Anxiety Disorders

Introduction to Anxiety

Anxiety is a common psychological response to stress, characterized by feelings of mental uneasiness, apprehension, and helplessness. It is often related to an impending or actual threat to oneself or significant others.

• Stress response: Activation of physiological and psychological mechanisms.

• Feelings of apprehension: Mental uneasiness and worry.

• Helplessness: Perceived inability to manage or control the threat.

Anxiety Disorders Overview

Anxiety disorders are marked by excessive distress or fear, often in response to imminent danger (real or perceived). These disorders can impair daily functioning and relationships, but effective treatments are available.

• Impairment: Untreated anxiety can damage relationships and work ability.

• Treatment: Many do not realize the severity or recognize symptoms.

Pathophysiology of Anxiety Disorders

Biological and Environmental Factors

Anxiety disorders affect individuals of all ages and may arise from a combination of biological and environmental factors. Free-floating anxiety refers to anxiety not linked to a specific cause.

• Types: Generalized anxiety disorder (GAD), separation anxiety, panic disorder.

Etiology

The development of anxiety disorders is multifactorial, involving neurobiological, neurochemical, psychosocial, behavioral, and genetic components.

• Neurobiological: Nervous system abnormalities, especially in the limbic system (thalamus, hypothalamus, amygdala, hippocampus).

• Neurochemical: Imbalances in neurotransmitters such as serotonin, dopamine, norepinephrine, and GABA.

• Psychosocial: Life stressors, trauma, and social environment.

• Behavioral: Learned responses to stress.

• Genetic: Family history increases risk.

Neurotransmitters Involved

Risk Factors

Contributing Factors

• Childhood adversity (ACES): Early trauma increases risk.

• Family history: Genetic predisposition.

• Social factors: Poor communication, lack of social support.

• Chronic illness: Ongoing health issues.

• Traumatic events: Exposure to trauma.

• Personality traits: Shyness, perfectionism, chronic worry.

• Multiple stressors: Accumulation of life stressors.

Prevention

Strategies for Prevention

• Early intervention: Seek help early and monitor patterns of anxiety.

• Journaling: Catalog stressors and sources of relief.

• Substance avoidance: Avoid unhealthy substance use, especially for those with multiple risk factors.

Clinical Manifestations

Generalized Anxiety Disorder (GAD)

GAD is characterized by pervasive apprehension and worry, excessive anxiety for at least six months, and symptoms that interfere with daily functioning.

• Difficulty relaxing, fatigue

• Poor concentration

• Irritability

Panic Disorder

• Sudden attacks of terror (few minutes to an hour)

• Fear of unexplained symptoms

• Intense worry about next attack

• Cannot be due to substances

Phobias

• Intense, persistent fear of anxiety associated with a particular object or situation

• Contact with stressor produces severe panic

• Three categories: Specific, agoraphobia, social anxiety disorder

Levels of Anxiety

Classification and Manifestations

Treatment and Management

Collaborative Treatment

• Occurs in home and community settings

• Based on observation and history

• No lab tests for diagnosis; tests used to rule out physical illness

• Referral to mental health professionals

Pharmacological Therapy

• Antidepressants: SSRIs (escitalopram, fluoxetine, paroxetine, sertraline), SNRIs (duloxetine, venlafaxine)

• Benzodiazepines: alprazolam, clonazepam, lorazepam, diazepam (short-term use, risk of dependence, monitor for respiratory depression)

• Antianxiety drugs: Buspirone (requires daily use, takes 2-4 weeks for effect), Meprobamate (side effects: dizziness, drowsiness)

• MAOIs: infrequently used due to side effects and drug interactions

Nonpharmacologic Therapy

• Cognitive-behavioral therapy (CBT): Reframing thoughts, effective for all anxiety disorders

• Herbal preparations: Kava (risk of liver damage), lavender, chamomile

• Massage and relaxation techniques: Yoga, meditation, TM (transcendental meditation)

Lifespan Considerations

• Children

• Adolescents

• Pregnant women

• Older adults

• Adults

Nursing Process

Assessment

• Health history (illnesses, medications, supplements)

• Past and present stressors

• Home and work conditions

• Socioeconomic status

• Coping methods

• Physical assessment

Diagnosis

• Anxiety

• Fear

• Knowledge deficit

• Ineffective coping

• Disturbed sleep pattern

• Impaired social interaction

• Risk for ineffective self-health management

Planning

• Decrease in anxiety level

• Demonstrate effective coping mechanisms

• Demonstrate relaxation techniques

• Participate in psychotherapy

Interventions

Evaluation

• Anxiety diminished

• Improved coping mechanisms

• Self-regulation of anxiety response

• Engagement in healthy behaviors