generalised anxiety disorder

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SEMINAR ON GENERALISED ANXIETY DISORDERBY:-MR. SUNIL KUMARFINAL YEAR M.SCB.V.C.O.N.PUNE

ANXIETY

DEFINITION:-A FEELING OF WORRY, NERVOUSNESS, OR UNEASE ABOUT SOMETHING WITH AN UNCERTAIN OUTCOME.

ANXIETY DISORDER

Anxiety disorder:A chronic condition characterized by an excessive and persistent sense of apprehension, with physical symptoms such as sweating, palpitation, and feelings ofstress.

CLASSIFICATION OF ANXIETY DISORDER

Panic disordersGeneralised anxiety disordersPhobic disordersObsessive-compulsive disordersPost-traumatic stress disordersRelated disorders

Generalised anxiety disorder (GAD) is usually characterised by chronic anxiety unrealistic and excessive anxiety and worry, that is uncomfortable to the point of interfering with daily life.

A person with GAD worries excessively and feels highly anxious at least 50 per cent of the time for six months or more.

ETIOLOGY OF GAD

As with many mental health conditions, the exact cause of generalized anxiety disorder isn't fully understood, but it may include genetics as well as other risk factors.

RISK FACTORS-These factors may increase the risk of developing generalized anxiety disorder:Personality.A person whose temperament is timid or negative or who avoids anything dangerous may be more prone to generalized anxiety disorder than others are.Genetics.Generalized anxiety disorder may run in families.Being female.Women are diagnosed with generalized anxiety disorder somewhat more often than men are.

MEDICAL CONDITION:- The following medical conditions have been associated to a greater degree with individuals who suffer from GAD than in general population:Abnormalities in the hypothalamic-pituitary-adrenal and hypothalamic-pituitary-thyroid axes.Acute myocardial infarction.Phenochromocytomas.Substance intoxication and withdrawal (cocaine, alcohol, marijuana, opioids).Hypoglycaemia.Caffeine intoxication.Mitral valve prolapses.Complex partial seizures.

SIGN AND SYMPTOMS OF GAD

The symptoms of generalized anxiety disorder fluctuate. You may notice better and worse times of the day.

Not everyone with generalized anxiety disorder has the same symptoms. But most people with GAD experience a combination of a number of the following emotional, behavioural, and physical symptoms.

EMOTIONAL SYMPTOMS OF GENERALIZED ANXIETY DISORDER

Constant worries running through your head

Feeling like your anxiety is uncontrollable there is nothing you can do to stop the worrying

Intrusive thoughts about things that make you anxious you try to avoid thinking about them, but you cant

An inability to tolerate uncertainty you need to know whats going to happen in the future

A pervasive feeling of apprehension or dread

BEHAVIOURAL SYMPTOMS OF GENERALIZED ANXIETY DISORDER

Inability to relax, enjoy quiet time, or be by yourself

Difficulty concentrating or focusing on things

Putting things off because you feel overwhelmed

Avoiding situations that make you anxious

PHYSICAL SYMPTOMS OF GENERALIZED ANXIETY DISORDER

Feeling tense having muscle tightness or body aches

Having trouble falling asleep or staying asleep because your mind wont quit

Feeling edgy, restless, or jumpy

Stomach problems, nausea, diarrhoea

ICD-10 criteria

ICD-10 Generalized anxiety disorder"F41.1"Note: For children different criteria may be applied (see F93.80).

A period of at least six months with prominent tension, worry and feelings of apprehension, about everyday events and problems.

B. At least four symptoms out of the following list of items must be present, of which at least one from items (1) to (4).

Autonomic arousal symptoms

(1) Palpitations or pounding heart, or accelerated heart rate.

(2) Sweating.

(3) Trembling or shaking.

(4) Dry mouth (not due to medication or dehydration).

Symptoms concerning chest and abdomen

(5) Difficulty breathing.

(6) Feeling of choking.

(7) Chest pain or discomfort.

(8) Nausea or abdominal distress (e.g. churning in stomach).

Symptoms concerning brain and mind

(9) Feeling dizzy, unsteady, faint or light-headed.

(10) Feelings that objects are unreal (derealisation), or that one's self is distant or "not really here" (depersonalization).

(11) Fear of losing control, going crazy, or passing out.

12) Fear of dying.

General symptoms(13) Hot flushes or cold chills.(14) Numbness or tingling sensations.

