Causes of Panic disorder
Common Causes of Panic disorder
Following is a list of common causes of Panic disorder:
Panic disorder Causes: Book Excerpts
What causes Panic disorder?
Article excerpts about the
causes of Panic disorder:
Facts about Panic Disorder: NIMH (Excerpt)
Studies in animals and humans have focused on pinpointing the specific
brain areas and circuits involved in anxiety and fear, which underlie
anxiety disorders such as panic disorder. Fear, an emotion that evolved to
deal with danger, causes an automatic, rapid protective response that
occurs without the need for conscious thought. It has been found that the
body's fear response is coordinated by a small structure deep inside the
brain, called the amygdala.
The amygdala, although relatively small, is a very complicated
structure, and recent research suggests that anxiety disorders may be
associated with abnormal activitation in the amygdala. One aim of research
is to use such basic scientific knowledge to develop new therapies.
(Source: excerpt from Facts about Panic Disorder: NIMH)
Understanding Panic Disorder: NIMH (Excerpt)
is a description of some of the most
important new research on panic disorder and its causes.
Genetics. Panic disorder runs in families. One study has
shown that if one twin in a genetically identical pair has panic disorder,
it is likely that the other twin will also. Fraternal, or non-identical
twin pairs do not show this high degree of "concordance" with respect to
panic disorder. Thus, it appears that some genetic factor, in combination
with environment, may be responsible for vulnerability to this condition.
NIMH-supported scientists are studying families in which several
individuals have panic disorder. The aim of these studies is to identify
the specific gene or genes involved in the condition. Identification of
these genes may lead to new approaches for diagnosing and treating panic
disorder.
Brain and Biochemical Abnormalities. One line of evidence
suggests that panic disorder may be associated with increased activity in
the hippocampus and locus coeruleus, portions of the brain that monitor
external and internal stimuli and control the brain's responses to them.
Also, it has been shown that panic disorder patients have increased
activity in a portion of the nervous system called the adrenergic system,
which regulates such physiological functions as heart rate and body
temperature. However, it is not clear whether these increases reflect the
anxiety symptoms or whether they cause them.
Another group of studies suggests that people with panic disorder may
have abnormalities in their benzodiazepine receptors, brain components
that react with anxiety-reducing substances within the brain.
In conducting their research, scientists can use several different
techniques to provoke panic attacks in people who have panic disorder. The
best known method is intravenous administration of sodium lactate, the
same chemical that normally builds up in the muscles during heavy
exercise. Other substances that can trigger panic attacks in susceptible
people include caffeine (generally 5 or more cups of coffee are required).
Hyperventilation and breathing air with a higher-than-usual level of
carbon dioxide can also trigger panic attacks in people with panic
disorder.
Because these provocations generally do not trigger panic
attacks in people who do not have panic disorder, scientists have
inferred that individuals who have panic disorder are biologically
different in some way from people who do not. However, it is also true
that when the people prone to panic attacks are told in advance about the
sensations these provocations will cause, they are much less likely to
panic. This suggests that there is a strong psychological component, as
well as a biological one, to panic disorder.
NIMH-supported investigators are examining specific parts of the brain
and central nervous system to learn which ones play a role in panic
disorder, and how they may interact to give rise to this condition. Other
studies funded by the Institute are under way to determine what happens
during "provoked" panic attacks, and to investigate the role of breathing
irregularities in anxiety and panic attacks.
Animal Studies. Studies of anxiety in animals are
providing NIMH-sponsored researchers with clues to the underlying causes
of this phenomenon. One series of studies involves an inbred line of
pointer dogs that exhibit extreme, abnormal fearfulness when approached by
humans or startled by loud noises. In contrast with normal pointers, these
nervous dogs have been found to react more strongly to caffeine and to
have brain tissue that is richer in receptors for adenosine, a naturally
occurring sedative that normally exerts a calming effect within the brain.
Further study of these animals is expected to reveal how a genetic
predisposition toward anxiety is expressed in the brain.
Other animal studies involve macaque monkeys. Some of these animals
exhibit anxiety when challenged with an infusion of lactate, much like
people with panic disorder. Other macaques do not exhibit this response.
NIMH-supported scientists are attempting to determine how the brains of
the responsive and non-responsive monkeys differ. This research should
provide additional information on the causes of panic disorder.
In addition, research with rats is exploring the effect of various
medications on the parts of the brain involved in anxiety. The aim is to
develop a clearer picture of which components of the brain are responsible
for anxiety, and to learn how their actions can be brought under better
control.
Cognitive Factors. Scientists funded by NIMH are
investigating the basic thought processes and emotions that come into play
during a panic attack and those that contribute to the development and
persistence of agoraphobia. The Institute also supports research
evaluating the impact of various versions of cognitive-behavioral therapy
to determine which variants of the procedure are effective for which
people. The NIMH panic disorder research program will also explore the
effects of interpersonal stress such as marital conflict on panic disorder
with agoraphobia and determine if including spouses in the
cognitive-behavioral treatment of the condition improves outcome. (Source: excerpt from Understanding Panic Disorder: NIMH)
Related information on causes of Panic disorder:
As with all medical conditions,
there may be many causal factors.
Further relevant information on causes of Panic disorder may be found in:
Causes of Panic disorder: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the causes of Panic disorder.
Anxiety:
Differential Diagnosis
(In a Page: Signs and Symptoms)
- Generalized anxiety disorder
–Excessive worry associated with at least three symptoms, including restlessness or edgy feeling, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance
–The most common anxiety disorder in primary care
- Panic disorder
–Recurrent, unpredictable panic attacks with intense apprehension, fear or terror, and somatic symptoms (e.g., tachycardia)
–May present with or without agoraphobia
-
Depression: Anxiety often presents in a mixed state with depression
-
Medications (e.g., bronchodilators, steroids, antidepressants, antihypertensives)
-
Substance use, including drugs (e.g., alcohol, caffeine, cocaine, cannabis)
-
Obsessive-compulsive disorder
–Obsessions are persistent ideas, images, or impulses that generate anxiety
–Compulsions are intentional repetitive behaviors or mental acts aimed at reducing the distress of obsessions
- Anxiety disorder due to a general medical condition
–Cardiovascular etiologies include MI, angina, arrhythmias, CAD, CHF, MVP
–Respiratory etiologies include asthma, COPD, and pulmonary embolism
–Endocrine etiologies include hyper- or hypothyroidism, hypoglycemia, and Cushing's syndrome
–Neurological etiologies include Parkinson's disease and epilepsy
–Cancer
-
Pheochromocytoma: Adrenal tumor that usually presents with hypertension and increased heart rate and sometimes with fright reaction of sweating, headache, and pale facial appearance
-
Parkinson's disease: Presents with tremor at rest, usually in one hand (as opposed to the more generalized essential tremor in anxiety)
-
Post-traumatic or acute stress disorder
-
Social anxiety disorder
-
Specific phobia
-
Bipolar disorder (especially manic stage)
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Agitation:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
❑ Alcohol withdrawal syndrome. Mild to severe agitation occurs in alcohol withdrawal syndrome, along with hyperactivity, tremors, and anxiety. With delirium, the potentially life-threatening stage of alcohol withdrawal, severe agitation accompanies hallucinations, insomnia, diaphoresis, and a depressed mood. The patient’s pulse rate and temperature rise as withdrawal progresses; status epilepticus, cardiac exhaustion, and shock can occur.
❑ Anxiety. Anxiety produces varying degrees of agitation. The patient may be unaware of his anxiety or may complain of it without knowing its cause. Other findings include nausea, vomiting, diarrhea, cool and clammy skin, frontal headache, back pain, insomnia, and tremors.
❑ Dementia. Mild to severe agitation can result from many common syndromes, such as Alzheimer’s and Huntington’s diseases. The patient may display a decrease in memory, attention span, problem-solving ability, and alertness. Hypoactivity, wandering behavior, hallucinations, aphasia, and insomnia may also occur.
