Chronic Anxiety Disorder Symptoms

Generalized Anxiety Disorder (GAD)

• 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

Characteristics of GAD

• Chronic, persistent, and excessive anxiety worries lasting >6 months
• Muscle tension
• Irritability
• Difficulty sleeping
• Decreased energy and attention
• Restlessness
• May refuse to leave home due to fear

Nursing Interventions for GAD

• 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

Post-Traumatic Stress Disorder (PTSD)

• 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)

Goals for PTSD

• 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

Obsessive-Compulsive Disorder (OCD)

• 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