119 Questions
What percentage of the global population currently experiences an anxiety disorder?
4%
What is the estimated number of people worldwide who had an anxiety disorder in 2019?
301 million
What is a common barrier to care for people with anxiety disorders?
All of the above
What is a characteristic of anxiety disorders?
They are typically accompanied by physical tension
What is the primary impact of anxiety disorders on daily life?
They interfere with daily activities
What is the ranking of anxiety disorders among all mental disorders?
Most common
What is a common symptom of anxiety disorders?
Excessive worry and fear
What is a key consideration when making a judgement about anxiety symptoms related to a medical condition?
The etiological relationship between the anxiety symptoms and the medical condition through a physiological mechanism
What is the primary purpose of the 'other specified anxiety disorder' category?
To specify the reason why a presentation does not meet the criteria for a specific anxiety disorder
What is a characteristic of the 'unspecified anxiety disorder' category?
It is used when the clinician does not want to specify the reason why the criteria are not met
What is an example of a cultural-specific anxiety disorder?
Wind attacks (Vietnamese culture)
What is a common feature of anxiety disorders in the anxiety disorders diagnostic class?
They all cause significant distress or impairment
What is a key difference between the 'other specified anxiety disorder' and 'unspecified anxiety disorder' categories?
The specific reason why the criteria are not met for a specific anxiety disorder
What is a characteristic of anxiety symptoms related to a medical condition?
They can be etiologically related to the medical condition through a physiological mechanism
What is a common feature of presentations in the 'other specified anxiety disorder' and 'unspecified anxiety disorder' categories?
They often cause significant distress or impairment
What is the primary purpose of a psychological evaluation in the diagnosis of anxiety?
To compare symptoms to the criteria in the DSM-5
What is the classification of clinical symptoms of anxiety that involves feelings of restlessness and inability to relax?
Mild anxiety symptoms
What is the term for the client's experience of periodic warnings of threat that prompt them to take necessary steps to prevent a threat or lessen its consequences?
Normal anxiety response
What is the characteristic of anxiety that involves an inability to concentrate on multiple things at once?
Moderate anxiety
What is the term for the client's experience of an exaggerated feeling of wellbeing that is not directly proportional to a specific circumstance or situation?
Euphoria
What is the purpose of comparing symptoms to the criteria in the DSM-5?
To diagnose anxiety disorders
What is the classification of anxiety that involves an increase in alertness to inner feelings or the environment?
Mild anxiety
What is the term for the continuum of anxiety responses that ranges from adaptive responses to maladaptive responses?
Continuum of anxiety responses
What is a key diagnostic criterion for anxiety related to impending divorce or life changing event?
Avoidance behaviour
Which of the following is a physiological symptom of anxiety?
Hypervigilance
What is a key component of the planning phase for anxiety management?
Developing problem-solving skills
What is the primary goal of the evaluation phase in anxiety management?
To assess the client's ability to understand anxiety
What is a common behavioural symptom of anxiety?
Pacing
What is a key difference between anxiety and fear?
Anxiety is an emotional response to an unknown object or situation, while fear is a response to a known or recognized danger
What is a coping mechanism for anxiety that involves physical activity?
Channeling the client's behaviour into physical activities
What is a key etiological theory of anxiety?
All of the above
What is the primary difference between fear and anxiety?
Fear is a response to a real threat, while anxiety is a response to a perceived threat.
What is a characteristic of mild anxiety?
It can lead to maladaptive coping strategies if left unaddressed.
What is the main criterion for diagnosing an anxiety disorder?
The interference of anxiety with daily functioning.
How are anxiety levels typically classified?
By the level of distress and impairment experienced.
What is a physiological effect of anxiety?
A pounding heart.
What is a characteristic of moderate anxiety?
It is characterized by frequent or persistent symptoms, but with better daily functioning than severe anxiety.
What is a potential consequence of unaddressed mild anxiety?
It can lead to maladaptive coping strategies or more severe mental conditions.
What is a factor that can influence anxiety levels?
All of the above.
What is a key consideration when making a judgment about anxiety symptoms related to a medical condition?
The physiological mechanism etiologically relating the symptoms to the medical condition
What is the primary purpose of the 'other specified anxiety disorder' category?
To specify the reason why the criteria for a specific anxiety disorder are not met
What is a characteristic of the 'unspecified anxiety disorder' category?
It includes presentations with insufficient information to make a specific diagnosis
What is a common feature of presentations in the 'other specified anxiety disorder' and 'unspecified anxiety disorder' categories?
