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Mental Health Matters: Recognizing and Supporting Clients with Anxiety

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Mental Health Matters: Recognizing and Supporting Clients with Anxiety Mental Health Matters: Recognizing and CSM: February 7, 2015 Supporting Clients with Anxiety Presenters Margaret Danilovich, PT, DPT, GCS Clincal Instructor, Northwestern University, Chicago, IL. Mental Health Matters: Recognizing and Supporting Clients with Anxiety Heather Feldner, PT, MPT, PCS Clinical Instructor, University of Illinois at Combined Section Meeting 2015 Chicago, Chicago, IL. February 4th-7th, 2015 Anna Russo, MSW, LSW, CADC Social Worker and Certified Drug and Alcohol Counselor, Compass Health Center, Northbrook, IL. Course Description Course Objectives Emerging evidence supports the strong impact of anxiety 1. Explain the etiology, symptoms, and prevalence of on client outcomes, as well as demonstrating the efficacy anxiety disorders. of exercise as an adjunct treatment in anxiety 2. Identify appropriate screening tools for clients presenting management. However, research also indicates that with anxiety and evaluate the psychometric properties of physical therapists may not routinely screen for or these measures. adequately respond to symptoms of anxiety in their 3. Describe strategies to implement anxiety screening clients. The purpose of this course is to improve physical within a physical therapy examination and evaluate therapists’ knowledge and confidence in recognizing, findings that may necessitate referral to a mental health screening, and making referrals for clients with anxiety. professional. Participants will also practice direct intervention strategies 4. Implement strategies to facilitate motivation and in- to facilitate motivation and in-session anxiety symptom session symptom management in clients with anxiety, management, in order to maximize the holistic health including education on the benefits of physical activity as outcomes of their clients. an adjunct treatment for anxiety. Background Background Widespread problem affecting Economic costs to ~ 20% of the population society: ! Mental health condition recognition often ~ 75% experience a comorbid ! $42 billion/year occurs through clinical judgment vs. mental health disorder in their ! ! of costs associated validated screening tool lifetime with repeated use of (Scalzitti, 1997; Haggman et al., 2004) health care services & for Increased risk for all anxiety ! Casual talk of patients & provider relief of symptoms that disorders if: mimic physical illness ! Anxiety affects: female ! Patients with generalized low SES Treatment outcomes (Jack, 2010) anxiety disorder have low levels of formal education higher medical costs than Adherence to treatment recommendations single (Minor and Brown, 1993) patients without anxiety depression (Anxiety and Depression Association of America) Missed visits = loss of revenue! (Eaton, 2006) " Property of Feldner, Danilovich, and Russo. Not to be copied without permission. 1 Mental Health Matters: Recognizing and CSM: February 7, 2015 Supporting Clients with Anxiety Fear vs. Anxiety vs. Anxiety Disorder Anxiety Pathways Fear Anxiety Anxiety Disorders Pre-morbid Injury / Illness worsened anxiety Emotional response to Anticipation of a future Excessive fear and Anxiety real or perceived threat anxiety immediate danger Intervene Muscle tension and Behavioral disturbances Surge of autonomic Injury / Anxiety worsened health arousal necessary for vigilance, cautious outcomes fight or flight and avoidant illness Intervene Anxiety Pathways Anxiety and Hospitalizations Pre-morbid Anxiety New onset Anxiety ! Injury/illness " anxiety ! In patients with burn ! In patients without a pre- ! Hospitalizations are a source of stress injury, those with pre- existing condition, those Hospitals produce anxiety because of: existing psychiatric with high post-injury ! 1) real fears – bodily pain and lack of information diagnoses (including distress (but no pre- about procedures anxiety) had longer existing diagnosis) had 2) underlying conflicts – loss of identity and hospital stays, delayed similarly prolonged assuming the patient role wound healing, and more hospital stays, number of 3) cultural factors – behavior of health care surgeries. (34-40 days vs procedures, and professionals and patient behavior 13 days decreased adherence to expectations PT protocols 4) anxiety related to control of emotions (Ramsden and Taylor, 1988) (Tarrier et al., 2005; Wisley et al., 2010) Anxiety Disorders Generalized Anxiety Disorder (GAD) ! Excessive anxiety and worry more days than not for at least 6 months for multiple events/activities ! The individual finds it difficult to control the worry ! 