Generalized anxiety disorder
Generalized anxiety disorder: Excerpt from Professional Guide to Diseases (Eighth Edition)
Anxiety is a feeling of apprehension that some describe as an exaggerated feeling of impending doom, dread, or uneasiness. Unlike fear — a reaction to danger from a specific external source — anxiety is a reaction to an internal threat, such as an unacceptable impulse or a repressed thought that’s straining to reach a conscious level.
A rational response to a real threat, occasional anxiety is a normal part of life. Overwhelming anxiety, however, can result in generalized anxiety disorder — uncontrollable, unreasonable worry that persists for at least 6 months and narrows perceptions or interferes with normal functioning. Recent evidence indicates that the prevalence of generalized anxiety disorder is greater than previously thought and may be even greater than that of depression.
Causes and incidence
Theorists share a common premise: Conflict, whether intrapsychic, sociopersonal, or interpersonal, promotes an anxiety state.
Generalized anxiety disorder has a 1-year prevalence range from 3% to 8%. It’s more common in women than in men, and half of all cases begin in childhood or adolescence.
Signs and symptoms
Generalized anxiety disorder can begin at any age but typically has an onset in the 20s and 30s. Psychological or physiologic symptoms of anxiety states vary with the degree of anxiety. Mild anxiety mainly causes psychological symptoms, with unusual self-awareness and alertness to the environment. Moderate anxiety leads to selective inattention but with the ability to concentrate on a single task. Severe anxiety causes an inability to concentrate on more than scattered details of a task. A panic state with acute anxiety causes a complete loss of concentration, typically with unintelligible speech.
Physical examination of the patient with generalized anxiety disorder may reveal signs or symptoms of motor tension, including trembling, muscle aches and spasms, headaches, and an inability to relax. Autonomic signs and symptoms include shortness of breath, tachycardia, sweating, and abdominal complaints.
In addition, the patient may startle easily and complain of feeling apprehensive, fearful, or angry. There may also be difficulty concentrating, eating, and sleeping. The medical, psychiatric, and psychosocial histories fail to identify a specific physical or environmental cause of the anxiety.
Diagnosis
For characteristic findings in patients with this condition, see Diagnosing generalized anxiety disorder.
Laboratory tests must exclude organic causes of the patient’s signs and symptoms, such as hyperthyroidism, pheochromocytoma, coronary artery disease, supraventricular tachycardia, and Ménière’s disease. For example, an electrocardiogram can rule out myocardial ischemia in a patient who complains of chest pain. Blood tests, including complete blood count, white blood cell count and differential, and serum lactate and calcium levels, can rule out hypocalcemia.
Because anxiety is the central feature of other mental disorders, psychiatric evaluation must rule out phobias, obsessive-compulsive disorder, depression, and acute schizophrenia.
Behaviors commonly associated with a diagnosis of anxiety may have cultural origins or acceptance. For example, Hispanics may experience “susto,” or a state of anxiety, insomnia, anorexia, and social withdrawal, following a frightening stimulus. Koreans may experience “Hwa-byung” — a state of anxiety and irritability, with various physiologic symptoms, such as headache and palpitations. African-Americans may experience “blockout,” involving collapse, dizziness, and reduced physical movement in time of stress.
Treatment
A combination of drug therapy and psychotherapy may help a patient with generalized anxiety disorder. Benzodiazepines may relieve mild anxiety and improve the patient’s ability to cope.
ELDER TIP A benzodiazepine with a long half-life tends to accumulate in an older patient’s system and may cause oversedation. Benzodiazepines are sometimes given along with opioids to add to the analgesic effect or as a preanesthetic. Remember, if the elderly psychiatric patient is scheduled for surgery, he may take longer to recover from anesthesia if these combinations are used.
Tricyclic antidepressants or higher doses of short-acting benzodiazepines may relieve severe anxiety and panic attacks. Buspirone, an antianxiety drug, causes the patient less sedation and poses less risk of physical and psychological dependence than the benzodiazepines.
Psychotherapy for generalized anxiety disorder has two goals: helping the patient identify and deal with the cause of the anxiety and eliminating environmental factors that precipitate an anxious reaction. In addition, the patient can learn relaxation techniques, such as deep breathing, progressive muscle relaxation, focused relaxation, and visualization.
Special considerations
❑ Stay with the patient when he’s anxious, and encourage him to discuss his feelings. Reduce environmental stimuli and remain calm.
❑ Administer antianxiety drugs or tricyclic antidepressants as prescribed, and evaluate the patient’s response. Teach the patient about prescribed medications, including the need for compliance with the medication regimen. Review adverse reactions.
❑ Teach the patient effective coping strategies and relaxation techniques. Help him identify stressful situations that trigger his anxiety, and provide positive reinforcement when he uses alternative coping strategies.
Pictures
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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