They both include symptoms characteristic of an anxiety disorder that cause clinically significant distress or impairment
What must be established before making a judgment about anxiety symptoms related to a medical condition?
The etiological relationship between the anxiety symptoms and the medical condition
What is an example of a cultural-specific anxiety disorder?
Wind attacks (Vietnamese culture)
What is a characteristic of anxiety symptoms related to a medical condition?
They are etiologically related to the medical condition through a physiological mechanism
What is a key difference between the 'other specified anxiety disorder' and 'unspecified anxiety disorder' categories?
The specified reason for not meeting the criteria for a specific anxiety disorder
What is a common consequence of untreated social phobia?
All of the above
Which anxiety disorder is characterized by a fear of being alone in public places?
Agoraphobia
What is the primary difference between a panic attack and an anxiety attack?
Panic attacks occur without warning
What is a common symptom of generalized anxiety disorder?
All of the above
Which of the following is a characteristic of social phobia?
Fear of public speaking
What is the primary diagnostic criterion for agoraphobia?
Fear of being alone in public places
What is a common complication of panic disorder?
All of the above
Which of the following is a characteristic of claustrophobia?
Fear of closed spaces
What is the primary reason why benzodiazepines are no longer recommended as the first line of treatment for anxiety symptoms?
Due to their high level of dependence
What type of medication is effective in treating social phobias?
Beta blockers
What is the primary indication for prescribing neuroleptics in anxiety management?
When the client's symptoms are severe and cause extreme functional impairment
What type of medication is prescribed when the client cannot tolerate benzodiazepines or selective serotonin reuptake inhibitors?
Neuroleptics
What is the primary advantage of using selective serotonin reuptake inhibitors (SSRIs) in anxiety management?
They are less likely to cause dependence
What is the primary mechanism of action of selective serotonin reuptake inhibitors (SSRIs) in anxiety management?
They increase the levels of serotonin in the brain
What is the primary indication for using atypical agents such as buspirone in anxiety management?
When the client cannot tolerate benzodiazepines or selective serotonin reuptake inhibitors
What is the primary benefit of using interactive therapy in anxiety management?
It is beneficial for clients suffering from generalized anxiety disorder
What is the primary purpose of a mental health specialist checking for signs of an underlying medical condition?
To rule out potential complications that may need treatment
What is the term for the client's experience of periodic warnings of threat that prompt them to take necessary steps to prevent a threat or lessen its consequences?
Normal
What is the classification of anxiety that involves an inability to concentrate on multiple things at once?
Moderate anxiety
What is the primary goal of comparing symptoms to the criteria in the DSM-5?
To help pinpoint a diagnosis and check for related complications
What is the term for the continuum of anxiety responses that ranges from adaptive responses to maladaptive responses?
Continuum of anxiety responses
What is the primary purpose of a psychological evaluation in the diagnosis of anxiety?
To help pinpoint a diagnosis and check for related complications
What is the classification of clinical symptoms of anxiety that involves feelings of restlessness and inability to relax?
Mild anxiety
What is the primary role of a mental health specialist in the diagnosis and treatment of anxiety?
To conduct a psychological evaluation and provide psychotherapy
What is the primary consequence of anxiety disorders on daily life?
Interference with daily activities
What is a major complication of anxiety disorders if left untreated?
Substance abuse
What is the primary purpose of the DSM-5 criteria in the diagnosis of anxiety disorders?
To compare symptoms to a standardized set of criteria
What is a key medical factor to consider when making a diagnosis of anxiety disorder?
Co-occurring medical conditions
What is the primary classification of anxiety disorders according to the DSM-5?
Anxiety disorders, obsessive-compulsive disorders, and trauma-related disorders
What is a key consideration when developing a treatment plan for anxiety disorders?
The presence of co-occurring medical conditions
What is the primary goal of medical and nursing management of anxiety disorders?
To reduce anxiety symptoms
What should be established before making a judgment about anxiety symptoms related to a medical condition?
The physiological mechanism
What is a characteristic of the 'unspecified anxiety disorder' category?
The clinician chooses not to specify the reason why the criteria are not met
What is an example of a cultural-specific anxiety disorder?
Wind attacks (Vietnamese culture)
What is a characteristic of anxiety symptoms related to a medical condition?
They can be etiologically related to the medical condition
What is the primary purpose of the 'other specified anxiety disorder' category?
To specify the reason why the criteria are not met for any specific anxiety disorder
What is a characteristic of presentations in the 'other specified anxiety disorder' and 'unspecified anxiety disorder' categories?
The symptoms characteristic of an anxiety disorder predominate
What is a key difference between the 'other specified anxiety disorder' and 'unspecified anxiety disorder' categories?
