Mental Health Nursing

Anxiety Disorders

  • Nursing
  • Mental Health Nursing
  • 2021-10-21 01:17:04
  • 4 minutes, 25 seconds

Anxiety Disorders

Anxiety is a sustained feeling of uneasiness and apprehension about some undefined threat either physical or psychological with threats to self-esteem, wellbeing or bodily harm.

❖ Anxiety vs Fear
❖ Fear: acute, immediate response to suddenly appearing, imminent danger (proximal threats)
❖ Fear involves subjective feelings of apprehension and objective physiological changes such as rapid heartbeat, muscle tremor etc in preparation for flight or fight tendencies.
❖ Unlike fear, anxiety stems from sources that are not obvious or seem minor to the person who suffers.

Causes of anxiety

Many theories exist since the advent of Freud's pioneering work identifying anxiety as a universal human emotion that directs human behaviour.
The cognitive model attributes anxiety to a disordered thinking (the cognitive triad)

Other causes of anxiety include: Dysfunctional beliefs/rules, Biological basis i.e. the limbic system

Levels of Anxiety

◼ Mild: adaptive day to day tension
◼ Moderate: difficulty focusing with mild somatic complaints such as mild stomach upsets
◼ Severe: unable to focus on problem-solving, increased physical discomfort, direction needed to focus attention
◼ Panic: awe, dread, terror, distortion of perception, disorganized personality

Maladaptive coping to anxiety leads to Anxiety disorders with a common feature of anxiety:

❑ Generalized anxiety disorder
❑ Selective mutism
❑ Separation anxiety disorder
❑ Specific phobia
❑ Social anxiety disorder (social phobia)
❑ Panic disorder
❑ Agoraphobia
❑ Substance/medication-Induced Anxiety Disorder.

Generalized Anxiety Disorder

This is an anxiety disorder characterized by excessive anxiety and worry occurring on most days for at least 6 months.

The anxiety is about a number of different events or activities and the individual finds it difficult to control.

The affected person has at least three or more of the following:

❑ Restlessness or feeling keyed up
❑ Being easily fatigued
❑ Difficulty concentrating or mind going blank
❑ Irritability
❑ Muscle tension
❑ Sleep disturbance.

In children just one symptom.

Most common in adults and females.

Panic disorder

◼ Recurrent unexpected panic attacks.
◼ A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four (or more) of the following symptoms occur:

❑ Palpitations, pounding heart, accelerated heart rate
❑ Sweating
❑ Trembling or shaking
❑ Chest pain or discomfort
❑ Nausea or abdominal distress.
❑ Feeling dizzy, unsteady, lightheaded, or faint
❑ Derealization or depersonalization
❑ Fear of losing control or going crazy
❑ Paresthesia (numbness or tingling sensation)
❑ A sensation of shortness of breath or smothering
❑ Fear of dying
❑ Chills or hot flushes
❑ Feeling of choking

◼ At least one of the attacks has been followed by 1 month or more of either :
❑ Persistent concern or worry about additional panic attacks or their consequences or
❑ A significant maladaptive change in behavior related to the attacks

◼ Not attributed to substance effect, medical condition or another mental disorder.

Separation Anxiety Disorder

◼ Essential feature is excessive fear or anxiety concerning separation from home or attachment figures exceeding what may be expected at the given developmental level.
◼ Individuals with separation anxiety disorder have symptoms that meet at least three of the following criteria: they experience persistent excessive fear when;

❑ separation from home or major attachment figures
❑ worry about the well-being or death of attachment figures
❑ worry about untoward events to themselves
❑ reluctance or refusal to go out by themselves or being alone
❑ reluctance or refusal to go to sleep alone
❑ repeated nightmares
❑ Physiological features such as headache upon separation

◼ The disturbance must last for a period of at least 4 weeks in children and adolescents and 6 months or more in adults

◼ It causes significant distress or impairment in social, academic and occupational life.

◼ Risk factors include afterlife stress, parental overprotection and intrusiveness.

◼ The most prevalent anxiety disorder in children under 12yrs.

Selective Mutism

◼ Consistent failure to speak in specific social situations in which there is an expectation for speaking (e.g., at school) despite speaking in other situations for at least 1 month.

◼ Such children do not initiate speech or reciprocally respond when spoken to by others except the very close family members or friends.

◼ It interferes with educational or occupational achievement or with social communication.

◼ The failure to speak is not attributable to a lack of knowledge of, or comfort with, the spoken language required in the social situation.

◼ The disturbance is not better explained by a communication disorder

Specific Phobia

◼ Revolves around specific or single feared objects or situation that is not in fact objectively dangerous

◼ There’s active avoidance of the phobic objects or situations lasting for 6 or more months.

◼ The fear and anxiety is out of proportion and is the immediate response to the object or situation.

o Acrophobia – heights
o Apiphobia – bees
o Ailurophobia – cats
o Astrophobia – lightning
o Aviophobia – flying
o Claustrophobia – closed spaces
o Cynophobia – dogs
o Entomophobia – insects
o Pyrophobia – fire
o Gephyrophobia – bridge crossing
o Hematophobia – blood
o Hydrophobia – water
o Microphobia – germs
o Monophobia or
autophobia – being alone.
o Nyctophobia – night
o Xenophobia – strangers

Management of Anxiety Disorders

◼ CBT: Challenge negative thinking patterns that contribute to anxiety, replacing them with positive, realistic thoughts
◼ Habituation, flooding and implosive therapies
◼ Train patient relaxation techniques:

❑ Recognize your own feelings of anxiety
❑ Mental exercises: crossword puzzle or playing general knowledge games.
❑ Focusing on a neutral object with as much detail as possible.
❑ Progressive relaxation 15- 20 minutes. Jacobson 1938(tensing and relax muscles)
❑ Benson’s meditation (1975) technique
❑ Develop a set of verbal and nonverbal and environmental manipulation skills

Use of anti-anxiety agents

◼ Propranolol for physical symptoms of anxiety
◼ Alprazolam is the treatment of choice for panic disorder; others include clomipramine, fluoxetine, imipramine and phenelzine.
◼ Others include imipramine and buspirone for generalized anxiety disorder, phenelzine for phobias
◼ Benzodiazepines sparingly

References: NCBI, Mental health nursing

Daniel Ogera

Medical educator, passionate about simplifying difficult medical concepts for easier understanding and mastery by nursing and medical students.

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  • Topic:Nursing
  • Duration:4 minutes, 25 seconds
  • Subtopic:Mental Health Nursing

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