Symptoms of tension

(15) Muscle tension or aches and pains.

(16) Restlessness and inability to relax.

(17) Feeling keyed up, or on edge, or of mental tension.

(18) A sensation of a lump in the throat, or difficulty with swallowing.

Other non-specific symptoms

(19) Exaggerated response to minor surprises or being startled.

(20) Difficulty in concentrating, or mind going blank, because of worrying or anxiety.

(21) Persistent irritability.

(22) Difficulty getting to sleep because of worrying.

DIFFERENCE B/W NORMAL WORRY AND GADNORMAL WORRYYour worrying doesnt get in the way of your daily activities and responsibilities.Youre able to control your worrying.Your worries, while unpleasant, dont cause significant distress.Your worries are limited to a specific, small number of realistic concerns.Your bouts of worrying last for only a short time period.

GENERALISED ANXIETY DISORDERYour worrying significantly disrupts your job, activities, or social life.Your worrying is uncontrollable.Your worries are extremely upsetting and stressful.You worry about all sorts of things, and tend to expect the worst.Youve been worrying almost every day for at least six months.

DIAGNOSTIC CRITERIA FOR GAD

To help diagnose generalized anxiety disorder, your health provider may:-

Do a physical exam to look for signs that your anxiety might be linked to an underlying medical conditionOrder blood or urine tests or other tests, if a medical condition is suspectedAsk detailed questions about your symptoms and medical historyUse psychological questionnaires to help determine a diagnosis

DSM-5 criteria for generalized anxiety disorder include:

Excessive anxiety and worry about several events or activities most days of the week for at least six months

Difficulty controlling your feelings of worry

Anxiety or worry that causes you significant distress or interferes with your daily life

At least three of the following symptoms in adults and one of the following in children: Restlessness, Fatigue, Trouble concentrating, Irritability, Muscle tension or Sleep problems

Anxiety that isn't related to another mental health condition, such as panic attacks or post-traumatic stress disorder (PTSD), substance abuse, or a medical condition

Generalized anxiety disorder often occurs along with other mental health problems, which can make diagnosis and treatment more challenging. Some disorders that commonly occur with generalized anxiety disorder include:

PhobiasPanic disorderDepressionSubstance abusePTSD

TREATMENT AND DRUGS:-

The two main treatments for generalized anxiety disorder are psychotherapy and medications. You may benefit most from a combination of the two. It may take some trial and error to discover which treatments work best for you.

PSYCHOTHERAPY

Also known as talk therapy or psychological counselling, psychotherapy involves working with a therapist to reduce your anxiety symptoms. It can be an effective treatment for generalized anxiety disorder.

Cognitive behavioural therapy is one of the most effective forms of psychotherapy for generalized anxiety disorder. Generally a short-term treatment, cognitive behavioural therapy focuses on teaching you specific skills to gradually return to the activities you've avoided because of anxiety. Through this process, your symptoms improve as you build on your initial success.

MEDICATIONS

The drugs used for GAD will be:

Benzodiazepines

Buspirone (anti-anxiety medication)

Alpidem (Alpidem(Ananxyl) is an anxiolytic drug from the imidazopyridine family, related to the more well-known sleeping medication zolpidem)

Tricyclic drug or beta-adrenergic antigens (e.g., propranolol).

NURSING MANAGEMENT:-

The assessment for GAD will be on the basis of following essential features of disorders:Excessive anxiety and worry about a number of events that the individual finds difficulty to controlRestlessness or feeling keyed up or on edgeBeing easily fatiguedDifficulty concentrating or mind going blackIrritabilityMuscle tensionSleep disturbance (difficulty falling or staying asleep or restless, unsatisfying sleep).

NURSING DIAGNOSISPanic anxiety related to real or perceived threat to biological integrity or self- concept evidenced by any or all of the physical symptoms identified by the DSM-IV-TR as being descriptive of GAD.Powerless related to impaired cognition evidenced by verbal expressions of no control over life situation and nonparticipation in decision making related to own care or life situation.HopelessnessImpaired social communication Irritability

PLANNING:

The following criteria may be used for measurement of outcomes in the care of the client with GAD . The same may be used as an objective, in which the client:

Is able to recognise signs of escalating anxiety.

Is able to intervene so that anxiety does not reach the panic level.

Is able to discuss long-term plan to prevent panic anxiety when stressful situation occurs.

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