Chronic Anxiety Disorder Symptoms

Study Notes

Chronic anxiety is considered "MISERABLE" if patient has >3 symptoms
GAD requires 6 months of symptoms to confirm diagnosis
Symptoms include:
- Muscle tension
- Irritability
- Decreased sleep
- Decreased energy
- Restlessness
- Decreased attention
GAD can cause clinically significant impairment in social, occupational, or other important areas of functioning
Onset is not uncommon after age 20
Depressive symptoms and numerous somatic complaints are common

Provide a quiet environment during assessment and care to avoid stimuli/triggers
Help patient acknowledge anxiety and develop coping strategies
Anxiety medication (Buspirone) may be administered, but only after assessing patient's level of anxiety and exhausting nursing interventions

Exposure to a terrifying or life-threatening event
Can develop after exposure to threat of death, such as home invasion, robbery, serious injury, or sexual violation
May develop within hours or after several months or years
DSM-5 criteria for PTSD include four diagnostic clusters:
- Re-experiencing (spontaneous recollection of traumatic event, recurrent nightmares, flashbacks, or intense psychologic distress)
- Avoidance (avoiding distressing memories, feelings, or external reminders of the traumatic event)
- Negative alterations (distorted sense of blame, diminished interest in activities, inability to remember key aspects of the event)
- Arousal (aggression, recklessness, self-destructive behavior, sleep disturbances, hypervigilance, or other related problems)

Long-term management
Teach client and family members how to manage
Encourage verbalization and validation of feelings
Assign familiar staff with patient to ensure good rapport
Allow patient to talk about their trauma at their own pace
Instruct client to avoid maladaptive behaviors that can impair judgment and cloud thoughts

Goal: identifying triggers/situations that increase anxiety and ritualistic behavior
Characteristics include:
- Intrusive thoughts
- Mind-based thoughts
- Unwanted thoughts
- Recurrent thoughts
- Distressing thoughts
- Resistant thoughts
Interventions include:
- Discussing anxiety-provoking triggers that precipitate ritualistic behaviors
- Teaching family not to interrupt compulsive behavior unless it becomes harmful
SSRIs (Clomipramine) may be used to treat OCD, with higher doses possibly needed to treat both anxiety and OCD diagnoses