Anxiety Disorder

Anxiety Disorders Overview

  • Anxiety disorders encompass various types, each with distinct characteristics.

General Anxiety Disorder (GAD)

  • Definition: Clients experience extreme persistent worry about normal, everyday issues. Common concerns include:

    • Work

    • Bills

    • School

    • Family

    • Nursing care plans

  • Duration: Symptoms persist for six months or more.

Social Anxiety Disorder (SAD)

  • Definition: This disorder involves intense anxiety or fear during social situations.

  • Common Triggers:

    • Public speaking (notably)

    • Eating or drinking in front of others

  • Importance: Frequently appears on exams and NCLEX.

Panic Disorder

  • Definition: Clients experience unexpected panic attacks and live in a constant state of panic.

Separation Anxiety Disorder

  • Definition: A notable disorder in pediatrics where children display excessive fear about being separated from their parents.

  • Example Scenario: An individual expresses excessive worry every time they leave for work, causing their mother to become extremely anxious.

    • Supports the diagnosis of Separation Anxiety Disorder.

Other Disorders

  • Obsessive Compulsive Disorder (OCD)

  • Post-Traumatic Stress Disorder (PTSD)

    • These disorders are addressed in separate discussions.

Pathophysiology of Anxiety

  • During periods of severe anxiety, the mind shifts into a panic state.

  • Physiological Response:

    • Fight or Flight Mode: Activates the sympathetic nervous system (SNS), referred to as the stress nervous system.

    • Shifting of blood flow:

    • Blood is redirected from extremities to core organs.

    • Effects on Vital Signs:

      • Increased respiratory rate

      • Elevated heart rate

      • Higher blood pressure

      • Increased blood sugar levels

      • Dilated pupils

Physiological Signs of Anxiety (select all that apply)

  • Increased pulse rate

  • Hyperglycemia

  • Dilated wide pupils

  • Dilated bronchioles

  • Peripheral constriction of blood vessels.

Classification of Anxiety

  • Anxiety can be categorized similarly to pizza sizes:

    • Small Anxiety: Mild symptoms

    • Medium Anxiety: Moderate symptoms

    • Large Anxiety: Severe symptoms

    • Extra Extra Large Anxiety: Panic attacks or panic disorder (characterized by unexpected, recurring panic attacks).

Symptoms of Anxiety by Severity Level

  1. Mild Anxiety:

    • Symptoms include:

      • Restlessness

      • Irritability

      • Example: Seeing a spider or bee from a distance.

  2. Moderate Anxiety:

    • Symptoms escalate to:

      • Increased respiratory rate and heart rate

      • Pacing back and forth

      • Slightly reduced perception/concentration (in response to a closer threat).

  3. Severe Anxiety:

    • Symptoms worsen:

      • Hyperventilation

      • Extreme pacing and feelings of impending doom.

      • Difficulty following directions (example: reacting uncontrollably when a spider lands on you).

  4. Panic Attack Symptoms:

    • Severe fear, sense of death, and detachment from reality.

    • Physical symptoms may resemble a heart attack, including:

      • Chest pain

      • Heart palpitations

      • Trembling

      • Numbness

      • Hyperventilation

      • Sweating

      • Nausea and choking sensation.

Clinical Manifestations

  • Example Question: A client is pacing and expresses feelings of impending doom; this indicates Severe Anxiety.

  • NCLEX Connection: Clients experiencing panic attacks often voice fear of impending doom.

  • Scenario: Patient scheduling surgery presents symptoms (chest pain, choking sensation); indicates panic disorder.

Prioritized Interventions for Severe Anxiety and Panic Attacks

  1. Remain with the Client: Top priority and common NCLEX strategy.

  2. Place the Client in a Quiet Room: Environment matters.

  3. Speak Calmly with Simple Words: Avoid complex instructions.

Key Guidelines

  • Do Not tell the client to relax or discuss the panic attack while it’s occurring.