❑ Drug withdrawal syndrome. Mild to severe agitation occurs in drug withdrawal syndrome. Related findings vary with the drug, but include anxiety, abdominal cramps, diaphoresis, and anorexia. With opioid or barbiturate withdrawal, a decreased level of consciousness (LOC), seizures, and elevated blood pressure, heart rate, and respiratory rate can also occur.
❑ Hepatic encephalopathy. Agitation occurs only with fulminating encephalopathy. Other findings include drowsiness, stupor, fetor hepaticus, asterixis, and hyperreflexia.
❑ Hypersensitivity reaction. Moderate to severe agitation appears, possibly as the first sign of a reaction. Depending on the severity of the reaction, agitation may be accompanied by urticaria, pruritus, and facial and dependent edema.
With anaphylactic shock, a potentially life-threatening reaction, agitation occurs rapidly along with apprehension, urticaria or diffuse erythema, warm and moist skin, paresthesia, pruritus, edema, dyspnea, wheezing, stridor, hypotension, and tachycardia. Abdominal cramps, vomiting, and diarrhea can also occur.
❑ Hypoxemia. Beginning as restlessness, agitation rapidly worsens. The patient may be confused and have impaired judgment and motor coordination. He may also have tachycardia, tachypnea, dyspnea, and cyanosis.
❑ Increased intracranial pressure (ICP). Agitation usually precedes other early signs and symptoms, such as head-ache, nausea, and vomiting. Increased ICP produces respiratory changes, such as Cheyne-Stokes, cluster, ataxic, or apneustic breathing; sluggish, nonreactive, or unequal pupils; widening pulse pressure; tachycardia; a decreased LOC; seizures; and motor changes such as decerebrate or decorticate posture.
❑ Post-head trauma syndrome. Shortly after, or even years after injury, mild to severe agitation develops, characterized by disorientation, loss of concentration, angry outbursts, and emotional lability. Other findings include fatigue, wandering behavior, and poor judgment.
❑ Vitamin B6 deficiency. Agitation can range from mild to severe. Other effects include seizures, peripheral paresthesia, and dermatitis. Oculogyric crisis may also occur.
Other causes
❑ Drugs. Mild to moderate agitation, which is commonly dose related, develops as an adverse reaction to central nervous system stimulants — especially appetite suppressants, such as amphetamines and amphetamine-like drugs; sympathomimetics, such as ephedrine; caffeine; and theophylline.
❑ Radiographic contrast media. Reaction to the contrast medium injected during various diagnostic tests produces moderate to severe agitation along with other signs of hypersensitivity.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Anxiety:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
❑ Acute respiratory distress syndrome. Acute anxiety occurs along with tachycardia, mental sluggishness and, in severe cases, hypotension. Other respiratory signs and symptoms include dyspnea, tachypnea, intercostal and suprasternal retractions, crackles, and rhonchi.
❑ Anaphylactic shock. Acute anxiety usually signals the onset of anaphylactic shock. It’s accompanied by urticaria, angioedema, pruritus, and shortness of breath. Soon, other signs and symptoms develop: light-headedness, hypotension, tachycardia, nasal congestion, sneezing, wheezing, dyspnea, a barking cough, abdominal cramps, vomiting, diarrhea, and urinary urgency and incontinence.
❑ Angina pectoris. Acute anxiety may either precede or follow an attack of angina pectoris. An attack produces sharp and crushing substernal or anterior chest pain that may radiate to the back, neck, arms, or jaw. The pain may be relieved by nitroglycerin or rest, which eases anxiety.
❑ Asthma. With allergic asthma attacks, acute anxiety occurs with dyspnea, wheezing, a productive cough, accessory muscle use, hyperresonant lung fields, diminished breath sounds, coarse crackles, cyanosis, tachycardia, and diaphoresis.
❑ Autonomic hyperreflexia. The earliest signs of autonomic hyperreflexia may be acute anxiety accompanied by severe headache and dramatic hypertension. Pallor and motor and sensory deficits occur below the level of the lesion; flushing occurs above it.
❑ Cardiogenic shock. Acute anxiety is accompanied by cool, pale, clammy skin; tachycardia; a weak, thready pulse; tachypnea; ventricular gallop; crackles; jugular vein distention; decreased urine output; hypotension; narrowing pulse pressure; and peripheral edema.
❑ Chronic obstructive pulmonary disease (COPD). Acute anxiety, exertional dyspnea, cough, wheezing, crackles, hyperresonant lung fields, tachypnea, and accessory muscle use characterize COPD.
❑ Heart failure. With heart failure, acute anxiety is commonly the first symptom of inadequate oxygenation. Associated findings include restlessness, shortness of breath, tachypnea, decreased LOC, edema, crackles, ventricular gallop, hypotension, diaphoresis, and cyanosis.
❑ Hyperthyroidism. Acute anxiety may be an early sign of hyperthyroidism. Classic signs and symptoms include heat intolerance, weight loss despite increased appetite, nervousness, tremor, palpitations, sweating, an enlarged thyroid, and diarrhea. Exophthalmos may occur.
❑ Mitral valve prolapse. Panic may occur in patients with mitral valve prolapse, referred to as the click-murmur syndrome. The disorder may also cause paroxysmal palpitations accompanied by sharp, stabbing, or aching precordial pain. Its hallmark is a midsystolic click, followed by an apical systolic murmur.
❑ Mood disorder. Anxiety may be the patient’s chief complaint in the depressive or manic form of mood disorder. With the depressive form, chronic anxiety occurs with varying severity. Associated findings include dysphoria; anger; insomnia or hypersomnia; decreased libido, interest, energy, and concentration; appetite disturbance; multiple somatic complaints; and suicidal thoughts. With the manic form, the patient’s chief complaint may be a reduced need for sleep, hyperactivity, increased energy, rapid or pressured speech and, in severe cases, paranoid ideas and other psychotic symptoms.
❑ Myocardial infarction (MI). With MI, a life-threatening disorder, acute anxiety commonly occurs with persistent, crushing substernal pain that may radiate to the left arm, jaw, neck, or shoulder blades. It can be accompanied by shortness of breath, nausea, vomiting, diaphoresis, and cool, pale skin.
❑ Obsessive-compulsive disorder. Chronic anxiety occurs with obsessive-compulsive disorder, along with recurrent, unshakable thoughts or impulses to perform ritualistic acts. The patient recognizes these acts as irrational, but is unable to control them. Anxiety builds if he can’t perform these acts and diminishes after he does.
❑ Pheochromocytoma. Acute, severe anxiety accompanies pheochromocytoma’s cardinal sign: persistent or paroxysmal hypertension. Common associated signs and symptoms include tachycardia, diaphoresis, orthostatic hypotension, tachypnea, flushing, a severe headache, palpitations, nausea, vomiting, epigastric pain, and paresthesia.
❑ Phobias. With phobias, chronic anxiety occurs along with a persistent fear of an object, activity, or situation that results in a compelling desire to avoid it. The patient recognizes the fear as irrational, but can’t suppress it.
❑ Pneumonia. Acute anxiety may occur with pneumonia because of hypoxemia. Other findings include a productive cough, pleuritic chest pain, fever, chills, crackles, diminished breath sounds, and hyperresonant lung fields.
❑ Pneumothorax. Acute anxiety occurs in moderate to severe pneumothorax associated with profound respiratory distress. It’s accompanied by sharp pleuritic pain, coughing, shortness of breath, cyanosis, asymmetrical chest expansion, pallor, jugular vein distention, and a weak, rapid pulse.
❑ Postconcussion syndrome. Postconcussion syndrome may produce chronic anxiety or periodic attacks of acute anxiety. Associated signs and symptoms include irritability, insomnia, dizziness, and a mild headache. The anxiety is usually most pronounced in situations demanding attention, judgment, or comprehension.