The clinician's choice to specify or not specify the reason why the criteria are not met
What must be established before making a judgment about anxiety symptoms related to a medical condition?
The physiological mechanism
What is the primary characteristic of Agoraphobia?
Fear of being alone in public places
Which phobia is characterized by a fear of germs or dirt?
Mysophobia
What is the primary characteristic of Social Phobia?
Desire to avoid situations in which others may criticize a person
Which anxiety disorder is characterized by unrealistic or excessive anxiety or worry occurring more days than not, in a six-month period?
Generalized Anxiety Disorder
What is the primary characteristic of Panic Disorder?
Recurrent unexpected panic attacks
Which phobia is characterized by a fear of strangers?
Xenophobia
What is the primary reason why benzodiazepines are no longer recommended as the first line of treatment for anxiety?
Due to high level of dependence
What type of medication is commonly used to treat social phobias?
Beta blockers
What is the primary characteristic of Claustrophobia?
Fear of closed spaces
Which anxiety disorder is characterized by a fear of public speaking?
Glossophobia
What is the primary indication for prescribing neuroleptics in the treatment of anxiety?
When clinical symptoms cause extreme functional impairment
What is the term for the classification of anxiety that involves an increase in alertness to inner feelings or the environment?
Hypervigilance
What is the primary goal of interactive therapy in the treatment of anxiety disorders?
To reduce symptoms of anxiety
What is the primary difference between selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs)?
Mechanism of action
What is the primary indication for prescribing antidepressants in the treatment of anxiety?
To treat anxiety
In treating which anxiety disorders are beta blockers effective?
Social Phobia
What is the primary goal of the nursing management of anxiety?
To identify the client's level of anxiety
Which of the following is a cognitive-behavioral technique used to treat social phobia and panic disorder?
Cognitive Behaviour therapy (CBT)
What is the primary purpose of using a screening tool or assessment scale in anxiety assessment?
To determine the client's level of anxiety
What is a characteristic of a client with severe anxiety?
All of the above
What is the purpose of assessing the client's general appearance in anxiety assessment?
To observe for signs of severe distress
Which of the following are common signs and symptoms associated with anxiety disorders?
Increased appetite
What is the purpose of using relaxation techniques in anxiety management?
To promote relaxation and reduce anxiety
What is a key component of the nursing management of anxiety?
All of the above
What is the primary goal of the nursing management of persons diagnosed with anxiety disorders?
To provide emotional support and alleviate symptoms
What is the primary focus of medical management in anxiety disorders?
Providing pharmacological interventions
Which of the following is a common clinical feature of social anxiety disorder?
Fear of being evaluated or judged by others
Which of the following best describes a primary characteristic of agoraphobia?
Fear of places where escape might be difficult
What is the primary difference between a specific phobia and social anxiety disorder?
The object or situation feared
What is the primary goal of the evaluation phase in anxiety management?
To assess the severity of anxiety symptoms
What is a common consequence of unaddressed mild anxiety?
Escalation to more severe anxiety symptoms
What is the primary difference between anxiety and fear?
The object or situation feared
What is a characteristic symptom of anxiety disorders?
Physical tension
Study Notes
Overview of Anxiety Disorders
- Anxiety disorders are the most common of all mental disorders, affecting approximately 4% of the global population
- Symptoms include fear, worry, physical tension, and behavioral and cognitive symptoms that are intense, excessive, and difficult to control
- Anxiety disorders interfere with daily activities and can impair a person's family, social, and school or working life
Classification of Anxiety Disorders
- Anxiety disorders are classified into several categories, including panic disorder, social anxiety disorder, specific phobia, and generalized anxiety disorder
- Other specified anxiety disorder and unspecified anxiety disorder are also recognized categories
Clinical Symptoms and Diagnostic Characteristics
- Clinical symptoms of anxiety can be classified as physiological, psychological, emotional, behavioral, and intellectual or cognitive
- Symptoms may vary according to the level of anxiety exhibited by the client
- Anxiety occurs on a continuum, ranging from adaptive responses (anticipation) to maladaptive responses (panic)
Levels of Anxiety
- Levels of anxiety can be influenced by personality, coping strategies, life experiences, and gender
