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Generalized Anxiety Disorder
Explain the difference between an adjustment disorder and anxiety disorder.
The major differentiating factor between the two is that adjustment disorders occur as a response to a stressor whereas anxiety disorders do not have to have a triggering or precipitating event. An example of adjustment disorder would be when a person begins failing school classes after being broken up with by a significant other or after being fired from a job. This goes beyond what would normally be expected after one of these situations occur and is usually associated with a decrease in the person’s ability to function in work, school or relationships (American Psychiatric Association [APA], 2013). The symptoms are similar to acute stress disorders but do not last more than six months.
Diagnostic Criteria for Generalized Anxiety Disorder
A person meets criteria for diagnosis of generalized anxiety disorder (GAD) when they experience “excessive anxiety and worry, occurring more days than not for at least six months, about any number of events or activities” and they are unable to control the amount of worrying they do (APA, 2013, GAD section). Three or more of the following six symptoms must also be experienced by the patient. “Restlessness or feeling on edge, very easily fatigued, difficulty concentrating or mind going blank, irritability, muscle tension, and trouble sleeping” (APA, 2013, GAD section) . These symptoms must be so intense that they significantly impair the person’s ability to function in most areas and responsibilities in their lives. There is no medical cause for this excessive worry and drugs and alcohol are not a factor. All other mental disorders are ruled out before this diagnosis is made.
Evidenced-based psychotherapy and psychopharmacologic treatments for GAD.
While there are many psychotherapeutic treatments for GAD, there are also some lifestyle changes that can be helpful. Practicing sleep hygiene for insomnia and exercising can both go a long way in helping to alleviate some anxiety symptoms (Stein & Sareen, 2015). As far as psychopharmacology goes, “selective-serotonin reuptake inhibitors (SSRI’s) and serotonin-norepinephrine reuptake inhibitors (SNRI’s) are generally considered to be first-line medications for GAD” (Stein & Sareen, 2015, p. 2062). One specific SSRI or SNRI has been shown to be more effective than others. There are some adjunctive treatments available such as buspirone, gabapentin, benzodiazepines and antihistamines. Benzodiazepines should be used with caution due to potential for patients to misuse them or develop a tolerance to them. Most of the time benzos are only used in the early part of treatment until the SSRI or SNRI takes full effect. On occasion, the antipsychotic quetiapine has been used to treat anxious episodes as well. The first-line psychotherapy for GAD is cognitive behavioral therapy, but relaxation therapy, mindfulness therapy, and psychodynamic therapies have also been shown to be effective (Stein & Sareen, 2015).
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/dsm-psychiatryonline-org.ezp.waldenulibrary.org/doi/full/10.1176/appi.books.9780890425596.dsm06
Ronningstam, E. (2014). Gabbard’s treatments of psychiatric disorders. American Psychiatric Publishing. https://doi.org/10.1176/appi.books.9781585625048.gg72
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Wolters Kluwer.
Stein, M. B., & Sareen, J. (2015). Generalized Anxiety Disorder. The New England Journal of Medicine, 373(21), 2059–2068. https://doi.org/10.1056/NEJM1502514