Anxiety Discussion Paper
Identifying and discerning mental diseases in the general populace may be tough, though not as difficult as anxiety. While anxiety is a normal reaction in instances of impending danger, it may become pathological if it causes severe distress and impairs an individual’s functioning.
Most people associate anxiety with a generalized anxiety disorder (GAD); however, other types of anxiety exist, among them, panic attacks, phobias, and obsessive-compulsive disorders. Regardless of the various diagnostic criteria for each form of anxiety, a difficult-to-control feeling of dread or concern cuts across.
The goal of this paper is to examine the pathophysiology and pharmacologic treatment of GAD, to state clinical guidelines for assessment and diagnosis, to examine how the disease affects patients, families, and the community, and to describe three potentially feasible strategies for managing the disease in my current healthcare organization.
Pathophysiology of Anxiety, and Evidence-Based Pharmacological Treatments
While the actual pathophysiology of GAD is unclear, various theories have been presented to explain the disease’s mechanism. According to psychodynamic theory, anxiety is a signal or indication that something is disrupting the psychological equilibrium (Simon et al., 2020).
The signal, therefore, arouses the desire to execute a protective move known as repression, which, if unsuccessful, causes worry to come unchallenged to the forefront. An alternative explanation, behavioral theory, proposes that anxiety is a natural reaction that an organism has to a stimulus such as pain.
According to cognitive behavioral theory (CBT), people process information selectively, devoting greater attention to threat-related information that causes anxiety (Simon et al., 2020). The biological explanation of pathogenesis, which is actively being explored, is the most useful scientific foundation for anxiety.
Multiple pieces of evidence support the biological theory, including (1) the twin heritability of anxiety of 30-60%, (2) the infusion of chemicals such as caffeine, sodium lactate, and isoproterenol that cause panic attacks, (3) benzodiazepine drugs that facilitate GABA neurotransmission relieve anxiety, and (4) a finding that people with GAD have a larger amygdala (the anatomical basis of anxiety) than people without GAD (Steimer, 2022). The many explanations for anxiety pathophysiology give a solid basis on which to address the condition.
Patients with GAD greatly benefit from psychopharmacologic therapy. In my resident state, Texas, mental disease care follows the American Psychiatric Association (APA) guidelines and the National Institute for Health and Care Excellence (NICE). Both recommendations coincide in that selective serotonin reuptake inhibitors (SSRIs) are first-line pharmacologic medications and that if one therapy fails after a sufficient trial period, another SSRI drug is attempted.
However, if the symptoms linger continuously even after using the SSRI, serotonin-norepinephrine reuptake inhibitors (SNRIs) or tricyclic antidepressants (TCA) might be used (Strawn et al., 2018). Benzodiazepines are frequently utilized as adjuvant therapy; however, care must be taken owing to their significant potential for addiction, undue sedation, and cognitive impairment.
Following the APA and the NICE guidelines, treatment of the condition across the whole of Texas state has been streamlined. In the institution where I am attached, the three FDA-approved SSRIs routinely utilized are Sertraline, Escitalopram, and Paroxetine. Sertraline is more often prescribed than other drugs in the same class due to its lower cost and ease of availability.
A typical prescription for a patient might so be as follows: Sertraline 50 mg per oral per day, may be raised by 25 mg at weekly intervals, not to exceed 200 mg per day (DeMartini et al., 2019). Due to several considerations, such as cost, side effects, and drug-drug interactions, clinicians may opt to prescribe one drug instead of another or substitute one drug for another.
Clinical Guidelines for Assessment, Diagnosis, and Patient Education for the Disease Process
Treatment of mental disorders requires an adequate prodromal phase of patient assessment and formulation of the appropriate diagnosis. The examination of patients with GAD starts the moment they enter the psychiatric clinic, with a psychiatric history and a mental state exam. A comprehensive history, along with a relevant mental state exam, increases the likelihood of correctly diagnosing GAD.
Compliance with the DSM-5 diagnostic criteria enhances the accuracy of the diagnosis of GAD. The patient must have experienced extreme anxiety or a state of worry about many events or activities in criteria in condition A, and the worry must have lasted longer than six months (APA, 2013).
Individuals must find it difficult to control their worry in criterion B, while there must be additional accompanying motoric symptoms such as tremors, restlessness, muscular twitches, or autonomic symptoms such as sweating, hyperventilation, or flushes in criteria C (APA, 2013).
The anxiety must be severe enough to produce distress or impairment in critical areas of functioning (criteria D); the anxiety cannot be attributable to physiological consequences of substance abuse or a medical disease (criteria E), and the disturbance cannot be explained by another mental disorder (criteria F). The initial laboratory investigations may be limited to a complete blood count to rule out infectious illnesses, thyroid function tests to rule out hyperthyroidism, and urine drug screen to rule out substance or medication-related toxicity or withdrawal.
