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General Anxiety Disorder in the General Population
Jordan Harris PBCC Psych Prof. Heffner 11/27/07 Word Count: 2077
Generalized Anxiety Disorder is a crippling anxiety disorder, causing both physical and mental problems. When these problems and symptoms such as intense anxiety, insomnia, and accelerated heartbeat persist for six months or more and cause dysfunctions in patients’ social or business lives it can be diagnosed as GAD. This disorder is most commonly treated with a class of Antidepressants called Selective Serotonin Reuptake Inhibitors. However the most effective treatment is generally a combination SSRIs and cognitive-behavior therapy, which attempts to give the patient strategies to deal with their anxiety and change their thought patterns.
GENERAL ANXIETY DISORDER IN THE GENERAL POPULATION
Many normal Americans experience anxiety, sometimes even intense anxiety, on a daily basis. However, what distinguishes anxiety from General Anxiety Disorder or GAD is the anxiety lasts 6 months or more is chronic and is usually accompanied by insomnia, restlessness and irritability (Brinkerhoff 2004). Approximately 4 million Americans are diagnosed with this disorder every year or about 3.6% of the population (Helgoe 2005). Some experts believe this number is low due to underdiagnosis of this disorder and believe it to be more like 8-9% of the general population suffers from GAD (Helgoe 2005). Treatment options are varied although the most commonly used is drug therapy. Many drugs used effectively against depression, like SSRIs such as Paxil, Lexapro and Zoloft, have been found to treat GAD as well as depression ( Helgoe 2005). Cognitive Behavior therapy has been found to be beneficial, both on its own and in conjunction with medications (Hyman 2006). Prognosis for people with Generalized Anxiety Order is good, if their problem is chronic they may need to be medicated but with therapy in addition to medicine they can often learn to handle their anxiety better and ultimately to lead healthier lives (Hyman 2006).
GAD DIAGNOSIS Anxiety disorders are the most common psychiatric illness in the United States, at least one in every twenty Americans will suffer from an
anxiety disorder at some time in their life (Brinkerhoff 2004). An anxiety disorder is when someone’s anxiety is excessive for the challenge or situation that they are facing (Hyman 2006). When the anxiety is excessive and indeed interferes with an individual’s daily life and routine that is when an anxiety disorder may be diagnosed (Hyman 2006). Anxiety is different from fear in that anxiety is usually vague, and ill defined sometimes about things that are future oriented in nature (Hyman 2006). Anxiety can be considered the brain’s healthy fear response gone haywire and that triggers our brain’s fight or flight response mistakenly in situations that are not threatening (Hyman 2006). Generalized Anxiety Disorder (GAD) is a type of anxiety disorder that is defined by: excessive anxiety lasting more than six months with no reasonable cause, and may include restlessness, irritability, insomnia, difficulty concentrating and muscle tension (Binkerhoff 2004). Generally to be diagnosed with GAD patients both have the excessive anxiety and three of the other more minor symptoms as well and the focus of their anxiety is not defined by another anxiety disorder (Helgoe 2005). According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria GAD would not be diagnosed for example if the patient’s anxiety was found to be caused by social phobia
GAD or obsessive compulsive disorder (Brinkerhoff 2004). Also the anxiety must be of such severity that it limits the patient’s social and/or occupational functioning or cause significant distress (Helgoe 2005). Basically GAD is diagnosed when the person’s anxiety is a handicap and pre-occupies their thoughts almost constantly (Hunt 2005). Also to be considered GAD patients must be worried about numerous events and
activities (Hyman 2006). GAD is diagnosed in women more often than in men (Birkenhoff 2004). It appears women are diagnosed more than
twice as often as men for most anxiety disorders, including GAD, the only exceptions being obsessive compulsive disorder and social phobia (Helgoe 2005). However, this number may be somewhat skewed by the tendency of women to seek help more readily for mental health problems (Helgoe 2005). Doctors should do a thorough history as Generalized Anxiety Disorder is known to have some genetic components (Birkenhoff 2004). Identical twin studies have shown that anxiety disorders do tend to run in families, as when one identical twin has an anxiety disorder it is more likely to occur in their identical twin than it is in a fraternal twin (Hyman 2006). In a July 2003 issue of the Archives of General Psychiatry found that about 1/3 of the subjects fear conditioning process could be attributed to genetic rather than environmental factors (Hunt 2005). If a few of your relatives have suffered from anxiety disorders some doctors’ feel you may “inherit a more sensitive alarm system” (Helgoe 2005 p.5). In the case of
GAD GAD you have a 20% risk of developing the disorder if a blood relative also suffers from it and a 10% chance is a blood relative suffers from clinical depression (Hunt 2005).
