Anxiety
Affects the way a person thinks, feels, behaves. Occasional anxiety is common
- Anxiety disorders often occur with substance misuse or depression, including perinatal depression
- Panic attack — mind and body overreact to situation
- Usually lasts less than an hour — starts suddenly, gets worse quickly
- Person may think they are going to die, having a heart attack, going mad
- Phobia — strong anxiety/fear reaction to certain situations or objects
- Anxiety and fear reactions can last for months or years — can be triggered by stressful event or be an adverse effect of medicine
Possible symptoms
- Spiritual
- Worry more than usual about traditional or normal life matters
- Uncomfortable or uneasy spirit
- Thoughts and emotions
- Feeling of worry, panic, lack of control over life, impending sense of doom, being judged negatively by others, eg thought to be stupid, ugly
- Fear of having a heart attack, going mad, going crazy
- Intrusive thoughts/memories/nightmares or flashbacks about traumatic events
- Physical
- Pacing, agitated, body shakes, unable to relax, restless, 'on edge'
- Headache, chest pain, racing heart, tight chest, stomach pain/nausea, faint
- Breathless/hyperventilating — breathing fast, shallow, dry mouth
- Choking feeling, can’t swallow
- Insomnia (trouble getting to sleep, waking frequently)
- Behavioural
- Gives up easily, finds it hard to finish things
- Using more alcohol or other drugs including tobacco
- Avoiding things that make them anxious — people, leaving home, certain things or places, reminders of traumatic events
- Hypervigilant (always looking out for danger)
- Repetitive behaviours
- Seeking reassurance all the time
Do first
- Take person somewhere calm and quiet, if possible
- Be calm and supportive — reassure them they are safe and experience will stop
- Encourage slow deep breathing through nose — take a few seconds to breathe in then a few seconds to breathe out. At least 10 times
Ask
- About worries
- Symptoms
- When did these feelings start
- What triggers feelings, how long do they usually last
- What helps
- Thoughts of self harm or suicide
- Unhappy or sad mood — see Depression
- Cultural explanation — is presentation outside what is normal in community now
- Family history of anxiety
- Alcohol (grog) and/or other drug use — long term and recent
Check
- File notes for medical history, medicines review
- Calculate age-appropriate REWS
- Adult — AVPU, RR, O2 sats, pulse, BP, Temp
- Child (less than 13 years) — AVPU, respiratory distress, RR, O2 sats, pulse, central capillary refill time, Temp
- Weight, BGL
- Head-to-toe exam
Do
- Be calm and supportive — reassure them they are safe and experience will stop
- If short-term symptoms — 2–3 days
- Review in 1 week — anxiety may get better itself
- If long-term, more serious anxiety condition or not getting better
- Adult Health Check or School-aged and young person’s health check
- FBC, UEC, LFT, TFT, HbA1c, syphilis serology
- Medical consult — advice about treatment and psychologist referral
Ongoing management
- Mental health team consult if not responding to treatment
- Make management plan
- Consider mental health plan if applicable
- Practical problem solving — what is important to do first, how to do it
- Education about anxiety, relaxation training, practice slow deep breathing
- Education about regulating sleeping patterns in managing anxiety