Death anxiety as a function of aging anxiety

To assess how different facets of aging anxiety contributed to the prediction of tangible and existential death anxiety, 167 Americans of various Christian denominations completed a battery of questionnaires. Multiple regression analyses, controlling for demographic variables and previously demonstrated predictors of death anxiety, revealed that the aging anxiety dimensions of physical appearance concern and fear of losses each positively predicted tangible death anxiety. In addition, the aging anxiety dimension of fear of losses predicted existential death anxiety. Results are discussed with respect to the multifaceted nature of death anxiety and how different forms of aging anxiety contribute to anxieties about death.     

Biology of anxiety

Our understanding of the biological basis of anxiety is far from complete, although our knowledge of both the neuropharmacologic and molecular basis of anxiety has increased. This article reviews our current knowledge of the possible biological basis of generalized anxiety disorder and panic disorder.     

Generalized anxiety disorder

Generalized anxiety disorder is a relatively new clinical entity and current understanding of this syndrome lacks a solid research base. However, useful generalizations can be derived from earlier studies of anxiety neurosis and other previously defined anxiety syndromes. Most persons with GAD are seen by primary care physicians, but recognizing these patients may be difficult. In the primary care setting they often present with physical complaints suggesting a specific organ system disease. Depression and substance abuse may be presenting problems in patients with primary GAD. Primary care physicians are usually able to provide appropriate care for generalized anxiety disorder patients. By keeping in mind the cognitive, behavioral, affective, and physiologic aspects of the syndrome, they can appropriately address the specific therapeutic needs of individual patients. The nature of the doctor-patient relationship in primary care favors the development of therapeutic trust that is important for effective management of GAD. Drug therapy is a useful adjunct in the treatment of many patients with GAD. However, the use of drugs as the sole therapeutic modality is seldom appropriate.     

Generalized anxiety disorder

Patients with generalized anxiety disorder experience worry or anxiety and a number of physical and psychologic symptoms. The disorder is frequently difficult to diagnose because of the variety of presentations and the common occurrence of comorbid medical or psychiatric conditions. The lifetime prevalence is approximately 4 to 6 percent in the general population and is more common in women than in men. It is often chronic, and patients with this disorder are more likely to be seen by family physicians than by psychiatrists. Treatment consists of pharmacotherapy and various forms of psychotherapy. The benzodiazepines are used for short-term treatment, but because of the frequently chronic nature of generalized anxiety disorder, they may need to be continued for months to years. Buspirone and antidepressants are also used for the pharmacologic management of patients with generalized anxiety disorder. Patients must receive an appropriate pharmacologic trial with dosage titrated to optimal levels as judged by the control of symptoms and the tolerance of side effects. Psychiatric consultation should be considered for patients who do not respond to an appropriate trial of pharmacotherapy.     

Stress and anxiety

Anxiety is the psychophysiologic signal that the stress response has been initiated. The stress response's by-product, stress, is difficult to define. The response has multiple dimensions that have yielded research with many foci. Most salient to nursing are investigations of psychobiologic variables, the influence of life events, and the interactional model of the stress response. The stress response can be viewed as an interactional process that causes psychophysiologic reactions that are immediate and can occur up to and including physiologic events 3 weeks after confrontation with the stressor. The literature suggests that neuroendocrine alterations in response to confrontation with a stressor may influence immunocompetence. Intervention and prevention studies of stress focus on pharmacotherapy, psychotherapy, behavioral techniques, personality engineering, relaxation training, and biofeedback. Nursing research on stress has proliferated in the 1980s. Implications for nursing intervention include coping strategies that fall into four categories: behavioral, physical, cognitive, and emotional.     

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