❑ Posttraumatic stress disorder. Posttraumatic stress disorder occurs in the patient who has experienced an extreme traumatic event. It produces chronic anxiety of varying severity and is accompanied by intrusive, vivid memories and thoughts of the traumatic event. The patient also relives the event in dreams and nightmares. Insomnia, depression, and feelings of numbness and detachment are common.
❑ Pulmonary edema. With pulmonary edema, acute anxiety occurs with dyspnea, orthopnea, cough with frothy sputum, tachycardia, tachypnea, crackles, ventricular gallop, hypotension, and a thready pulse. The patient’s skin may be cool, clammy, and cyanotic.
❑ Pulmonary embolism. With pulmonary embolism, acute anxiety is usually accompanied by dyspnea, tachypnea, chest pain, tachycardia, blood-tinged sputum, and a low-grade fever.
❑ Rabies. Anxiety signals the beginning of the acute phase of rabies, a rare disorder, which is commonly accompanied by painful laryngeal spasms associated with difficulty swallowing and, as a result, hydrophobia.
❑ Somatoform disorder. Somatoform disorder, which usually begins in young adulthood, is characterized by anxiety and multiple somatic complaints that can’t be explained physiologically. The symptoms aren’t produced intentionally, but are severe enough to significantly impair functioning. Pain disorder, conversion disorder, and hypochondriasis are examples of somatoform disorder.
Other causes
❑ Drugs. Many drugs cause anxiety, especially sympathomimetics and central nervous system stimulants. In addition, many antidepressants may cause paradoxical anxiety.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Skin, clammy:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Anxiety
An acute anxiety attack commonly produces cold, clammy skin on the forehead, palms, and soles. Other features include pallor, a dry mouth, tachycardia or bradycardia, palpitations, and hypertension or hypotension. The patient may also develop tremors, breathlessness, a headache, muscle tension, nausea, vomiting, abdominal distention, diarrhea, increased urination, and sharp chest pain.
Arrhythmias
Cardiac arrhythmias may produce generalized cool, clammy skin along with mental status changes, dizziness, and hypotension.
Cardiogenic shock
Generalized cool, moist, pale skin accompanies confusion, restlessness, hypotension, tachycardia, tachypnea, narrowing pulse pressure, cyanosis, and oliguria.
Heat exhaustion
In the acute stage of heat exhaustion, generalized cold, clammy skin accompanies an ashen appearance, a headache, confusion, syncope, giddiness and, possibly, a subnormal temperature, with mild heat exhaustion. The patient may exhibit a rapid and thready pulse, nausea, vomiting, tachypnea, oliguria, thirst, muscle cramps, and hypotension.
Hypoglycemia (acute)
Generalized cool, clammy skin or diaphoresis may accompany irritability, tremors, palpitations, hunger, a headache, tachycardia, and anxiety. Central nervous system disturbances include blurred vision, diplopia, confusion, motor weakness, hemiplegia, and coma. These signs and symptoms typically resolve after the patient is given glucose.
Hypovolemic shock
With hypovolemic shock, generalized pale, cold, clammy skin accompanies a subnormal body temperature, hypotension with narrowing pulse pressure, tachycardia, tachypnea, and a rapid, thready pulse. Other findings are flat neck veins, an increased capillary refill time, decreased urine output, confusion, and a decreased level of consciousness.
Septic shock
The cold shock stage causes generalized cold, clammy skin. Associated findings include a rapid and thready pulse, severe hypotension, persistent oliguria or anuria, and respiratory failure.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Generalized anxiety disorder:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
Theorists share a common premise: Conflict, whether intrapsychic, sociopersonal, or interpersonal, promotes an anxiety state.
Generalized anxiety disorder has a 1-year prevalence range from 3% to 8%. It’s more common in women than in men, and half of all cases begin in childhood or adolescence.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Panic disorder:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
Like other anxiety disorders, panic disorder may stem from a combination of physical and psychological factors. For example, some theorists emphasize the role of stressful events or unconscious conflicts that occur early in childhood.
Recent evidence indicates that alterations in brain biochemistry, especially in norepinephrine, serotonin, and gamma-aminobutyric acid activity, may also contribute to panic disorder.
Panic disorder affects about 2% of the population. Symptoms usually develop before age 25.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Agitation:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Affective disturbances
Agitation may occur in either the depressive or manic phase of affective disturbances and in personality disorders, such as borderline and antisocial personality disorders. The hallmark of the depressive form is depressed mood upon awakening, which eases during the day. Chronic anxiety may be mild or severe. Psychomotor agitation may be characterized by an inability to sit still, hand-wringing, pacing, and irritability. Other findings in the manic state may include decreased sleep, pressured speech, and grandiosity.
Alcohol withdrawal syndrome
Mild to severe agitation occurs with hyperactivity, tremors, and anxiety. In delirium tremens, the potentially life-threatening stage of alcohol withdrawal, severe agitation accompanies hallucinations, insomnia, diaphoresis, and depressed mood. Pulse rate and temperature rise as withdrawal progresses; status epilepticus, cardiac arrhythmias, and shock can occur.
Anxiety
Anxiety is a common symptom that produces varying degrees of agitation. The patient may be unaware of his anxiety or may complain of it without knowing its cause. Other findings may include nausea, vomiting, diarrhea, cool and clammy skin, frontal headache, back pain, insomnia, and tremors.
Chronic renal failure
Moderate to severe agitation occurs in chronic renal failure, which is marked by confusion and memory loss. The agitation is accompanied by diverse signs and symptoms, such as nausea, vomiting, anorexia, mouth ulcers, ammonia breath odor, GI bleeding, pallor, edema, dry skin, and uremic frost.
Dementia
Mild to severe agitation can result from many common dementia syndromes, such as Alzheimer’s and Huntington’s diseases. The patient may display a decrease in memory, attention span, problem-solving ability, and alertness. Hypoactivity, wandering behavior, hallucinations, aphasia, and insomnia may also occur.
Drug withdrawal syndrome
Findings vary with the drug but include mild to severe agitation, anxiety, abdominal cramps, diaphoresis, and anorexia. In opioid or barbiturate withdrawal, a decreased level of consciousness (LOC), seizures, and elevated blood pressure, heart rate, and respiratory rate can also occur.
Hepatic encephalopathy
Agitation occurs only in fulminating encephalopathy. Other findings include drowsiness, stupor, fetor hepaticus, asterixis, and hyperreflexia.
Hypersensitivity reaction
Moderate to severe agitation may be the first sign of a hypersensitivity reaction. Depending on the severity of the reaction, agitation may be accompanied by urticaria, pruritus, and facial and dependent edema.
In anaphylactic shock, a potentially life-threatening reaction, agitation occurs rapidly along with apprehension, urticaria or diffuse erythema, warm and moist skin, paresthesia, pruritus, edema, dyspnea, wheezing, stridor, hypotension, and tachycardia. Abdominal cramps, vomiting, and diarrhea can also occur.
Hypoxemia
Beginning as restlessness, agitation rapidly worsens in hypoxemia. The patient may be confused and have impaired judgment and motor coordination. He may also have tachycardia, tachypnea, dyspnea, and cyanosis.
Increased intracranial pressure (ICP)
Agitation usually precedes other early signs and symptoms, such as headache, nausea, and vomiting. Increased ICP produces respiratory changes, such as Cheyne-Stokes, cluster, ataxic, or apneustic breathing; sluggish, nonreactive, or unequal pupils; widening pulse pressure; tachycardia; decreased LOC; seizures; and motor changes, such as decerebrate or decorticate posture.
Organic brain syndrome
In organic brain syndrome, agitation is manifested as hyperactivity, emotional lability, confusion, and memory loss. Slurred or incoherent speech and paranoid behavior may also occur.
