an endocrinologist, identifiedthe physiologic aspects of stress, which he labeled thegeneral adaptation syndrome. He used laboratory animalsto assess biologic system changes; the stages of the body’sphysical responses to pain, heat, toxins, and restraint; and,later, the mind’s emotional responses to real or perceivedstressors. He determined three stages of reaction to stress: In the alarm reaction stage, stress stimulates the bodyto send messages from the hypothalamus to the glands(such as the adrenal gland, to send out adrenaline andnorepinephrine for fuel) and organs (such as the liver, toreconvert glycogen stores to glucose for food) to preparefor potential defense needs. In the resistance stage, the digestive system reducesfunction to shunt blood to areas needed for defense. Thelungs take in more air, and the heart beats faster andharder so it can circulate this highly oxygenated andhighly nourished blood to the muscles to defend thebody by fight, flight, or freeze behaviors. If the personadapts to the stress, the body responses relax, and thegland, organ, and systemic responses abate. The exhaustion stage occurs when the person hasresponded negatively to anxiety and stress: body storesare depleted or the emotional components are notresolved, resulting in continual arousal of the physiologic responses and little reserve capacity.Autonomic nervous system responses to fear and anxiety generate the involuntary activities of the body thatare involved in self-preservation. Sympathetic nerve fibers“charge up” the vital signs at any hint of danger to preparethe body’s defenses. The adrenal glands release adrenalin(epinephrine), which causes the body to take in more oxygen, dilate the pupils, and increase arterial pressure andheart rate while constricting the peripheral vessels andshunting blood from the gastrointestinal and reproductivesystems and increasing glycogenolysis to free glucose forfuel for the heart, muscles, and central nervous system.When the danger has passed, parasympathetic nerve fibersreverse this process and return the body to normal operating conditions until the next sign of threat reactivates thesympathetic responses.Anxiety causes uncomfortable cognitive, psychomotor,and physiologic responses such as difficulty with logicalthought, increasingly agitated motor activity, and elevatedvital signs. To reduce these uncomfortable feelings, the person tries to reduce the level of discomfort by implementingnew adaptive behaviors or defense mechanisms. Adaptivebehaviors can be positive and help the person to learn, forThree reactions or stages of stress
10458-13 UT4-CH13.qxd7/12/0711:18 AMPage 243Chapter 13 ANXIETY AND STRESS-RELATED ILLNESSexample, using imagery techniques to refocus attention ona pleasant scene, practicing sequential relaxation of thebody from head to toe, and breathing slowly and steadily toreduce muscle tension and vital signs. Negative responses toanxiety can result in maladaptive behaviors such as tensionheadaches, pain syndromes, and stress-related responsesthat reduce the efficiency of the immune system.People can communicate anxiety to others both verballyand nonverbally. If someone yells “fire,” others aroundthem can become anxious as they picture a fire and the possible threat that represents. Viewing a distraught mothersearching for her lost child in a shopping mall can causeanxiety in others as they imagine the panic she is experiencing. They can convey anxiety nonverbally throughempathy, which is the sense of walking in another person’sshoes for a moment in time (Sullivan, 1952). Examples ofnonverbal empathetic communication are when the familyof a client undergoing surgery can tell from the physician’sbody language that their loved one has died, when thenurse reads a plea for help in a client’s eyes, or when a person feels the tension in a room where two people have beenarguing and are now not speaking to each other.Levels of AnxietyAnxiety has both healthy and harmful aspects depending onits degree and duration as well as on how well the person243copes with it. Anxiety has four levels: mild, moderate,severe, and panic (Table 13.1). Each level causes both physiologic and emotional changes in the person.Mild anxiety is a sensation that something is different andwarrants special attention. Sensory stimulation increases andhelps the person focus attention to learn, solve problems,think, act, feel, and protect himself or herself. Mild anxietyoften motivates people to make changes or to engage in goaldirected activity. For example, it helps students to focus onstudying for an examination.Moderate anxiety is the disturbing feeling that something is definitely wrong; the person becomes nervous oragitated. In moderate anxiety, the person can still