Anxiety Case Study
Anxiety is among the most common psychiatric disorders in the general population globally. It is characterized by a flight or fight response. Anxiety disorders are related to a broad spectrum of conditions that are characterized by excessive and persistent fear, worry, anxiety, and avoidance behavior (Penninx et al., 2021). Anxiety disorders include generalized anxiety disorder, panic disorder, social anxiety disorder, specific phobias, and selective mutism.
These disorders are more common in females. Specific phobias are the most prevalent form with an annual rate of 12.1%, followed by social anxiety disorder with an annual prevalence rate of 7.4% (Penninx et al., 2021). This assignment will explore the pathophysiology of anxiety, diagnostic testing, treatment modalities, and finally reflect on this condition.
Pathophysiology of the Disease
Anxiety is related to fear and manifests as a future-oriented mood state consisting of complex affective, physiological, cognitive, and behavioral systems. It usually stems from an interaction of genetic, psychosocial, and environmental factors. The important mediators of anxiety in the central nervous system include serotonin, norepinephrine, dopamine, and GABA (Penninx et al., 2021).
The disruption of the serotonin system and dysfunction of the GABAergic inhibitory transmission is considered the principal neurobiological factors for the development of anxiety. Meanwhile, the autonomic nervous system, especially the sympathetic nervous system, plays a crucial role in the development of the signs and symptoms.
However, the amygdala is responsible for tempering anxiety symptoms. Substance abuse, stress, psychological trauma, and medical conditions can also lead to anxiety. Clinical manifestations of anxiety include nervousness, restlessness, irritability, muscle tension, fatigue, somnolence, concentration difficulties, insomnia, recurrent panic attacks, sweating, palpitations, and avoidance (Penninx et al., 2021).
Diagnostic Testing
Anxiety disorders are a clinical diagnosis based on the criteria defined by the diagnostic and statistical manual of mental disorders 5th edition (DSM-5). However, diagnostic tests may be required to exclude other causes of anxiety (Ströhle et al., 2018).
For instance, complete blood count, urea, creatinine and electrolytes, random blood sugar, thyroid function tests, arterial blood gases, urinalysis, and urine drug screen to exclude conditions such as infection, hyperthyroidism, electrolyte abnormalities, hypoglycemia, and substance abuse that may manifest with anxiety. Imaging modalities such as electroencephalography, brain CT, echocardiography, and chest radiography may be crucial to exclude underlying neurological, cardiovascular, and respiratory diseases.
Treatment Modalities
Treatment modalities for anxiety are broadly categorized into pharmacological and nonpharmacological approaches. Pharmacological approaches include SSRIs, SNRIs, benzodiazepines, beta-blockers, tricyclic antidepressants, and tranquilizers. SSRIs such as sertraline, escitalopram, and fluoxetine are effective against all forms of anxiety and are regarded as the first-line treatment (Garakani et al., 2020).
SNRIs such as venlafaxine are effective as SSRIs and are considered first-line, especially for generalized anxiety disorder. The use of benzodiazepines is limited to short-term treatment of anxiety, while side effects limit the use of tricyclic antidepressants for anxiety. Psychotherapy, particularly cognitive behavioral therapy, is the principal nonpharmacological approach for the management of anxiety.
It is a structured, didactic, and goal-oriented therapy that helps identify and modify characteristic maladaptive thinking patterns and beliefs that precipitate and sustain anxiety symptoms. Finally, acute anxiety can be treated with a benzodiazepine, while chronic anxiety may be managed with pharmacotherapy, psychotherapy, or a combination of both.
How does the information, in this case, inform the practice of a master’s prepared nurse?
A master’s prepared nurse should understand that the flight and fight response that causes anxiety is a normal occurrence. A master’s prepared nurse should acknowledge that anxiety results from an interaction of biopsychosocial factors, including genetic vulnerability, which interacts with stress, trauma, or situations to produce clinically significant syndromes.
Consequently, nurses should always look for potential underlying triggers in patients presenting with anxiety. Concerning the evaluation of this condition, mastering the DSM-5 criteria is elemental to distinguish between anxiety disorders and anxiety due to other medical or substance use. Regarding the treatment, selective serotonin reuptake inhibitors should be considered first-line pharmacotherapy and combined with cognitive behavioral therapy for efficacy.
