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ANXIETY, Anxiety is a response arising in anticipation, primary symptom is…
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- primary symptom is free-floating anxiety: excessive worry that is hard to control, focus may shift quickly
- not connected to a specific stimulus
- biological causes: abnormal function of limbic system, abnormal function of GABA, norepinephrine, and serotonin
- genetic contribution play a role
- origins for anxiety disorders: neurobiological, neurochemical, psychosocial, behavioral genetic, and humanistic theories
- amygdala: the "emotional brain" that is strongly related to anxiety - individual differences in the structure of the brain or injury to the brain can alter anxiety response
- disturbances in neurotransmitter regulation can cause anxiety reactions
- numerous different theories on what is thought to cause anxiety, although exact reasonings are not known
- levels: can range from mild anxiety to full panic
There are currently no lab tests that can diagnose anxiety disorders, but a full medical history and physical exam is recommended
- tests can be completed to rule out physical illnesses that might have been thought to cause the symptoms
- diagnoses are made by mental health providers and often follow the criteria listed in the DSM-5
For mild anxiety:
- education on how to recognize triggers
- how to identify anxiety levels
- edu. on self management and diversion techniques
- encouraging muscle relaxation
- stress importance of taking medications regularly and going to therapy regularly
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- more prevalent in girls and kids of low socioeconomic background
- 3-5% have some kind of anxiety disorder
- common symptom is separation anxiety
- inappropriate or excessive worrying
- treated with CBT, medication, or both
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- 8% have an anxiety disorder
- difficulty in distinguishing anxiety and normal developmental challenges
- girls are 2x more likely to be diagnosed
- issues relating to social acceptance and independence
- may appear shy or withdrawn
- extreme emotions
- comorbid with other mental health problems
Pregnant women
- psychologic stress and mild anxiety are very common
- 18-20% of women will develop severe anxiety
- common stressors relating to resources, employment, and personal responsibilities
- careful caution with medications for anxiety
Older Adults
- at increased risk due to cognitive impairments or increasing physical impairments
- easier to misdiagnose
Observation and patient interview
- interview regarding current and previous illnesses, medications, and past/present stressors
- also ask about methods of coping and the use of drugs or alcohol
- observe physical symptoms associated with anxiety (muscle tension/twitching, sweating, nausea, diarrhea, and urinary frequency)
- review of medical history
- consider family history
- assess emotional and psychological well-being
Physical examination
- focus on any body systems that are relevant to the patients current complaints
For moderate anxiety:
- focus on trying to prevent escalation of symptoms
- using exercise to reduce stress
- identify current stressors
- identify past coping strategies
For severe anxiety:
- use clear, direct communication
- ask simple questions
- administer meds as ordered
For panic:
- active supervision, clear and direct communications
- maintain a calm demeanor
- speak slowly and reduce environmental stimuli
- set limits as necessary to ensure safety
Perfusion
- increased heart rate and respiratory rates can have an impact on perfusion
Oxygenation
- Increased respiratory rate, can decrease oxygen levels
Acid-base balance
- increased respirations from hyperventilating can have an impact on acid-base balance
Integrative health
- anxiety can play a major impact on all aspects of a person's health and overall well being and therefore should be viewed from numerous perspectives
Relaxation and Meditation
- often times relaxation techniques and meditation are used to help reduce the severity of anxiety