processinformation, solve problems, and learn new things withassistance from others. He or she has difficulty concentrating independently but can be redirected to the topic. Forexample, the nurse might be giving preoperative instructions to a client who is anxious about the upcoming surgical procedure. As the nurse is teaching, the client’s attentionwanders but the nurse can regain the client’s attention anddirect him or her back to the task at hand.As the person progresses to severe anxiety and panic,more primitive survival skills take over, defensive responsesensue, and cognitive skills decrease significantly. A person with severe anxiety has trouble thinking and reasoning. Muscles tighten and vital signs increase. The personpaces; is restless, irritable, and angry; or uses other similar emotional-psychomotor means to release tension. Inpanic, the emotional-psychomotor realm predominates withaccompanying fight, flight, or freeze responses. Adrenalinesurge greatly increases vital signs. Pupils enlarge to let inmore light, and the only cognitive process focuses on theperson’s defense.Working With Anxious ClientsPhysiologic responseNurses encounter anxious clients and families in a widevariety of situations such as before surgery and in emergency departments, intensive care units, offices, and clinics.First and foremost, the nurse must assess the person’sanxiety level because that determines what interventionsare likely to be effective.Mild anxiety is an asset to the client and requires no directintervention. People with mild anxiety can learn and solveproblems and are even eager for information. Teaching canbe very effective when the client is mildly anxious.In moderate anxiety, the nurse must be certain that theclient is following what the nurse is saying. The client’sattention can wander, and he or she may have some difficulty concentrating over time. Speaking in short, simple, andeasy-to-understand sentences is effective; the nurse muststop to ensure that the client is still taking in informationcorrectly. The nurse may need to redirect the client back tothe topic if the client goes off on an unrelated tangent.When anxiety becomes severe, the client no longer canpay attention or take in information. The nurse’s goal mustbe to lower the person’s anxiety level to moderate or mild
10458-13 UT4-CH13.qxd2447/12/0711:18 AMPage 244UNIT 4 NURSING PRACTICE FOR PSYCHIATRIC DISORDERSTable 13.1LEVELS OF ANXIETYAnxiety LevelPsychological ResponsesPhysiologic ResponsesMildWide perceptual fieldSharpened sensesIncreased motivationEffective problem solvingIncreased learning abilityIrritabilityRestlessnessFidgetingGI “butterflies”Difficulty sleepingHypersensitivity to noiseModeratePerceptual field narrowed to immediate taskSelectively attentiveCannot connect thoughts or events independentlyIncreased use of automatismsMuscle tensionDiaphoresisPounding pulseHeadacheDry mouthHigh voice pitchFaster rate of speechGI upsetFrequent urinationSeverePerceptual field reduced to one detail or scattered detailsCannot complete tasksCannot solve problems or learn effectivelyBehavior geared toward anxiety relief and is usually ineffectiveDoesn’t respond to redirectionFeels awe, dread, or horrorCriesRitualistic behaviorSevere headacheNausea, vomiting, and diarrheaTremblingRigid stanceVertigoPaleTachycardiaChest painPanicPerceptual field reduced to focus on selfCannot process any environmental stimuliDistorted perceptionsLoss of rational thoughtDoesn’t recognize potential dangerCan’t communicate verballyPossible delusions and hallucinationMay be suicidalMay bolt and runORTotally immobile and muteDilated pupilsIncreased blood pressure and pulseFlight, fight, or freezeLevels of anxietybefore proceeding with anything else. It is also essential toremain with the person because anxiety is likely to worsenif he or she is left alone. Talking to the client in a low, calm,and soothing voice can help. If the person cannot sit still,walking with him or her while talking can be effective.What the nurse talks about matters less than how he orshe says the words. Helping the person to take deep evenbreaths can help lower anxiety.During panic-level anxiety, the person’s safety is theprimary concern. He or she cannot perceive potential harmand may have no capacity for rational thought. The nursemust keep talking to the person in a comforting manner,even though the client cannot process what the nurse issaying. Going to a small, quiet, and nonstimulating environment may help to reduce anxiety. The nurse can reassure the person that this is anxiety, that it will pass, and thathe or she is in a safe place. The nurse should remain withthe client until the panic recedes. Panic-level anxiety is notsustained indefinitely but can last from 5 to 30 minutes.
