Concept 31 for Nursing Practice: Anxiety (4th Edition)

Definition and Scope of Anxiety

  • Verbatim Definition: Anxiety is defined as a subjectively distressful experience activated by the perception of threat, which has both a potential psychological and physiological etiology and expression.

  • The Anxiety Scope/Continuum: The concept of anxiety exists on a continuum because an individual's anxiety level fluctuates. The scope ranges as follows:

    • No anxiety

    • Mild anxiety

    • Moderate anxiety

    • Severe anxiety

    • Panic

Normal Physiological Processes and Neurobiology

  • Physical Response Systems: Anxiety triggers the following physiological processes:

    • Fight-or-Flight Response: The immediate survival mechanism activated by perceived danger.

    • General Adaptation Syndrome: The body's three-stage response to stress (alarm, resistance, and exhaustion).

  • Biological Components:

    • Brain structure and neurochemistry play primary roles in the expression of anxiety.

    • Genetic Influence: An individual's genetic makeup can predispose them to stress and anxiety.

Clinical Consequences and Associated Medical Conditions

  • Impact of Mild to Moderate Anxiety:

    • Depending on the specific person or the situation, these levels may actually have a positive impact.

    • If the impact is not positive, increased anxiety levels can result.

  • Impact of Severe Anxiety to Panic:

    • These states can lead to injury to self or others.

    • In some cases, this leads to suicide, which is primarily driven by impulsivity.

  • Conditions Commonly Associated with Anxiety: Anxiety is frequently observed in conjunction with the following medical conditions:

    • Cancer

    • Chronic obstructive pulmonary disease (COPD)

    • Asthma

    • Heart disease

    • Diabetes

    • Drug or alcohol withdrawal

    • Thyroid disease

    • Pheochromocytoma

    • Chronic infections

    • Vestibular dysfunction

    • Irritable bowel syndrome (IBS)

Prevalence and Population Risk Factors

  • General Prevalence: Anxiety is the most prevalent subgroup of mental illness, affecting people of all ages and backgrounds.

  • Gender: The lifetime prevalence of anxiety is higher among females than males.

  • Age: The prevalence by age peaks in middle adulthood, specifically between the ages of 30s30\text{s} and 50s50\text{s}.

  • Race and Ethnicity: Non-Hispanic whites exhibit a higher incidence of anxiety compared to Hispanics and non-Hispanic blacks.

  • Socioeconomic Status (SES): Lower SES is linked to higher rates of anxiety in youth.

  • Familial Patterns: Certain anxiety disorders demonstrate clear patterns of occurrence within families.

  • Individual Risk Factors:

    • Temperament

    • Environmental factors

    • Genetics

    • Physiologic factors

Recognizing Anxiety: Diagnostic and Screening Tools

  • Diagnostic Confirmation: There are no specific diagnostic tests used to confirm a diagnosis of anxiety.

  • Ancillary Testing: Some diagnostic tests may be useful to detect underlying medical conditions that contribute to an individual's anxiety.

  • Validation Tools: Practitioners utilize specific anxiety screening tools, including:

    • Beck Anxiety Inventory (BAI)

    • Spence Children’s Anxiety Scale (SCAS)

    • Revised Children’s Manifest Anxiety Scale (RCMAS-2)

Clinical Management: Primary and Secondary Prevention

  • Primary Prevention Strategies:

    • Conducting well visits across the entire lifespan.

    • Obtaining a thorough family history.

    • Fostering healthy family functioning.

    • Ensuring early recognition and referral for symptoms based on anxiety.

  • Secondary Prevention (Screening):

    • There are currently no population-based screening recommendations for anxiety.

    • The use of monitoring and specific screening tools allows for early identification and subsequent treatment.

Collaborative Interventions: Pharmacological and Psychological Therapies

  • Pharmacotherapy: Choice of medication depends on the specific etiology and may include:

    • β\beta-adrenergic receptor antagonists

    • Benzodiazepines

    • Nonbenzodiazepine antianxiety agents

    • Antidepressants:

      • Selective serotonin reuptake inhibitors (SSRIs)

      • Serotonin-norepinephrine reuptake inhibitors (SNRIs)

      • Tricyclic antidepressants (TCAs)

      • Monoamine oxidase (MAO) inhibitors

  • Psychotherapy and Other Therapies:

    • Psychoeducation

    • Cognitive behavioral therapy (CBT)

    • Prolonged exposure therapy

    • Cognitive processing therapy

    • Mindfulness-based cognitive therapy

    • Eye movement desensitization and reprocessing (EMDR)

Interrelated Concepts and Featured Exemplars

  • Interrelated Concepts: Anxiety is closely linked with clinical concepts including:

    • Stress and Coping

    • Mood and Affect

    • Person-Centered Care

    • Interpersonal Violence

  • Featured Exemplars: Common clinical manifestations of anxiety include:

    • Simple phobia

    • Social phobia

    • Panic disorder

    • Generalized anxiety disorder (GAD)

    • Obsessive-compulsive disorder (OCD)

Questions and Collaborative Learning Activities

  • Collaborative Learning #1: Individual students are instructed to complete a screening tool provided by their instructor. Learning groups should then compare and contrast the symptoms found on that tool with the cognitive and physiological symptoms categorized under "recognizing anxiety."

  • Collaborative Learning #2 (Link Exemplars): In learning groups, students must generate a list of up to five conditions that manifest with anxiety across pediatric, adult, and geriatric populations.

  • Discussion Prompt: "How would you treat an anxiety state in each of these persons (pediatric, adult, geriatric), regardless of the etiology?"