Post–head trauma syndrome
Shortly—or even years—after injury, mild to severe agitation develops, characterized by disorientation, loss of concentration, angry outbursts, and emotional lability. Fatigue, wandering behavior, and poor judgment are other findings.
Vitamin B6 Deficiency
Agitation can range from mild to severe. Other effects include seizures, peripheral paresthesia, and dermatitis. Oculogyric crisis may also occur.
Other causes
Drugs
Mild to moderate agitation, which is commonly dose related, is an adverse effect of central nervous system stimulants—especially appetite suppressants, such as amphetamines and amphetamine-like drugs; sympathomimetics such as ephedrine; caffeine; and theophylline.
Radiographic contrast media
Injection of a contrast medium during various diagnostic tests may produce moderate to severe agitation along with other signs of hypersensitivity.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Anxiety:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Acute respiratory distress syndrome
Acute anxiety occurs along with tachycardia, mental sluggishness and, in severe cases, hypotension. Respiratory signs and symptoms include dyspnea, tachypnea, intercostal and suprasternal retractions, crackles, and rhonchi.
Anaphylactic shock
Acute anxiety is usually the first sign of anaphylactic shock. It’s accompanied by urticaria, angioedema, pruritus, and shortness of breath. Soon, other signs and symptoms develop: light-headedness, hypotension, tachycardia, nasal congestion, sneezing, wheezing, dyspnea, barking cough, abdominal cramps, vomiting, diarrhea, and urinary urgency and incontinence.
Angina pectoris
Acute anxiety may either precede or follow an attack of angina pectoris. An attack produces sharp and crushing substernal or anterior chest pain that may radiate to the back, neck, arms, or jaw. The pain may be relieved by nitroglycerin or rest, which eases anxiety.
Asthma
In allergic asthma attacks, acute anxiety occurs with dyspnea, wheezing, productive cough, accessory muscle use, hyperresonant lung fields, diminished breath sounds, coarse crackles, cyanosis, tachycardia, and diaphoresis.
Autonomic hyperreflexia
The earliest signs of autonomic hyperreflexia may be acute anxiety accompanied by a severe headache and dramatic hypertension. Pallor and motor and sensory deficits occur below the level of the lesion; flushing occurs above it.
Cardiogenic shock
Acute anxiety is accompanied by cool, pale, clammy skin; tachycardia; weak, thready pulse; tachypnea; ventricular gallop; crackles; jugular vein distention; decreased urine output; hypotension; narrowing pulse pressure; and peripheral edema.
Chronic obstructive pulmonary disease (COPD)
Acute anxiety, exertional dyspnea, cough, wheezing, crackles, hyperresonant lung fields, tachypnea, and accessory muscle use characterize COPD.
Heart failure
In heart failure, acute anxiety is commonly the first symptom of inadequate oxygenation. Associated findings include restlessness, shortness of breath, tachypnea, decreased LOC, edema, crackles, ventricular gallop, hypotension, diaphoresis, and cyanosis.
Hyperthyroidism
Acute anxiety may be an early sign of hyperthyroidism. Classic signs and symptoms include heat intolerance, weight loss despite increased appetite, nervousness, tremor, palpitations, diaphoresis, an enlarged thyroid, and diarrhea. Exophthalmos also may occur.
Hyperventilation syndrome
Hyperventilation syndrome produces acute anxiety, pallor, circumoral and peripheral paresthesia and, occasionally, carpopedal spasms.
Hypochondriasis
Mild to moderate chronic anxiety occurs in hypochondriasis. The patient focuses more on the belief that he has a specific serious disease rather than on the actual symptoms. Difficulty swallowing, back pain, light-headedness, and upset stomach are common complaints. The patient tends to “physician hop” and isn’t reassured by favorable physical examinations and laboratory test results.
Hypoglycemia
Anxiety resulting from hypoglycemia is usually mild to moderate and associated with hunger, mild headache, palpitations, blurred vision, weakness, and diaphoresis.
Mitral valve prolapse
Panic may occur in patients with this valvular disorder, also known as click-murmur syndrome because its hallmark is a midsystolic click, followed by an apical systolic murmur. Mitral valve prolapse also may cause paroxysmal palpitations accompanied by sharp, stabbing, or aching precordial pain.
Mood disorder
Anxiety may be the patient’s chief complaint in the depressive or manic form of mood disorder. In the depressive form, chronic anxiety of varying severity occurs along with dysphoria; anger; insomnia or hypersomnia; decreased libido, interest, energy, and concentration; appetite disturbance; multiple somatic complaints; and suicidal thoughts. In the manic form, the patient’s chief complaint may be a reduced need for sleep, hyperactivity, increased energy, rapid or pressured speech and, in severe cases, paranoid ideas and other psychotic symptoms.
Myocardial infarction (MI)
In this life-threatening disorder, acute anxiety commonly occurs with persistent, crushing substernal pain that may radiate to the left arm, jaw, neck, or shoulder blades. MI may be accompanied by shortness of breath, nausea, vomiting, diaphoresis, and cool, pale skin.
Obsessive-compulsive disorder
Chronic anxiety occurs in obsessive-compulsive disorder, which is marked by recurrent, unshakable thoughts or impulses to perform ritualistic acts. The patient recognizes these acts as irrational but is unable to control them. Anxiety builds if he can’t perform these acts and diminishes after he does.
Pheochromocytoma
Acute, severe anxiety accompanies pheochromocytoma’s cardinal sign: persistent or paroxysmal hypertension. Other common findings include tachycardia, diaphoresis, orthostatic hypotension, tachypnea, flushing, severe headache, palpitations, nausea, vomiting, epigastric pain, and paresthesia.
Phobias
In phobias, chronic anxiety accompanies persistent fear of an object, an activity, or a situation that results in a compelling desire to avoid it. The patient recognizes the fear as irrational but can’t suppress it.
Pneumonia
Acute anxiety may occur in pneumonia because of hypoxemia. Other findings include productive cough, pleuritic chest pain, fever, chills, crackles, diminished breath sounds, and hyperresonant lung fields.
Pneumothorax
Acute anxiety occurs in moderate to severe pneumothorax associated with profound respiratory distress. It’s accompanied by sharp pleuritic pain, coughing, shortness of breath, cyanosis, asymmetrical chest expansion, pallor, jugular vein distention, and a weak, rapid pulse.
Postconcussion syndrome
Postconcussion syndrome may produce chronic anxiety or periodic attacks of acute anxiety. The anxiety is usually most pronounced in situations demanding attention, judgment, or comprehension. Associated signs and symptoms include irritability, insomnia, dizziness, and mild headache.
Posttraumatic stress disorder
Posttraumatic stress disorder occurs in patients who have experienced an extremely traumatic event. It produces chronic anxiety of varying severity and is accompanied by intrusive, vivid memories and thoughts of the traumatic event. The patient also relives the event in dreams and nightmares. Insomnia, depression, and feelings of numbness and detachment are common.
Pulmonary edema
In pulmonary edema, acute anxiety occurs with dyspnea, orthopnea, cough with frothy sputum, tachycardia, tachypnea, crackles, ventricular gallop, hypotension, and thready pulse. The patient’s skin may be cool, clammy, and cyanotic.
Pulmonary embolism
Acute anxiety is usually accompanied by dyspnea, tachypnea, chest pain, tachycardia, blood-tinged sputum, and low-grade fever.
Rabies
Anxiety signals the beginning of the acute phase of rabies. This rare disorder is characterized by painful laryngeal spasms associated with difficulty swallowing and, as a result, hydrophobia.
Somatoform disorder
Somatoform disorder, which usually begins in young adulthood, is characterized by anxiety and multiple somatic complaints that can’t be explained physiologically. The symptoms aren’t produced intentionally but are severe enough to significantly impair functioning. Pain disorder, conversion disorder, and hypochondriasis are examples of somatoform disorder.