10458-13 UT4-CH13.qxd7/12/0711:18 AMPage 245Chapter 13 ANXIETY AND STRESS-RELATED ILLNESSWhen working with an anxious person, the nurse mustbe aware of his or her own anxiety level. It is easy for thenurse to become increasingly anxious. Remaining calm andin control is essential if the nurse is going to work effectively with the client.Short-term anxiety can be treated with anxiolytic medications (Table 13.2). Most of these drugs are benzodiazepines, which are commonly prescribed for anxiety.Benzodiazepines have a high potential for abuse and dependence, however, so their use should be short-term, ideallyno longer than 4 to 6 weeks. These drugs are designed torelieve anxiety so that the person can deal more effectivelywith whatever crisis or situation is causing stress. Unfortunately, many people see these drugs as a “cure” for anxietyand continue to use them instead of learning more effectivecoping skills or making needed changes. Chapter 2 containsadditional information about anxiolytic drugs.Overview of Anxiety DisordersAnxiety disorders are diagnosed when anxiety no longerfunctions as a signal of danger or a motivation for neededchange but becomes chronic and permeates major portionsof the person’s life, resulting in maladaptive behaviors andemotional disability. Anxiety disorders have many manifestations, but anxiety is the key feature of each (AmericanPsychiatric Association [APA], 2000). Types of anxiety disorders include the following: Agoraphobia with or without panic disorder Panic disorderTable 13.2245 Specific phobia Social phobia OCD Generalized anxiety disorder (GAD) Acute stress disorder Posttraumatic stress disorderPanic disorder and OCD are the most common and arethe focus of this chapter. Posttraumatic stress disorder isaddressed in Chapter 11.INCIDENCEAnxiety disorders have the highest prevalence rates ofall mental disorders in the United States. Nearly one infour adults in the United States is affected, and the magnitude of anxiety disorders in young people is similar(Merikangas, 2005). Anxiety disorders are more prevalent in women, people younger than age 45 years, peoplewho are divorced or separated, and people of lower socioeconomic status. The exception is OCD, which is equallyprevalent in men and women but is more common amongboys than girls.ONSET AND CLINICAL COURSEThe onset and clinical course of anxiety disorders areextremely variable depending on the specific disorder.These aspects are discussed later in this chapter withinthe context of each disorder.ANXIOLYTIC DRUGSGeneric (Trade) NameSpeed of OnsetSide EffectsNursing ImplicationsBenzodiazepinesDiazepam (Valium)Chlorazepate (Tranxene)Alprazolam (Xanax)Chlordiazepoxide (Librium)Clonazepam (Klonopin)Very ess, clumsiness, sedation, headache, fatigue,sexual dysfunction, blurredvision, dry throat andmouth, constipation, highpotential for abuse anddependenceAvoid other CNS depressants such asantihistamines and alcohol.Avoid caffeine.Take care with potentially hazardousactivities such as driving.Rise slowly from lying or sitting position.Use sugar-free beverages or hard candy.Drink adequate fluids.Take only as prescribed.Do not stop taking the drug abruptly.Dizziness, restlessness, agitation, drowsiness, headache,weakness, nausea, vomiting, paradoxical excitementor euphoriaRise slowly from sitting position.Take care with potentially hazardousactivities such as driving.Take with food.Report persistent restlessness, agitation,excitement, or euphoria to physician.Lorazepam (Ativan)Oxazepam (Serax)NonbenzodiazepinesBuspirone (BuSpar)Meprobamate(Miltown, Equanil)Moderately slowModerately slowVery slowRapid
10458-13 UT4-CH13.qxd7/12/0711:18 AMPage 246DSM-IV-TR DIAGNOSTIC CRITERIA: SYMPTOMS OF ANXIETY DISORDERSDisorderSymptomsAgoraphobia is anxiety about or avoidance of placesor situations from which escape might be difficultor help might be unavailable.Avoids being outside alone or at home alone; avoids traveling invehicles; impaired ability to work; difficulty meeting daily responsibilities (e.g., grocery shopping, going to appointments); knowsresponse is extremeA discrete episode of panic lasting 15 to 30 minutes with four ormore of the following: palpitations, sweating, trembling or shaking, shortness of breath, choking or smothering sensation, chestpain or discomfort, nausea, derealization or depersonalization,fear of dying or going crazy, paresthesias, chills or hot flashesMarked anxiety response to the object or situation; avoidance orsuffered endurance of object or situation; significant distress orimpairment of daily routine, occupation, or social functioning;adolescents and adults recognize their fear as excessive orunreasonable.Fear of embarrassment or inability to perform; avoidance or dreadedendurance of behavior or situation; recognition that response isirrational or excessive; belief that others are judging him or hernegatively; significant distress or impairment in relationships,work, or