NUR 6121 Mental Health Disorders Study Guide | William Patterson University

ANXIETY DISORDERS – APRN STUDY
GUIDE (Chapter 227)
EMERGENCY DEPARTMENT REFERRAL
Immediate ED referral if:

 Risk of harm to self or others
 Gravely disabled (cannot meet basic needs)
 Severe medication reactions:
o Serotonin syndrome
o Serotonin withdrawal
o Neuroleptic malignant syndrome
o Lithium toxicity

💡 Exam pearl: Safety always overrides diagnosis.

DEFINITION & EPIDEMIOLOGY
 Most common mental health disorders
 ~⅓ of the population affected lifetime
 Females > males
 Typically earlier onset than mood disorders
 Major global disability burden

Normal vs Pathologic Anxiety

 Normal: adaptive, protective, situational
 Pathologic: persistent, excessive, overwhelming, disabling




DSM-5 ANXIETY DISORDERS
Know what is and is not in this category:

Anxiety Disorders

 Separation anxiety disorder
 Selective mutism

,  Specific phobia
 Social anxiety disorder (social phobia)
 Panic disorder
 Agoraphobia
 Substance/medication-induced anxiety disorder
 Anxiety disorder due to medical condition
 Generalized Anxiety Disorder (GAD)

Related but Separate DSM-5 Chapters

 OCD → Obsessive-Compulsive & Related Disorders
 PTSD & ASD → Trauma- & Stressor-Related Disorders

💡 Exam pearl: OCD and PTSD are no longer classified as anxiety disorders in DSM-5.

PATHOPHYSIOLOGY (HIGH-YIELD)
Key Concepts

 Body cannot distinguish fear vs anxiety
 Chronic activation → maladaptive

Brain Structures

 Amygdala → fear, panic, phobias
 CSTC circuit → generalized anxiety & worry
 Prefrontal cortex involvement → impaired regulation

HPA Axis

1. Stressor → Hypothalamus releases CRF
2. Pituitary releases ACTH
3. Adrenals release cortisol
4. Normally negative feedback shuts it down

Chronic stress →

 Hypercortisolemia
 Increased SNS activity
 Inflammation
 Structural brain changes
 Increased vulnerability to anxiety disorders

,GENETICS & NEUROTRANSMITTERS
Genetics

 Up to 6x increased risk with first-degree relative
 Gene–environment interaction critical
 Epigenetic changes can be transgenerational

Notable genes

 5-HTTLPR (serotonin transporter)
 CADM2
 NCAM1
 MSRA

Neurotransmitters

 Serotonin
 Norepinephrine
 Dopamine
 GABA

💡dysregulation.
Exam pearl: Anxiety ≠ too much or too little of one neurotransmitter — it’s complex




CLINICAL PRESENTATION
General Features

 Excessive worry/fear
 Physical complaints common
 Frequently first seen in primary care or ED
 High comorbidity with depression & substance use

GAD (VERY TESTED)

 Excessive anxiety more days than not
 ≥ 6 months
 ≥ 3 of 6 symptoms:
1. Restlessness/on edge
2. Fatigue

, 3. Difficulty concentrating
4. Irritability
5. Muscle tension
6. Sleep disturbance

Associated physical symptoms

 Tachycardia, HTN
 SOB
 GI symptoms
 Headaches
 IBS



Other Key Disorders

Specific Phobia

 Immediate fear response
 Avoidance
 Often multiple phobias

Social Anxiety Disorder

 Fear of scrutiny
 Avoids social situations

Panic Disorder

 Recurrent unexpected panic attacks
 Peak within minutes
 Panic attacks can occur with other disorders

OCD

 Obsessions (thoughts)
 Compulsions (behaviors)
 Impairment proportional to severity




DIAGNOSTICS
Essential Rule