Other causes
Drugs
Many drugs cause anxiety, especially sympathomimetics and central nervous system stimulants. In addition, many antidepressants may cause paradoxical anxiety.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Skin, clammy:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Anxiety
An acute anxiety attack commonly produces cold, clammy skin on the forehead, palms, and soles. Other features include pallor, dry mouth, tachycardia or bradycardia, palpitations, and hypertension or hypotension. The patient may also develop tremors, breathlessness, headache, muscle tension, nausea, vomiting, abdominal distention, diarrhea, increased urination, and sharp chest pain.
Arrhythmias
Cardiac arrhythmias may produce generalized cool, clammy skin along with mental status changes, dizziness, and hypotension.
Cardiogenic shock
Generalized cool, moist, pale skin accompanies confusion, restlessness, hypotension, tachycardia, tachypnea, narrowing pulse pressure, cyanosis, and oliguria.
Heat exhaustion
In the acute stage of heat exhaustion, generalized cold, clammy skin accompanies an ashen appearance, headache, confusion, syncope, giddiness and, possibly, a subnormal temperature, with mild heat exhaustion. The patient may exhibit a rapid and thready pulse, nausea, vomiting, tachypnea, oliguria, thirst, muscle cramps, and hypotension.
Hypoglycemia (acute)
Generalized cool, clammy skin or diaphoresis may accompany irritability, tremors, palpitations, hunger, headache, tachycardia, and anxiety. Central nervous system disturbances include blurred vision, diplopia, confusion, motor weakness, hemiplegia, and coma. These signs and symptoms typically resolve after the patient is given glucose.
Hypovolemic shock
With this common form of shock, generalized pale, cold, clammy skin accompanies subnormal body temperature, hypotension with narrowing pulse pressure, tachycardia, tachypnea, and rapid, thready pulse. Other findings are flat neck veins, increased capillary refill time, decreased urine output, confusion, and decreased level of consciousness.
Septic shock
The cold shock stage causes generalized cold, clammy skin. Associated findings include rapid and thready pulse, severe hypotension, persistent oliguria or anuria, and respiratory failure.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Anxiety:
Differential Overview
(Field Guide to Bedside Diagnosis)
❑ Situational/characterologic
❑ Post-traumatic stress disorder
❑ Drugs/withdrawal
❑ Generalized anxiety disorder
❑ Panic disorder
❑ Phobia
❑ Agitated depression
❑ Hypoglycemia
❑ Hyperthyroidism
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Anxiety disorder, generalized:
Causes
(Handbook of Diseases)
Etiology is thought to involve the y-aminobutyric acid (GABA) A receptor–chloride ion channel complex. Benzodiazepines bind two separate GABA-A receptor sites: Type I has broad anatomic distribution, and type II is concentrated in the hippocampus, striatum, and neocortex. Serotonin (5-hydroxytryptamine [5-HT]) also appears to have a role in anxiety. Theorists share a common premise: Con-flict — whether intrapsychic, sociopersonal, or interpersonal — promotes an anxiety state.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Panic disorder:
Causes
(Handbook of Diseases)
As with other anxiety disorders, panic disorder may stem from a combination of physiologic and psychological factors. Evidence implicates hereditary and temporal lobe dysfunction, and some theorists emphasize the role of stressful events or unconscious conflicts that occur early in childhood. The disorder may also develop as a persistent pattern of maladaptive behavior acquired by learning.
Alterations in brain biochemistry, especially in norepinephrine, serotonin, and gamma-aminobutyric acid activity, may also contribute to panic disorder.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Skin, clammy:
Medical causes
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Anxiety
An acute anxiety attack commonly produces cold, clammy skin on the forehead, palms, and soles. Other features include pallor, dry mouth, tachycardia or bradycardia, palpitations, and hypertension or hypotension. The patient may also develop tremors, breathlessness, headache, muscle tension, nausea, vomiting, abdominal distention, diarrhea, increased urination, and sharp chest pain.
Arrhythmias
Cardiac arrhythmias may produce generalized cool, clammy skin along with mental status changes, dizziness, and hypotension.
Cardiogenic shock
Generalized cool, moist, pale skin accompanies confusion, restlessness, hypotension, tachycardia, tachypnea, narrowing pulse pressure, cyanosis, and oliguria.
Heat exhaustion
In the acute stage of heat exhaustion, generalized cold, clammy skin accompanies an ashen appearance, headache, confusion, syncope, giddiness and, possibly, a subnormal temperature, with mild heat exhaustion. The patient may exhibit a rapid and thready pulse, nausea, vomiting, tachypnea, oliguria, thirst, muscle cramps, hypotension, blurred vision, and loss of consciousness.
Hypoglycemia (acute)
Generalized cool, clammy skin or diaphoresis may accompany irritability, tremors, palpitations, hunger, headache, tachycardia, and anxiety. Central nervous system disturbances include blurred vision, diplopia, confusion, motor weakness, hemiplegia, and coma. These signs and symptoms typically resolve after the patient is given glucose.
Hypovolemic shock
With this common form of shock, generalized pale, cold, clammy skin accompanies subnormal body temperature, hypotension with narrowing pulse pressure, tachycardia, tachypnea, and a rapid, thready pulse. Other findings are flat neck veins, increased capillary refill time, decreased urine output, confusion, and a decreased level of consciousness.
Septic shock
The cold shock stage causes generalized cold, clammy skin. Associated findings include a rapid and thready pulse, severe hypotension, persistent oliguria or anuria, and respiratory failure.
» READ BOOK EXCERPT ONLINE »
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Agitation:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Affectivedisturbance
Agitation may occur in depressed and manic phases of affectivedisturbance and in personality disorders, such as borderline and antisocial personality disorders. In its depressive form, chronic anxiety occurs with varying severity. The hallmark is depressed mood upon awakening, which eases during the day. Psychomotor agitation may be characterized by an inability to sit still, hand-wringing, pacing, and irritability. Other findings in manic states may include decreased sleep, pressured speech, and grandiosity.
Alcohol withdrawal syndrome
With alcohol withdrawal syndrome, mild to severe agitation occurs. It may be accompanied by hyperactivity, tremors, and anxiety. With delirium tremens, the potentially life-threatening stage of alcohol withdrawal, severe agitation accompanies hallucinations, insomnia, diaphoresis, and depressed mood. Pulse rate and temperature rise as withdrawal progresses; status epilepticus, cardiac exhaustion, and shock can occur.
Anxiety
Anxiety produces varying degrees of agitation. The patient may be unaware of his anxiety or may complain of it without knowing its cause. Other findings include nausea, vomiting, diarrhea, cool and clammy skin, frontal headache, back pain, insomnia, and tremors.
Chronic renal failure
Moderate to severe agitation occurs with chronic renal failure, marked especially by confusion and memory loss. The agitation is accompanied by diverse signs and symptoms, such as nausea, vomiting, anorexia, mouth ulcers, ammonia breath odor, GI bleeding, pallor, edema, dry skin, and uremic frost.
Dementia
Mild to severe agitation related to dementia can result from many common syndromes, such as Alzheimer’s and Huntington’s diseases. The patient may display a decrease in memory, attention span, problem-solving ability, and alertness. Hypoactivity, wandering behavior, hallucinations, aphasia, and insomnia may also occur.
Drug withdrawal syndrome
In drug withdrawal syndrome, mild to severe agitation occurs. Related findings vary with the drug but include anxiety, abdominal cramps, diaphoresis, and anorexia. With narcotic or barbiturate withdrawal, a decreased level of consciousness (LOC), seizures, and elevated blood pressure, heart rate, and respiratory rate can also occur.
