How Do You Diagnose Generalized Anxiety Disorder
As described in the previous slide, you have to have those symptoms of extreme worry and ruminations in combination with the physical symptoms of anxiety. So you have to have these constellation of symptoms as described in the previous slides, and it cant be normal worry- it has to be pathological worrying. So in addition to the pathological worry, ruminations, and the physical symptoms, in order to make the diagnosis of GAD, it needs to interfere with your life and it needs to disrupt your functioning- GAD can actually paralyzed you to the point where youre not able to do anything else and youre not able to accomplish tasks. It can also negatively impact your relationships and your job performance. It affects your ability to care for yourself- so when the worry and anxiety disrupts your life to the point where youre not able to take care yourself or it impacts your relationships or your job performance, then it could be generalized anxiety disorder. Also, before making the diagnosis of generalized anxiety disorder, these symptoms are not the result of a substance such as caffeine or amphetamines, as these substances can make you highly anxious and irritable and it can look like you might have generalized anxiety disorder.
Introduction To Emotional Processing
Mood and anxiety disorders are characterized by a variety of neuroendocrine, neurotransmitter, and neuroanatomical disruptions. Identifying the most functionally relevant differences is complicated by the high degree of interconnectivity between neurotransmitter- and neuropeptide-containing circuits in limbic, brain stem, and higher cortical brain areas. Furthermore, a primary alteration in brain structure or function or in neurotransmitter signaling may result from environmental experiences and underlying genetic predisposition such alterations can increase the risk for psychopathology.
Therapy For Generalized Anxiety Disorder
While GAD impacts many aspects of a persons life, there is hope and help. Cognitive Behavioral Therapy is an evidence-based treatment for GAD. In this therapy, people learn about their disorder. Next they learn about common thought problems as well as how they can approach their thoughts from a rational point of view. Exposure and Response Prevention is also used in the treatment of GAD. In ERP, people face the things that cause anxiety in order to learn how to live with fear in a more adaptive way. People often experience habituation in this process. That is to say, while doing exposures they get used to the things that cause their fear.
Mindfulness can also be a helpful approach in the treatment of GAD. Through this approach, people learn to accept the presence of thoughts and feelings without judgment. You can read more about Mindfulness here.
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Symptoms Of Generalised Anxiety Disorder
People with generalised anxiety disorder experience several mental, emotional and physical symptoms, including:
- excessive and unreasonable worry over events or activities, such as work, school or health
- excessive worry about their capacity and confidence to deal with situations
- inability to control or stop their worrying
- feelings of apprehension
- sleep disturbance .
Can Anxiety Disorders Be Prevented
You cant prevent anxiety disorders. But you can take steps to control or reduce your symptoms:
- Check out medications: Talk to a healthcare provider or pharmacist before taking over-the-counter medications or herbal remedies. Some of these contain chemicals that may make anxiety symptoms worse.
- Limit caffeine: Stop or limit how much caffeine you consume, including coffee, tea, cola and chocolate.
- Live a healthy lifestyle: Exercise regularly and eat a healthy, balanced diet.
- Seek help: Get counseling and support if you experienced a traumatic or disturbing event. Doing so can help prevent anxiety and other unpleasant feelings from disrupting your life.
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Generalized Anxiety Disorder Self
Support from other people is vital to overcoming GAD. Social interaction with someone who cares about you is the most effective way to calm your nervous system and diffuse anxiety, so its important to find someone you can connect with face to face on a regular basisyour significant other, a family member, or a friend, perhaps. This person should be someone you can talk to for an uninterrupted period of time, someone who will listen to you without judging, criticizing, or continually being distracted by the phone or other people.
Build a strong support system. Human beings are social creatures. Were not meant to live in isolation. But a strong support system doesnt necessarily mean a vast network of friends. Dont underestimate the benefit of a few people you can trust and count on to be there for you.
Talk it out when your worries start spiraling. If you start to feel overwhelmed with anxiety, meet with a trusted family member or friend. Just talking face to face about your worries can make them seem less threatening.
