Anxiety

Affects the way a person thinks, feels, behaves. Occasional anxiety is common

• Anxiety disorders often occur with substance misuse or depression, including perinatal depression
• Panic attack — mind and body overreact to situation
• Usually lasts less than an hour — starts suddenly, gets worse quickly
• Person may think they are going to die, having a heart attack, going mad
• Phobia — strong anxiety/fear reaction to certain situations or objects
• Anxiety and fear reactions can last for months or years — can be triggered by stressful event or be an adverse effect of medicine

Possible symptoms

• Spiritual
• Worry more than usual about traditional or normal life matters
• Uncomfortable or uneasy spirit

• Thoughts and emotions
• Feeling of worry, panic, lack of control over life, impending sense of doom, being judged negatively by others, eg thought to be stupid, ugly
• Fear of having a heart attack, going mad, going crazy
• Intrusive thoughts/memories/nightmares or flashbacks about traumatic events

• Physical
• Pacing, agitated, body shakes, unable to relax, restless, 'on edge'
• Headache, chest pain, racing heart, tight chest, stomach pain/nausea, faint
• Breathless/hyperventilating — breathing fast, shallow, dry mouth
• Choking feeling, can’t swallow
• Insomnia (trouble getting to sleep, waking frequently)

• Behavioural
• Gives up easily, finds it hard to finish things
• Using more alcohol or other drugs including tobacco
• Avoiding things that make them anxious — people, leaving home, certain things or places, reminders of traumatic events
• Hypervigilant (always looking out for danger)
• Repetitive behaviours
• Seeking reassurance all the time

Do first

• Take person somewhere calm and quiet, if possible
• Be calm and supportive — reassure them they are safe and experience will stop
• Encourage slow deep breathing through nose — take a few seconds to breathe in then a few seconds to breathe out. At least 10 times

Ask

• About worries
• Symptoms
• When did these feelings start
• What triggers feelings, how long do they usually last
• What helps
• Thoughts of self harm or suicide
• Unhappy or sad mood — see Depression
• Cultural explanation — is presentation outside what is normal in community now
• Family history of anxiety
• Alcohol (grog) and/or other drug use — long term and recent

Check

• File notes for medical history, medicines review

• Head-to-toe exam

Do

• Be calm and supportive — reassure them they are safe and experience will stop
• If short-term symptoms — 2–3 days
• Review in 1 week — anxiety may get better itself

• If long-term, more serious anxiety condition or not getting better
• Adult Health Check or School-aged and young person’s health check 
• FBC, UEC, LFT, TFT, HbA1c, syphilis serology
• Medical consult — advice about treatment and psychologist referral

Ongoing management

• Mental health team consult if not responding to treatment
• Make management plan
• Consider mental health plan if applicable
• Practical problem solving — what is important to do first, how to do it
• Education about anxiety, relaxation training, practice slow deep breathing
• Education about regulating sleeping patterns in managing anxiety