Hepatic encephalopathy
Agitation occurs with fulminating hepatic encephalopathy. Other findings include drowsiness, stupor, fetor hepaticus (musty, sweet breath odor), asterixis, and hyperreflexia. Lethargy, aberrant behavior, and apraxia may also occur.
Hypersensitivity reaction
Moderate to severe agitation may be the first sign of a hypersensitivity reaction. Depending on the severity of the reaction, agitation may be accompanied by urticaria, pruritus, and facial and dependent edema.
With anaphylactic shock, a potentially life-threatening reaction, agitation occurs rapidly along with apprehension, urticaria or diffuse erythema, skin that’s warm and moist, paresthesia, pruritus, edema, dyspnea, wheezing, stridor, hypotension, and tachycardia. Abdominal cramps, vomiting, and diarrhea can also occur.
Hypoxemia
Beginning as restlessness, agitation rapidly worsens with hypoxemia. The patient may be confused and have impaired judgment and motor coordination. He may also have tachycardia, tachypnea, dyspnea, and cyanosis.
Increased intracranial pressure
With increased intracranial pressure (ICP), agitation usually precedes other early signs and symptoms, such as headache, nausea, and vomiting. ICP produces respiratory changes, such as Cheyne-Stokes, cluster, ataxic, or apneustic breathing; sluggish, nonreactive, or unequal pupils; widening pulse pressure; tachycardia; decreased LOC; seizures; and motor changes, such as decerebrate or decorticate posture.
Organic brain syndrome
With organic brain syndrome, agitation is manifested as hyperactivity, emotional lability, confusion, and memory loss. Slurred or incoherent speech and paranoid behavior may also occur.
Post–head trauma syndrome
Shortly after — or even years after — head trauma, mild to severe agitation develops, characterized by disorientation, loss of concentration, angry outbursts, and emotional lability. Other findings include fatigue, wandering behavior, and poor judgment.
Vitamin B6 deficiency
With vitamin B6 deficiency, agitation can range from mild to severe. Other effects include seizures, peripheral paresthesia, and dermatitis. Oculogyric crisis may also occur.
Other causes
Drugs
Mild to moderate agitation, which is commonly dose related, develops as an adverse reaction to central nervous system stimulants — especially appetite suppressants, such as amphetamines and amphetamine-like drugs; sympathomimetics such as ephedrine; caffeine; and theophylline.
Radiographic contrast media
Reaction to the contrast medium injected during various diagnostic tests produces moderate to severe agitation along with other signs of hypersensitivity.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Anxiety:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Acute respiratory distress syndrome
With acute respiratory distress syndrome (ARDS), acute anxiety occurs along with tachycardia, mental sluggishness and, in severe cases, hypotension. Other respiratory signs and symptoms include dyspnea, tachypnea, intercostal and suprasternal retractions, crackles, and rhonchi.
Anaphylactic shock
Acute anxiety usually signals the onset of anaphylactic shock. It’s accompanied by urticaria, angioedema, pruritus, and shortness of breath. Soon, other signs and symptoms develop: light-headedness, hypotension, tachycardia, nasal congestion, sneezing, wheezing, dyspnea, barking cough, abdominal cramps, vomiting, diarrhea, and urinary urgency and incontinence.
Angina pectoris
Acute anxiety may either precede or follow an attack of angina pectoris. An attack produces sharp and crushing substernal or anterior chest pain that may radiate to the back, neck, arms, or jaw. The pain may be relieved by nitroglycerin or rest, which eases anxiety.
Asthma
During allergic asthma attacks, acute anxiety occurs with dyspnea, wheezing, productive cough, accessory muscle use, hyperresonant lung fields, diminished breath sounds, coarse crackles, cyanosis, tachycardia, and diaphoresis.
Autonomic hyperreflexia
The earliest signs of autonomic hyperreflexia may be acute anxiety accompanied by severe headache and dramatic hypertension. Pallor and motor and sensory deficits occur below the level of the lesion; flushing occurs above it.
Cardiogenic shock
With cardiogenic shock, acute anxiety is accompanied by cool, pale, clammy skin; tachycardia; weak, thready pulse; tachypnea; ventricular gallop; crackles; jugular vein distention; decreased urine output; hypotension; narrowing pulse pressure; and peripheral edema.
Chronic obstructive pulmonary disease
Acute anxiety, exertional dyspnea, cough, wheezing, crackles, hyperresonant lung fields, tachypnea, and accessory muscle use characterize chronic obstructive pulmonary disease (COPD). Other signs and symptoms include barrel chest, pursed-lip breathing, and finger clubbing (late in the disease).
Heart failure
Acute anxiety is commonly the first symptom of inadequate oxygenation in a patient with heart failure. Associated findings include restlessness, shortness of breath, tachypnea, decreased LOC, edema, crackles, ventricular gallop, hypotension, diaphoresis, and cyanosis.
Hyperthyroidism
Acute anxiety may be an early sign of hyperthyroidism. Classic signs and symptoms include heat intolerance, weight loss despite increased appetite, nervousness, tremor, palpitations, sweating, an enlarged thyroid, and diarrhea. Exophthalmos may occur.
Hyperventilation syndrome
Hyperventilation syndrome produces acute anxiety, pallor, circumoral and peripheral paresthesia and, occasionally, carpopedal spasms. Other signs and symptoms include chest pain, tachycardia, belching, flatus, and dizziness.
Hypochondriasis
Mild to moderate chronic anxiety occurs with hypochondriasis. The patient focuses more on the belief that he has a specific serious disease than on the actual symptoms. Difficulty swallowing, back pain, light-headedness, and upset stomach are common complaints. The patient tends to “physician hop” and isn’t reassured by favorable physical examinations and laboratory test results.
Hypoglycemia
Anxiety resulting from hypoglycemia is usually mild to moderate and associated with hunger, mild headache, palpitations, blurred vision, weakness, and diaphoresis. Other signs and symptoms include nervousness, dizziness, and tingling and numbness around the mouth.
Mitral valve prolapse
Panic may occur in patients with mitral valve prolapse, referred to as the click-murmur syndrome. The disorder also may cause paroxysmal palpitations accompanied by sharp, stabbing, or aching precordial pain. Its hallmark is a midsystolic click, followed by an apical systolic murmur.
Mood disorder
Anxiety may be the patient’s chief complaint in the depressive or manic form of mood disorder. With the depressive form, chronic anxiety occurs with varying severity. Associated findings include dysphoria; anger; insomnia or hypersomnia; decreased libido, energy, and concentration; appetite disturbance; multiple somatic complaints; and suicidal thoughts. With the manic form, the patient’s chief complaint may be a reduced need for sleep, hyperactivity, increased energy, rapid or pressured speech and, in severe cases, paranoid ideas and other psychotic symptoms.
Myocardial infarction
With myocardial infarction, a life-threatening disorder, acute anxiety commonly occurs with persistent, crushing substernal pain that may radiate to the left arm, jaw, neck, or shoulder blades. It can be accompanied by shortness of breath, nausea, vomiting, diaphoresis, and cool, pale skin.
Obsessive-compulsive disorder
Chronic anxiety occurs with obsessive-compulsive disorder, along with recurrent, unshakable thoughts or impulses to perform ritualistic acts. The patient recognizes these acts as irrational but can’t control them. Anxiety builds if he can’t perform these acts and diminishes after he does.
Pheochromocytoma
Acute, severe anxiety accompanies the cardinal sign of pheochromocytoma: persistent or paroxysmal hypertension. Common associated signs and symptoms include tachycardia, diaphoresis, orthostatic hypotension, tachypnea, flushing, severe headache, palpitations, nausea, vomiting, epigastric pain, and paresthesia.
Phobias
With phobias, chronic anxiety occurs along with persistent fear of an object, activity, or situation that results in a compelling desire to avoid it. The patient recognizes the fear as irrational but can’t suppress it.
