Anxiety

Anxiety is one of the most prevalent mental health conditions, affecting around 4.05% (301 million) people globally (Javaid et al, 2023). There are many causes and types of anxiety. However, the signs and symptoms of anxiety are broadly similar, with varying degrees of severity. 

Anxiety is a mental health condition that links to fear about something which is yet to happen (Mind, 2021). Pathological anxiety relates to an exaggerated fear of a perceived threat or potential danger and, in these situations, causes an exaggerated response (eg hypervigilance) (Wieser and Keil, 2020).

The National Institute for Health and Care Excellence (NICE, 2020) identify a range of disorders associated with anxiety, including:

• generalised anxiety disorder
• panic disorder (with and without agoraphobia)
• post-traumatic stress disorder
• obsessive–compulsive disorder
• social phobia
• specific phobias (eg of spiders)
• acute stress disorder

Pennix et al (2021) identified how the various anxiety disorders often co-exist in the same individual and

Generalised anxiety disorder

Generalised anxiety disorder manifests as chronic and uncontrollable worry which interferes with how an individual functions and leads their life. Generalised anxiety disorder is often characterised by restlessness and disturbed sleep (Pary et al, 2019). Other common symptoms people experience are:

• being easily startled
• forgetfulness
• poor concentration
• indecisiveness
• irritability
• headaches
• sweatiness
• nausea
• heart palpitations (NICE, 2020)

Panic disorder

Panic disorder refers to repeated, unanticipated increases of extreme fear (Pary et al, 2019). This causes panic attacks to take place, which are often accompanied by at least 1 month of concern about having further attacks and the consequence of these (NICE, 2020). Perrotta (2019) identified how panic attacks represent an abnormal response to a neutral or slightly stressful occurrence. Typical signs and symptoms include:

• palpitations
• tachycardia
• sweating
• tremors
• dyspnoea
• abdominal discomfort
• light-headedness or fainting
• feelings of unreality
• depersonalisation
• fear of losing control or dying
• paraesthesia
• chills or hot

Pennix et al (2021) identified anxiety disorders as being related to dysfunctional circuits in the brain, particularly in the way in which it responds to danger. There is also some evidence that anxiety disorders, including generalised anxiety disorder and panic disorder, may be linked to:

• genetics or family history
• drug use (eg alcohol and benzodiazepines)
• chronic or acute emotional or physical stress
• trauma (physical or psychological) (Gale, 2023)

It is important that people who may be experiencing an anxiety disorder are assessed in order to identify the disorder, symptom severity and any impairment to their functioning (NICE, 2014)

Generalised anxiety disorder

Generalised anxiety disorder is most commonly seen in association with a depressive disorder, with generalised anxiety disorder being the primary diagnosis. Therefore, generalised anxiety disorder with no comorbidity is not typical. Generalised anxiety disorder is diagnosed according to Diagnostic and Statistical Manual of Mental Disorders criteria (American Psychiatric Association, 2022) and is characterised by:

• excessive worry
• difficulty controlling worry

As well as at least three of the following:

• difficulty concentrating
• fatigue
• irritability
• restlessness
• sleep disturbance
• muscle tension (NICE, 2020)

Nurses should consider a diagnosis of generalised anxiety disorder for people who meet the above criteria, have a chronic health issue, seek regular reassurance about physical symptoms or are always worrying about something.

Panic disorder

Panic disorder is

It is often more effective to prevent anxiety and panic disorder, than to try to cure them once established. For many people, this means:

• avoiding illicit drug use
• keeping alcohol use moderate
• reducing or stopping smoking
• reducing stress
• getting help when experiencing the early symptoms of stress or anxiety (Saneei et al, 2021)

Anxiety and panic disorder can impact people in several ways, for different amounts of time and with varying severity; this needs to be considered before any management approach is undertaken. It is also imperative that management of anxiety and panic disorder is carried out when other causes for the signs and symptoms have been excluded or managed, for example a metabolic condition or another mental health condition (NICE, 2023).

Step 1

The first stage of managing generalised anxiety disorder and panic disorder is to provide a diagnosis, offer information and advice to the person and actively monitor

American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5 (text revision). 5th edn. Washington, DC: American Psychiatric Publishing; 2022

Bandelow B, Michaelis S. Epidemiology of anxiety disorders in the 21st century. Dialogues in Clin Neurosci. 2015;17(3):327-335. https://doi.org/10.31887/DCNS.2015.17.3/bbandelow 

Carpenter JK, Andrews LA, Witcraft SM et al. Cognitive behavioral therapy for anxiety and related disorders: A meta-analysis of randomized placebo-controlled trials. Depress Anxiety. 2018;35(6):502-514. https://doi.org/10.1002/da.22728 

Gale C. Generalised anxiety disorder. 2023. https://bestpractice.bmj.com/topics/en-gb/120 (accessed 13 November 2023)

Javaid SF, Hashim IJ, Hashim MJ et al. Epidemiology of anxiety disorders: global burden and sociodemographic associations. Middle East Curr Psychiatry 30, 44 (2023). https://doi.org/10.1186/s43045-023-00315-3 

Mind. Anxiety and panic attacks. 2021. https://www.mind.org.uk/information-support/types-of-mental-health-problems/anxiety-and-panic-attacks/about-anxiety/ (accessed 13 November 2023)

National Institute for Health and Care Excellence (NICE). Anxiety disorders. 2014. https://www.nice.org.uk/guidance/qs53 (accessed 13 November 2023)

National Institute for Health and Care Excellence (NICE). Generalised anxiety disorder and panic disorder in adults: management. 2020. https://www.nice.org.uk/guidance/cg113 (accessed 13 November