Anxiety

Question 1

What is anxiety?

Answer 1

A feeling of apprehension, uneasiness, uncertainty, or dread resulting from a real or perceived threat.

Question 2

What is normal anxiety?

Answer 2

A healthy reaction necessary for survival, providing the energy needed to carry out everyday tasks and strive toward goals

Question 3

What are different types of anxiety disorders?

Answer 3

Separation Anxiety Disorder
- Selective Mutism
- Phobias (social phobia common, agoraphobia also common)
- Panic Disorders
-Generalized Anxiety Disorder (GAD, very common)
-Substance/Medication Induced Anxiety Disorder
-Anxiety due to another medical condition

Question 4

What are disorders related to anxiety?

Answer 4

-Somatic Symptoms (Somatic symptom disorder, Illness anxiety disorder, conversion disorder, factitious disorder)
- Obsessive Compulsive Disorders (OCD, body dysmorphic disorder, trichotillomania, hoarding, excoriation)
Trauma and Stressor Related Disorders (Reactive Attachment Disorder(child),adjustment disorder, PTSD, acute stress disorder)
- Dissociative Disorders (depersonalization/derealization disorder, dissociative amnesia, dissociative identity disorder)

Question 5

What is the etiology of anxiety?

Answer 5

Multifactorial
- Biological factors (genetics, neurobiological: limbic system, hypothalamic-pituitary-adrenal system, brain structure)
- Psychological factors (different theories primarily related to personality)
- Environmental factors (exposure to trauma)
- Sociocultural factors (culture)

Question 6

What is a common element of anxiety-related disorders?

Answer 6

Those affected experience a degree of anxiety so high that it interferes with personal, occupational, or social functioning.

Question 7

What are the four levels of anxiety as idenitified by Peplau?

Answer 7

• mild
• moderate
• severe
• panic

Question 8

Define mild anxiety.

Answer 8

The level of anxiety that occurs in the normal experience of everyday living and that allows an individual to perceive reality in sharp focus. A person experiencing a mild level of anxiety sees, hears, and grasps more information, and problem solving becomes more effective.

Question 9

Define moderate anxiety.

Answer 9

A level of anxiety that interferes with what a person sees, hears, and grasps—the perceptual field narrows, and some details are excluded from observation.

Question 10

Define severe anxiety.

Answer 10

A level of anxiety that seriously impairs the person’s ability to notice his or her environment, even when it is pointed out by another. A person with severe anxiety may instead focus on one particular detail or many scattered details.

Question 11

Define panic.

Answer 11

The most extreme level of anxiety, marked by an inability to process the meaning of activity in the environment, noticeably disturbed behaviour, and, sometimes, a lost sense of reality.

Question 12

What medications are commonly used to assist with anxiety?

Answer 12

BENZODIAZEPINES

Question 13

What neurotransmitter do benzodiazepines work on?

Answer 13

GABA
GENERALLY: Drugs used to treat anxiety increase the effectiveness of GABA or increase serotonin and/or norepinephrine

Question 14

What is the clinical picture of mild anxiety?

Answer 14

Impatience, restlessness, irritability

Often results in a heightened perceptual field but does not interfere with ability to learn or problem solve. Often a helpful, protective response. Can be motivating.

Question 15

What interventions are there for mild anxiety?

Answer 15

Often no intervention is required

Question 16

What is the clinical picture of moderate anxiety?

Answer 16

MODERATE: Shakiness, decreased concentration (asking same question), increased respiration, increased pulse and muscle tension. Physical complaints.

Narrowed perceptual field, diminished ability to problem solve. Can be redirected at this point. Needs help

Question 17

What interventions are there for moderate levels of anxiety?

Answer 17

• Be calm and relaxed. Ask questions to clarify, i.e. “Can you give me an example of what you mean?”.
• Try to have the person connect to their thoughts and feelings, “What were you thinking right before you became anxious?”
• Ask about past coping.
• Validate and Reassure
• Suggest energy outlets: exercise, dancing, some type of physical game.

Question 18

What is the clinical picture of severe levels of anxiety?

Answer 18

Confusion, feelings of dread, increased physical complaints, hyperventilating, tachycardia, threats and demands, loud and rapid speech.

Perceptual field is greatly reduced, often focused on one detail. Unable to problem solve, perceptions distorted.

Question 19

What is the clinical picture of panic?

Answer 19

Feeling of Terror, fight or flight, pupils dilated, unable to communicate, shakiness, hallucinations, delusions

Unable to focus, may be psychotic, Unable to problem solve

Question 20

What are the interventions for severe anxiety and panic?

Answer 20

Maintain calm
Validate and Reassure
Stay with the person
If possible move to a low stimuli environment
Keep your voice low and steady
Reinforce reality
Look for physical and safety needs: water, food, need to use bathroom, pain relief, family connection
Be firm: “You cannot harm anyone. You will need to stay in control. We Can help you”
Things may progress to need for medication or seclusion