Know who to avoid when youre feeling anxious. Your anxious take on life may be something you learned when you were growing up. If your mother is a chronic worrier, she is not the best person to call when youre feeling anxiousno matter how close you are. When considering who to turn to, ask yourself whether you tend to feel better or worse after talking to that person about a problem.
How Do Anxiety Disorders Affect Children
Its normal for children to feel some amount of anxiety, worry or fear at certain points. For example, a child may feel scared of a thunderstorm or barking dog. A teenager might get anxious about an upcoming test or school dance.
But sometimes, children approach these situations with overwhelming dread or they cant stop thinking about all the fears tied to one of these events. It may seem that none of your comforts help. These children often get stuck on their worries. They have a hard time doing their daily activities, like going to school, playing and falling asleep. Theyre extremely reluctant to try something new.
When thinking about your childs anxiety levels, getting stuck is key. It separates the regular worries of childhood from an anxiety disorder that needs professional help. If the anxiety or worry interferes with your childs ability to function, it may be time to seek help
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How To Cope And Get Support
- Stick your treatment plan and remain consistent.
- Work with your counselor to pinpoint the cause of your anxiety, and then take steps toward addressing it.
- Whenever you feel symptoms of generalized anxiety disorder coming on, go for a walk, or engage in a favorite hobby. This helps refocus your mind on something positive.
- Dont dwell on things in the past, which can no longer be changed.
- Socialize with your loved ones and participate in enjoyable activities.
- Join a support group for those with generalized anxiety disorder. Here youll hopefully find compassion, understanding, and a way to bond over shared experiences. Check online for organizations like the National Alliance on Mental Illness .
Differential Diagnosis And Comorbidity
When evaluating a patient for a suspected anxiety disorder, it is important to exclude medical conditions with similar presentations . Other psychiatric disorders use of substances such as caffeine, albuterol, levothyroxine, or decongestants or substance withdrawal may also present with similar symptoms and should be ruled out.5
Complicating the diagnosis of GAD and PD is that many conditions in the differential diagnosis are also common comorbidities. Additionally, many patients with GAD or PD meet criteria for other psychiatric disorders, including major depressive disorder and social phobia. Evidence suggests that GAD and PD usually occur with at least one other psychiatric disorder, such as mood, anxiety, or substance use disorders.10 When anxiety disorders occur with other conditions, historic, physical, and laboratory findings may be helpful in distinguishing each diagnosis and developing appropriate treatment plans.
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When Should I Go To The Emergency Room For An Anxiety Disorder
Symptoms of an anxiety disorder can resemble symptoms of a heart attack or another health emergency. If youre experiencing an anxiety attack for the first time, or youre concerned in any way about your health, call 911 or head to the nearest ER. A healthcare provider will check you for serious or life-threatening conditions.
If youre having an anxiety attack and unsure whether you should head to an ER or not, its better to go. Healthcare professionals can make sure youre OK and give you any necessary treatment.
What Treatments Should I Be Offered For Gad
Some treatments may not be suitable for you, depending on your exact circumstances. If you have questions about specific treatments and options covered, please talk to a member of your healthcare team.
Treatments for GAD include psychological treatments and medication. These are explained below. Most treatments can be provided by your GP or other healthcare professionals in primary care.
If you have a learning disability or other problem that may affect your understanding, you should be offered the same treatments as other people with GAD. The treatment may be adapted to suit your needs.
If you also have depression or another kind of anxiety disorder , your healthcare professional should discuss with you which condition would be best treated first.
If you have problems with alcohol or drugs you may be offered treatment for your alcohol or drug problem first. This is because GAD sometimes gets better after an alcohol or drug problem is treated.
GAD may get better by itself with no treatment at all, or after discussions with and advice from a healthcare professional.
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What Are The Causes And Risk Factors For Gad
Experts donât know the exact causes of generalized anxiety disorder. Several things — including genetics, brain chemistry, and environmental stresses — appear to contribute to its development.