social life; anxiety can be severe or panic level.Recurrent, persistent, unwanted, intrusive thoughts, impulses, orimages beyond worrying about realistic life problems; attemptsto ignore, suppress, or neutralize obsessions with compulsionsthat are mostly ineffective; adults and adolescents recognize thatobsessions and compulsions are excessive and unreasonable.Apprehensive expectations more days than not for 6 months ormore about several events or activities; uncontrollable worrying;significant distress or impaired social or occupational functioning;three of the following symptoms: restlessness, easily fatigued,difficulty concentrating or mind going blank, irritability, muscletension, sleep disturbanceExposure to traumatic event causing intense fear, helplessness, orhorror; marked anxiety symptoms or increased arousal; significant distress or impaired functioning; persistent re-experiencingof the event; three of the following symptoms: sense of emotional numbing or detachment, feeling dazed, derealization,depersonalization, dissociative amnesia (inability to recall important aspect of the event)Exposure to traumatic event involving intense fear, helplessness orhorror; re-experiencing (intrusive recollections or dreams, flashbacks, physical and psychological distress over reminders of theevent); avoidance of memory-provoking stimuli and numbing ofgeneral responsiveness (avoidance of thoughts, feelings, conversations, people, places, amnesia, diminished interest or participation in life events, feeling detached or estranged from others,restricted affect, sense of foreboding); increased arousal (sleepdisturbance, irritability or angry outbursts, difficulty concentrating, hypervigilance, exaggerated startle response); significantdistress or impairmentPanic disorder is characterized by recurrent,unexpected panic attacks that cause constantconcern. Panic attack is the sudden onset ofintense apprehension, fearfulness, or terrorassociated with feelings of impending doom.Specific phobia is characterized by significant anxiety provoked by a specific feared object or situation, which often leads to avoidance behavior.Social phobia is characterized by anxiety provokedby certain types of social or performance situations,which often leads to avoidance behavior.Obsessive-compulsive disorder involves obsessions(thoughts, impulses, or images) that cause markedanxiety and/or compulsions (repetitive behaviors ormental acts) that attempt to neutralize anxiety.Generalized anxiety disorder is characterized by atleast 6 months of persistent and excessive worryand anxiety.Acute stress disorder is the development of anxiety,dissociation, and other symptoms within 1 monthof exposure to an extremely traumatic stressor; itlasts 2 days to 4 weeks.Posttraumatic stress disorder is characterized bythe re-experiencing of an extremely traumaticevent, avoidance of stimuli associated with theevent, numbing of responsiveness, and persistentincreased arousal; it begins within 3 months toyears after the event and may last a few monthsor years.Adapted from American Psychiatric Association. (2000). DSM-IV-TR: Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington DC:Author.
10458-13 UT4-CH13.qxd7/12/0711:18 AMPage 247Chapter 13 ANXIETY AND STRESS-RELATED ILLNESSNursing Care Plan247Anxious BehaviorNursing DiagnosisAnxiety: Vague uneasy feeling of discomfort or dread accompanied by an autonomic response (the source oftennonspecific or unknown to the individual); a feeling of apprehension caused by anticipation of danger. It is an alertingsignal that warns of impending danger and enables the individual to take measures to deal with the threat.ASSESSMENT DATAEXPECTED OUTCOMES ImmediateThe client will Be free from injury Discuss feelings of dread, anxiety, and so forth Respond to relaxation techniques with a decreasedanxiety levelDecreased attention spanRestlessness, irritabilityPoor impulse controlFeelings of discomfort, apprehension, orhelplessness Hyperactivity, pacing Wringing hands Perceptual field deficits Decreased ability to communicate verballyIn addition, in panic anxiety Inability to discriminate harmful stimuli orsituations Disorganized thought processes DelusionsStabilizationThe client will Demonstrate the ability to perform relaxationtechniques Reduce own anxiety levelCommunityThe client will Be free from anxiety attacks Manage the anxiety response to stress effectivelyIMPLEMENTATIONNursing Interventions *denotes collaborativeinterventionsRationaleRemain with the client at all times when levels of anxietyare high (severe or panic).The client’s safety is a priority. A highly anxiousclient should not be left alone—his or her anxietywill escalate.Anxious behavior can be escalated by externalstimuli. In a large area, the client can feel lost andpanicked, but a smaller room can enhance a senseof security.The client will feel more secure if you are calm and ifthe client feels you are in