Research Paper On General Anxiety Disorders
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Anxiety disorders are common among people of all developed and developing countries. Primary and secondary medical setup both get patients with anxiety disorder (King et al., 2008). These disorders are chronic and cause mental distress, poor quality of life, increased mortality and morbidity rate and financial constraints ( Wittchen and Jacobi, 2005). There are five types of anxiety disorders; namely, panic disorder (PD), obsessive-compulsive disorder (OCD), social anxiety disorder (SAD), post-traumatic stress disorder (PTSD) and generalized anxiety disorder (GAD). Treatment recommended includes pharmacological drugs, mainly anti-depressants, and psychological therapies, mainly cognitive behavioral therapy. In this research paper, Generalized Anxiety Disorder (GAD) is discussed in detail. It affects 6.8 million Americans and is more common in adult women. GAD rarely occurs alone and is accompanied by other anxiety disorders, depression, and drug or substance abuse. The onset of GAD is mostly before 25 years of age.
Generalized Anxiety Disorder
GAD is more prevalent in society than normal anxiety people face in daily life. It is a chronic or recurring disorder and is diagnostic criteria includes persistence of symptoms for more than six months. Remission of symptoms fully in between is not common. People experience exaggerated tension on casual things like money, health, family and work. They may even get anxious thinking about a busy day ahead. They are aware that they get worried much more than normal people but can’t help getting out of that phase. They experience insomnia, which is a lack of adequate sleep. The tension and anxiety are accompanied by physical signs and symptoms of headache, irritability, unexplained fatigue, hot flashes, sweating, mood disorders, muscle twitching, trembling hands, dizziness, and dyspnea. Individuals get scared easily and face difficulty in concentrating at their work. GAD patients live a life of constant depression. They experience somatic symptoms like nausea and psychological dysphagia. Vertigo (spinning of head) and syncope (fall to the ground) is also common in patients with GAD. When they are less anxious, they can interact in society well but at the time of severe anxiety they prefer to remain alone.
Anxiety disorders are caused by a combination of genetic, environmental, behavioral and developmental abnormalities. Researchers are looking into the regions of the brain which control emotions and behavior of an individual. It is found that amygdala, an almond-shaped lobe in brain, is responsible for triggering the response to fear after processing sensory signals (Bishop et al., 2004; Tillfors et al., 2001). This study is valuable to find specific treatment for anxiety disorders. Study of family members and twin study has proven that genes play a critical role in anxiety disorders (Torgersen, S., 1983).
Diagnosis of GAD is made clinically. Symptoms should be persistent for six months or more. A suicidal behavior can be found, but this is not a case all the time. The most common criteria for diagnosis is Diagnostic and Statistical Manual, DSM-I, 1952 to DSM-IV, 1994, according to American Psychiatric Association, 1994. Before making a definite diagnosis, other conditions like cardiac diseases, thyroid disorders, drug use and drug withdrawal must be excluded, and detailed history and physical examination must be done. Mental Status Examination must be done in GAD patients, and two elements must be looked into in detail. The suicidal behavior of patients must be evaluated by detailed history taking and orientation of patient must be seen (Sareen, J., Cox, B. J., Afifi, T. O., de Graaf, R., Asmundson, G. J., ten Have, M., & Stein, M. B., 2005)
Treatment of GAD and other anxiety disorders is generally same. It includes pharmacological drugs and psychotherapy. Mostly, patients require a combination of both. The treatment option also depends on patient’s choice and on the physician. Treatment of GAD and other anxiety disorders is essential otherwise it may cause disputes in the family and on the job, they may get involved in excessive alcohol intake to fight anxiety or take abusive drugs.
The most common pharmacological treatment includes administration of antidepressants like selective serotonin reuptake inhibitors, SSRI. These are taken for long period of time, much longer after symptoms start to taper down. SSRI can cause mild side effects like nausea or jittery feeling, but it is for as short time and a switch to another class of SSRI can also relieve symptoms. GAD, in particular, is treated by Venlafaxine, which is a drug closely related to SSRI (Baldwin et al., 2005; Lecrubier and Judge, 1997). Other drugs can also be given. Tricyclics like Imipramine can be given for GAD and panic disorders. Benzodiazepines like Alprazolam and Clonazepam can also be given. Busipirone is a new class of azipirones used especially for the treatment of GAD.
