Anxiety disorders Flashcards
What are anxiety disorders?
Excessive fear, worry and associated behavioural disturbances occurring persistently over a sustained period of at least 6 months
Difference between fear and anxiety?
Fear is the emotional response to a real or perceived imminent threat and anxiety is the anticipation of future threat
What are the four domains affected by anxiety?
- Cognition
- Affect
- Behaviour
- Physical state
How is cognition impacted by anxiety?
- Impaired attention
- Poor concentration
- Forgetfulness
- Errors in judgement
- Preoccupation
- Thought blocking
- Decreased perceptual field
- Frightening visual images
- Reduced creativity
- Diminished productivity
- Confusion
- Hypervigilance
- Self consciousness
- Loss of objectivity
- Fear of losing control
- Injury or death
Common affect in anxiety disorders
- Anxious
- Tense
- Agitated
- Irritable
- Nervous
How is behaviour impacted by anxiety?
- Restlessness (psychomotor agitation)
- Muscular tension
- Tremors
- Rapid speech
- Avoidance
- Hyperventilation
- Accident prone
- Interpersonal withdrawal
- Inhibition
- Uncoordination
- Catastrophising
Physical state symptoms of anxiety
- HTN
- Palpitations
- Hypotension
- Bradycardia
- Faint
- Rapid shallow breathing
- Shortness of breath
- Choking sensation
- Gasping for air
- Flushed face
- Pallor
- Diaphoresis
- Loss of appetite
- Abdominal discomfort/pain
- Diarrhoea
- Nausea
- Vomiting
- Dilated pupils
- Increased urine output
What are the four types of anxiety disorders that we need to know?
- Generalised anxiety disorder
- Social anxiety disorder (social phobia)
- Panic disorder
- Obsessive-compulsive disorder
What are signs and symptoms of panic disorder?
- SOB, choking or smothering sensation
- Sweating
- Dizziness, light-headed, faint or unsteady
- Hypotension, tachycardia, chest pain or discomfort, palpitations, chills or hot flushes
- Nausea or abdominal distress
- Numbness or tingling sensations (paraesthesia)
- Agitation, poor motor coordination, involuntary movements, entire body trembling, facial expression of terror
- Feeling of losing control/going mad, fear of dying
- Completely disrupted perceptual field with derealisation
What are healthy and unhealthy coping strategies for mild anxiety?
Healthy - exercise, phone a friend, cry, eat, sleep, distraction, talk about concerns, relaxation techniques, read a book
Unhealthy - maladaptive coping mechanisms such as increased risk-taking behaviours or increased use of alcohol/illicit drugs to reduce anxiety
Factors of generalised anxiety disorder (GAD)
- Generalised anxiety and worry which is excessive, occurring for more days than not for at least 6 months, about several events or activities
- Difficult to control worry
- No single factor has been established as the cause
- More prevalent in women than men
- Common comorbidities include mood disorders and substance related disorders
- Headaches are common
- 50% have symptoms since childhood
- Panic is not present
- Anxiety is free floating, there is no specific trigger
Factors of social anxiety disorder (social phobia)
- Involves anxiety in response to exposure to certain social or performance situations such as public speaking or examinations
- Pts feel they are negatively judged by others, flawed or incompetent
- This leads to an all or nothing approach; avoid the situation or get a perfect outcome
- Therefore, avoidance is the most common response and often appears trivial
- Exhaustion of avoiding certain situations and physical response can result in reduced mental capacity to cope
- Difficult to control feelings of discomfort and be able to coach or manage their feelings in public
- Therefore, common for patients to manage through alcohol and drug use, making long-term treatment difficult and complex due to co-morbidity
- Other likely co-morbidities are anorexia nervosa, mood disorders and personality disorders
Factors of obsessive compulsive disorder
- Characterised by recurrent intrusive/unwanted obsessions which cause marked anxiety/distress
- Compulsions are the repetitive behavioural actions the patient conducts in an attempt to neutralise their anxiety/distress
- Obsessions are persistent ideas, thoughts, impulses or images that become more distressing for the patient when attempts are made to block them
What are common obsessions in OCD?
- Thoughts of being contaminated
- Repeated doubts whether they have performed/completed tasks
- Need for items in a particular order and be symmetrical
Nursing management of OCD
- Establish therapeutic rapport and sustain therapeutic relationship
- Assess and identify patient obsessions and compulsions
- Identify frequency, duration and limitations arising from OCD
- CBT for ritual prevention
- Encourage and support the patient to gradually tolerate anxiety provoking situations - exposure therapy
- Administer SSRI antidepressant which reduce OCD symptoms by 20-40%
- Be firm that the patient’s situation can improve and celebrate success
Factors of panic disorder (not symptoms)
- Recurrent and unexpected panic attacks
- These attacks have a sudden, intense and overwhelming sense of doom and fear where the patient feels helpless
- The reaction of alarm which makes the body secrete cortisol and adrenaline in order to have a “fight or flight” response and defend oneself
- Common to have comorbid depression
- Peak onset is adolescence
- Rare in children and people over 45
- Common in families
- Long term treatment - medication (benzodiazepines) and psychotherapy
Nursing management of manic disorder
During a panic attack
- Stay with pt, reassure and encourage the patient they will be okay
- If in high stimulus environment, move to quieter area
- Remove the trigger (if known)
- Reinforce desired behaviours
- Keep communication in short simple sentences
- Remain calm, use reassuring tone of voice with open body language
- Instruct to use abdominal breathing
- Administer anti-anxiety or benzodiazepine meds to assist the pt to resume control
After a panic attack
- Educate the pt that they have experienced a panic attack and provide written materials where possible due to residual anxiety
- Many pts will be fearful of a reoccurrence
- Keep explanations short and simple to assist retention of information
- Provide the pt with a list of symptoms associated with panic attacks
- If no history, refer the pt to the GP for further investigations
PTSD vs anxiety
With PTSD, there is a pattern of reliving the event, rather than remembering it
Symptoms of PTSD
- Sleep disturbances
- Tension
- Irritability
- Frustration
- Nightmares
- Avoiding triggers
- A method of coping during the flashbacks is for the mind to shutdown, feel numb, dissociate from reality and even feel nothing
How long can PTSD symptoms be delayed post incident?
6 months
Do anti-anxiety medications cure anxiety disorders?
No, they act to reduce symptoms to the level the patient can sleep, think rationally and tolerate their anxiety
Types of anti-anxiety medications
- Benzodiazepines (diazepam)
- Antidepressants in low doses such as SSRIs
- Beta blockers for physical symptom control (propranolol), these are non-sedating
How to treat anxiety disorders
Symptoms management by medication and psychotherapy