control of the situation.The client’s ability to deal with abstractions orcomplexity is impaired.The client may not make sound decisions or may beunable to make decisions or solve problems.Medication may be necessary to decrease anxiety to alevel at which the client can feel safe.Move the client to a quiet area with minimal ordecreased stimuli such as a small room or seclusionarea.Remain calm in your approach to the client.Use short, simple, and clear statements.Avoid asking or forcing the client to make choices.PRN medications may be indicated for high levelsof anxiety, delusions, disorganized thoughts, andso forth.Be aware of your own feelings and level of discomfort.Anxiety is communicated interpersonally. Beingwith an anxious client can raise your own anxietylevel.continued
10458-13 UT4-CH13.qxd2487/12/0711:18 AMPage 248UNIT 4 NURSING PRACTICE FOR PSYCHIATRIC DISORDERSNursing Care Plan: Anxious Behavior, cont.IMPLEMENTATIONNursing Interventions *denotes collaborativeinterventionsRationaleEncourage the client’s participation in relaxationexercises such as deep breathing, progressive musclerelaxation, meditation, and imagining being in aquiet, peaceful place.Teach the client to use relaxation techniquesindependently.Help the client see that mild anxiety can be a positivecatalyst for change and does not need to be avoided.Relaxation exercises are effective, nonchemical ways toreduce anxiety.Using relaxation techniques can give the client confidence in having control over anxiety.The client may feel that all anxiety is bad and not useful.Adapted from Schultz, J. M., & Videbeck, S. L. (2005). Lippincott’s manual of psychiatric care plans (7th ed.). Philadelphia: Lippincott Williams &Wilkins.RELATED DISORDERSAnxiety disorder due to a general medical condition is diagnosed when the prominent symptoms of anxiety are judgedto result directly from a physiologic condition. The personmay have panic attacks, generalized anxiety, or obsessionsor compulsions. Medical conditions causing this disordercan include endocrine dysfunction, chronic obstructivepulmonary disease, congestive heart failure, and neurologic conditions.Substance-induced anxiety disorder is anxiety directlycaused by drug abuse, a medication, or exposure to a toxin.Symptoms include prominent anxiety, panic attacks, phobias, obsessions, or compulsions.Separation anxiety disorder is excessive anxiety concerning separation from home or from persons, parents,or caregivers to whom the client is attached. It occurswhen it is no longer developmentally appropriate andbefore 18 years of age.Adjustment disorder is an emotional response to a stressful event, such as one involving financial issues, medicalillness, or a relationship problem, that results in clinicallysignificant symptoms such as marked distress or impairedfunctioning.ETIOLOGYBiologic TheoriesGENETIC THEORIESAnxiety may have an inherited component because firstdegree relatives of clients with increased anxiety have higherrates of developing anxiety. Heritability refers to the proportion of a disorder that can be attributed to genetic factors: High heritabilities are greater than 0.6 and indicate thatgenetic influences dominate. Moderate heritabilities are 0.3 to 0.5 and suggest aneven greater influence of genetic and nongenetic factors. Heritabilities less than 0.3 mean that genetics are negligible as a primary cause of the disorder.Panic disorder and social and specific phobias, including agoraphobia, have moderate heritability. GAD and OCDtend to be more common in families, indicating a stronggenetic component, but still require further in-depth study(McMahon & Kassem, 2005). At this point, current researchindicates a clear genetic susceptibility to or vulnerability foranxiety disorders; however, additional factors are necessaryfor these disorders to actually develop.NEUROCHEMICAL THEORIESGamma-aminobutyric acid (γ-aminobutyric acid; GABA)is the amino acid neurotransmitter believed to be dysfunctional in anxiety disorders. GABA, an inhibitory neurotransmitter, functions as the body’s natural antianxietyagent by reducing cell excitability, thus decreasing therate of neuronal firing. It is available in one third of thenerve synapses, especially those in the limbic system andin the locus ceruleus, the area where the neurotransmitternorepinephrine, which excites cellular function, is produced. Because GABA reduces anxiety and norepinephrine increases it, researchers believe that a problem withthe regulation of these neurotransmitters occurs in anxiety disorders.Serotonin, the indolamine neurotransmitter usuallyimplicated in psychosis and mood disorders, has manysubtypes. 5-Hydroxytryptamine type 1a plays a role inanxiety, and it also affects aggression and mood. Serotoninis believed to play a distinct role in OCD, panic disorder,and GAD. An excess of norepinephrine is suspected inpanic disorder, GAD, and posttraumatic stress disorder(Neumeister et al., 2005).