Most people, about 90%, who are diagnosed with GAD also suffer form another psychiatric disorder, oftentimes depression (Hyman 2006). It is unknown which comes first the GAD or the depression. When these two disorders occur together they are considered bi-directional; people who are depressed tend to become more anxious the more depressed they are and people who are anxious oftentimes become more depressed the more anxious they get (Helgoe 2005).
SYMPTOMS Anxiety disorders and Generalized Anxiety Disorder in particular strike among a huge range of people, young and old and across all race lines (Hunt 2005). Because of that fact the symptoms of GAD can very greatly. Symptoms are generally broken into three categories: physical symptoms, mental symptoms and behavioral symptoms. Physical symptoms can encompass: fast heartbeat, stomach discomfort, shortness of breath, nausea, sweating, and muscle tightness (Hyman 2006). Patients
suffering from GAD oftentimes complain of physical ailments such as headaches, backaches, and in women, even menstrual cramping (Birkenhoff 2004). Patients with GAD often also suffer from an exaggerated startle response (Hyman 2006). Doctors do need to take care
GAD when diagnosing GAD as some of its physical symptoms can also be caused by other physical illnesses or even medication the person is taking (Helgoe 2005). Physical causes like hyperthyroidism and hypoglycemia need to be ruled out before GAD is diagnosed as their symptoms, including accelerated heart rate and anxiety can mimic that of GAD (Helgoe 2005). Medications or stimulants such as amphetamines, caffeine, and cocaine can also produce anxiety like symptoms (Helgoe 2005).
CAUSES & TREATMENTS Patients who suffer from Generalized Anxiety Disease generally have an imbalance of three neurotransmitters, serotonin, noradrenaline, and gamma aminobutyric acid (GABA) (Hyman 2006). GAD can also
be exacerbated by certain lifestyle choices, genetics, and biology; because of that many treatments for GAD include Cognitive Behavior Therapy (Hyman 2006). Some risk factors that may increase a person’s chance of
developing GAD include: childhood adversity, serious illness such as cancer (due to excessive worry about finances, treatment and the future), stress, and genetics. Drug treatments are probably the most common treatment used for Generalized Anxiety Disorder. These drug treatments fall into six categories: Antidepressants, Benzodiazepines, Buspar, Anticonvulsants, Beta-Blockers, and Antihistamines. Of these six the most common are
GAD Antidepressants and Benzodiazepines (Helgoe 2005). Antidepressants are generally considered the first line medication to treat anxiety and are themselves broken down into four categories (Helgoe 2005). Selective Serotonin Reuptake Inhibitors (SSRIs) work on depression and anxiety by increasing the amount of serotonin available to
synapses of the nerve cells allowing chemical signals to travel across these gaps more effectively (Hyman 2006). SSRIs must be taken on a daily basis and can take four to eight weeks to work (Brinkerhoff 2004). These medicines can initially increase a patient’s level of anxiety and to counteract this effect doctors often start with low doses of the SSRIs and then slowly increase the dosage (Brinkerhoff 2004). As this category of drugs treats both depression and anxiety it is often the first choice of medication for patients suffering from both conditions (Brinkerhoff 2004). Drugs that fall into this category include: Prozac, Luvox, Paxil, Zoloft, Celexa, and Lexapro (Helgoe 2005). Although all these drugs are considered SSRIs, they all work slightly differently and sometimes a patient may need to try several before finding one that works (Hyman 2006). A few drugs that are similar to SSRIs but not considered technically in the same category of drugs are Cymbalta and Effexor (Helgoe 2005). None of these drugs are considered addictive and are
non-sedating (Hunt 2005). Tricyclic antidepressants (TCAs) are considered the third choice for treatment of anxiety disorders (Brinkerhoff 2004). TCAs are first
