Anxiety and Panic Disorders

Anxiety

• Feeling of discomfort, apprehension, or dread related to anticipation of danger, with a nonspecific or unknown source.

Levels of Anxiety

• Acute Anxiety: characterized by >3 symptoms, considered Panic Disorder.
• Symptoms:
  • Sweating
  • Trembling
  • Unsteady
  • Dissociation
  • Elevated heart rate
  • Nausea
  • Tingling
• Best treatment: Cognitive Behavioral Therapy (CBT).
• Most invasive treatment: Benzodiazepines.

Panic Attack

• Sudden, overwhelming feeling of terror or impending doom.
• Symptoms:
  • Palpitations, pounding heart, or accelerated heart rate
  • Sweating
  • Trembling or shaking
  • Sensations of shortness of breath or smothering
  • Feelings of choking
  • Chest pain or discomfort
  • Nausea or abdominal distress
  • Feeling dizzy, unsteady, lightheaded, or faint
  • Chills or heat sensations
  • Paresthesias (numbness or tingling sensations)
  • Derealization (feelings of unreality) or depersonalization (feelings of being detached from oneself)
  • Fear of losing control, going crazy, or dying
• Characteristics:
  • Feelings of impending doom
  • Recurrent panic attacks
  • Unpredictable onset
  • Intense apprehension, fear, or terror
  • Usually lasts minutes or, more rarely, hours (5-20 minutes)

Panic Disorder

• Average age of onset: late 20s
• Risk factors:
  • Genetic vulnerability
  • Predisposition for negative emotions
  • History of childhood physical/sexual abuse
  • Smoking
• Nursing interventions:
  • Calm approach
  • Comfort patient
  • Clear and simple words
  • Assess suicidal thoughts
  • Stay with patient 1:1

Phobias

• Often associated with panic disorder
• Types of phobias:
  • Agoraphobia: fear of situation or fear of being in places or situations from which escape might be difficult or in which help might not be available
  • Social Anxiety: fear of judgment or evaluation by others
  • Separation Anxiety: fear of separating from a person
  • Specific Phobia: fear of specific objects or situations that could conceivably cause harm

Treatment of Phobias

• Systematic Desensitization: slow exposure to fear, promoting familiarity
• Implosion Therapy (flooding): exposing the patient to a large number of undesirable stimuli to turn off the phobic response
• Nursing interventions for Phobias: "SLEA"
  • Stay with patient during panic attack related to phobia and maintain calm approach
  • Long term: teach patient to face the phobia/things that cause irrational fear
  • Encourage the client to explore underlying causes of fear

Selective Mutism

• Consistent failure to speak in specific social situations where speaking is expected
• Affects achievement academically or socially
• Interferes with regular communication