Generalized Anxiety Disorder

Abstract

General anxiety disorder is a condition that tends to affect the general population, contributing to cognitive and physical impairment of the patient. Studies have shown the GADs can be a disabling disorder that affects the young population and the condition worsens as people age. Some scholars have suggested that GADs tends to accelerate the aging process and reduces the quality of life of those affected. Studies have also shown that the disorder can range from mild to moderate, and it can escalate to highly uncontrollable fears. Scholars have found that at a certain time in people’s lives, there are increased chances of experiencing severe symptoms that may contribute to disability as a result of GADs. However, selective serotonin reuptake inhibitors (SSRIs) is increasingly being used to manage this condition and it has proved to be effective due to its efficacy and simplicity.

Introduction/Background

General anxiety disorders (GADs) tend to affect the general population, but studies have shown that these disorders are mostly prevalent among young people and adults, while the older people are severely affected as they age. The processing efficiency theory by Eysenck argues that anxiety affect cognitive performance of an individual by preempting the storage and processing resources of the memory system. GADs are said to be the most disabling form of mental disorders among adolescents and adults. Historically, studies have shown that GADs can range from mild to moderate severity, to highly circumscribed fears. A study done by Epidemiological Catchment Area (ECA) showed that about a quarter of the public experience disability, severe symptoms, and handicap as a result of GADs at a certain point of their lifetime. This research paper critically analyzes the effects of GAD and the effectiveness of treatment and management options that are available.

Body

Research studies have tried to establish if GADs are related to accelerated aging process. GADs are highly prevalent across an individual’s lifespan, and has detrimental impacts on the day-to-day somatic health, functioning, and quality of life. Among the general population, the one year prevalence is around 11% while the lifetime prevalence is 17%, with different disorders being more prevalent at certain stages of the lifespan.  Childhood is predominated by phobias, adulthood by panic disorders (PDs), and adulthood the aged by agoraphobia (AG) and GAD. Anxiety disorders may also begin at late onsets, with the prevalence of 3-4% starting after 55-60 years. Scholars have also shown that most people associate aging with cognitive and physical declines and this implies that aging apprehension is justified. Despite the fact that most people believe that aging is closely associated GADs and other negative impacts, very little is understood about how aging contributes to this outcome.

Efficient management of GADs has been a major challenge for several doctors since patients tend to portray a wide range of symptoms. However, the medication of choice for managing this condition has been selective serotonin reuptake inhibitors (SSRIs) due to their efficacy and safety. Although a huge number of patients respond favorably to SSRI therapy, close to 30% are not able to tolerate these drugs and they may have incomplete or unfavorable response. When it comes to treatment, these disorders are first categorized into GAD, agoraphobia and PD, phobic disorder (also includes social phobia), obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD). SSRIs which used to treat depression have revolutionized the way anxiety is treated and replaced chronic reliance on benzodiazepines (BZs). Other antidepressants such as tianeptine have proved to be efficient in adjustment disorders where both depression and anxiety are involved.

Research Problem Statement

GAD is a mental disorder that can be characterized with persistent worries and anxiety that may be overbearing and challenging to manage, and has both physical and psychological symptoms. 

Research Purpose

The purpose of this research is to identify the main effects of GAD and the factors that contribute to this disorder. This will be instrumental in enabling the researcher to analyze the most effective ways of managing and treating the condition more effectively.

Research Questions

• How does GAD manifest itself among the general population?
• Which demographic group is likely to be affected by this disorder and what is its prevalence?
• Does GADs contribute to accelerated or increased rate of aging?
• What are the most effective management techniques that can be used to treat GADs?

Theoretical Framework

Scholars have come up with different theories relating to the way anxiety affects cognitive performance of an individual. Processing efficiency theory by Eysenck argues that the working memory system is affected by anxiety when its storage and processing resources are obstructed. Working memory is the phonological loop whose role is to store briefly and manipulate verbal information, conduct attention tasks, and coordinate other subsystems. Therefore, GADs limits the storage and processing capacities of the working memory. Therefore, performances of activities that rely on the working memory are greatly interfered with. Essentially, Eysenck’s theory argues that people with anxiety tend to produce excess amounts of worry and intrusive thoughts that overburden the working memory resources.

