Anxiety: Response to Stress & Anxiety Levels

• Anxiety is a vague feeling of dread or apprehension.
• Anxiety differs from fear.
• Anxiety is normal and unavoidable and can be positive.
• Anxiety disorders share a key feature of excessive anxiety with behavioral, emotional, cognitive, and physiological responses.
• Anxiety disorders significantly impair daily routines, social lives, and occupational functioning.

Anxiety as a Response to Stress

• General adaptation syndrome (Hans Selye) involves three stages
• Alarm reaction stage
• Resistance stage
• Exhaustion stage

Levels of Anxiety

• Mild anxiety involves sensing something different, requiring special attention; increased awareness and attention; motivational.
• Moderate anxiety involves feeling something is definitely wrong; nervousness/agitation; ability to take information but difficulty concentrating; can be redirected; GI upset
• Severe anxiety is characterized by trouble thinking and reasoning; nausea and vomiting, diarrhea; tightened muscles; increased vital signs; restless, irritable, angry; decreased cognitive skills and judgment.
• Panic is characterized by fight, flight, or freeze response; increased vital signs; cognitive processes focusing on defense; loss of judgment and rational thought.

Working With Anxious Clients

• First, practice self-awareness of anxiety level.
• Next, assessment of person's anxiety level will determine appropriate intervention:
• No direct intervention is required for mild anxiety
• Moderate anxiety requires redirection or refocus with short, simple sentences.
• Severe anxiety requires de-escalation of anxiety level first.
• Panic requires ensuring patient safety, and one should remain with the patient.
• Short-term use of anxiolytics may be indicated.

Anxiety Disorders

• Agoraphobia
• Panic disorder
• Specific phobia
• Social anxiety disorder (social phobia)
• Generalized anxiety disorder (GAD)
• Anxiety disorders prevail more in women and people under 45 years old.
• Onset of anxiety disorders and their clinical course are extremely variable.
• Related disorders include:
  • Selective mutism
  • Anxiety disorder due to another medical condition
  • Substance/medication-induced anxiety disorder
  • Separation anxiety disorder

Etiology of Anxiety Disorders

• Biologic theories
  • Genetic theories – 1st degree relative
  • GABA dysfunctional
• In adults, anxiety arises from the person's need to conform to the norms and values of their cultural group.

Treatment for Anxiety Disorders

• Combination of medications and therapy.
• Medications of choice include anxiolytics, and antidepressants.
• Cognitive-behavioral therapy (CBT)
• Positive reframing (turning negative messages into positive ones)
• Decatastrophizing (making more realistic appraisal of situation)
• Assertiveness training (learn to negotiate interpersonal situations)
• Brown bag

Age-Related Considerations

• Conditions that may be seen in children:
  • Selective mutism
  • Separation anxiety
  • Social anxiety disorder (can persist into adulthood)
• Late-life anxiety disorders
  • Most common are phobias such as agoraphobia and generalized anxiety disorder (GAD)
  • Treatment of choice: selective serotonin reuptake inhibitor (SSRI) antidepressants

Panic Disorder

• Discrete episodes of panic attacks that last 15 to 30 minutes with no stimulus for panic response.
• Disorder diagnosed when recurrent, unexpected attacks followed by at least 1 month of concern/worry about future attacks.
• Half of people with panic disorder have agoraphobia.
• Increased risk of suicidality.
• Avoidance behavior.
• Primary and secondary gain.
• 4 or more of the following symptoms are present during a panic attack:
  • Palpitations
  • Sweating
  • Tremors
  • Shortness of breath
  • Sense of suffocation
  • Chest pain
  • Nausea
  • Abdominal distress
  • Dizziness
  • Paresthesias
  • Chills, or hot flashes.

Panic Disorder Treatment

• CBT:
• Deep breathing, relaxation techniques
• Teaching the patient the signs and symptoms of escalating anxiety
• Brown bag
• Benzodiazepines, SSRIs, tricyclic antidepressants, antihypertensives (clonidine, propranolol)

Panic Disorder and Nursing Process

• Assessment includes:
  • History - previous attack
  • Automatisms
  • Depersonalization and derealization
  • Disorganized thoughts, loss of rational thinking, may even consider suicide
  • Judgment is suspended
  • Roles and relationships
  • Problems with eating and sleeping

Nursing Actions for Panic Disorder

• Promoting safety and comfort and being grounded
• Using therapeutic communication
• Managing anxiety
• Providing client and family education

Question

• A nurse should expect Automatisms to be assessed in a client with panic disorder.
• Rationale: A client with panic disorder would demonstrate automatisms, irrational thinking, self-blame, and disorganized thoughts.

Phobias

• Intense, illogical, persistent fear of specific object or situation.
• Response is out of proportion to the situation or circumstance.
• Categories include agoraphobia, specific phobia, and social anxiety.
• Categories of specific phobias include:
  • natural environment,
  • blood-injection,
  • situational,
  • animal,
  • other types of specific phobias

Phobias Treatment

• Behavioral therapy: systematic desensitization, flooding
• Medications
  • Alprazolam
  • Buspirone
  • Sertraline
  • Paroxetine

Explore anxiety, its difference from fear, and its potential benefits. The general adaptation syndrome (Hans Selye) involves alarm, resistance, and exhaustion stages. Understand mild, moderate, and severe levels of anxiety and their symptoms.