Generalized Anxiety disorder (GAD)

Anxiety is a normal human response to situations such as danger.  It is part of the body’s protection system in the fight or flight response.  Anxiety gives us the ability anticipate things that might happen in the future. Short term anxiety is normal response. When a person develops severe, long term anxiety it becomes a problem. Anxiety is different from fear.  Fear is a physiological response to specific threat or situation. Anxiety is general and not a specific response to a situation. (Mitchell, 2013) Generalized Anxiety Disorder Symptoms.

Generalized Anxiety Disorder (GAD) is excessive worry and anxiety for a period of more than six months.  (Mitchell, 2013) There is an inability to control the worry, and always have at least 1 physical symptom. (Imran, 2017) Symptoms include restlessness, irritability, muscle tension, poor concentration, trouble making decisions and fearing making a mistake. Putting things off to avoid making a mistake is usual symptom.  This can lead to social isolation, tardiness or missing work or school.  Some of the common worries people with GAD experience include, not meeting personal relationship expectations, job worries, finances, and health of other family members. These symptoms affect daily living in more than one area of a person’s life.  Sleep troubles are common, as the person spends time reviewing the events of the day and anticipating problems in the future. (Halter, 2013)

Children and Adolescents

In children and adolescents Generalized Anxiety Disorder is one of the most common anxiety disorders. Even though it is a very common problem in children it is often not noticed and therefore left untreated. The criteria for diagnosis in children are largely the same as for adults. Comorbidity is common among youth with GAD around 75% of youth meet the standards for another diagnosis. The most common comorbid diagnosis among pediatric patients is depression.  Some of the other comorbid conditions include Social Anxiety Disorder, Obsessive-Compulsive Disorder, Posttraumatic Stress Disorder, Autism, Substance-Induced Anxiety Disorder.  Some factors put children at a higher risk for GAD.  Female children are two times as likely to have GAD than boys. Age factors into pediatric risks, usually GAD starts in teenage years.  Other factors include; living in an Urban area, exposure to violence, history of trauma, Psychosocial stress like low income. Parents who have an anxiety disorder puts a child at a higher risk.  (Imran, 2017)

Treatment for youth include multiple treatment avenues.  The first line of treatment in children is psychological therapy.  Cognitive Behavior Therapy is often combined with selective serotonin reuptake inhibitors (SSRIs).  This combination therapy is more effective than medication or therapy alone. Other therapeutic treatment includes family therapy. SSRI’s are generally well tolerated in children and are most effective in treating GAD. Benzodiazepines safety and side effects have not been tested for pediatric use, therefore are not used as a pharmacological treatment.  (Imran, 2017)

Older Adults

Generalized Anxiety Disorder is one of the most common mental disorders in older adults. Symptoms are the same as younger population.   In older adults GAD can cause and increase in cardiovascular problems, higher than normal health care use, declines in cognitive performance.  First line treatment for older adults is SSRIs.  Studies have shown that Cognitive Behavioral therapy (CBT) is not as effective in older adults as it is the younger population. However Cognitive behavioral therapy is still important in treatment after and SSRI has been started.  (Wetherell, 2013)

Pharmacological 

Treatments. Pharmacological treatments include Antidepressants and Antianxiety drugs are the most common classes of medication given.  Selective serotonin reuptake inhibitors (SSRIs) are the first choice in treatment.  SSRI’s have a good safety profile and are effective in treating coexisting depression disorders. Selective Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) are also used with success in treating GAD.  Monoamine Oxidase inhibitors (MAOIs) are only used when first line antidepressants fail in treatment.  MAOIs have more significant side effects and carry the risk of life threatening hypertensive crisis.  (Halter, 2013)

Antianxiety (anxiolytic) drugs are commonly used to help address the physical and psychological symptoms involved in anxiety disorders. Benzodiazepines are prescribed commonly. They are favored due to their quick onset and safety profile.  It is recommended that Benzodiazepines are only used short term due to the high risk of dependency.

Benzodiazepines side effects can reduce function during the day.  Central nervous system side effects include sedation and decreased cognitive function.  (Halter, 2013) 

On occasion other classes of medications include Beta-Blockers, antihistamines and anticonvulsants. These are typically used if the first line of treatment is unsuccessful.  Beta Blockers block the nerve that increase heart rate, lowering the sympathetic nervous system response to anxiety.  Antihistamines have been used as an alternative to benzodiazepines. Antihistamines don’t have a risk of dependency and are a safe alternative.  (Halter, 2013)

Nonpharmacologic Treatments

Nonpharmacologic treatments include; health teaching, cognitive behavioral therapy and behavior therapy. Behavior therapy involves teaching the patient activities to help with relaxation and anxiety.  Relaxation training teaches exercises for breathing and relaxing muscles to reduce the stress response.  This lowers the heart rate and respiratory rate reducing anxiety. Modeling is the patient imitating appropriate response behavior to a situation, following the therapist actions. Thought stopping therapy involves interruption of the negative thought or anxiety.  The patient is taught to interrupt the thought with “Stop” or use a rubber band to snap on the wrist.  This helps the patient redirect their thoughts to a positive thought.  (Halter, 2013)

Cognitive behavior therapy (CBT) is more than just therapy.  CBT includes restructuring, teaching self-observation for signs of panic and psychoeducation among other treatments. (Halter, 2013) Usually the goals of CBT involve identifying the fears and anxiety triggers.  Once identified confronting the anxiety triggers and evaluating the likelihood of the event happening.  Therapy also helps the patient cope with their insecurities causing anxiety. CBT can also help patients suffering from coexisting depression.  (“Treatment options for generalized anxiety disorder”, 2017)

Conclusion

Generalized Anxiety disorder (GAD) although very common is a treatable condition. Symptoms can be managed with save effective antidepressants and antianxiety medications.  Behavior therapies can help patients cope with anxiety’s physical and mental symptoms. These treatments are often effective in treating depression a common comorbid condition. The outlook for  is usually positive with effective treatment.