Postconcussion syndrome
Postconcussion syndrome may produce chronic anxiety or periodic attacks of acute anxiety. Associated signs and symptoms include irritability, insomnia, dizziness, and mild headache. The anxiety is usually most pronounced in situations demanding attention, judgment, or comprehension.
Posttraumatic stress disorder
Posttraumatic stress disorder occurs in patients who have experienced an extreme traumatic event. It produces chronic anxiety of varying severity and is accompanied by intrusive, vivid memories and thoughts of the traumatic event. The patient also relives the event in dreams and nightmares. Insomnia, depression, and feelings of numbness and detachment are common.
Pulmonary edema
With pulmonary edema, acute anxiety occurs with dyspnea, orthopnea, cough with frothy sputum, tachycardia, tachypnea, crackles, ventricular gallop, hypotension, and thready pulse. The patient’s skin may be cool, clammy, and cyanotic.
Pulmonary embolism
Hypoxia resulting from a pulmonary embolus may lead to acute anxiety and restlessness. The patient may also experience dyspnea, tachypnea, chest pain, tachycardia, blood-tinged sputum, and low-grade fever.
Somatoform disorder
Somatoform disorder, which usually begins in young adulthood, is characterized by anxiety and multiple somatic complaints that can’t be explained physiologically. The symptoms aren’t produced intentionally but are severe enough to significantly impair functioning. Pain disorder, conversion disorder, and hypochondriasis are examples of a somatoform disorder.
Other causes
Drugs
Many drugs cause anxiety, especially sympathomimetics and central nervous system stimulants. In addition, many antidepressants may cause paradoxical anxiety.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Skin, clammy:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Anxiety
An acute anxiety attack commonly produces cold, clammy skin on the forehead, palms, and soles. Other features include pallor, dry mouth, tachycardia or bradycardia, palpitations, and hypertension or hypotension. The patient may also develop tremors, breathlessness, headache, muscle tension, nausea, vomiting, abdominal distention, diarrhea, increased urination, and sharp chest pain.
Cardiac arrhythmias
Cardiac arrhythmias may produce generalized cool, clammy skin along with mental status changes, dizziness, and hypotension. The pulse rate may be rapid, slow, or irregular. The patient may report palpitations, chest pain, diaphoresis, light-headedness, and weakness.
Cardiogenic shock
With cardiogenic shock, generalized cool, moist, pale skin accompanies confusion, restlessness, hypotension, tachycardia, tachypnea, narrowing pulse pressure, cyanosis, and oliguria. Associated signs and symptoms include anginal pain, dyspnea, jugular vein distention, ventricular gallop, and a weak, rapid pulse.
Heat exhaustion
In the acute stage of heat exhaustion, generalized cold, clammy skin accompanies an ashen appearance, headache, confusion, syncope, giddiness and, possibly, a subnormal temperature, with mild heat exhaustion. The patient may exhibit a rapid and thready pulse, nausea, vomiting, tachypnea, oliguria, thirst, muscle cramps, and hypotension.
Hypoglycemia (acute)
With acute hypoglycemia, generalized cool, clammy skin or diaphoresis may accompany irritability, tremors, palpitations, hunger, headache, tachycardia, and anxiety. Central nervous system disturbances include blurred vision, diplopia, confusion, motor weakness, hemiplegia, and coma. These signs and symptoms typically resolve after the patient is given glucose.
Hypovolemic shock
With hypovolemic shock, generalized pale, cold, clammy skin accompanies subnormal body temperature, hypotension with narrowing pulse pressure, tachycardia, tachypnea, and rapid, thready pulse. Other findings are flat neck veins, increased capillary refill time, decreased urine output, confusion, and decreased level of consciousness.
Septic shock
The cold shock stage of septic shock causes generalized cold, clammy skin. Associated findings include rapid and thready pulse, severe hypotension, persistent oliguria or anuria, and respiratory failure.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Agitation:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Alcohol withdrawal syndrome.Mild to severe agitation occurs in alcohol withdrawal syndrome, along with hyperactivity, tremors, and anxiety. With delirium, the potentially life-threatening stage of alcohol withdrawal, severe agitation accompanies hallucinations, insomnia, diaphoresis, and a depressed mood. The patient's pulse rate and temperature rise as withdrawal progresses; status epilepticus, cardiac exhaustion, and shock can occur.
Anxiety.Anxiety produces varying degrees of agitation. The patient may be unaware of his anxiety or may complain of it without knowing its cause. Other findings include nausea, vomiting, diarrhea, cool and clammy skin, frontal headache, back pain, insomnia, and tremors.
Dementia.Mild to severe agitation can result from many common syndromes, such as Alzheimer's and Huntington's diseases. The patient may display a decrease in memory, attention span, problem-solving ability, and alertness. Hypoactivity, wandering behavior, hallucinations, aphasia, and insomnia may also occur.
Drug withdrawal syndrome.Mild to severe agitation occurs in drug withdrawal syndrome. Related findings vary with the drug, but include anxiety, abdominal cramps, diaphoresis, and anorexia. With opioid or barbiturate withdrawal, a decreased level of consciousness (LOC), seizures, and elevated blood pressure, heart rate, and respiratory rate can also occur.
Hepatic encephalopathy.Agitation occurs only with fulminating hepatic encephalopathy. Other findings include drowsiness, stupor, fetor hepaticus, asterixis, and hyperreflexia.
Hypersensitivity reaction.Moderate to severe agitation appears, possibly as the first sign of a reaction. Depending on the severity of the reaction, agitation may be accompanied by urticaria, pruritus, and facial and dependent edema.
With anaphylactic shock,a potentially life-threatening reaction, agitation occurs rapidly along with apprehension, urticaria or diffuse erythema, warm and moist skin, paresthesia, pruritus, edema, dyspnea, wheezing, stridor, hypotension, and tachycardia. Abdominal cramps, vomiting, and diarrhea can also occur.
Hypoxemia.Beginning as restlessness, agitation rapidly worsens. The patient may be confused and have impaired judgment and motor coordination. He may also have tachycardia, tachypnea, dyspnea, and cyanosis.
Increased intracranial pressure (ICP).Agitation usually precedes other early signs and symptoms, such as headache, nausea, and vomiting. Increased ICP produces respiratory changes, such as Cheyne-Stokes, cluster, ataxic, or apneustic breathing; sluggish, nonreactive, or unequal pupils; widening pulse pressure; tachycardia; a decreased LOC; seizures; and motor changes such as decerebrate or decorticate posture.
Post-head trauma syndrome.Shortly after, or even years after a head injury, mild to severe agitation may develop, characterized by disorientation, loss of concentration, angry outbursts, and emotional lability. Other findings include fatigue, wandering behavior, and poor judgment.
Vitamin B6 deficiency.Agitation can range from mild to severe. Other effects include seizures, peripheral paresthesia, and dermatitis. Oculogyric crisis may also occur.
Other causes
Drugs.Mild to moderate agitation, which is commonly dose related, develops as an adverse reaction to central nervous system stimulants—especially appetite suppressants, such as amphetamines and amphetamine-like drugs; sympathomimetics, such as ephedrine; caffeine; and theophylline.
Radiographic contrast media.Reaction to the contrast medium injected during various diagnostic tests produces moderate to severe agitation along with other signs of hypersensitivity.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Anxiety:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Acute respiratory distress syndrome (ARDS).Acute anxiety occurs with ARDS along with tachycardia, mental sluggishness and, in severe cases, hypotension. Other respiratory signs and symptoms include dyspnea, tachypnea, intercostal and suprasternal retractions, crackles, rhonchi, and decreased pulse oximetry.
