Symptom Management

Anxiety

Anxiety is a common symptom among patients with a life-threatening disease, sometimes occurring with depression.

Characteristics of anxiety include:

	Feelings of fear, worry or apprehension
	Additional symptoms, such as tension, restlessness, jitteriness, insomnia, fatigue, distractibility, shortness of breath, numbness or muscle tension
	Long duration (generalized anxiety) or short, intense bouts (panic attacks)

Causes of anxiety can include:

	Difficulty adjusting to the illness
	Common fears about death, including isolation and separation
	Poorly-controlled pain
	Side effects of medication
	Withdrawal from benzodiazepines or opioids, if these are decreased abruptly
	Medical conditions, such as dehydration, electrolyte imbalance, or withdrawal from drugs such as nicotine or alcohol.

Some anxiety is a normal response to the frightening situation facing patients with a life-threatening illness. However, if anxiety begins to cause the patient distress, there are several treatment options.

Treatment of anxiety can include:

Stress management techniques, such as progressive relaxation, guided imagery and hypnosis

	Counseling
	Support from family, friends, spiritual leaders and peers
	Control of pain, side effects from medication and other medical conditions, where possible

Medication can include:

	Benzodiazepines
	Other tranquilizers, such as the phenothiazines and haloperidol
	Antihistamines, especially hydroxyzine
	Antidepressants
	Opioids

Counseling for Anxiety

	Establishing a bond to decrease the patient's sense of isolation
	Fostering a sense of self-worth
	Correcting misconceptions about the past and present
	Integrating the present illness into a continuum of life experience
	Emphasizing past strengths
	Supporting ways of coping that the patient has used successfully in the past
	Helping the patient meet interpersonal goals, such as reconciling differences with a family member or maintaining relationships with friends
	Exploring issues of separation, loss and the unknown that arise when facing death
	Addressing practical concerns
	Addressing needs of the family and other caregivers.