- Genetics. Some research suggests that family history plays a part in making it more likely that a person will have GAD. This means that the tendency to develop GAD may be passed on in families. But no anxiety genes have been identified, and families may also pass down the tendency through lifestyle or environment.
- Brain chemistry. This is complex. GAD has been linked to problems with certain nerve cell pathways that connect particular brain regions involved in thinking and emotion. These nerve cell connections depend on chemicals called neurotransmitters that send information from one nerve cell to the next. If the pathways that connect particular brain regions donât work well, problems related to mood or anxiety may result. Medicines, psychotherapies, or other treatments that are thought to work on these neurotransmitters may improve the signaling between circuits and help to improve symptoms related to anxiety or depression.
- Environmental factors. Trauma and stressful events such as abuse, the death of a loved one, divorce, and changing jobs or schools may contribute to GAD. The condition can also worsen when stress feels out of hand. The use of and withdrawal from addictive substances can also worsen anxiety.
Treating Children And Adolescents
Whereas specific phobias, SAD, and separation anxiety disorder are common in younger people, PDA and GAD are relatively rare. There are some randomized, placebo-controlled studies of pharmacotherapy for anxiety disorders in children and adolescents showing efficacy of sertraline, fluoxetine, and duloxetine in young patients with GAD, of venlafaxine and paroxetine in SAD, and of sertraline, fluvoxamine, and fluoxetine in mixed samples, including patients with separation anxiety disorder, GAD, and SAD. However, little is known about the value of long-term treatment. The combination of CBT and sertraline was found to be more effective than both treatment modalities alone.
For children and youths with separation anxiety disorder, several treatment studies exist. However, no controlled studies on the treatment of adults with this disorder could be traced.
There is also a paucity of treatment studies for children with selective mutism. Small studies have shown that psychotherapeutic approaches were at least better than waitlist controls., One review indicated that only two very small placebo-controlled drug studies showed efficacy of the SSRIs fluoxetine and sertraline.
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Selective Serotonin Reuptake Inhibitors And Selective Serotonin Norepinephrine Reuptake Inhibitors
Due to their positive benefit/risk balance, selective serotonin reuptake inhibitors and selective serotonin norepinephrine reuptake inhibitors . During the first 2 weeks, adverse effects may be stronger. Initial jitteriness or an increase in anxiety symptoms may occur, which may reduce the patients’ treatment compliance. Lowering the starting dose of the antidepressants may reduce these adverse effects. A review of studies in depressed patients suggested that SNRIs may be less well tolerated than the SSRIs. However, according to clinical experience, tolerability may differ among patients, and it is also possible that an individual patient may experience less adverse effects when switched from an SSRI to an SNRI.
Some SSRIs and SNRIs are inhibitors of cytochrome P450 enzymes and hence may interact with other psychopharmacological drugs and medications for medical illnesses. After stopping treatment with an SSRI, withdrawal reactions may occur. However, these are much less frequent and severe than the withdrawal reactions observed after terminating benzodiazepine treatment. These adverse reactions may be more frequent with paroxetine than with sertraline or fluoxetine.
Which Treatment Is Most Suitable
When deciding whether to have psychological treatment or use medication, your personal preference and individual needs will play a big role. The right kind of psychological treatment can be very effective and help you to overcome your anxiety. But it takes a lot of motivation and determination, and you often have to wait a long time to get an appointment. Depending on a persons individual situation and the severity of their disorder, it might therefore be a good idea to start taking medication first. Sometimes it isn’t really possible to begin psychological therapy until medication has been used to at least partially relieve the symptoms.
Some people don’t want to start taking antidepressants because they are afraid they might end up becoming dependent on them. But unlike some painkillers, sedatives and sleeping pills antidepressants do not lead to dependency. Others see taking tablets to cope with their problems as a sign of weakness. But there’s no reason to feel ashamed of taking medication to treat a mental illness. Medicine can be helpful, and in some cases even necessary, when trying to overcome anxiety.
Regardless of what decision you make, there are medications and psychological treatments that can help you cope with generalized anxiety disorder and start living a normal life again.
