NR 667 VISE Assignment: Latest Updated|100% Verified: Guaranteed A+ Score Solution

Etiology: Anxiety (Ans- -Behavioral theory: a conditioned response to specific environmental stimuli -Genetic component: 1st degree relatives increases the likelihood 8-fold -Biologic theories: Norepi, serotonin, and GABA are poorly regulated; the ANS inappropriately responds to stimuli; cerebral pathology causes anxiety; HPA axis highly implicated Risk factors: Anxiety (Ans- -Organic causes: endocrinopathies, cardiorespiratory disorders, anemia -Use or withdrawal from medications/substances: alcohol, caffeine, cocaine, steroids, lidocaine, oral contraceptives, NSAIDs, SSRIs, -Family history -Psychiatric disorders: MDD, PTSD, personality disorders, schizophrenia Assessment findings: Anxiety (Ans- -Children: separation anxiety after age 3-4 years (can be present in adulthood); unrealistic worry about harm to self or family; persistent worry about past behavior, competence, or future events-Adults: apprehension, restlessness, edginess, distractibility, insomnia -Somatic complaints: fatigue, headaches, paresthesia, near syncope, derealization, dizziness, diaphoresis, palpitations, tachycardia, chest pain/tightness, dyspnea, hyperventilation, N/V/D, excessive rumination Differential diagnosis: Anxiety (Ans- -OCD -Oppositional defiant disorder -Personality disorder -Depression -Bipolar disorder -ADD -Cognitive disorder (i.e. delirium) -Substance intoxication or withdrawal -PTSD -Any medical condition that involves stimulation of the sympathetic nervous system Final diagnosis: Anxiety (Ans- -TSH, CBC, UA, urine drug screen, arrhythmias, hyperthyroidism, drugs-Psychologic testing: PROMIS, Hamilton anxiety scale, Zung anxiety selfassessment, GAD-7 Non-pharm treatment: Anxiety (Ans- -Psychotherapy: education about dx, treatment plan, and prognosis; support and empathetic listening; 1st-line treatment for children and adolescents; relaxation techniques; CBT; reconditioning (exposure to feared stimuli in a controlled setting to develop tolerance and eventually eradicate the anxiety response) -General measures: regular exercise, healthy diet, adequate sleep, limit caffeine, serial office visits Pharmacological management: Anxiety (Ans- -Benzodiazepines should be of limited duration with the intent of allowing the patient to benefit from behavioral treatments -Drugs should play an adjunctive role, except in panic disorder -Drugs reduce, not eradicate, symptoms -Long-term use of SSRIs may be requiredPregnancy/lactation considerations: Anxiety (Ans- -Sertraline may be used Follow-up: Anxiety (Ans- -Regular f/u visits are importance to reinforce education about nonpharm management and proper medication use -Avoid prescribing anxiolytics by phone -Watch for signs of medication misuse -TCAs require periodic serum levels + baseline and f/u EKGs