Anaphylactic shock.Acute anxiety usually signals the onset of anaphylacticshock. It's accompanied by urticaria, angioedema, pruritus, and shortness of breath. Soon, other signs and symptoms develop: light-headedness, hypotension, tachycardia, nasal congestion, sneezing, wheezing, dyspnea, a barking cough, abdominal cramps, vomiting, diarrhea, and urinary urgency and incontinence.
Angina pectoris.Acute anxiety may either precede or follow an attack of angina pectoris. An attack produces sharp and crushing substernal or anterior chest pain that may radiate to the back, neck, arms, or jaw. The pain may be relieved by nitroglycerin or rest, which eases anxiety.
Asthma.With allergic asthma attacks, acute anxiety occurs with dyspnea, wheezing, a productive cough, accessory muscle use, hyperresonant lung fields, diminished breath sounds, coarse crackles, cyanosis, decreased pulse oximetry, tachycardia, and diaphoresis.
Autonomic hyperreflexia.The earliest signs of autonomic hyperreflexia may be acute anxiety accompanied by severe headache and dramatic hypertension. Pallor and motor and sensory deficits occur below the level of the lesion; flushing occurs above it.
Cardiogenic shock.Acute anxiety in cardiogenic shock is accompanied by cool, pale, clammy skin; tachycardia; a weak, thready pulse; tachypnea; ventricular gallop; crackles; jugular vein distention; decreased urine output; hypotension; narrowing pulse pressure; and peripheral edema.
Chronic obstructive pulmonary
disease (COPD).Acute anxiety, exertional dyspnea, cough, wheezing, crackles, hyperresonant lung fields, tachypnea, and accessory muscle use characterize COPD.
Generalized anxiety disorder.Anxiety may be the patient's chief complaint in this type of anxiety disorder. It's characterized by excessive, unrealistic worry lasting 6 months or more. Associated findings include trembling, insomnia, GI disturbances, dizziness, irritability, and muscle aches.
Heart failure.With heart failure, acute anxiety is commonly the first symptom of inadequate oxygenation. Associated findings include restlessness, shortness of breath, tachypnea, decreased LOC, edema, crackles, ventricular gallop, hypotension, diaphoresis, cyanosis, and decreased pulse oximetry.
Hyperthyroidism.Acute anxiety may be an early sign of hyperthyroidism. Classic signs and symptoms include heat intolerance, weight loss despite increased appetite, nervousness, tremor, palpitations, sweating, an enlarged thyroid, and diarrhea. Exophthalmos may occur.
Mitral valve prolapse.Panic may occur in patients with mitral valve prolapse, referred to as the click-murmur syndrome. The disorder may also cause paroxysmal palpitations accompanied by sharp, stabbing, or aching precordial pain. Its hallmark is a midsystolic click, followed by an apical systolic murmur.
Myocardial infarction (MI).With MI, a life-threatening disorder, acute anxiety commonly occurs with persistent, crushing substernal pain that may radiate to the left arm, jaw, neck, or shoulder blades. It can be accompanied by shortness of breath, nausea, vomiting, diaphoresis, and cool, pale skin.
Obsessive-compulsive disorder.Chronic anxiety occurs with obsessive-compulsive disorder, along with recurrent, unshakable thoughts or impulses to perform ritualistic acts. The patient recognizes these acts as irrational, but is unable to control them. Anxiety builds if he can't perform these acts and diminishes after he does.
Pheochromocytoma.Acute, severe anxiety accompanies pheochromocytoma's cardinal sign: persistent or paroxysmal hypertension. Common associated signs and symptoms include tachycardia, diaphoresis, orthostatic hypotension, tachypnea, flushing, a severe headache, palpitations, nausea, vomiting, epigastric pain, and paresthesia.
Phobias.With phobias, chronic anxiety occurs along with a persistent fear of an object, activity, or situation that results in a compelling desire to avoid it. The patient recognizes the fear as irrational, but can't suppress it.
Pneumonia.Acute anxiety may occur with pneumonia because of hypoxemia. Other findings include a productive cough, pleuritic chest pain, fever, chills, crackles, diminished breath sounds, and hyperresonant lung fields.
Pneumothorax.Acute anxiety occurs in moderate to severe pneumothorax associated with profound respiratory distress. It's accompanied by sharp pleuritic pain, coughing, shortness of breath, cyanosis, asymmetrical chest expansion, pallor, jugular vein distention, and a weak, rapid pulse.
Postconcussion syndrome.Postconcussion syndrome may produce chronic anxiety or periodic attacks of acute anxiety. Associated signs and symptoms include irritability, insomnia, dizziness, and a mild headache. The anxiety is usually most pronounced in situations demanding attention, judgment, or comprehension.
Posttraumatic stress disorder.Posttraumatic stress disorder produces chronic anxiety of varying severity and is accompanied by intrusive, vivid memories and thoughts of the traumatic event. The patient may relive the event in dreams and nightmares. Insomnia, depression, and feelings of numbness and detachment are common.
Pulmonary edema.With pulmonary edema, acute anxiety occurs with dyspnea, orthopnea, cough with frothy sputum, tachycardia, tachypnea, crackles, decreased pulse oximetry, ventricular gallop, hypotension, and a thready pulse. The patient's skin may be cool, clammy, and cyanotic.
Pulmonary embolism.With pulmonary embolism, acute anxiety is usually accompanied by dyspnea, tachypnea, chest pain, tachycardia, blood-tinged sputum, and a low-grade fever.
Rabies.Anxiety signals the beginning of the acute phase of rabies, a rare disorder, which is commonly accompanied by painful laryngeal spasms associated with difficulty swallowing and, as a result, hydrophobia.
Somatoform disorder.Somatoform disorder is characterized by anxiety and multiple somatic complaints that can't be explained physiologically. The symptoms aren't produced intentionally, but are severe enough to significantly impair functioning. Pain disorder, conversion disorder, and hypochondriasis are examples of somatoform disorder.
Other causes
Drugs.Many drugs cause anxiety, especially sympathomimetics and central nervous system stimulants. In addition, many antidepressants may cause paradoxical anxiety.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Skin, clammy:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Anxiety.An acute anxiety attack commonly produces cold, clammy skin on the forehead, palms, and soles. Other features include pallor, a dry mouth, tachycardia or bradycardia, palpitations, and hypertension or hypotension. The patient may also develop tremors, breathlessness, headache, muscle tension, nausea, vomiting, abdominal distention, diarrhea, increased urination, and sharp chest pain.
Arrhythmias.Cardiac arrhythmias may produce generalized cool, clammy skin along with mental status changes, dizziness, and hypotension.
Cardiogenic shock.Generalized cool, moist, pale skin accompanies confusion, restlessness, hypotension, tachycardia, tachypnea, narrowing pulse pressure, cyanosis, and oliguria.
Heat exhaustion.In the acute stage of heat exhaustion, generalized cold, clammy skin accompanies an ashen appearance, headache, confusion, syncope, giddiness and, possibly, a subnormal temperature, with mild heat exhaustion. The patient may exhibit a rapid and thready pulse, nausea, vomiting, tachypnea, oliguria, thirst, muscle cramps, and hypotension.
Hypoglycemia (acute).Generalized cool, clammy skin or diaphoresis may accompany irritability, tremors, palpitations, hunger, headache, tachycardia, and anxiety. Central nervous system disturbances include blurred vision, diplopia, confusion, motor weakness, hemiplegia, and coma. These signs and symptoms typically resolve after the patient is given glucose.
Hypovolemic shock.With hypovolemic shock, generalized pale, cold, clammy skin accompanies a subnormal body temperature, hypotension with narrowing pulse pressure, tachycardia, tachypnea, and a rapid, thready pulse. Other findings are flat neck veins, an increased capillary refill time, decreased urine output, confusion, and decreased level of consciousness.
Septic shock.The cold shock stage causes generalized cold, clammy skin. Associated findings include a rapid and thready pulse, severe hypotension, persistent oliguria or anuria, and respiratory failure.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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