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What Is Generalized Anxiety Disorder
The definition of generalized anxiety disorder , according to the Anxiety and Depression Association of America, is a condition characterized by persistent and excessive worry about a number of different things. People with GAD may anticipate disaster and may be overly concerned about money, health, family, work or other issues.
Like with other anxiety disorders, people who struggle with GAD deal with a sense of uncontrollable and excessive worry. The amount of worrying that people with GAD do about a topic seems to be unwarranted, as they expect the worst to happen even when there isnt any evidence that it will. Some of the biggest sources of worry among people with GAD can include: performance at work or in school, catastrophes and natural disasters like earthquakes or war, finances, job security, health, relationships, children and family as well as other peoples opinions.
In order to diagnose someone with GAD, doctors use the criteria listed in the DSM-5 , which is the handbook used by healthcare professionals in the United States and much of the world to diagnose psychiatric conditions.
Generalized anxiety disorder is diagnosed when a person finds it difficult to control worry on more days than not for at least six months. The person must also display at least three or more of the generalized anxiety disorder symptoms described below.
Who Can Diagnose Anxiety Disorders
If your provider finds no signs of physical illness, they may refer you to a psychiatrist or psychologist. These mental health professionals specialize in diagnosing and treating mental illnesses. They may use specially designed interview and assessment tools to figure out if you have an anxiety disorder. Typically, the provider bases a diagnosis on:
- Your reported symptoms, including how intense they are and how long they last.
- Discussion of how the symptoms interfere with your daily life.
- The providers observation of your attitude and behavior.
Providers also consult the Diagnostic and Statistical Manual of Mental Disorders . The American Psychiatric Association publishes the DSM-5. Its the standard reference manual for diagnosing mental illnesses.
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Genetic Contribution To Posttraumatic Stress Disorder
The heritability for PTSD has an estimated range of 30% to 40%, probably resulting from a variety of genes, each with relatively small contributions to the genetic predisposition for this disorder.â Because of the importance of the environmental impact for this disorder, linkage studies in pedigrees cannot be conducted easily. Candidate gene association studies also are confounded by the problem of matching for environmental exposure and largely have been limited by small sample size therefore these studies would able to detect only large genetic effects.
Other genes interacting with early-life stress also are strong candidates for influencing susceptibility for PTSD. Preclinical studies indicate that the persistent hyperactivity of the HPA axis associated with ELS is mediated by a hyperactive CRF1 system, with chronic overactivity of CRF1 in limbic brain regions., In fact, the authors have shown that a haplotype within the gene encoding CRF1 interacts with child abuse to predict depression severity in adults. These polymorphisms, however, did not interact with ELS to predict PTSD symptoms.
Neurotransmitter And Neuroendocrine Signaling In Generalized Anxiety Disorder
Amino acid neurotransmitters
The observed limbic overactivity in patients who have GAD could result from decreased inhibitory neurotransmission, increased excitatory neurotransmission, or a combination of these two processes. Dysregulation of GABA inhibitory neurotransmission has been documented in several anxiety disorders . GABAA receptor downregulation is observed in patients who have GAD and has been hypothesized to play a role in the etiology of this illness . In support of this hypothesis is the finding that symptoms of GAD, including excessive worry, hypervigilance, and psychomotor agitation, are treated effectively with GABAA facilitators such as benzodiazepines and barbiturates . Furthermore, treatment with riluzole, an anti-glutamatergic agent, seems to improve GAD symptoms.,
Monoamines
Although all the SSRIs have shown efficacy in GAD, the drug most frequently studied in anxiety is paroxetine, which decreases symptoms of harm avoidance. It is important to note that GAD often is comorbid with other disorders, including MDD, PD, and SAD, each of which also has shown responsiveness to SSRI treatment.
More concrete evidence supporting a role for 5-HT circuitry in GAD includes challenge with the 5-HT2c/5-HT3 agonist mCPP, which elicits anxiety and anger in patients who have GAD .
Neuropeptides
Corticotropin-releasing factor and the hypothalamic-pituitary-adrenal axis
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