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Panic Disorder 8-13-20 - Coggle Diagram
Panic Disorder 8-13-20
Pathophysiology
A panic attack is a sudden episode of intense fear that triggers severe physical reactions when there is no real danger or apparent cause. Panic attacks can be very frightening. When panic attacks occur, you might think you're losing control, having a heart attack or even dying.
In the central nervous system (CNS) the major mediators of the symptoms of anxiety disorders appear to be norepinephrine, serotonin, dopamine, and gamma-aminobutyric acid (GABA).
Peripherally, the autonomic nervous system, especially the sympathetic nervous system, mediates many of the symptoms.
Other neurotrasmitters and peptides, such as corticotropin-releasing factor, may be involved.
Nursing Interventions:
Stay calm and be nonthreatening. Maintain a calm, nonthreatening manner while working with client; anxiety is contagious and may be transferred from staff to client or vice versa.
Assure client of safety. Reassure client of his or her safety and security; this can be conveyed by physical presence of the nurse; do not leave client alone at this time.
Be clear and concise with words. Use simple words and brief messages, speak calmly and clearly, to explain hospital experiences to client; in an intensely anxious situation, client is unable to comprehend anything but the most elementary communication.
Provide a non-stimulating environment. Keep immediate surroundings low in stimuli (dim lighting, few people, simple decor); a stimulating environment may increase level of anxiety.
Administer medications as prescribed. Administer tranquilizing medication, as ordered by physician; assess medication for effectiveness and for adverse side effects.
Recognize precipitating factors. When level of anxiety has been reduced, explore with client possible reasons for occurrence; recognition of precipitating factors is the first step in teaching client to interrupt escalation of anxiety.
Encourage client to verbalize feelings. Encourage client to talk about traumatic experience under nonthreatening conditions; help client work through feelings of guilt related to the traumatic event; help client understand that this was an event to which most people would have responded in like manner.
Medications:
Selective serotonin reuptake inhibitors. The SSRIs are first-line agents for long-term management of anxiety disorders, with control gradually achieved over a 2-to 4-wk course, depending on required dosage increases.
Serotonin and norepinephrine reuptake inhibitors. Pharmacologic agents with reuptake inhibition of serotonin and norepinephrine may be helpful in a variety of mood and anxiety disorders.
Atypical antidepressants. Antidepressants that are not FDA-approved for the treatment of a given anxiety disorder still may be beneficial for the treatment of anxiety disorders; mirtazapine acts distinctly as an alpha-2 antagonist, consequently increasing synaptic norepinephrine and serotonin, while also blocking some postsynaptic serotonergic receptors that conceptually mediate excessive anxiety when stimulated with serotonin.
Tricyclic antidepressants. The tricyclic antidepressants are a complex group of drugs that have central and peripheral anticholinergic effects, as well as sedative effects.
Benzodiazepines. Benzodiazepines often are used with antidepressants as adjunct treatment; they are especially useful in the management of acute situational anxiety disorder and adjustment disorder where the duration of pharmacotherapy is anticipated to be 6 weeks or less and for the rapid control of anxiety attacks.
Antianxiety agents. Buspirone is a non-sedating antipsychotic drug unrelated to benzodiazepines, barbiturates, and other sedative hypnotics; it has fewer cognitive and psychomotor adverse effects, which makes its use preferable in elderly patients.
Anticonvulsant. The drug of choice in this category is the gamma-aminobutyric acid derivative pregabalin (Lyrica).
Antihypertensive agent. Agents in this class may have a positive effect on the physiological symptoms of anxiety; beta-blockers may be useful for the circumscribed treatment of situational/performance anxiety on an as-needed basis.
Monoamine oxidase inhibitor (MAOI). MAOIs are most commonly prescribed for patients with social phobia.
Antipsychotic agent. Atypical and typical antipsychotic medications are generally used more as augmentation strategies and are second-line treatment options in generalized anxiety disorder.
Important Assessments:
EEG, lumbar puncture, and head/brain imaging. Rule out CNS disorder using EEG, lumbar puncture, brain computed tomography scan, as indicated by history and associated clinical findings.
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Tests for infection. Rule out infectious causes using rapid plasma reagent test, lumbar puncture, or HIV testing.
Arterial blood gas analysis. Arterial blood gas analysis is useful in confirming hyperventilation and excluding hypoxemia or metabolic acidosis.
Chest radiography. Chest radiography is useful in excluding other causes of dyspnea with chest pain.
Thyroid function. Hyperthyroidism is one of the most common medical causes for anxiety related to a medical condition.
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Patient Education:
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Encourage the patient to consider positive self-talk like “Anxiety won’t kill me,” “I can do this one step at a time,” “Right now I need to breathe and stretch,” “I don’t have to be perfect.”
Recommend patient to keep a log of episodes of anxiety. Instruct the patient to describe what is experienced and the events leading up to and surrounding the event. The patient should note how the anxiety dissipates.
Educate patient on new anxiety-reducing skills (e.g., relaxation, deep breathing, positive visualization, and reassuring self-statements).
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Teach patient to visualize or fantasize about the absence of anxiety or pain, successful experience of the situation, resolution of conflict, or outcome of procedure.
Teach use of appropriate community resources in emergency situations (e.g., suicidal thoughts), such as hotlines, emergency rooms, law enforcement, and judicial systems.