Psychotherapy holds an important role in the treatment of anxiety disorders. It involves talking to therapists about the situations in which patient experience anxiety and other symptoms of the disease. The therapist may be a psychiatrist, psychologist, counselor and/or social worker. Cognitive-behavioral therapy is used for the treatment of anxiety disorders (Hofmann, S. G., & Smits, J. A., 2008). This is a twofold therapy: cognitive therapy aims to treat the thinking pattern of patients with fear or worries, and the behavioral part aims to deal with the reaction of patients to anxiety-provoking circumstances. Patients are guided that they must not consider their anxiety attacks as heart attacks, those with social phobias must not consider that people are always watching them. By doing this, they gain confidence to deal with their fears and then they are taught to desensitize their fears. They are exposed to similar situations which cause fears called exposure therapy. They are also treated with relaxation therapy in which patient have to take deep breaths in fresh air to feel relax. CBT usually lasts for 12 months. It can be individual therapy or in a group form in which different people with same or similar symptoms are counseled and talked with.
GAD screening is uncommon. However, a survey was conducted among school children, and those with depression and anxiety symptoms were given cognitive behavioral therapy for eight weeks. It was found after three years that they do not experience those symptoms or to a very little extent. So, prevention of anxiety disorders must be considered as it does have a positive outcome.
GAD in pregnancy
In pregnancy and in the postpartum period the symptoms of GAD may get worse (Ross, L. E., McLean, L. M., & Psych, C., 2006). The mothers are given psychotherapy but the need to administer pharmacological drugs is mostly required. These drugs may cause adverse effects on the health of the fetus as the drugs cross the placenta. However, Buspirone is considered safe during pregnancy.
Anxiety disorders are one of the most common disorders in America. It is less prevalent in children. GAD includes many signs and symptoms and people must consult the doctor when they feel that they are having anxiety more than normal, and it is continuous over a long period of time family support is essential for he people with anxiety disorders and they may be called to CBT sessions. Research in locating the area of the brain involved in anxiety is important so as to come up with better treatment.
Bishop, S., et al., 2004a. Prefrontal cortical function and anxiety: controlling attention to threat-related stimuli. Nat. Neurosci. 7 (2), 184–188.
Fricchione, G. (2004). Generalized anxiety disorder. New England Journal of Medicine, 351(7), 675-682.
Hofmann, S. G., & Smits, J. A. (2008). Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. The Journal of clinical psychiatry, 69(4), 621
King, M., et al., 2008. Prevalence of common mental disorders in general practice attendees across Europe. Br. J. Psychiatry 192 (5), 362–367.
King, L. (n.d.). Experience Psychology.
Matthew Garner H. (2009). Research in anxiety disorders: From the bench to the bedside. Elsevier.
National Institute of Mental Health. (n.d.). Retrieved from http://www.nimh.nih.gov/health/topics/generalized-anxiety-disorder-gad/index.shtml#part_145362
Ross, L. E., McLean, L. M., & Psych, C. (2006). Anxiety disorders during pregnancy and the postpartum period: a systematic review. depression, 6(9)
Sareen, J., Cox, B. J., Afifi, T. O., de Graaf, R., Asmundson, G. J., ten Have, M., & Stein, M. B. (2005). Anxiety disorders and risk for suicidal ideation and suicide attempts: a population-based longitudinal study of adults. Archives of General Psychiatry, 62(11), 1249-1257.
Torgersen, S. (1983). Genetic factors in anxiety disorders. Archives of General Psychiatry, 40(10), 1085-1089.
Wittchen, H.-U., Jacobi, F., 2005. Size and burden of mental disorders in Europe: a critical review and appraisal of 27 studies. Eur. Neuropsychopharmacol. 15, 357–376.
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