Week 5 - Generalized Anxiety Disorder Flashcards
What is GAD?
“Anxiety is a feeling of fear, worry, nervousness or unease. It acts as the body’s alarm system to warn us when there may be a threat”
- It can manifest through cognitive, behavioural and physical symptoms
How is GAD characterized in the DSM-5?
Generalized Anxiety Disorder or GAD, is characterized by the DSM-5 as excessive anxiety and worry that is out of proportion in terms of duration, frequency and duration
- These factors are disproportionate because there is a low likelihood and/or impact of the anticipated event
What is the impact of GAD?
The anxiety causes significant distress and impairs psychosocial functioning, meaning it interferes with day to day tasks and the maintenance of relationships.
When does GAD develop? Why?
Generalized anxiety disorder can develop at any age but the median age is 30, and it rarely occurs prior to adolescence.
- Age determines the content of the worry as adults tend to worry about job responsibilities, health and finances, and younger individuals worry about school and sporting performance
Signs and symptoms of GAD?
There are two main categories of symptoms of GAD:
- the worry itself; and
- the associated physical symptoms
1) The worry is usually described as persistent, excessive & uncontrollable worry about life events and activities, and a fixation on all the potential “threats” that may come up
2) The physical symptoms are many, and can include jitteriness, agitation, disturbed sleep, impaired concentration, restlessness, fatigue, irritability, muscle tension/pain, lightheadedness, dizziness, sweating, palpitations, and stomach distress
T/F
Symptoms tend to be chronic, but with periods of increased and decreased intensity
True
Risk factors (5)
1) Genetic predisposition. You are estimated to be 5 times more likely to develop GAD if you have a close relative with the condition.
2) Recent or prolonged exposure to stressful situations including personal health concerns, such as having a painful long-term health condition like arthritis, or concern for family illnesses.
3) Excessive use of caffeine, alcohol, tobacco and drugs. These substances exacerbate one’s experience with existing anxiety and make other pre-existing medical conditions worse.
4) An imbalance in brain chemistry with chemicals such as serotonin and noradrenaline, which are involved in the control and regulation of mood.
5) Differences in the way threats are perceived, development, and personality can be a consequence of traumatic events leading to instability during childhood.
Diagnostics?
- What is important to note?
According to the DSM-5, GAD is defined as “the presence of excessive anxiety and worry about a variety of topics, events, or activities. Worry occurs more often than not for at least 6 months and is clearly excessive”
- It is important to note that for section C of the DSM-5 diagnostic criteria, only one symptom is required for a diagnosis in children, whereas for adults, three or more symptoms are required. While they do experience much of the same symptoms as adults, children may display their anxiety through different behaviours, such as frequent reassurance-seeking
Why is GAD often undiagnosed?
GAD can often go undiagnosed because it is not easily recognizable in primary care settings. This may be attributed to the stigma surrounding mental illness and due to a focus on the physical symptoms associated with GAD rather than the psychological symptoms
What is used as a screening tool?
The GAD-7 is a questionnaire that can be used in primary care as a screening tool for GAD.
- It may also be used as a tool to compare a client’s scores over time, serving to assess if treatment or medication are working.
What types of treatment is there? (2)
Medications are often used when symptoms cause marked impairment in different areas of functioning such as school/work, family life, and social life and leisure activities
- The first line of pharmacological treatment options are antidepressants.
- Antidepressants that are selective serotonin reuptake inhibitors (SSRIs) (i.e. sertraline) are typically tried first.
- A different class of antidepressants, serotonin norepinephrine reuptake inhibitors (SNRIs) (i.e. venlafaxine), have also shown effectiveness to treat GAD symptoms
- Benzodiazepines, which are considered second-line medical therapy, may be used. However, there is a risk of physical and psychological dependence on these types of medications.
2) Psychological Therapies:
- The most commonly used and researched form of psychotherapy is Cognitive-Behavioural Therapy (CBT)
- CBT is a symptom focused treatment that is provided to clients individually from a trained psychotherapist.
- CBT usually occurs for six to 12 sessions, and each session is typically one hour in length
- It can now also be delivered through an online format.
- Other therapies include relaxation response training (which can be done through progressive muscle relaxation or diaphragmatic breathing), mindful meditation training, and behavioural therapy on its own
What is important as a nurse?
Given the comorbidity of GAD among individuals with chronic physical health conditions and other mental health disorders, GAD may often be overlooked or left unaddressed
- This is important to consider as in primary care settings, nurses can often be the first point of contact with individuals with anxiety.
- It is important to obtain a comprehensive health history, assessing both the physical and mental health concerns of the client.
- As nurses are collecting and interpreting information, it is also important to provide information to patients and family members
In the case of GAD, trust may be especially important as a client with GAD may have cognitive distortions and incessant worry - why?
If the client is unable to trust the nurse as part of the nurse-client relationship, this may add to the client’s anxiety and vulnerability.
If somehow trust in the nurse-client relationship is broken, it may be very difficult to re-establish trust with the client, which may contribute further to the client’s suffering and anxiety.
GAD and stigma:
- In relation to GAD, worrying about stigma can affect seeking help and treatment
- Further, stigma can worsen the symptoms of GAD by providing the patient with another reason to worry.
- “People with genuine anxiety disorders can often be misdiagnosed and mismanaged due to negative public and professional attitudes to anxiety and the ‘worried well’.
- Misdiagnosis includes not taking symptoms seriously and giving patients pejorative labels such as ‘personality disorder’ or ‘inadequate’”
- We have advocacy groups all around the country to address this issue, such as the “Active Minds Western” club at Western, whose purpose is to eliminate/lessen stigma and educate others
