WHAT WENT WRONG?
Patients exhibit symptoms when an imbalance develops between the number of
open receptor sites and the number of available neurotransmitters. Neurotransmitters
are released from one side of a synapse and land on a specific receptor site across
the synapse. Asecond mechanism exists (a reuptake mechanism) to remove excess
neurotransmitters left within the space between where they are released and where
they fill the receptor sites. When there are insufficient neurotransmitters available
to fill the open neurotransmitter receptor sites, the patient develops symptoms.
Patients experience an uncontrollable feeling of anxiousness which is present more
days than not.
Symptom onset is typically in late teens through early thirties. Anxiety is more
common in women and in patients with a family history of anxiety.

PROGNOSIS

Without proper treatment the anxiety will continue, and symptoms may even
progress. The patient’s quality of life is adversely affected. Social functioning be-
comes impaired and in some cases the patient becomes more socially isolated.
Physical symptoms continue, at times necessitating visits to a primary care provider
or even the emergency room. With proper treatment, the symptoms are controlled,
neurotransmitter balance is restored, and remission is achieved. The symptoms will
typically recur at a later point, even when properly treated. It may be months or
years after a successful course of treatment before the symptoms recur. The treat-
ment that was effective in the past will typically be effective again in the future. A
longer treatment course is recommended for subsequent treatment cycles when
using SSRIs (selective serotonin reuptake inhibitors).

SIGNS AND SYMPTOMS

• Fear, tension, apprehension due to alteration in neurotransmission
• Persistent worry
• Trouble concentrating
• Irritability and restlessness
• Tachycardia, palpitations, elevated blood pressure due to autonomic nervous
system stimulation
• Hyperventilation due to fear, elevated heart rate, and palpitations
• Sweating, tremors due to autonomic nervous system stimulation
• Sleep disturbance and fatigue due to alteration in neurotransmission
• Headache due to nervous system irritability and lack of sleep
TREATMENT
• Administer anxiolytics for acute management:
• alprazolam, clonazepam, clorazepate, diazepam, lorazepam, oxazepam

• Monitor for respiratory depression or decrease in blood pressure.
• Have benzodiazepine antagonist (flumazenil) on hand to reverse effect if
needed.
• Administer antidepressants:
• selective serotonin reuptake inhibitors—paroxetine
• selective serotonin and norepinephrine reuptake inhibitors—venlafaxine
• tricyclics
• Administer buspirone.
• Administer beta-blockers for symptom control.
• Psychotherapy.
• Cognitive-behavioral therapy.
• Relaxation techniques such as biofeedback.
• Desensitization—repeated exposures to graded doses of the object or situa-
tion that produces the anxiety.
• Group therapy.
• Family therapy.
• Emotive therapy.



NURSING DIAGNOSIS

• Sleep pattern disturbance
• Anxiety
• Fear
• Impaired social interaction
• Ineffective role performance
NURSING INTERVENTION
• Monitor medication intake.
• Discuss patient response to therapy.
• Monitor vital signs, watch for elevation in blood pressure with some
medications.

• Monitor weight; some medications are associated with changes in weight.
• Monitor sleep; ask patient about restful sleep during the night or difficulty
falling asleep.
• Teach patient to avoid alcohol intake with benzodiazepine use.

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