10458-13 UT4-CH13.qxd7/12/0711:18 AMPage 249Chapter 13 ANXIETY AND STRESS-RELATED ILLNESSPsychodynamic TheoriesINTRAPSYCHIC/PSYCHOANALYTIC THEORIESFreud (1936) saw a person’s innate anxiety as the stimulusfor behavior. He described defense mechanisms as thehuman’s attempt to control awareness of and to reduceanxiety (see Chapter 3). Defense mechanisms are cognitive distortions that a person uses unconsciously to maintain a sense of being in control of a situation, to lessendiscomfort, and to deal with stress. Because defense mechanisms arise from the unconscious, the person is unawareof using them. Some people overuse defense mechanisms,which stops them from learning a variety of appropriatemethods to resolve anxiety-producing situations. The dependence on one or two defense mechanisms also can inhibitemotional growth, lead to poor problem-solving skills, andcreate difficulty with relationships.INTERPERSONAL THEORYHarry Stack Sullivan (1952) viewed anxiety as being generated from problems in interpersonal relationships. Caregivers can communicate anxiety to infants or childrenthrough inadequate nurturing, agitation when holding orhandling the child, and distorted messages. Such communicated anxiety can result in dysfunction such as failureto achieve age-appropriate developmental tasks. In adults,anxiety arises from the person’s need to conform to thenorms and values of his or her cultural group. The higherthe level of anxiety, the lower the ability to communicateand to solve problems and the greater chance for anxietydisorders to develop.Hildegard Peplau (1952) understood that humans existin interpersonal and physiologic realms; thus, the nursecan bette
Chapter 13 Anxiety and Stress-Related Illness Chapter 14 Schizophrenia Chapter 15 Mood Disorders Chapter 16 Personality Disorders Chapter 17 Substance Abuse Chapter 18 Eating Disorders Chapter 19 Somatoform Disorders Chapter 20 Child and Adolescent Disorders Chapter 21 Cognitive Disorders 10458-13_UT4-CH13.qxd 7/12/07 11:18 AM Page 239
Langfeldt stressed several factors: insidious onset, feelings of derealization and depersonalization, autism, and emotional blunting. Researchers after Langfeldt gave true schizophrenia other names: nuclear schizophrenia, process schizophrenia, and nonremitting schizophrenia. Schneider de
Schizophrenia in Children and Adolescents Background: Pediatric schizophrenia is divided into two basic categories according to age of onset. When onset occurs before the age of 13, it is referred to as very-early-onset schizophrenia (VEOS). Depending on the source, VEOS may also be referred to as Childhood-Onset Schizophrenia, or COS;
Describe the disabling psychiatric disorders associated with schizophrenia. 2. Identify the incidence and prevalence of schizophrenia. 3. List the various causes linked to schizophrenia. 4. Discuss the signs and symptoms of schizophrenia. 5. Differentiate between the positive and negative symptoms of schizophrenia. 6. Illustrate the phases of .
Schizophrenia is one of the top leading causes of disability in the United States and roughly 3.5 million people in America are diagnosed with schizophrenia (Schizophrenia and Related Disorders Alliance of America, n. d.). Approximately 25% of patients with schizophrenia reached full remission, roughly 50% of schizophrenic patients show improvement
Chapter 6 Relapse prevention in patients with schizophrenia: The development of a nursing intervention protocol 99 Chapter 7 Relapse prevention in patients with schizophrenia: . the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations are also present for at least a month (or less if . CHAPTER 1 - 16 - .
chapter, (check local phone book), or the Schizophrenia Society of Canada 1-888-772-4673. The Schizophrenia Society of Canada is interested in hearing from you. If you find this resource useful, or if you have suggestions or questions, please let us know. Email messages can be sent to info@schizophrenia.ca, or phone 1-888-772-4673.
schizophrenia has very high diagnostic stability, with 80–90% of in-dividuals receiving an initial diagnosis of schizophrenia retaining that diagnosis at 1–10 years (Haahr et al., 2008; Bromet et al., 2011). Therefore, the core of the DSM-IV diagnostic criteria for schizophrenia will be retained in DSM-5, with modest changes pro-
Schizophrenia is a chronic, debilitating, serious mental illness (SMI) that affects approximately 0.3 to 0.7% of the global population. Patients with schizophrenia have a significant decline in life expectancy. In a comparison of 220 unique dis-ease conditions, acute schizophrenia was shown to impose the highest degree of
