ANXIETY
INTRODUCTION AND DEFINITION
Anxiety
This is a natural part of life, and most of us experience it from time to time. Anxiety is a natural
reaction that involves mind and body. It serves an important basic survival functions.
Anxiety can be described as a sense of uneasiness, nervousness, worry, fear or dread of what is
about to happen or what might happen.
OR This is anticipation of future threats.
Anxiety disorders include disorders that share features with excessive fear, worry and
behavioral disturbances.
Fear is the emotional response to real or perceived imminent /impending threat.
Anxiety disorder
Are mental health conditions that involve excessive amount of fear, nervousness, worry, or
dread? This can cause a person to feel preoccupied, distracted, tense and always on the alert.
Types of Anxiety Disorders:
i) Generalized anxiety disorder
Someone with GAD worries excessively about many things e.g. about school, the health and
safety of family members and the future. They always think of the worst that could happen.
Along with worry and dread, people with GAD have physical symptoms such as chest pain,
headache, stomach pain or vomiting among others. GAD can make a person miss school and
social activities.
Common symptoms include:
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Sleep disturbance
Fatigue
Muscle tension (muscle pains)
Inability to concentrate
Restlessness among others.
(ii) Panic disorder – is characterized by spontaneous and unexpected panic attacks. These
attacks may range from several attacks a day to a few attacks a year. A panic attack is a period
of intense fear in which 4 of the 13 symptoms below develop abruptly, and peak in minutes of
symptom onset.
These attacks should not arise from substance abuse, medical condition or other mental
disorders. Symptoms include:
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Accelerated heart rate
Sweating
Trembling
Sense of shortness of breath
Feeling of choking
Chest pain / discomfort
Nausea
Dizziness
Fear of losing control
Fear of dying
Tingling sensations
Chills and hot flashes.
Panic disorder is more common in women than men.
Management
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In acute panic attacks, give benzodiazepine e.g. diazepam 10 – 20 mg stat. Continue with
dose of 10 – 20 mg a day.
Re-assure the patient.
Transport patient to medical facility to exclude physical illness.
Refer to mental health worker for further management.
Other points to note
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Educate patient to avoid substances e.g. caffeine.
Discourage alcohol consumption.
(iii) Phobias
A phobia is a fear that produces a conscious avoidance of a feared object, activity or situation.
The affected person usually recognizes that the reaction is excessive. There are 3 types of
phobias:
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Social phobia
Specific phobia
Agoraphobia.
Social phobia – is a strong and persisting fear of a situation in which embarrassment can occur.
A person has a problem with public speaking, eating at a hotel or using public washrooms.
Specific phobia – is a persistent fear of an object or situation. It is more common than social
phobia. Examples include:
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Fear of animals – dogs, spiders, …
Fear of natural environment – water, height,
Fear of blood or injections
Situational type – enclosed places, future plans…
Agoraphobia – is the fear of being in places from which exits would be difficult. About 75 % of
people with agoraphobia have panic disorder.
Anxiety is the most common feature in phobia disorders.
Management
This can be both drug and psychological management. Refer to a mental health worker for
psychological management. Drugs that can be used include benzodiazepines if there is a panic
attack. Other drugs include Selective Serotonin Reuptake Inhibitors (SSRIs) eg fluoxetine can
be prescribed by a mental health worker.
iv) Separation anxiety disorder
Is persistent fear or anxiety about separation of attachment figure to a degree that is
developmentally inappropriate?
OR is a type of anxiety where an individual (commonly found in children) worries a lot about
being a part from family members or other close people.
v) Selective mutism
Is anxiety disorder in which person who is otherwise capable to speak is unable to speak when
exposed to specific situation, places and people?
Summary
Anxiety disorders can be disabling. Getting the problem treated can help a person feel like
himself again, relaxed and ready for the good things in life. Try to help the person to stay patient
and positive. It can one time to feel better and encourage them to face the fears.
ANXIETY SCREENING AND MANAGEMENT ALGORITHM
SCREENED FOR ANXIETY
USING THE SRQ - 20
SRQ-20 < 6,
SRQ>=6, screeen for
anxiety using the GAD 7
tool
Manage the client as per the
GAD7 Severity scores
Provide
Phsycoeducation
GAD 7 SEVERITY SCORE AND MANGEMENT GUIDES
Assessment Score
0-4(minimal), 5-9 (mild)
Management
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10-14 (moderate)
Psychoeducation
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Address
current
psychosocial stressors 
(refer to MNS job aid ,
pg9)
Strengthen support
Teach
stress
management such as
relaxation techniques
Exit
15-21 (severe)
Psychoeducation (refer to 
MNS job aid, pg 9)
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Enrol
them
into
Psychotherapy sessions. (8 
sessions)
Psychoeducation
Psychotherapy
sessions(8 sessions)
Medications
TREATMENT MANAGEMENT
TREATMENT
 Psychosocial interventions: counselling including psychoeducation, psychotherapy
For an acute episode or intense prolonged anxiety
 Benzodiazepines e.g. diazepam 5 mg 1-2 times daily
– Increase if necessary to 15-30 mg daily in divided doses Elderly: Give half the above
dose
– Duration of therapy 1-2 weeks, tapering off to zero within 6 weeks
If poor response: refer to specialist
 Fluoxetine 20 mg once a day for long term management of the anxiety disorder
– Continue antidepressant for 4 to 6 weeks then evaluate the response
LOC
All Levels
HC IIIs and
IVs
Hospitals
and RRHs
ASSESS FOR IMPROVEMENT
Is the person improving?
NO
YES
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Continue with treatment plan
 Follow up as needed
if the person is not improving or the
career insists on further investigations
and treatment,
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Consulting a specialist.