How should the master’s prepared nurse use this information to design a patient education session for someone with this condition?
Master’s prepared nurses should consider that anxiety causes significant impairment in social, academic, and occupational impairment while designing patient education. Therefore, it is vital to emphasize the importance of treatment adherence.
Similarly, the patient family should be involved in healthcare decision-making to provide social and financial support to the patient (Apor et al., 2018). Patient education should further be age appropriate. Finally, the patient and his family should receive education on the impact of anxiety on mood, behavior, and relationships.
What was the most important information presented in this case?
Perhaps the most important information presented with regard to anxiety is its evaluation and management. Anxiety disorders is a clinical diagnosis based on the DSM-5 criteria. The DSM-5highlights the several types of anxiety disorders specifying the clinical criteria for each. Similarly, while evaluating these patients, it is vital to exclude substance abuse and medical disorders that manifest with anxiety through laboratory and imaging testing.
The management of this condition is critical to enhancing social, academic, personal, and occupational functioning and reducing mortality. Pharmacotherapy with SSRIs is considered the first line, although a combination with cognitive behavioral therapy gives optimal outcome.
What was the most confusing or challenging information presented in this case?
The most challenging or confusing information concerning anxiety is that anxiety is regarded as a normal fight and flight response. Being a normal occurrence, it is not uncommon to find that most healthcare providers, particularly nurses, do not have a broad base of knowledge concerning the disorder. Consequently, prompt diagnosis and management of this condition may be difficult, or rather the disorder may go unnoticed.
Patients with anxiety disorders rarely seek treatment since anxiety is regarded as a normal occurrence. Lastly, anxiety disorders may coexist with other comorbidities, particularly depression and alcohol use disorder leading to significant morbidity and mortality.
Discuss a patient safety issue that can be addressed for a patient with the condition presented in this case.
A patient with an anxiety disorder has an increased risk of suicide. The risk of suicide in these patients is related to several factors. Firstly, a vast majority of these patients are females and consider anxiety a normal occurrence hence rarely seeks professional treatment. Secondly, anxiety disorders cause a significant social, academic, occupational, and personal function impairment and therefore manifest as a disability.
Finally, anxiety disorders have high rates of comorbidity, particularly with major depression and alcohol and drug abuse. Collectively, these present a considerable significant risk of suicide in an additive fashion. Consequently, individuals with anxiety disorders are at an increased risk of morbidity and mortality.
Conclusion
Anxiety is a normal occurrence. Nevertheless, anxiety disorders cause significant occupational, social and academic impairment. Consequently, all patients presenting with anxiety should be evaluated and treated after exclusion of other medical disorders. Treatment should involve both pharmacotherapies with SSRIs and psychotherapy with cognitive behavioral therapy.
References
Apor, E., Connell, N. T., Faricy-Anderson, K., Barth, P., Youssef, R., Fenton, M., Sikov, W. M., Thomas, A., Rosati, K., Schumacher, A., Lombardo, A., Korber, S., Khurshid, H., Safran, H., & Mega, A. (2018). Prechemotherapy education: Reducing patient anxiety through nurse-led teaching sessions. Clinical Journal of Oncology Nursing, 22(1), 76–82. https://doi.org/10.1188/18.CJON.76-82
Garakani, A., Murrough, J. W., Freire, R. C., Thom, R. P., Larkin, K., Buono, F. D., & Iosifescu, D. V. (2020). Pharmacotherapy of anxiety disorders: Current and emerging treatment options. Frontiers in Psychiatry, 11, 595584. https://doi.org/10.3389/fpsyt.2020.595584
Penninx, B. W., Pine, D. S., Holmes, E. A., & Reif, A. (2021). Anxiety disorders. Lancet, 397(10277). https://doi.org/10.1016/s0140-6736(21)00359-7
Ströhle, A., Gensichen, J., & Domschke, K. (2018). The diagnosis and treatment of anxiety disorders. Deutsches Arzteblatt International, 155(37), 611–620. https://doi.org/10.3238/arztebl.2018.0611