3 or more of the following symptoms occur more days than not for 6 months: # Restlessness, feeling keyed up, or on edge # Being easily fatigued # Difficulty concentrating or mind going blank # Irritability # Muscle Tension # Sleep Disturbance Property of Feldner, Danilovich, and Russo. Not to be copied without permission. 2 Mental Health Matters: Recognizing and CSM: February 7, 2015 Supporting Clients with Anxiety Generalized Anxiety Disorder (GAD) Trauma and Stressor Related Disorders ! The symptoms cause clinically significant distress/ Acute Stress Disorder and PTSD impairment in important areas of functioning. ! Patient often presents as anxious ! Not attributable to a substance or other medical condition ! Often occurs after exposure to actual or threatened death, serious injury, or sexual violation ! Not better explained by another mental disorder ! Trauma survivors show more physical improvement when also treated for mental health conditions (Zatzick, 2013). Populations with High Prevalence of Anxiety Anxiety in SCI, Stroke, and TBI ! 24-28% of patients with SCI had anxiety during the first 12 weeks of hospitalization ! Stroke ! 60% of patients with SCI had anxiety 48 weeks post- ! SCI injury (Kennedy & Rogers, 2000) ! 29% of stroke survivors met the clinical cutoff for ! Pain anxiety while still hospitalized. (Broomfield et al., 2014) ! Dementia ! 21-29% of stroke survivors had anxiety in chronic post- stroke period (Barker-Collo, 2007; Lincoln et al., 2013) ! ICU admission and/or prolonged hospitalization ! 10.2% of patients with TBI were clinically diagnosed CAD/MI ! with GAD (Hiott & Labbate, 2002) Anxiety & Pain Dementia and Anxiety ! 5-20% of persons with dementia have anxiety disorders Reciprocal relationship between pain and anxiety ! ! 8-71% of persons with dementia have anxiety symptoms # anxiety levels predict pain behavior and severity in acute and chronic situations ! Significant issue with diagnosis due to overlap in symptoms between dementia & anxiety (Feretti, 2001) ! Anxiety-induced hyperalgesia is thought to be mediated ! Anxiety symptoms tend to be greater in Vascular dementia vs. Alzheimer’s by responses in the hippocampus and amygdala, and ! Anxiety relatively stable across dementia severity under terminal stage poor descending pain modulation signals. ! Factors underlying a direct relationship between anxiety and dementia: # Neural degeneration responsibility for cognitive decline could also affect ! Pain and anxiety responses successfully controlled or limbic structures associated with emotional regulation lessened via pharmacotherapy, psychotherapeutic # Dementia symptoms overlap with anxiety - makes it hard to determine causality (Seignourel, 2009) techniques, or both in combination. (Ploghaus et al., 2001) ! Unclear if anxiety is part of a broader syndrome with agitation or depression " ! Recommendation: Clinically assess anxiety symptoms independently (Seignourel, 2009) Property of Feldner, Danilovich, and Russo. Not to be copied without permission. 3 Mental Health Matters: Recognizing and CSM: February 7, 2015 Supporting Clients with Anxiety ICU / prolonged hospitalization and anxiety Anxiety and CAD/MI ! Association between anxiety and heart disease (Kawachi, 1994) ! Anxiety occurring in 12-78% of persons who have been in the ICU (Gustad et al., 2008; Lizana, 2003) ! In-hospital anxiety incidence ~ 50% in patients with acute coronary syndrome ! In 6-18 months after ICU discharge, patients 30% more likely than those hospitalized but not in the ICU to report anxiety (Ringdal, 2009) ! 2.5 fold risk increase for ischemic complications in ! At one year after ICU discharge, unemployment and level of patients with anxiety following MI optimism were independent predictors of anxiety (Myhren, 2010) ! Patients with acute MI and a high level of anxiety had a 5 ! Anxiety is more prevalent in cases of mechanical ventilation. fold increase in risk for recurrent ischemia, re-infarction, or (Gustad et al., 2008) death compared with patients with MI without high anxiety # Early in-hospital anxiety following MI is one of the best predictors for in-hospital complications (Thurston, 2013) $%&'()*"+(,'-./0%1"" $%&'02*/-1"" 3415'60%("73485.69:"3()."320-;(61"7<%,(6.29" " 3(%=0,'.=(5'%(1">"?.%.&"7.256.=02.@9:"$/A.%"7206.=(5.@9:"B.2'4@" 7,'.=(5.@9:"C20%05'%"7-20%.=(5.@9" " $%/-0%A421.%)1" D(5.;0)("7B.2560'-"$-',9:"E(F6()02"7G.6H.@.=(5'%(9:"I.@'-).2"7I.@0)6'F'%(9:" E6'2(5).2"7J&*-.6H.=(5'%(9" " $)*5'-.2"$%/51*-K0/-1">".210"41(,".)"20L(6",01(1"M06"@00,"1).H'2'=./0%"" +06("6(-(%)2*"72.1)"NO"*(.619"#"P'15(6,.2"76(15(6',0%(9Q"R*56(&."702.%=.5'%(9:" 8(60S4(2"7S4(/.5'%(9:"$H'2'M*"7.6'5'56.=02(9:"<%A(F."7T.2'5(6',0%(9" PATIENT EXAMINATION " $%/,(56(11.%)1" G(2(&."7-').2056.@9:"T60=.-"7U40&(/%(9:"I4A0&"7U4A0&.@'%(9:T.&'2" 75.60&(/%(9:"R020V"71(6)6.2'%(9:"W2.A'2"7.@*)6'5)*2(%(9:"E60M.%'2" 7'@'56.@'%(9:"X.6,'2"7TK(%(2='%(9:"WY(&06"7A(%2.M.&'%(9:"Z(22H4)6'%" 7H45605'0%9:"P(@(60%"7@'6).=.5'%(9" 84H[(-/A("<%)(6A'(L"" Assessing Pain C(*"6(150%1(1",46'%F"14H[(-/A("'%)(6A'(L\"
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