To help them on their road to recovery, patients must be empowered by informed health education. The patients must be made aware that anxiety is a normal response to danger; nevertheless, it becomes pathological when it becomes excessive and significantly impairs critical areas of functioning. Patients must also be made aware of their anxiety triggers and instructed on how to prevent them.
At home, the patient will be advised to (1) take the medications as prescribed, (2) attend any counseling appointments if scheduled, and (3) participate in relaxation strategies such as soothing and calming music and mindfulness activities such as yoga. Furthermore, to ensure treatment continuity even after discharge, the mental healthcare professional must offer patients contact information and educate them on when to call.
The Impact of the Disease on the Patients, Families, and Populations in Communities
GAD and its treatment have an impact on the whole family and the community, in addition to the person. GAD creates substantial distress and hinders an individual’s ability to complete tasks at home, school, or job in a timely and efficient manner (DeMartini et al., 2019).
Anxiety produces considerable impairment in addition to decreased focus, exhaustion, and related motoric symptoms such as tremors and muscle twitching. Yang et al. (2021) discovered that anxiety disorders caused 28.68 million disability-adjusted life years (DALYs) in 2019 in a systematic evaluation done from 1990 to 2021 on the global, regional, and national burden of anxiety disorder. Because patients with GAD may need lifetime care, family members may experience chronic grief or emotional stress due to the psychological challenges of caring for a chronically sick patient.
Because of the caregiving role, family members or designated carers may quit their occupations and modify their schedule, duties, or employment status to devote more time to the patient’s care. The long-term effect of giving up a job at the price of caregiving duty is that both the patient and the caregiver become less financially solid. To the broader community, as GAD patients may be impaired in diverse areas of functioning, they become less productive and hence a burden.
Strategies to implement Best Practices for managing the Disease in my Current Healthcare Organization
Given the rapid adoption of technology in the healthcare system, the first solution to ensure patient continuity of care would be the development of a virtual means of care. Patients will be able to book virtual consultations with the healthcare team regularly to discuss their management goals and get more health education on better home-based anxiety management strategies.
The second method would be to establish a department inside the institution that is fully staffed with psychotherapists capable of giving a variety of psychotherapy treatments or referring patients to other facilities that are more advanced in psychotherapy interventions.
DeMartini et al. (2019) state that the most successful treatment of GAD requires a two-pronged approach involving both medication and psychotherapy; hence, establishing a psychotherapy department inside the hospital would be a suitable strategy.
Third, connecting patients with community-based groups that assist them in coping with their anxiety would not only aid their recovery but will also allow them to resume their economic vitality. The Anxiety and Depression Association of America and the National Alliance on Mental Illness are two examples of mental health organizations that might be incredibly beneficial to GAD sufferers.
Because GAD is a stress-related condition, stressful life events have a predisposing, triggering, and maintaining role in its development. Since the actual pathophysiologic process is unknown, multiple explanations have been presented; nonetheless, the biological theory, although still actively researched, is far more scientifically logical.
Many FDA-approved medications are helpful in the treatment of GAD, including sertraline and escitalopram; however, their options may be restricted owing to price, side effects, and drug interactions. In such circumstances, as described in the APA and NICE guidelines, a different medication of the same class or a different class may be recommended.
A clinician must acknowledge the consequences of GAD for patients, families, and the broader community to devise measures outside the hospital’s vicinity to minimize the burden the patients feel or present to the people closest to them.
DeMartini, J., Patel, G., & Fancher, T. L. (2019). Generalized anxiety disorder. Annals of Internal Medicine, 170(7), ITC49–ITC64. https://doi.org/10.7326/AITC201904020
Simon, N., Hollander, E., Rothbaum, B. O., & Stein, D. J. (2020). The American Psychiatric Association Publishing Textbook of anxiety, trauma, and OCD-Related Disorders. American Psychiatric Pub. https://books.google.at/books?id=6OreDwAAQBAJ
Steimer, T. (2022). The biology of fear-and anxiety-related behaviors. Dialogues in clinical neuroscience. Dialogues in Clinical Neuroscience. https://doi.org/10.31887/DCNS.2002.4.3/tsteimer
Strawn, J. R., Geracioti, L., Rajdev, N., Clemenza, K., & Levine, A. (2018). Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: an evidence-based treatment review. Expert Opinion on Pharmacotherapy, 19(10), 1057–1070. https://doi.org/10.1080/14656566.2018.1491966
Yang, X., Fang, Y., Chen, H., Zhang, T., Yin, X., Man, J., Yang, L., & Lu, M. (2021). Global, regional and national burden of anxiety disorders from 1990 to 2019: results from the Global Burden of Disease Study 2019. Epidemiology and Psychiatric Sciences, 30, e36. https://doi.org/10.1017/S2045796021000275