Anxiety Disorders

Question 1

What is fear?

Answer 1

• A cognitive response to a specific source or object that the person can identify or describe
• Involves intellectual or cognitive appraisal of threatening stimuli
• Fear provokes anxiety

Question 2

What is anxiety?

Answer 2

• Integral part of human experience
• A vague, subjective feeling of uneasiness, tension, apprehension or dread
• Results from an external threat to one’s integrity
• Function of anxiety is to warn individual of impending threat, conflict or danger

Question 3

What are the four levels of anxiety?

Answer 3

Mild, moderate, severe and panic

Question 4

Describe mild anxiety:

Answer 4

• Feels comfortable/safe, carries through with habitual behaviours
• Aware of surroundings, thoughts controlled, able to learn and problem solve
• Vitals normal, mild muscle tension
• Generally we live in a state of mild anxiety

Question 5

Describe moderate anxiety:

Answer 5

• Vitals slightly elevated, tension present
• Feels ready and challenged, and able to engage in competition and learn new skills
• Able to learn and problem solve
• Can be a good place to be when trying to accomplish goals
• Perceptual field narrows, can be confused

Question 6

Describe severe anxiety:

Answer 6

• Fight or flight, ANS stimulated
• Feels threatened/startled
• Shaky, stuttering, disorganized
• PF narrows, selective attention, time distortion, problem-solving is difficult

Question 7

Describe panic anxiety:

Answer 7

• Can occur in someone exposed to high levels of stress and living with chronic stress
• Body reaches exhaustion state from prolonged ANS stimulation
• Intervention required
• PF scattered/closed, no problem solving
• Feels helpless/angry/fearful
• Combative or withdrawn

Question 8

What is signal anxiety?

Answer 8

• Identifiable cause, environmental cue

- Ex. phobias (becoming frightened easily when seeing a spider)

Question 9

What is trait anxiety?

Answer 9

Function of personality structure, learned anxious behavior from upbringing

Question 10

What is state anxiety?

Answer 10

• Conflicting or stressful situations
• A state where you are in conflict
• Ex. upcoming exam, competing demands for time, trouble at work, etc.

Question 11

What is free-floating anxiety?

Answer 11

• Unattached to any idea or event
• Comes on randomly
• Gives a sense of impending doom, as if about to die; a sense of severe dread or fear

Question 12

Describe the epidemiology of anxiety:

Answer 12

• The most common psychiatric disorders tx by HCP’s
• Approx 19 million Canadian’s are affected
• More common in women than men
• Affects all ages, however the typical age of onset for panic disorders is in late adolescence and early adulthood
• High co-morbid rates of anxiety and depression

Question 13

What is generalized anxiety disorder?

Answer 13

• People who tend to feel anxious more often than not, resulting in excessive anxiety and worry
• Present for at least 6 months, with the presence of 3 of the following: restlessness, edginess, fatigue, poor concentration, irritability, muscle tension and sleep disturbance
• Anxiety and worry that interferes with normal social and occupational functioning

Question 14

What are panic attacks?

Answer 14

• A physical symptom of anxiety; it is NOT a psychiatric illness!
• Discrete period of intense fear, discomfort, dread or doom
• Develops abruptly, and peaks within 10 minutes
• Exhibits are least four symptoms: shortness of breath, chest tightness, increased HR, palpitations, feelings of doom, sweating/trembling, dissociation

Question 15

What are the criteria for panic disorder?

Answer 15

• Must meet these two criteria:
• Presence of recurrent or unexpected panic attacks
• At least one of the attacks is followed by: persistent concern about having additional attacks; worry about the implications of the attack; or a significant change in behaviors as a result
• Must be present for at least one month

Question 16

What are phobias?

Answer 16

Fear of something that can lead to feelings of panic or intense anxiety in response to a specific situation

Question 17

What is agoraphobia?

Answer 17

• Anxiety about being where escape is difficult
• Situations are avoided or endured with anxiety
• Leaving a comfort zone causes huge anxiety (ex. leaving your home, fear of open spaces, etc.)
• Not due to the effects of a medical condition, substance or other mental disorder

Question 18

What is specific phobia?

Answer 18

• Marked, persistent, excessive fear
• Cued by presence/anticipation of specific objects or situations
• Exposure to the phobic stimulus provokes an anxiety response/panic attack
• Avoided or endured with anxiety
• Persons with a simple phobia recognize that their fear is excessive or unreasonable

Question 19

What is social phobia?

Answer 19

• Marked, persistent fear of one or more social or performance situations, exposing individual to scrutiny while behaving in an embarrassing way
• Only able to have social relationships with familiar people
• Recently on the rise; technology replaces our natural social skills and makes it difficult to endure real-life encounters
• Only able to have social relationships with familiar people
• Avoids social or performance situations or endure them with intense anxiety or distress
• Treated with psychotherapy or SSRI’s; self-treatment with substances on the rise (alcohol and cannabis to take the ‘edge off’)

Question 20

What is PTSD?

Answer 20

• Reaction to traumatic events
• Symptoms are present for more than one month and will impair functioning
• Recurrence, avoidance and heightened arousal

Question 21

What is acute stress disorder?

Answer 21

• Similar to PTSD, but short-lived (~2-30 days)
• Experience three symptoms indicating dissociation (detached, numbness)
• The symptoms of dissociation prevent the individual from adaptively coping with the trauma
• Not able to pursue a necessary task

Question 22

What is OCD?

Answer 22

• Obsessions: recurrent or persistent unwanted thoughts, impulses or images that cause anxiety
• Compulsions: repetitive behaviors that the person feels driven to perform in response to the obsession
• Obsession cannot be suppressed/ignored and therefore interferes with normal functioning
• Treated with behavioral therapy or medications (SSRI’s, TCA’s)

Question 23

Describe the nursing assessment that goes along with treating anxiety disorders:

Answer 23

• Safety risk
• Physical symptoms
• Discussion re: response to stress and coping mechanisms

Question 24

What are nursing diagnoses for individuals with anxiety?

Answer 24

• Ineffective coping
• Self-care deficit
• Ineffective role performance
• Loneliness
• Spiritual distress
• Powerlessness
• Isolation

Question 25

How do we plan is nursing care for these individuals?

Answer 25

- Goal is to improve coping - Involve people in therapy - Ideal to have treated by outpatient therapy

Question 26

What are some nursing interventions for anxiety?

Answer 26

- Deep breathing exercises - Mindfulness - Behavioral cognitive therapy - Healthy sleep and wake patterns - Nutrition - Decrease intake of stimulants (ex. coffee) - Meditation - Positive self-talk - Teaching assertiveness, social skills and communication techniques - Acceptance therapy - Social supports - Do NOT try to have patients distract selves or avoid anxiety, has potential to make worse in the long run - Medications (benzos, SSRI's, TCA's, beta-blockers, etc.)