Anxiety Disorders

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Anxiety

Mild: Normal, alert, motivated; perceptual field broad
Moderate: Focused on immediate concerns; selective inattention; decreased concentration
Severe: Focused on specific details; unable to problem-solve; distorted perceptions
Panic: Unable to focus; loss of control; distorted perceptions; may hallucinate

Excessive worry about multiple things for ≥6 months
Physical symptoms: restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance
Treatment: CBT, SSRIs (sertraline, escitalopram), SNRIs, buspirone

Recurrent, unexpected panic attacks
Panic attack: sudden intense fear, palpitations, sweating, trembling, shortness of breath, chest pain, nausea, dizziness, fear of dying
Agoraphobia: fear of being in situations where escape might be difficult
Treatment: SSRIs, SNRIs, benzodiazepines (short-term), CBT

Obsessions: recurrent, persistent thoughts, impulses, images (ego-dystonic)
Compulsions: repetitive behaviors performed to reduce anxiety (rituals)
Patients recognize behavior is unreasonable but feel powerless to control it
Treatment: SSRIs (fluoxetine, fluvoxamine), clomipramine, CBT, exposure and response prevention

Priority: Safety first - assess for suicidal/homicidal ideation
For panic attacks: stay with patient, provide calm environment, use simple directions
For PTSD: avoid re-traumatization, use grounding techniques, create safe environment
For OCD: don't interrupt rituals unless dangerous; set limits on ritual time

SSRIs: sertraline (Zoloft), escitalopram (Lexapro), fluoxetine (Prozac) - first-line; takes 4-6 weeks for full effect
Benzodiazepines: alprazolam (Xanax), lorazepam (Ativan) - short-term only due to dependence risk; monitor for sedation
Buspirone: non-sedating, non-addictive alternative for GAD; takes 2-4 weeks for effect
Beta-blockers: propranolol for performance anxiety/physical symptoms

Using silence: Allows patient to organize thoughts and feelings
Active listening: Pay attention to both verbal and nonverbal cues
Clarifying: "I'm not sure I understand. Tell me more."
Focusing: "Let's talk more about that feeling."
Restating: "You're saying that you feel alone."
Exploring: "What happened before you felt that way?"
Validating: "I can see this is difficult for you."
Grounding: "Tell me 5 things you can see, 4 you can touch, 3 you can hear..."
Deep breathing: Model slow, deep breathing for anxious patients

Assess for panic attacks: hyperventilation, chest pain, feeling of impending doom
For PTSD: avoid triggers, use grounding techniques, never force recounting of trauma
For OCD: assess for contamination fears, hand washing leading to skin breakdown

Source: DSM-5-TR, NCLEX-RN Test Plan. For educational purposes only. Always follow facility protocols and current clinical guidelines.