Introduction

Anxiety disorders are among the most common mental health conditions encountered by prehospital providers. Recognizing and effectively managing these disorders is crucial for providing optimal care to patients experiencing anxiety-related emergencies.

Anxiety is a natural human response to stress or perceived threats, often characterized by feelings of apprehension, worry, or fear. It is a normal part of life and can serve as a protective mechanism, prompting individuals to anticipate and prepare for potential dangers. However, when anxiety becomes excessive, persistent, or debilitating, it may indicate the presence of an anxiety disorder.

Aetiology

The aetiology of anxiety disorders is multifaceted and involves a complex interplay of genetic, biological, psychological, and environmental factors. Understanding these contributing factors can provide insight into the development and maintenance of anxiety disorders:

Types Of Anxiety Disorders

Anxiety disorders encompass a spectrum of mental health conditions characterized by excessive fear, worry, and apprehension. Some of the most common types of anxiety disorders include:

Generalised Anxiety Disorder (GAD)

Generalized Anxiety Disorder (GAD) is a common and chronic mental health condition characterized by excessive, persistent, and uncontrollable worry about a wide range of everyday concerns. Individuals with GAD often experience heightened levels of anxiety and apprehension, even when there is little or no apparent reason for it. This chronic worry can significantly interfere with daily functioning and quality of life.

Generalized Anxiety Disorder often presents with:

• Personal sensation of nervousness
• Challenges in sustaining focus
• Muscular tension or restlessness
• Heightened sympathetic nervous system activity.
• Feelings of irritability
• Disrupted sleep patterns.

Phobic Anxiety Disorders

Phobic anxiety disorders encompass a group of mental health conditions characterized by intense, irrational fear or anxiety related to specific objects, situations, or activities. These fears are disproportionate to any actual threat posed by the feared stimuli and can lead to avoidance behaviours and significant impairment in daily functioning. Some common phobic anxiety disorders include:

Specific Phobias: Specific phobias involve an intense fear of objects (e.g., spiders, needles), situations (e.g., heights, flying), or activities (e.g., public speaking). Individuals with specific phobias experience severe anxiety or panic when exposed to their feared stimuli and often go to great lengths to avoid them.

Social Anxiety Disorder (SAD): Also known as social phobia, SAD is characterized by an intense fear of social situations or performance situations where individuals may be scrutinized or judged by others. People with SAD may experience anxiety or distress in various social settings, leading to avoidance of social interactions or public speaking opportunities.

Agoraphobia: Agoraphobia involves a fear of situations or places where escape may be difficult, or help may not be readily available in the event of a panic attack or other anxiety-related symptoms. Individuals with agoraphobia often avoid crowded spaces, public transportation, or situations where they feel trapped or unable to escape.

Panic Disorder

Panic Disorder is characterized by recurrent and unexpected panic attacks, which are sudden episodes of intense fear or discomfort. These attacks can occur abruptly and peak within minutes, often accompanied by physical symptoms such as palpitations, sweating, trembling, shortness of breath, chest pain, nausea, or dizziness. Fear of future panic attacks and avoidance of triggering situations are hallmark features of panic disorder.

Assessment

Assessing anxiety in the prehospital setting involves several key steps to ensure comprehensive evaluation and appropriate management:

Initial Observation: Begin by observing the patient’s demeanor, body language, and overall appearance for signs of distress, restlessness, or agitation.

History Taking: Obtain a detailed history of the present illness, including the onset, duration, and severity of symptoms. Inquire about any precipitating events, recent stressors, or triggers that may have contributed to the anxiety episode.

Medical History: Gather information about the patient’s past medical history, including any known psychiatric diagnoses, medications, substance use, or previous episodes of anxiety or panic attacks.

Vital Signs: Assess vital signs, including heart rate, blood pressure, respiratory rate, and oxygen saturation, to evaluate for any physiological abnormalities or signs of distress.

Physical Examination: Perform a focused physical examination to evaluate for any signs of distress, such as diaphoresis, tremors, or muscular tension. Assess for any coexisting medical conditions or potential causes of anxiety symptoms.

Mental Status Examination: Conduct a brief mental status examination to assess the patient’s orientation, mood, affect, thought content, and cognition. Evaluate for any signs of psychosis, suicidal ideation, or impaired reality testing.

Screening Tools: Consider using validated screening tools, such as the Generalized Anxiety Disorder 7-item scale (GAD-7) or the Patient Health Questionnaire (PHQ-9), to assess the severity of anxiety symptoms and monitor treatment response over time.

Psychosocial Assessment: Explore the patient’s psychosocial context, including social support networks, living environment, occupational or academic stressors, and coping mechanisms. Inquire about any recent life changes or traumatic events that may have contributed to the anxiety episode.

Risk Assessment: Evaluate the patient’s risk of harm to themselves or others, including the presence of suicidal ideation or self-injurious behaviours. Implement appropriate safety measures as needed to ensure the patient’s well-being.

Collaboration and Referral: Collaborate with mental health professionals, such as psychiatric emergency services or crisis intervention teams, to coordinate further assessment, treatment, and disposition. Consider referral to appropriate community resources, such as outpatient counselling services or support groups, for ongoing management of anxiety symptoms.

Management

The management of anxiety involves a multifaceted approach aimed at reducing symptoms, improving coping skills, and enhancing overall well-being. Depending on the severity of symptoms and individual needs, management strategies may include:

Psychotherapy: Cognitive-behavioural therapy (CBT) is one of the most effective forms of psychotherapy for anxiety disorders. CBT helps individuals identify and challenge irrational thoughts and beliefs that contribute to anxiety, learn relaxation techniques, and develop coping strategies to manage symptoms effectively.

Medication: Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), are commonly prescribed to alleviate symptoms of anxiety disorders. Benzodiazepines may be used on a short-term basis to provide rapid relief of acute anxiety symptoms, but long-term use is generally avoided due to the risk of dependence and tolerance.

Conclusion

Effective management of anxiety in the prehospital setting requires a holistic approach that addresses the physical, psychological, and social aspects of the condition. By conducting thorough assessments, providing reassurance, and implementing appropriate interventions, prehospital providers can help alleviate distress and promote safety for individuals experiencing anxiety-related emergencies.

Collaboration with mental health professionals and community resources is essential for facilitating ongoing support and treatment. With compassionate care and comprehensive strategies, prehospital providers play a crucial role in supporting individuals with anxiety disorders on their journey towards recovery and improved well-being.

Key Points

Bibliography

National Institute of Mental Health. (2023). Anxiety Disorders. National Institute of Mental Health; National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/anxiety-disorders

NHS. (2022, October 5). Overview – Generalised Anxiety Disorder in Adults. NHS. https://www.nhs.uk/mental-health/conditions/generalised-anxiety-disorder/overview