Generalized Anxiety Disorder (GAD)

 Is characterized by anxiety that is persistent, overwhelming,

uncontrollable, and out of proportion to stimulus.
 Emerges slowly and tends to be chronic.
 Usual onset is early 20s and affects 3% of the population.
Panic Disorder

 Represents anxiety in its most severe form.

 Characterized by recurrent, unexpected panic attacks that
cause intense apprehension and feelings of impending doom. It may
change patient’s behavior.
Obsessive-Compulsive Disorder (OCD)

 Characterized by unwanted, recurrent, intrusive thoughts or

images (obsession) that the person tries to alleviate
through repetitive behaviors or mental acts (compulsions).
 Obsession produces anxiety and compulsions are meant to reduce
anxiety or prevent some dreaded event from happening.
Compulsions typically are overt behaviors like hand washing,
counting, and praying.
Phobic Disorder

 Social phobia commonly involves anxieties about speaking or

eating in public and using public restroom. It is associated with deep
concern that others will see the patient’s anxiety symptoms (e.g.
sweating, blushing) or will judge him as weak and stupid.
 Specific phobias are divided into five subtypes: natural
environment, animal, blood-injection-injury, situational, and others.
Post-traumatic Stress Disorder (PTSD)

 Characterized by persistent, recurrent images and memories

of a serious traumatic event that the person has either
experienced or witnessed, impairing his ability to function. 
Medical Management
Individuals who are stressed and anxious can benefit from these
therapies:

 Social supports, psychotherapy, cognitive or behavioral therapy

 Pharmacotherapy
 Supportive counselling
Nursing Management
Here are the nursing responsibilities for taking care of patients who are
stressed and anxious:

Nursing Assessment

 Assess level of anxiety. Review familial and physiological

factors (e.g. genetic depressive factors); psychiatric illness; active
medical conditions (e.g. thyroid problems, metabolic imbalances).
Monitor vital signs.
 Description of feelings (expressed and displayed). Conduct
interview and observe behaviors.
 Awareness and ability to recognize and express feelings.
 Related substance use, if present.
Nursing Diagnosis

 Anxiety related to unconscious conflict about essential goals and

values of life, threat to self-concept, positive or negative self-talk, or
physiological factors (e.g. hyperthyroidism, pulmonary embolism,
dysrhythmias).
Planning and Goals

 Treatment plan and individual responsibility for activities.

 Teaching plan.
Nursing Interventions
 Assist clients to identify feelings and begin to deal with
problems. Establish a therapeutic relationship. Be available to client
for listening and talking. Assist client to develop self-awareness of
verbal and nonverbal behaviors. Clarify meaning of feelings and
actions by providing feedback and checking meaning with client.
Most of all, acknowledge anxiety and fear. When dealing with
children, be truthful and avoid bribing.
 Promote wellness. Assist client with identifying new methods of
coping with disabling anxiety. Review happenings, thoughts, and
feelings preceding the anxiety attack. List helpful resources and
people. Assist in developing skills (e.g. awareness of negative
thoughts, saying “Stop”, and substituting a positive thought).
Evaluation

 Client involvement
 Client response to interventions, teaching, and actions performed.
Discharge and Home Care Guidelines

Instruct patient and family to adhere to these reminders:

 Relaxation techniques (e.g. deep breathing, imagery, music

therapy)
 Maintaining learned positive coping strategies
 Avoidance of triggers
 Stress management techniques
 Strict adherence to medication (if doctor prescribed) and therapy
schedule

Causes

The causes of anxiety disorders aren't fully understood. Life

experiences such as traumatic events appear to trigger anxiety
disorders in people who are already prone to anxiety. Inherited
traits also can be a factor.

Medical causes

For some people, anxiety may be linked to an underlying health

issue. In some cases, anxiety signs and symptoms are the first
indicators of a medical illness. If your doctor suspects your
anxiety may have a medical cause, he or she may order tests to
look for signs of a problem.

Examples of medical problems that can be linked to anxiety

include:

 Heart disease

 Diabetes

 Thyroid problems, such as hyperthyroidism

 Respiratory disorders, such as chronic obstructive

pulmonary disease (COPD) and asthma

 Drug misuse or withdrawal

 Withdrawal from alcohol, anti-anxiety medications

(benzodiazepines) or other medications

 Chronic pain or irritable bowel syndrome

 Rare tumors that produce certain fight-or-flight hormones

Sometimes anxiety can be a side effect of certain medications.

It's possible that your anxiety may be due to an underlying

medical condition if:

 You don't have any blood relatives (such as a parent or

sibling) with an anxiety disorder
  You didn't have an anxiety disorder as a child

 You don't avoid certain things or situations because of

anxiety

 You have a sudden occurrence of anxiety that seems

unrelated to life events and you didn't have a previous
history of anxiety

Risk factors

These factors may increase your risk of developing an anxiety

disorder:

 Trauma. Children who endured abuse or trauma or

witnessed traumatic events are at higher risk of developing
an anxiety disorder at some point in life. Adults who
experience a traumatic event also can develop anxiety
disorders.

 Stress due to an illness. Having a health condition or

serious illness can cause significant worry about issues such
as your treatment and your future.

 Stress buildup. A big event or a buildup of smaller stressful

life situations may trigger excessive anxiety — for example,
a death in the family, work stress or ongoing worry about
finances.

 Personality. People with certain personality types are more

prone to anxiety disorders than others are.

 Other mental health disorders. People with other mental

health disorders, such as depression, often also have an
anxiety disorder.

 Having blood relatives with an anxiety disorder. Anxiety

disorders can run in families.
  Drugs or alcohol. Drug or alcohol use or misuse or
withdrawal can cause or worsen anxiety.

Complications

Having an anxiety disorder does more than make you worry. It

can also lead to, or worsen, other mental and physical
conditions, such as:

 Depression (which often occurs with an anxiety disorder) or

other mental health disorders

 Substance misuse

 Trouble sleeping (insomnia)

 Digestive or bowel problems

 Headaches and chronic pain

 Social isolation

 Problems functioning at school or work

 Poor quality of life

 Suicide