- Anxiety levels are typically classified into four categories: mild, moderate, severe, and panic
- Mild anxiety symptoms may present as social anxiety or shyness and can be experienced in early childhood through to adulthood
- Moderate anxiety symptoms include feeling on edge, being unable to control worrying, and being unable to relax
- Severe anxiety symptoms include significant distress and impairment in social, occupational, or other areas of functioning
Diagnosis and Treatment
- A mental health specialist may conduct a psychological evaluation to help pinpoint a diagnosis and check for related complications
- The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria are used to compare symptoms and diagnose anxiety disorders
- Treatment for anxiety disorders may involve psychotherapy and medication
Nursing Diagnoses
- Anxiety related to impending divorce or life-changing event
- Impaired Verbal communication
- Ineffective coping
- Powerlessness
- Disturbed Sleep pattern
- Impaired Social interaction
Planning and Implementation
- Accept that the experience of anxiety is natural and inevitable
- Understand that the client's level of anxiety may fluctuate
- Develop problem-solving and coping skills
- Maintain a calm, non-judgmental attitude
- Convey acceptance and communicate in short, simple sentences
- Reduce environmental stimuli and assist the client in meeting basic needs
Common Phobias
- Acrophobia: fear of heights
- Astraphobia: fear of electrical storms
- Claustrophobia: fear of closed spaces
- Glossophobia: fear of public speaking
- Hematophobia: fear of blood
- Hydrophobia: fear of water
- Monophobia: fear of being alone
- Mysophobia: fear of germs or dirt
- Nyctophobia: fear of darkness
- Pyrophobia: fear of fire
- Xenophobia: fear of strangers
- Zoophobia: fear of animals
Clinical Features of Common Anxiety Disorders
- Agoraphobia: fear of being alone in public places, affects mostly women, and manifests between 18-35 years
- Social Phobia: fear of being criticized by others, begins early, interferes with development, and predisposes to depression and substance abuse
- Generalized Anxiety Disorder: characterized by unrealistic or excessive anxiety or worry, difficulty controlling worry, and experiencing 3 of 6 symptoms (restlessness, fatigue, impaired concentration, irritability, muscle tension, and sleep disturbance)
- Panic Disorder: characterized by recurrent unexpected panic attacks, sudden surge of intense fear or discomfort, and 4 or more of 13 physical and cognitive symptoms
Medical Management
- Psychotropic drugs are used to treat moderate to severe anxiety symptoms
- Multidimensional pharmacologic treatment approach may be necessary when medical or psychiatric disorders exist
- Common drugs used to treat anxiety include benzodiazepines, antidepressants, anxiolytics, beta blockers, and neuroleptics
- Benzodiazepines are no longer recommended as the first line of treatment due to high dependence
- Antidepressants (SSRIs and SNRIs) are the agents of choice
- Beta blockers are effective in treating social phobias
- Neuroleptics are prescribed when clinical symptoms cause extreme functional impairment or reach paranoid or delusional levels
Specific Medications
- Benzodiazepines: Alprazolam (Xanax), Clonazepam (Klonopin), Diazepam (Valium), and Lorazepam (Ativan)
- Selective Serotonin Reuptake Inhibitors (SSRIs): Citalopram (Celexa), Fluoxetine (Prozac), and Fluvoxamine (Luvox)
- Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): Venlafaxine (Effexor)
- Atypical Agents: Buspirone (Buspar)
- Beta blockers: Atenolol and Propranolol
- Antihistamines: Diphenhydramine (Benadryl)
Other Management
- Interactive therapy is beneficial for Generalized Anxiety Disorder
- Anxiety symptoms can be etiologically related to medical conditions
- Other specified anxiety disorder: symptoms characteristic of an anxiety disorder that cause clinically significant distress, but do not meet the full criteria for any anxiety disorder
- Unspecified anxiety disorder: symptoms characteristic of an anxiety disorder, but do not meet the full criteria for any anxiety disorder and insufficient information to make a specific diagnosis
Clinical Features & Diagnostic Characteristics
- Anxiety occurs on a continuum from adaptive responses to maladaptive responses
- Clinical symptoms of anxiety can be classified as physiologic, psychologic, emotional, behavioral, and intellectual or cognitive
- Normal: client experiences periodic warnings of threat
- Euphoria: exaggerated feeling of wellbeing
- Mild anxiety: increased alertness, inability to relax, and feelings of restlessness
- Moderate anxiety: inability to concentrate, only able to concentrate on one specific thing at a time
Common Phobias
- Acrophobia: fear of heights
- Astraphobia: fear of electrical storms
- Claustrophobia: fear of closed spaces
- Glossophobia: fear of public speaking
- Hematophobia: fear of blood
- Hydrophobia: fear of water
