Assessment & Management of

Psychological Symptoms
Anxiety and Depression
If you were to be diagnosed with cancer, how
do you think you would feel?
• Despite the availability of professional oncologist
and treatmentà cancer” inspires a degree of fear.

• Isolated and alone, and not know where to begin their

search for information, assistance, understanding, and support.

• Change pt Moods and question treatments.

• Prevent patient communication with providers.

• Reaching out to the patient spirituality as well physically

,emotional
 Aims

v Identify incidence associated with anxiety and

depression
v Identify the differences between anxiety and
depression
v Anxiety and depression symptoms assessment
v Demonstrate specific pharmacological, and non-
pharmacological therapies for anxiety and
depression
v Palliative nursing considerations and patient
education strategies for anxiety and depression
Ø There is a strong correlation between the diagnosis
of anxiety, and depression in patients receiving
palliative care for a life-limiting illness
Ø Individuals cope in many ways; sometimes,
patients may develop psychiatric symptoms
including anxiety, and depression
Ø As transient events, anxiety, and depression may
not cause long term issues
 Cont.

Ø In severe forms, these psychiatric issues may

inhibit the ability to have meaningful communication
with family and friends as part of life closure, cause
suffering, and affect quality of life

Ø Anxiety and depression are distinguished from

normal, expected emotional reactions to life-
threatening illness primarily by the severity and
duration of psychiatric symptoms
Should aim to identify:

1)the nature of the primary problem

and its possible causes 2) the severity
of relevant symptoms
Causes/nature of anxiety and
depression:
1- Physical symptoms: such as unrelieved pain, fatigue,
lymphoedema
2- Medical-induced factors: such as treatment-related side
effects
3-Substance-induced factors: such as drug and alcohol
abuse
4- History of mental health issues: such as prior depression
or anxiety
5-Suicide risk factors
6- Resources and strengths: support networks,
positive/protective factors
 ANXIETY

Definition
vAnxiety is defined as feelings of distress and
tension that lack a known stimulus
Signs and Symptoms of Anxiety

š Excessive worry, apprehension, foreboding

š Irritability, tension
š Agitation, restlessness, hyper arousal
š Insomnia
š Sweating, tachycardia
š Hyperventilation, shortness of breath
š Gastrointestinal distress, nausea
 ANXIETY

v Anxiety is a very subjective experience

v Symptoms must be present for at least 6
months and cause impairment in social or
occupational functioning
v it is often accompanied by somatic
complaints such as tachycardia, fatigue,
restlessness, difficulty concentrating, muscle
tension, headaches, palpitations , sweating,
abdominal discomfort, dizziness, urinary
frequency, and sleep disturbances
 Panic

qIn this most intense state of anxiety, the

individual is unable to focus on even one
detail within the environment.
 DEPRESSION

v Depression is defined as a mood disorder and

contains both psychological and somatic symptoms
that alter mood, affect, and personality
v It is defined as an episode of 2 weeks or longer
where there is loss of interest or pleasure in nearly
all activities
v it is different than Delirium which is known as
fluctuation periods of confusion and disorientation
Signs and Symptoms of
Depression
• Sad or depressed mood
• Insomnia or sleeping too much
• Anhedonia
• Guilt or hopelessness
• Low energy
• Difficulty thinking or concentrating
• Anorexia or eating too much
• Psychomotor retardation
• Recurrent suicidal ideations, plans or attempts
 Assessment

Ø Assessment requires caution for anxiety.

