Psychiatric Mental Health Nursing by Videbeck

13 ANXIETY ANDANXIETYDISORDERS 281

typically avoids people, places, and events associated
with previous panic attacks. For example, the person
may no longer ride the bus if he or she has had a panic
attack on a bus. Although avoiding these objects does
not stop the panic attacks, the person’s sense of help-
lessness is so great that he or she may take even more
restrictive measures to avoid them such as quitting
work and remaining at home.

PHYSIOLOGIC AND SELF-CARE CONCERNS

The client often reports problems sleeping and eat-

ing. The anxiety of apprehension between panic at-

tacks may interfere with adequate, restful sleep even

though the person may spend hours in bed. Clients

may experience loss of appetite or eat constantly in

an attempt to ease the anxiety.

Box 13-1

➤ HAMILTONRATINGSCALE FORANXIETY

Instructions:This checklist is to assist the physician or psychiatrist in evaluating each patient as to his degree of

anxiety and pathological condition. Please fill in the appropriate rating;

NONE = 0 MILD = 1 MODERATE = 2 SEVERE = 3 SEVERE, GROSSLY DISABLING = 4

ITEM RATING ITEM RATING

Anxious

mood

Tension

Fears

Insomnia

Intellectual

(cognitive)

Depressed

mood

Somatic

(muscular)

Somatic

(sensory)

Worries, anticipation of the

worst, fearful anticipation,

irritability

Feelings of tension, fatigabil-

ity, startle response,

moved to tears easily,

trembling, feelings of

restlessness, inability to

relax

Of dark, of strangers, of

being left alone, of ani-

mals, of traffic, of crowds

Difficulty in falling asleep,

broken sleep, unsatisfying

sleep and fatigue on wak-

ing, dreams, nightmares,

night-terrors

Difficulty in concentration,

poor memory

Loss of interest, lack of

pleasure in hobbies,

depression, early waking,

diurnal swing

Pains and aches, twitching,

stiffness, myoclonic jerks,

grinding of teeth, unsteady

voice, increased muscular

tone

Tinnitus, blurring of vision,

hot and cold flushes, feel-

ings of weakness, picking

sensation

Cardiovascular

symptoms

Respiratory

symptoms

Gastrointestinal

symptoms

Genitourinary

symptoms

Autonomic

symptoms

Behavior at

interview

Tachycardia, palpitations,

pain in chest, throbbing

of vessels, fainting feel-

ings, missing beat

Pressure or constriction in

chest, choking feelings,

sighing, dyspnea

Difficulty in swallowing,

wind, abdominal pain,

burning sensations, ab-

dominal fullness, nausea,

vomiting, borborygmi,

looseness of bowels, loss

of weight, constipation

Frequency of micturition,

urgency of micturition,

amenorrhea, menor-

rhagia, development of

frigidity, premature

ejaculation, loss of libido,

impotence

Dry mouth, flushing, pallor,

tendency to sweat, giddi-

ness, tension headache,

raising of hair

Fidgetting, restlessness or

pacing, tremor of hands,

furrowed brow, strained

face, sighing or rapid res-

piration, facial pallor,

swallowing, belching,

brisk tendon jerks, dilated

pupils, exophthalmos

ADDITIONAL COMMENTS:

Investigator’s signature:

Reprinted with permission from The British Journal of Medical Psychology(1959), Vol. 32, 50–55. © The British

Psychological Society.