Editing Mental Health and Psychosocial Nursing (section)

== Anxiety and Anxiety Disorders ==

=== Levels of Anxiety ===
{| class="wikitable"
! Level !! Perceptual field !! Learning !! Nursing action
|-
| Mild || Heightened, alert || Optimal learning || Teach now; use the energy
|-
| Moderate || Narrowed, selective attention || Learning possible with direction || Focus the client; short teaching
|-
| Severe || Greatly reduced, scattered detail || Learning not possible || Reduce stimuli, stay with client, simple directions
|-
| Panic || Distorted, loss of reality || None; risk of injury || Remain with client, calm firm voice, safe low-stimulus area, consider PRN anxiolytic
|}

Never leave a client in panic-level anxiety alone. Use short, simple, repeated sentences. Do not demand decisions.

=== Specific Disorders ===
* '''Generalized anxiety disorder''': excessive worry more days than not for at least 6 months with restlessness, fatigue, poor concentration, irritability, muscle tension, or sleep disturbance.
* '''Panic disorder''': recurrent unexpected panic attacks with persistent worry about further attacks or maladaptive behavior change. Attacks peak within minutes with palpitations, dyspnea, chest pain, choking sensation, derealization, and fear of dying. Rule out myocardial infarction, pulmonary embolism, hypoglycemia, thyrotoxicosis, and stimulant intoxication before attributing chest pain to panic.
* '''Agoraphobia''': fear of situations where escape may be difficult; often leads to housebound status.
* '''Specific phobia''' and '''social anxiety disorder''': treated with graded exposure and cognitive behavioral therapy; systematic desensitization pairs relaxation with a graded fear hierarchy.
* '''Obsessive-compulsive disorder''' (classified separately from anxiety disorders in DSM-5-TR): obsessions are intrusive thoughts; compulsions are repetitive acts that neutralize anxiety. '''Do not abruptly stop a ritual''', which raises anxiety sharply. Allow time for the ritual initially, then collaboratively set limits and gradually reduce it as coping improves. Treat skin breakdown from washing.
* '''Post-traumatic stress disorder''': exposure to actual or threatened death, serious injury, or sexual violence, followed by intrusion (flashbacks, nightmares), avoidance, negative alterations in cognition and mood, and hyperarousal, lasting more than 1 month. '''Acute stress disorder''' is the same picture lasting 3 days to 1 month. Trauma-informed care means asking permission before touch, explaining procedures in advance, minimizing restraint use, and giving the client control wherever possible.