  • Common NCLEX Mistakes:

    • Avoid suggesting deep breathing exercises as the first step.

Effective Coping Strategies

  • Top Three Strategies:

    1. Effective Coping Mechanisms: Gradually increase comfort when exposed to phobias.

    2. Cognitive Behavioral Therapy (CBT): Reframes thought processes to prevent negative patterns.

    3. Pharmacology: Medications to manage symptoms.

Key Points for Effective Coping

  • Three Exam Goals:

    1. Enhance comfort while facing phobias.

    2. Verbalize feelings and gain insight regarding anxiety.

    3. Implement self-distraction techniques.

  • Concept of Resilience:

    • Developed through practicing daily stress reduction methods (meditation, deep breathing).

Cognitive Behavioral Therapy (CBT)

  • Definition: A common psychotherapy technique that helps clients reframe thought processes to manage anxiety.

  • Axes to Identify:

    • Prevent negative thought patterns.

    • Adaptation to stress and anxiety.

Pharmacology in Anxiety Management

Medications:

  • Beta Blockers: Commonly used to manage symptoms due to SNS activation.

    • Examples: Atenolol, others ending in -lol.

    • Function: Slows heart rate, reduces blood pressure.

  • Antidepressants: Increases neurotransmitter concentration for mood elevation.

    • SSRIs: Sertraline, Paroxetine (most prescribed).

    • TCAs: Amitriptyline, Imipramine.

    • MAOIs: Phenelzine, Isocarboxazid.

  • Anxiolytics: Targeted anxiolytics commonly referenced in examination:

    • Benzodiazepines: Fast-acting but potentially addictive (examples: Alprazolam, Temazepam).

    • Mechanism of Action: Increases GABA, leading to decreased neuronal activity (GABA = Grandma).

    • Key Effects: Sedation, low heart rate, blood pressure, respiratory rate, potential for respiratory depression.

    • Buspirone: Non-sedating alternative, allowing normal activity (e.g., driving).

Important Considerations for Benzodiazepines

  • High addictive potential, not safe for long-term use.

  • Cautions include avoiding alcohol (increases sedation), and not operating heavy machinery.

  • Antidotes:

    • Flumazenil for benzodiazepine overdose.

    • Naloxone (brand name NARCAN) for opioid overdose.

Major Side Effects to Monitor

  • Sedation and sleepiness are main concerns; always taper off medications, never abrupt cessation.

  • Recognize re-bound anxiety as a significant risk.

Barbiturates

  • Definition

    • Class of drugs ending in "barbitol" (e.g., phenobarbital).

  • Pharmacokinetics

    • Duration in Body: Typically lasts longer, usually 3 to 5 days.

    • Elimination: Takes longer to clear from the body.

  • Risks and Toxicity

    • Higher risk for toxicity due to prolonged retention in the body.

    • Potential adverse effects include:

    • Hypotension

    • Respiratory depression

    • Death in severe cases.

  • Memory Aid

    • Associated with the word "bar"; one goes to a bar and experiences sedation, leading to prolonged toxic effects and heightened death rates due to the impact of these drugs.

Buspirone

  • Colloquial Name: Memory trick - "bus pirone" as in riding a "bus" because its effects are slow and withdrawal is easy.

    • Characteristics

  • Type: Atypical anxiolytic.

  • Sedation Status: Non-sedating; allows the individual to drive without impairment (i.e., "drive the bus").

    • Pharmacodynamics

  • Onset of Action: Takes a long time to take effect - approximately 2 to 4 weeks for full therapeutic effect.

  • Withdrawal: No withdrawal symptoms; safe for long-term use.

  • Addiction Potential: Not addictive, hence no risk for dependence or tolerance.

    • Usage

  • Not effective for acute anxiety attacks; must be taken on a regular schedule rather than on an as-needed basis.

    • Key Points for Patient Teaching

  • Driving is safe while on buspirone due to its non-sedative properties