Ø Required Skills, Training, and Confidence
Ø A history and review of medical conditions for
potential causes of anxiety is part of the
initial evaluation
 Assessment

Ø A physical exam may reveal tachycardia,

tachypnea, skin changes, rapid speech,
restlessness, and tremors
 Assessment
**Depression Assessment Areas
§ Ability to engage in life
§ Interest in world around them
§ Engagements in hobbies
§ View of life Feelings of hopelessness vs. optimism and
plans for the future
§ Self-worth worthlessness, any expressions of guilt or self-
recrimination,
§ Expression of suicidal ideation
§ Inability to anticipate anything with pleasure
§ The importance of the nursing assessment of unrecognized
depression will impairs quality of life, immune response and
survival
 **Suicide Assessment**
1) Do you feel life is not worth living?
2) Have you thought about harming yourself?
3) Are you thinking about suicide or taking your own
life?
4) Do you have a plan? What is it?
5) Have you ever attempted suicide?
vAny questions that receives a positive or “yes”
answer warrants more further questioning,
assessment, and intervention with the patient
and family
Interventions

š Expressive-supportive therapies (e.g. listen to the

person, encourage expression of feelings).
š Respectfully acknowledge the person’s sadness or
depressed feelings.
š Facilitate Referral to a social worker, psychologist, or
spiritual care provider for counselling.
š • Pharmacological modalities
 Pharmacological Managements for anx

Ø Benzodiazepines such as Lorazepam

(Ativan) /Diazepam (Valium)
Ø Neuroleptics such as Haloperidol (Haldol)
Ø Antihistamines such as Diphenhydramine
(Benadryl)
 Pharmacological Managements

vSelective serotonin reuptake inhibitors

(SSRIs) such as Sertraline (Zoloft )
ü have fewer long-term side
ü effects than the tricyclic antidepressants
and, in general, are the first line of
pharmacological antidepressant
treatment
ü unless specific side-effect profiles
associated with other classes of drugs
are desired
**Nonpharmacological Interventions for
Treatment of Depression

vCognitive Interventions
vInterpersonal interventions
vComplementary therapies
 Cognitive Interventions

q Cognitive approaches involve clarification of

misconceptions, review and reinforce realistic
ideas and modification of faulty assumptions by
identifying and correcting distorted, negative,
and catastrophic thinking.
q Communicating with a patient who has cognitive
impairment need to assess their orientation
abilities and use short words and simple
sentences
 Cognitive interventions

Ø Review and reinforce realistic ideas and

expectations.
Ø Help the patient test the accuracy of self-defeating
assumptions.
Ø Help the patient identify and test negative automatic
thoughts.
Ø Review and reinforce patient’s strengths.
Ø Set realistic, achievable goals.
Ø Explain all actions and plans, seek feedback and
participation in decision-making.
Ø Provide choices (e.g., about the timing of an activity).
Rest of the slides just for
yr information
 Interpersonal interventions

Ø Interpersonal interventions focus on

improved self-esteem, the development
of effective social skills, and dealing with
interpersonal and relationship difficulties.
 Behavioral interventions

Ø These interventions are often used in

combination with cognitive interventions,
such as self monitoring
Ø provide a possibility relationship between
positive reinforcement, and independent
behavior and positive interactions with the
environment.
Ø The aim is to maintain involvement in
activities associated with positive moods
and, if possible, to avoid situations that
trigger depression
 Complementary therapies

vComplementary therapies may help

reduce mild depressive symptoms, or
they may be used as an addition to other
therapies for more severe depressive
symptoms. It reduces mild depressive
symptoms alongside with medication
 Complementary therapies

Ø Humor
Ø Art and music therapies
Ø Aerobic exercise
Ø Phototherapy
Ø Aromatherapy and massage
 Summary

š Anxiety is a non-specific subjective feeling of

uneasiness, stress, and insecurity. Anxiety can range
from mild to severe depending on the perceived threat.
The expression of anxiety can include restlessness,
irritability, agitation, and panic
š Anxiety and depression are normal responses to events
in all our lives, especially illness
š Unrecognized depression impairs quality of life, immune
response and survival.
š The suicidal patient has difficulty expressing anger
toward others
 References
qFerrell, B. R., & Coyle, N. (2006). Text
Book of palliative nursing.2nd ed New
York: Oxford, University Press, Inc

qMatzo, ML., & Sherman, DW. (2006).

Palliative Care Nursing: Quality Care to
the end of Life. New York: NY: Springer
Publishing Company