Findings

Perna, et al.,found that a recent perspective revealed that people who have GADs, decreased levels of cognition or somatic health may be attributed to accelerated cellular aging as well as neuroprogression. They also found a close association between GADs and reduced language, memory, and executive functions among the aged population. These findings are similar to those of Wetherell, et al, who argue that unlike young people, the aged population portrays working memory deficits especially when it comes to processing tasks instead of storage tasks. This may be attributed to old people having working memories that are already reduced and who are exposed to anxiety across numerous cognitive domains. Kasteenpohja, et al found that anxiety disorders among the general public is usually under-diagnosed and little treatment is given to people with these disorders. Long delays are also experienced before receiving treatment, taking into consideration that psychological and pharmacological treatment procedures are scarce. However, scholars have found that SSRIs are effective in the management of GADs due to its efficiency and safety, thus reducing overreliance on benzodiazepines (BZs).

Discussion

Peer reviewed articles focus on the negative impacts of GADs on cognitive and physical performance of an individual and effective ways that can be used to manage these disorders. Wetherell, et al, argues that both young and old people are affected by GADs, but older people portray higher rates of anxiety and they tend to perform poorly in tasks that concern processing different verbal information.  These findings are supported by Perna, et al.,who argue that stressful and chronic conditions usually affect the somatic health, quality of life, and cognitive performance of older people than younger people. To address these issues, Kasteenpohja, et al  say that there is an urgent need for early diagnosis and proper treatment. A major problem that can have a negative impact on the treatment outcome is dropping out or discontinuation of the treatment plan before mental health is achieved. 

Zamorski & Albucher developed eight strategies aimed at managing patients that are unable to tolerate SSRIs and who have unsatisfactory responses. Accessibility of medication that are easy to use and safe has proved to be of huge significance for primary care health practitioners who have to deal with patients suffering from GADs and other mental illnesses. Shallcross, et al, say that although aging is often associated with cognitive and physical declines, it does not always imply that getting old is bad news. Roberge et al, suggest that with the discovery of modern psychotropic medications, it is important to have specified diagnosis that fall within particular spectrum so that each disorder can be treated within specific pharmacotherapy.

Recommendations for Nursing Practice

It is evident that GAD is a disorder whose main symptoms include persistent worries that are difficult to manage and which may portray a wide range physical and cognitive symptoms. This paper recommends that if GAD is to be adequately managed, early diagnosis is important to ensure that the disorder does not progress to chronic levels. Studies have also shown that when GAD reaches severe levels, it can lead to morbidity and other illnesses that can contribute to mortality. 

Further research is necessary to enable scholars to determine the most effective mechanisms of recognizing and managing this disorder before it reaches chronic stages. Scholars have already shown that GAD is closely related to comorbid psychiatric disorders and other associated illnesses which include depressive disorders and comorbid physical illness. From a personal perspective, further research studies are required since present studies have shown that diagnosis and management of GAD and other mental disorders is highly challenging. Apart from SSRIs which have been found to be effective in treating this disorder, additional medications are required to enhance primary care management.

Conclusion

This research paper has critically analyzed the impacts of GAD and the effectiveness of the treatment and management option. Studies have shown that GAD tends to affect the entire population but people who are worst affected are the aged population. The disorder tends to impair the cognitive, psychological and physical performance of the patients. In severe cases, GAD can contribute to morbidity which significantly affects a person’s quality of life. SSRIs have proved to be effective medications for the management of GADs and these drugs reduced reliance on the controversial BZ.

Basically, before these disorders can be treated, they are categorized into different groups, which include GADs, PDs, AGs, OCD, PTSD, and other phobias. This paper therefore provides a wonderful opportunity of analyzing the factors that contribute to GADs and ways of finding the most effective means of managing these conditions.