- Monophobia: fear of being alone
- Mysophobia: fear of germs or dirt
- Nyctophobia: fear of darkness
- Pyrophobia: fear of fire
- Xenophobia: fear of strangers
- Zoophobia: fear of animals
Clinical Features of Common Anxiety Disorders
Agoraphobia
- Fear of being alone in public places from which escape would be difficult or help would be unavailable
- Affects mostly women and manifests between 18-35 years
- Onset of symptoms may be sudden or gradual
Social Phobia
- Fear of being criticized or evaluated by others
- Begins early, interferes with development, and predisposes to depression and substance abuse
- Examples include fear of public speaking, eating, or drinking in public, using restrooms, or using public transportation
Generalized Anxiety Disorder
- Unrealistic or excessive anxiety or worry occurring more days than not in a 6-month period
- Concern is about several events such as job or school performance
- The individual is unable to control the worry
- Experienced 3 of the following 6 symptoms: restlessness, fatigue, impaired concentration, irritability, muscle tension, and sleep disturbance
Panic Disorder
- Characterized by recurrent unexpected panic attacks
- Panic attack is an abrupt surge of intense fear or intense discomfort that peaks within minutes
- Occurs without warning and for no discernible reason
Medical Management
- Psychotropic drugs are used to treat moderate to severe anxiety
- A multidimensional pharmacologic treatment approach may be necessary when medical or psychiatric disorders exist
- Common drugs used to treat anxiety include benzodiazepines, antidepressants, anxiolytics, beta blockers, and neuroleptics in some cases
Benzodiazepines
- Alprazolam (Xanax): 0.5-8mg
- Clonazepam (Klonopin): 0.5-20mg
- Diazepam (Valium): 2-40mg
- Lorazepam (Ativan): 1.0-10mg
Selective Serotonin Reuptake Inhibitors (SSRIs)
- Citalopram (Celexa): 10-50mg
- Fluoxetine (Prozac): 20-50mg
- Fluvoxamine (Luvox): 50-300mg
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
- Venlafaxine (Effexor): 75-375mg
Atypical Agents
- Buspirone (Buspar): 15-60mg
Beta Blockers
- Atenolol: 50-200mg
- Propranolol: 40-120mg
Antihistamines
- Diphenhydramine (Benadryl): 20-300mg
Other Management
- Interactive therapy: beneficial for Generalized Anxiety Disorder
- Cognitive-behavioral therapy (CBT): used to treat social phobia and panic disorder
- Uses behavioral techniques to desensitize fears or anxiety
- Visual imagery, change of pace or scenery, exercise or massage, systematic desensitization, relaxation exercise, and therapeutic touch can be used
Nursing Management
Assessment
- Identify the client's level of anxiety
- Determine whether a threat of self-harm exists
- Obtain a thorough history (physiologic, emotional, behavioral, cognitive functioning)
- Keep in mind that the chief complaint may not be anxiety
- Use a screening tool or assessment scale (Hamilton anxiety rating scale, Liebowitz Social Anxiety Scale)
General Appearance
- Client may be in severe distress or immobilized
- Engaged in purposeless, disorganized, or aggressive activity
- Feeling of dread or terror
- Express fear of losing control
- Ask about stressors
- Assess cognitive ability
Mood Affect and Feelings
- Ask client how they are feeling
- Symptoms can include prominent anxiety symptoms or panic attacks
Other Specified Anxiety Disorder
- Applies to presentations in which symptoms characteristic of an anxiety disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the anxiety disorders diagnostic class
- Examples: wind attacks (Vietnamese culture), attack of nerves (Latin American culture)
Unspecified Anxiety Disorder
- Applies to presentations in which symptoms characteristic of an anxiety disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the anxiety disorders diagnostic class
- Includes presentations in which there is insufficient information to make a more specific diagnosis
Objectives
- Overview of anxiety disorders
- Define anxiety, fear, and anxiety disorders
- Discuss the levels of anxiety
- Discuss the epidemiology of common anxiety disorders
- Discuss the causes of anxiety disorders
- Discuss complications of anxiety disorders
- Outline the classification of anxiety disorders according to the DSM-5 criteria
- Describe clinical symptoms and diagnostic characteristics
- Outline medical and nursing management of persons diagnosed with anxiety disorders
Overview
- Anxiety disorders are the most common of all mental disorders, affecting an estimated 4% of the global population
- In 2019, 301 million people in the world had an anxiety disorder
- Only about 1 in 4 people in need (27.6%) receive any treatment
- Barriers to care include lack of awareness, lack of investment in mental health services, lack of trained healthcare providers, and social stigma
Learn about the signs and diagnosis of anxiety, including when to see a mental health specialist and how they can help with treatment and psychotherapy.
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