Anxiety Disorders

Panic Disorder Generalized Anxiety Disorder (GAD) Phobias

1.The patient experiences recurrent panic
attacks
2. Episodes typically last 15-30 minutes
3. Four or more of the following symptoms are
present:
-Palpitations, SOB, Choking or Smothering
Sensation, Chest Pain, Nausea, Feelings of
Depersonalization, Fear of Dying, Chills or
Hot Flashes, Fear of going crazy, Decreased
perceptual and cognitive abilities
4. Pt may experience Changes in Behavior
and/or Persistent Worries about when the next
attack will occur
5. May experience Agoraphobia due to fear of
being in places where previous panic attacks
occurred.
*MAY BE CONFUSED WITH A HEART
ATTACK
*DOES NOT NECESSARILY FOLLOWS AN
STRESSFUL, IDENTIFIABLE EVENT
1. More than 6 months of uncontrollable, 1. The client fears a specific object or situation
excessive, unrealistic worries (inadequacy in to an unreasonable level. Phobias include:
interpersonal relationships, job responsibilities, -SOCIAL PHOBIA
finances, health of family members, household -AGORAPHOBIA
chores, and lateness for appointments) -SPECIFIC PHOBIAS:
2. GAD causes significant impairment in one or -Fear of specific objects (snakes, spiders,
more areas of functioning. strangers)
3. At least 3 of the following symptoms are -Fear of specific experiences (flying, being in
present: the dark, riding an elevator, being in an
-Fatigue enclosed space)
-Restlessness
-Inability to Concentrate
-Irritability
-Muscle Tension
-Sleep Disturbances
4. Characterized by Remissions and
exacerbations (no acute anxiety attack)

Obsessive Compulsive Disorder Post-Traumatic Stress Disorder (PTSD)

1. The client has intrusive thoughts of unrealistic obsessions and tries to
control these thoughts with compulsive behaviors, which are repetitive –
ritualistic-
-Clients who engage in constant ritualistic behaviors may have difficulty
meeting self-care needs-If rituals include constant hand washing or cle
aning, skin damage and infection may occur.
1. Exposure to a traumatic event causes intense fear, horror,
flashbacks, feelings of detachment and foreboding, restricted affect,
and impairment for longer than 1 month after the event. Symptoms may
last for years.
-ACUTE PTSD: Symptoms last less than 3 months-CHRONIC PTSD:
Symptoms last more than 3 months
SYMPTOMS:
-Recurrent, intrusive recollection of event
-Dreams or images
-Reliving through flashbacks, illusions, or hallucinations
-Irritability, difficulty with concentration, sleep disturbances, avoidance
of stimuli associated with trauma, inability to show feelings.
(it differs from Acute Stress Disorder in that ASD occurs after exposure
to a traumatic event, causing numbing, detachment and amnesia about
the event for NOT MORE than 4 weeks following the event, with
symptoms lasting from 2 days to 4 weeks)
Assessment
1. Perform a thorough Physical and Neurological examination to help determine if anxiety is primary or is secondary to another psychiatric disorder, a
medical condition, or substance use.
2. Assess Risk for Suicide
3. Perform psychosocial assessment (To help client identify the problem to be addressed by counseling (stressful marriage, recent loss, stressful job or
school situation)
4. Assess coping mechanisms
5. Use a standardized assessment scale, such as Hamilton Rating Scale for Anxiety.

Expected Outcomes
1. Client uses coping mechanisms to prevent panic anxiety when stressful situations occur.
2. Client verbalizes acceptance of life situations over which he or she has no control
3. The client is able to recognize signs of anxiety and intervene to prevent panic levels

Nursing Interventions
1. Ensure Safety
2. Stay with the client and provide support (Provide reassurance, use therapeutic communication skills, use open-ended questions, encourage client to
verbalize feelings)
3. Use relaxation breathing techniques as needed
4. Reduce environmental stimuli
5. Encourage physical activity like walking
6. Administer medications as prescribed (SSRIs, TCAs, MAOIs, Benzodiazepines (anxiolytics), Beta Blockers, Mood stabilizers)
7. Instill hope (but avoid false reassurance)
8. Enhance Self Esteem by encouraging positive statements about self and discussion of past achievements.
9. Postpone teaching until acute anxiety subsides: clients with panic attack or severe anxiety are unable to concentrate or learn.

In General, Interventions for Anxiety disorders attempt to:

1. Reduce Anxiety
2. Increase Self Esteem
3. Increase Reality Testing
4. Enhance Coping Mechanisms
5. Instill Hope
6. Relaxation Therapy

Anxiety Medications
 Panic Disorder Generalized Anxiety Phobias Obsessive Compulsive Post-Traumatic Stress
Disorder (GAD) Disorder (OCD) Disorder (PTSD)
1. SSRIs 1. SSRIs 1. SSRIs 1. SSRIs (Especially 1. SSRIs
2. Benzodiazepines 2. TCAS 2. Benzodiazepines Luvox) 2. TCAs
3. TCAs 3. Buspirone (Buspar) 3. Buspirone (Buspar) 3. Benzodiazepines
4. MAOIs 2. TCAs (Especially
4. SNRIs 4. Beta Blockers Anafranil) 4. SNRIs
5. Beta Blockers 5. MAOIs
5. Depakote (Valproic 5. Gabapentin
6. Depakote (Valproic Acid) (Neurontin) 6. Beta-Blockers
Acid) 7. Carbamazepine
+ (Tegretol)
+
+ Cognitive-Behavioral
+ +
Therapy Behavioral
Cognitive-Behavioral Therapy
Cognitive-Behavioral -Cognitive-Behavioral
Therapy
Therapy -Family
*No Benzodiazepines -Group Therapy with
survivors

FOR ACUTE ANXIETY ATTACK (AAA) Defense mechanisms: Nursing Diagnosis:

First Line of Treatment: Benzodiazepines
(the only time this group is first line for
anxiety disorders)
-Risk for Suicide (=Risk for self-directed violence)
Phobia: Displacement -Risk for others-directed violence
Compulsion: Undoing -Risk for injury to self or others
Obsession: Reaction-Formation/ Intellectualization -Anxiety (moderate, severe)
PTSD: Isolation/ Repression -Ineffective role performance
-Ineffective coping
-Disturbed thought process
-Disturbed Sleep Pattern
-Self-care deficit