Anxiety disorders: classification, symptoms, and treatment approaches

Anxiety Disorders

Studies showed that one out of 8 Americans between the ages of 18 and 54, or more than 19 million Americans, suffer from some form of anxiety disorder (National Institute of Anxiety and Stress, Inc. 2005). Anxiety disorders are the most common mental ailment in the U.S., more common than depression. Anxiety is also the most common health issue among those over 65 years old, who see an average of five doctors before the condition is successfully diagnosed. Until then, it costs the U.S. $46.6 billion a year. Women, more than men, suffer from anxiety and stress at twice the rate (NIASI).

Anxiety is said to be a subjective experience of threat that stimulates a stress response from a person (Frazier 2002). The stress response is often other subjective feelings that produce apprehension, uncertainty, uneasiness, dread and worry. Mild anxiety produces a sharper awareness of the surroundings and one's current situation and leads the person to deal with the stressor. Strong anxiety, on the other hand, changes his or her cognitive perception and function and often leads to hyper-vigilance, distraction, decreased ability to concentrate, altered memory and confusion.

Anxiety can activate the sympathetic nervous system and the hypothalamic-pituitary-adrenal systems (Frazier 2002). It produces a host of physiological responses, like increased oxygen use or hyperventilation, decreased immune response, and changed coagulation and autonomic tone. The likelihood of severe stress and of death has been observed in those already suffering from acute myocardial infarction and heart failure.

The different types of anxiety and their incidence or distribution are specific anxiety, 6.3% social, 5.3%; posttraumatic stress disorder, 5.2%; generalized anxiety, 4%; obsessive-compulsive anxiety disorder, 3.3%; agoraphobia, 3.2%; and panic disorder, 2.4% (National Institute of Anxiety and Stress, Inc. 2005). The main types are panic attacks and agoraphobia. A panic attack is an episode of intense fear and discomfort and symptoms, which usually peak within 10 minutes, and characterized by palpitations, sweating, trembling, shortness of breath and a sense of being smothered, choking, chest or abdominal discomfort, dizziness, a sense of unreality, fear of losing control of one's sanity, fear of dying, numbness and chills or hot flushes. Agoraphobia is the fear of being in particular places, persons or situations, which create or induce embarrassment or difficulty and which the sufferer avoids or tends to avoid. Panic attack or disorder may or many not be accompanied by agoraphobia and statistics show that more than 95% of those suffering from agoraphobia have a history of panic disorder. Anxiety can also be triggered by specific objects of phobia, such as animals, something in the natural environment, blood injection injury, situations, and other objects. Social phobia is, however, one of the two most common types. It is stimulated by specific social or performance situations, such as social gatherings, competitions, stage performance or appearance or business meetings. Obsessive-compulsive disorder, when severe, can be time or energy-consuming, distressing and annoying because the repetitive act interferes with a person's normal functioning. Posttraumatic stress disorder derives from dreams, flashbacks and other stressing recollection of painful events. Acute stress disorder occurs between two days and four weeks, while generalized anxiety lasts beyond six months. Anxiety may also be due to a general medical condition, such as endocrinal, cardiovascular, respiratory or metabolic; some substances, such as drugs or toxins; or something else that has remained un-diagnosed (NIASI).

Part 2 - Nursing Care Plan suitable nursing care plan for anxiety patients in the hospital setting should, first of all, observe standards for the safe, thoroughly planned and effective delivery of that care (Greenwood 1996). Nursing, being both interdisciplinary and intra-disciplinary, a care plan must enable the sharing of information among staff members to insure patient safety and continued care. And it should be both holistic and individualized. If it is not individualized, it can be mechanical, generalized and routine only (Greenwood).

The plan consists of restructured formats and tools, knowledge of the nursing process, documentation schedule, and accessibility (Greenwood 1996). In addition to routine and schedules of the traditional patient care plan is a three-column page for nursing diagnosis, goals and plans. The content of the written care plan must be accurate and complete. The most commonly used systems are the North American Nursing Diagnosis or NANDA diagnoses, but the suitable nursing plan should not apply only basic principles but also address the individual's unique needs and the types, amounts and frequencies in order to be holistic and patient-centered.

The plan must also allow only reasonable time for documentation and updating (Greenwood 1996). The depth and breadth of the initial assessment and care plan, the tool format and the amount of writing required are the other factors. And the written care plan must, most importantly, be readily accessible. If not, it becomes unusable. The nurse cannot be expected to memorize data or make unrealistically frequent visits to the nurses' station to acquire information. Relying on colleagues and repeated asking for information from the patient can affect the nurse's professional credibility (Greewood).

Part 3 - Drugs and Their Side Effects

The use of drugs in the care of anxiety patients has been associated with falls. These drugs are mostly anti-psychotics and benzodiazepines and other psychoactive ones that affect patient cognition, balance and motor coordination, pulse and blood pressure (Cooper 1993). Reports said that half of nursing home patients experienced a fall in the duration of their stay in such homes at a rate of two episodes per patient per year. The most common consequences are hip fracture, painful soft tissue injuries, bruises, sub-dural hematomas and burns, immobility, hypothermia, deep vein thrombosis, stasis pneumonia, joint contractures, dehydration, urinary tract infection and pressure sores.

Drugs such as anti-hypertensives and psychotropics produce orthosis, which is a fall in systolic blood pressure of 120 mm of the diastolic of 10 mm mercury of more, when moving from supine to upright position (Cooper 1993). The inappropriate use of narcotic analgesics, such as Darvocet-N 100, Talwin, Percocet, Vicodin and Lortabs, for arthritic pain may raise the tendency to a fall or develop confusion. Anticoagulants, such as Dilantin, Depakene and Tegretol, may also increase the incidence of falls, especially in ambulatory patients and may also be toxic as a sedative or in those with ataxic gait.

In summary, the drugs most associated with falls are long-acting benzodiazepines or LABZs, such as Valium, Dalmane, Librium, Tranxene, Centrax, Paxipam and Klonopin (Cooper 1993). These drugs are to be given for no more than 10 consecutive days for sleep or four consecutive months for anxiety unless gradual dose reduction is attempted and if functional improvement is observed or gained from the use of these LABZs. Prevention is still the most preferred approach (Cooper).