Week 5: Anxiety and Anxiety Disorders

Anxiety

A vague feeling of dread or apprehension, serving as a response to internal or external stimuli.

Symptoms may be behavioral, emotional, cognitive, or physical.

Unlike fear, which stems from identifiable external stimuli, this is appropriate for situations and fades when these situations are resolved.

Anxiety Disorders

• It involves excessive anxiety, including irrational panic and overwhelming worry.

• They cause significant distress and impair daily routines, social lives, and work functioning.

• Diagnosed when anxiety becomes chronic and pervasive, resulting in maladaptive behaviors and emotional disability.

Types of Anxiety Disorders

• Agoraphobia: Fear of being in situations where escape might be difficult.

• Panic Disorder: Most common; characterized by panic attacks.

• Specific Phobia: Intense, irrational fear of a specific object or situation.

• Social Anxiety Disorder: Fear of social situations.

• Generalized Anxiety Disorder (GAD): Excessive, uncontrollable worry (diagnosed when it results over 6 months).

• Anxiety Disorder Due to Another Medical Condition

• Substance/Medication-Induced Anxiety Disorder:

• Separation Anxiety Disorder: Excessive anxiety over separation from attachment figures, diagnosed before age 18.

Etiology of Anxiety

• Always note patient trauma history, type, and extent.

• Genetic Component: Higher anxiety rates among first-degree relatives.

  • High Heritability (>0.6): Indicates dominant genetic influence.

  • Moderate Heritability (0.3-0.5): Suggests a mix of genetic and non-genetic factors.

  • Low Heritability (<0.3)

• Neurochemical Theories:

  • GABA: Dysfunctional inhibitory neurotransmitter in anxiety disorders.

  • Norepinephrine: Excess found in panic disorder and PTSD.

  • Serotonin: Impacts anxiety and mood; linked to OCD and GAD.

• Psychodynamic Theories:

  • Freud posited anxiety stimulates behavior but may inhibit emotional growth.

• Behavioral Theory:

  • Anxiety can be learned and unlearned; behavior modification aids in this process.

Stress

• Wear and tear from life situations.

• Personal variability in stress responses.

• Common stressors include public speaking, marriage, and new jobs.

General Adaptation Syndrome (Hans Selye)

• Identified physiological aspects of stress through studies on laboratory animals.

• Stages of Reaction to Stress:

  • Alarm reaction: Messages from the hypothalamus trigger the release of adrenaline and norepinephrine from the adrenal glands and convert glycogen to glucose in the liver, preparing the body for defense with increased energy supply.

  • Resistance stage: The digestive system slows, while blood is directed to essential areas for defense, leading to heightened lung and heart activity for better oxygen circulation.

  • Exhaustion stage: The digestive system slows, while blood is directed to essential areas for defense, leading to heightened lung and heart activity for better oxygen circulation.

Physiological Responses to Anxiety

• Difficulty with logical thought.

• Increased agitation in motor activity.

• Elevated vital signs (heart rate, blood pressure).

• Adaptive behaviors to reduce discomfort, such as relaxation and imagery techniques.

• Maladaptive Behaviors: May manifest as tension headaches, pain syndromes, and other stress-related symptoms.

Levels of Anxiety

• Mild Anxiety (Level 1):

  • Sensation of something different; increased sensory stimulation.

  • Motivates change and goal-directed activity.

• Moderate Anxiety (Level 2):

  • Disturbing feelings, nervousness, or agitation.

  • Difficulty in independent concentration.

• Severe Anxiety (Level 3):

  • Trouble thinking and reasoning with increased muscle tension and vital signs.

  • Focus on self-defense.

• Panic Anxiety (Level 4):

  • Characterized by fight, flight, or freeze responses with an adrenaline surge.

Nursing Assessment for Anxiety

• Common Indicators:

  • Decreased attention span, restlessness, irritability, feelings of discomfort or helplessness, hyperactivity, and perceptual field deficits.

    • May see these be laced in with symptoms of psychosis or delusion when mixed with a diagnosis such as schizophrenia or other mental disorders.

• Expected Outcomes:

  • Immediate: Free from injury; discuss feelings within 24 to 48 hours.

  • Stabilization: Demonstrate relaxation techniques; manage anxiety response to stress effectively.

  • Community: Remain free from anxiety attacks, maintain a healthy anxiety response to stress.

    • Learn about what is in your toolbox.

Hamilton Rating Scale

• History of panic attacks and their impact

• General appearance and motor behavior

• Mood and affect

• Thought processes and content

• Sensorium and intellectual processes

• Judgement and insight

• Self-concept

• Roles and relationships

• Physiological and self-care concerns

Nursing Intervetions for a Client with Anxiety

• Assessing Anxiety Level:

  • Determines effective nursing actions.

  • For mild anxiety, no direct intervention is needed; effective teaching should suffice.

• For Moderate Anxiety:

  • Ensure the client follows the information presented; use short, simple sentences.

• Management for Severe and Panic Anxiety:

  • For severe anxiety, lower the anxiety level before proceeding, remain with the client, and speak calmly.

  • For panic anxiety, prioritize safety by moving to a quiet environment.

• If the client is in a panic, we have the right to meditate to ease their panic.

Treatment Options for Anxiety

• Benzodiazepines:

  • Examples: Diazepam (Valium), Alprazolam (Xanax)

  • Side Effects: Dizziness, sedation; high potential for abuse.

  • Do not stop abruptly.

• Nonbenzodiazepines:

  • Examples: Buspirone (BuSpar), Meprobamate (Miltown).

• SSRIs and Other Medications:

  • Examples: Fluoxetine (Prozac), Paroxetine (Paxil) for treating panic disorder, GAD, and social phobia.

  • First line of treatment, as it has the least amount of side effects.

• Combination of Medication and Therapy:

  • Produces better results than either alone; includes CBT for anxiety management.

Panic Disorder

• Characterized by episodes lasting 15 to 30 minutes with intense anxiety symptoms.

• Diagnostic Criteria: Recurrent panic attacks without environmental triggers; persistent concern about attacks; significant behavioral changes.

• Symptoms: palpitations, sweating, tremors, SOB, chest pain, nausea, dizziness, chills, or hot flashes.

• Panic Attacks: Early trauma may contribute to this and should be addressed.

  • Onset: peaks in late adolescence to mid-30s

Treatment Options for Panic Disorder

• Cognitive-Behavioral Therapy (CBT):

  • Includes deep breathing and relaxation techniques; medications can include SSRIs and antihypertensives.

  • Change the way a person thinks and channel positive thoughts.

• Safety and Comfort:

  • Providing a safe environment, remaining with the client during panic attacks, and using calm communication.