GAD choice however in treating people with attention deficit/hyper-activity disorders who also suffer with anxiety. TCAs, like SSRIs, also take some weeks to take effect and must be taken everyday; they are also a particularly inexpensive treatment choice (Helgoe 2005). TCAs can be unsafe due to their numerous side effects but like SSRIs are also nonsedating and not considered addictive (Helgoe 2005). Drugs in this class include Elavil, clomipramine, imipramine, Norpramin and Surmontil (Birkenhoff 2004). Benzodiazepines are a different line of drugs that are used to treat
GAD. These drugs offer immediate relief to anxiety, usually within 30-60 minutes, and can also help with sleep disturbances (Helgoe 2005). Other benefits of this drug class include acting as a muscle relaxant, an antiepileptic, and acting as an amnesic (Hunt 2005). Benzodiazepines function in the brain by enhancing the effects of gamma amino butyric acid (GABA), which is a neurotransmitter; GABA functions by inhibiting the activity of the many nerves in the brain (Hunt 2005). Unfortunately they are highly addictive and can become ineffective over time (Brinkerhoff 2004). If they are discontinued abruptly or tapered off they can cause rebound in anxiety symptoms (Brinkerhoff 2004). Because Benzodiazepines are fat-soluble they tend to stay in the body longer than some other medications (Hunt 2005). Because this class of drugs takes effect so quickly they are often given in conjunction with SSRIs to provide short-term relief from symptoms until the SSRIs begin to work (Hyman
GAD 10 2006). Beta-blockers, such as Tenormin and Inderal, are not used commonly but are still sometimes used on people when SSRIs are not effective. This class of drugs can help reduce the physical effects of anxiety such as rapid heartbeat, sweating, shaking and tremors (Hyman 2006). Buspar, and Anticonvulsants are gaining popularity with psychiatrists although their effects on anxiety are not well studied at this time (Helgoe 2005). Antihistamines, such as Benadryl, are occasionally used in the treatment of anxiety (Helgoe 2005). For Generalized Anxiety Disorder most doctors recommend Cognitive-Behavioral Therapy (CBT) in addition to drug therapy (Hyman 2006). CBT differs from traditional talk therapies in that instead of focusing on causes of the psychological issues from the past, therapists focus treatment on the present and identifying and changing unhealthy thought patterns (Hyman 2006). This type of therapy also focuses on adjusting the patients’ thinking to respond better to symptoms of anxiety (Helgoe 2005). CBT focuses on the present and future and so this type of treatment tends to be both briefer and at the same time more effective than other types of talk therapy (Hyman 2006). Many patients also find that in addition to drug and CBT therapy that joining a self-help group, practicing stress control techniques, aerobic exercise, and avoiding caffeine can help in treating GAD (Hunt 2005).
GAD 11 Generalized Anxiety Disorder can be a crippling anxiety disorder, causing both physical and mental problems. When these problems and symptoms such as intense anxiety, insomnia, and accelerated heartbeat persist for six months or more and causes dysfunction in their social or business lives it can be diagnosed as GAD. GAD is most often treated with a combination of Antidepressants and Cognitive-behavior therapy. As many people who suffer from GAD also suffer depression once the correct drug and dosage is found many patients experience a relief from their symptoms.
GAD 12 Brinkerhoff, Shirley (2004). Drug therapy and anxiety disorders. Philadelphia: Mason Crest Publishers.
Helgoe, L.A., Wilhelm, L.R., and Kommor, M.J. (2005). Anxiety answer book: professional, reassuring answers to your most pressing questions. Naperville, IL: Sourcebooks, Inc..
Hunt, Douglas (2005). What your doctor may not tell you about anxiety, phobias, & panic attacks: the all-natural program that can help you conquer your fears. New York: Warner Books.
Hyman, B.M. & Pedrick, C.P. (2006). Anxiety disorders. Minneapolis: Twenty-First Century Books.
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