Anxiety

Question 1

Describe the incidence associated with anxiety disorders

Answer 1

• MOST PREVELENT psychiatric disorders
• Associated with a high burden of illness
• Often under recognized and under treated in primary care
• Women are 1.5 times more likely than men to receive a diagnosis of anxiety disorder
• Treatment is indicated when the patient shows marked distress or suffers from complications resulting from disorder
• Anxiety disorders should be treated with psychotherapy, pharmacotherapy or a combination of both

Question 2

What are the subjective findings associated with anxiety?

Answer 2

Subjective Findings

• Restlessness/muscle tension
• Insomnia
• Apprehension/fear
• Depression
• Agitation
• Feeling threatened
• Overwhelmed
• Panic – sympathetic nervous system

Question 3

What are some physical manifestations of anxiety?

Answer 3

General physical manifestations:

• Diarrhea
• Urinary frequency/urgency
• Indigestion
• Dry mouth
• Headache
• Palpitations

Acute Manifestations:

• Trembling
• Diaphoresis
• Elevated vital signs
• Dilated pupils

Chronic Manifestations:

• Hypertension
• Muscular tension

Question 4

How do you manage a patient with anxiety?

Answer 4

• Rule out medical causes, such as uncontrolled pain or desaturation
• MILD anxiety: Initially, refer to mental health specialist for biofeedback or cognitive behavioral therapy
• ACUTELY increasing anxiety: Remove stimulus causing anxiety first, then progress to pharmacologic management if necessary.

Question 5

What 2 medications are used to treat anxiety?

Answer 5

Benzodiazepines:

• Short term use only
• Use with caution in elderly- may cause confusion and agitation

Buspirone (Buspar) – an SSRI

• Preferred over benzodiazepines when patient has an established diagnosis or anxiety disorder; does not provide immediate relief