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Introduction
Generalized anxiety disorder (GAD) is a psychological issue that is typified by extreme apprehension about events and actions. This excessive worry negatively impacts daily functioning, and individuals are concerned about health matters, destiny, family issues, monetary and work problems, and friendship outcomes. In this context, patients may present with restlessness, insomnia, fatigue, irritability, undue worry, and trembling (Mennin, Fresco, Ritter, & Heimberg, 2015). Notably, for a person to be diagnosed with GAD, he or she must have experienced these signs for at least six months (Stein & Sareen, 2015). This discussion revolves around several aspects of the condition such as incidence and prevalence, pathophysiology, physical assessment and examination, treatment and patient education, and follow-up and evaluation.
Incidence and Prevalence
Although a significant number of people around the world have encountered a bout of excessive worry, only five to eleven percent of individuals suffer from GAD. The National Institute of Mental Health (NIMH) documents that women have higher chances than men to suffer from this condition (NIMH, 2019). The prevalence stands at 3.4% and 1.9% for females and males, respectively. In the United States, the incidence is 2.7% of adults (Stein & Sareen, 2015). However, it should be noted that about 5.7% of the entire population suffer from generalized anxiety disorder (Stein & Sareen, 2015). In the United States, GAD is one of the leading contributors to disability in the workplace. Currently, incidences in the United Kingdom, Australia, Canada, Italy, and Taiwan are 5.9%, 3%, 2.5%, 2.9%, and 0.4%, respectively (Stein & Sareen, 2015). Moreover, this condition is prevalent in many nations across the world.
Pathophysiology
It is important for clinicians and other healthcare professionals handling patients with this condition to comprehend its pathophysiology from the viewpoint of advanced practice (Mennin et al., 2015). Excessive worry about issues has been associated with the disruption of the activities of the amygdala, which is a brain component that controls fear and anxiety. After sensory information enters the brain, it accesses the amygdala via the basolateral complex that processes data related to fear memories and sends their significance to threat to other parts such as sensory cortices (Stein & Sareen, 2015). Another critical area is the neighboring central nucleus of the amygdala that is important in the management of particular fear feedback in conjunction with the brainstem and cerebellum. In persons presenting with GAD, these functions are less distinct and, in most cases, the central nucleus is characterized by unusually large amounts of gray matter. In addition, patients amygdala areas show minimal connections with the cingulate portions of the brain that handle stimulus salience. However, they appear to have greater connectivity with parts that manage executive functions such as the parietal cortex as well as the prefrontal cortex (Stein & Sareen, 2015). These functional connections are established to compensate for the disruption of the activities of the amygdala.
Physical Assessment and Examination
Healthcare providers should conduct complete mental status assessments for individuals presenting with anxiety signs. Some of the physical features that may be assessed are appearance, behavior, cooperation during an examination, level of activity, affect, judgment, speech, and mood. Patients can have sweaty palms and irritability (Stein & Sareen, 2015). Moreover, their moods could be normal or depressed and possess uncontrolled thoughts of death. It is uncommon to identify suicidal thoughts.
Treatment and Education
Evidence-based treatment can be applied to manage or eliminate GAD before it becomes chronic. Anxiety should be reduced using cognitive behavioral therapy (CBT) as well as drugs such as SSRIs. Notably, this therapy has better outcomes than medications in the long run (Mennin et al., 2015; Stein & Sareen, 2015). However, a treatment approach that combines both drugs and therapy is the preferred strategy.
Educating patients suffering from GAD on this condition and the management approach being used is critical to increasing the probability of positive outcomes (Stein & Sareen, 2015). Individuals should be told about the importance of adhering to the treatment regimens and the cons of failing to stick to therapy and drugs.
Follow-up and Evaluation
Follow-ups and evaluations are important to determine the goals of treatment. If a healthcare provider finds out that the therapy and drugs are not resulting in the desired outcomes within a particular period, he or she may make changes to improve efficacy levels (Mennin et al., 2015). Follow-up evaluation visits can be scheduled for two weeks. However, if symptoms worsen, a patient would be advised to visit his or her provider immediately upon realizing that health is deteriorating. During such appointments, physical examinations and assessments are carried out to determine psychological state and other signs such as mood, speech, sweaty palms, and irritability (Stein & Sareen, 2015). These evaluations should be done when handling episodic, acute, or chronic cases of generalized anxiety disorder.
Conclusion
In conclusion, GAD is a psychological condition that arises from disruption of normal communication networks in the brain. Symptoms of this disorder include excessive worry about issues, lack of sleep, tiredness, irritability, sweaty palms, and trembling. There are greater prevalence and incidence rates in women than men. In addition, this type of depression is distributed throughout the world, both in the developing and industrialized nations. The best management approach involves a combination of therapy and medications. Patients should be taught the benefits of adhering to treatment and disadvantages of abandoning drugs and therapy. The pathophysiology of GAD revolves around malfunctioning of the amygdala of the brain. Follow-up and evaluation visits help to assess the outcomes of evidence-based treatment.
References
Mennin, D. S., Fresco, D. M., Ritter, M., & Heimberg, R. G. (2015). An open trial of emotion regulation therapy for generalized anxiety disorder and co-occurring depression. Depression and Anxiety, 32(8), 614-623.
NIMH. (2019). Depression.
Stein, M. B., & Sareen, J. (2015). Generalized anxiety disorder. New England Journal of Medicine, 373(21), 2059-2068.
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