Discussion
Biomedical Sciences: Generalised Anxiety Disorder
DC has the diagnosis of generalised anxiety disorder (GAD), a common anxiety disorder, with an estimated lifetime prevalence of 5% (using DSM-IV criteria)[1]. It is characterised by persistent and uncontrollable anxiety and worry that the patient usually recognises as excessive and irrational. It can be a chronic and debilitating condition, and worsens the prognosis for other conditions[2].
The exact mechanism of GAD is unclear. Given the high degree of cormorbidity of GAD and depression, and the fact that symptoms of both conditions respond to the same treatment, it is possible that the two conditions share a common neurobiological dysfunction[3]. The involvement of the serotonin (5-HT) system is perhaps the most researched mechanism. It is thought that serotonergic pathways between the dorsal raphe nucleus and the temporal lobe, hippocampus and amygdala play a key role in anxiety regulation and coping with chronic adversity and depression. In patients with GAD, 5-HT levels in cerebrospinal fluid are reduced compared to control patients, a finding replicated in suicidal individuals. Depletion of 5-HT in the brain during 5-HT depletion studies using tryptophan has been shown to cause relapse in depressed patients on selective serotonin re-uptake inhibitors (SSRIs), further supporting the role of 5-HT in depression. As yet, there have been no similar studies for GAD[3].
Results from neuro-imaging indicate that hyperactive brain circuits occur in GAD. It has been hypothesised that hyperactivity in specific areas gives rise to the symptoms of GAD (for example, hyperactivity in the basal ganglia and temporal lobes leads to motor tension and autonomic changes respectively)[3]...
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...larly important points to address[7].
In the case of DC, he possesses a number of epidemiological and clinical risk factors, and in that sense is at high risk of completed suicide in the next year. Both the Pierce (7/25) and Beck’s (25/45) scales indicate a medium suicidal intent. There are some reassuring features in the history, however: the act was impulsive; DC sought help immediately after the act; and he did not take the extra venlafaxine tablets available in his flat. His interview and mental state examination were also encouraging. There are several measures that could be taken to reduce his suicide risk, from the immediate (e.g. removing the additional venlafaxine tablets from his flat) to the longer-term (e.g. finding employment). Adequate social support must be in place before he returns home, through a combination of IHTT, his father and his CPN and OT.
Generalized Anxiety Disorder, also known as (GAD) is one of the several types of anxiety disorders. GAD according to our textbook (Lahey) is an uneasy sense of general tension and apprehension for no apparent reason that makes the individual highly uncomfortable because of its prolonged presence. GAD is much more than the normal anxiety people experience day to day. Without provoking, it is chronic and exaggerated worry and tension. This disorder can involve anticipating disaster, often worrying excessively about health, money, family or work. Sometimes, though, just the thought of getting through the day brings anxiety.
2. By looking through the case study, the most prominent problem Sara struggles with, is her persistent worry about different parts of her life including her job status, health and her relationship with her husband. For the past six months, she has been anxious and worried excessively, leading her to have difficulty sleeping. As she admitted, “ I cannot shut my brain off anymore, I am worrying all the time”, therefore her condition met the primary criteria of generalized anxiety disorder which is the excessive worry for at least 6 months more days than not, about diverse events and activities. Being restless, irritable, having sleep difficulty and being easily fatigued are four factors of GAD that are apparent in this case. “I have always had lots of energy but now at times I struggle to get out of bed and drag myself thorough the work day”; it indicates the fatigue she recently experienced. Fidgets with her jewellery when speaking and a nervous laugh she has, shows her persistent anxiety. Moreover, she was recently diagnosed with irritable bowel syndrome which has a high comorbidity with anxiety disorders. In conclusion, since she is persistently worried about different aspects of her life and she has the criteria for GAD, generalized anxiety disorder is the most likable disorder she has.
Although historically depression has been considered a character condition, evidence has accumulated suggesting the role of a biological substrate, namely serotonin, in subgroups of depressed patients. This accumulated evidence supports the indoleamine hypothesis of depression, which suggests that major depression results from a deficiency of available serotonin or inefficient serotonin. (16). We see that depletions of serotonin from certain regions of the brain such as the hypothalamus, amygdala, and cortical areas involved in cognition and other high processes, can have a great impact in contributing to depression.
Major Depressive Disorder, which is also referred to as Clinical Depression, is a disorder caused when low serotonin levels, that suppress pain perception and are often found in the pineal gland at the center of the brain, promote low levels of norepinephrine, a monoamine neurotransmitter that controls cognitive ability. This disabling disorder interferes with a person’s daily life as it prevents one from performing normal functions, such as eating, sleeping, interacting, or enjoying once pleasurable activities. According to the National Institute of Mental Health, the common symptoms of Major Depressive Disorder are continued feelings of anxiety, worthlessne...
Bearing in mind that an anxiety response is a result of various factors, there are different types of anxiety disorders. The most common type of anxiety disorders as described as specific phobias, social anxiety disorder (SAD), panic disorder (PD), generalized anxiety disorder (GAD), obsessive compulsive disorder (OCD) and post-traumatic stress disorder (PTSD). According to Anxiety and Depression Association of America (ADAA) (2016), specific phobias affect about 19 million adults in the U.S, while SAD affects 15 million, PD affects 6 million, GAD affects about 6.8 million, OCD affects about 2.2 million and PTSD affects 7.7 million adults respectively. Considering that anxiety disorders are the most common mental illness in the U.S, yet only about one-third of those suffering receive treatment (ADAA, 2016).
People with GAD have unrelenting, excessive, uncontrollably worries. The central cognition in people with GAD was summarised as "The world is potentially dangerous and I many not be able to cope with whatever comes from the future so I must anticipate all bad things that might happen so that is can avoid them or prepare for them" (Sibrava and Borkovec, 2006 as cited in Wilkinson et al., 2011, p.
What would be the criteria used to distinguish between clinically significant fear and anxiety, and everyday fear and anxiety?
Anxiety is a feeling of tension associated with a sense of threat of danger when the source of the danger is not known. In comparison, fear is a feeling of tension that is associated with a known source of danger. I believe it is normal for us to have some mild anxiety present in our daily lives. Everyday that I can think of I have some kind of anxiety though out that day. Anxiety warns us and enables us to get ready for the ‘fight or flight’ response. However, heightened anxiety is emotionally painful. It disrupts a person's daily functioning.
Fear and Anxiety are essential functions that occur in the brain that allow people to respond to stimuli appropriately. These feelings as normal as they are can cause problems and in 3.1 percent of adult Americans approximately 6.8 million people it does cause problems (“Generalized anxiety disorder”, 2014). A problem can arise when people have too much fear and anxiety; a problem is evident when it interferes with their life and their ability to do things. This is known as general anxiety disorder (GAD). When someone is suffering from generalized anxiety disorder they normally experience excessive exaggerated anxiety and worry about normal life events that give no clear reason for worry (“Generalized anxiety disorder”, 2014). This disorder can be debilitating and rule over people’s lives if it is severe and a better understanding of the disorder can be gained by looking at historical views, current views, causes and symptoms, case studies, differential diagnosis considerations, and treatment.
As the world leaps into the future, it seems that mental illness is becoming more of a problem among many people. One of the most common types of illness's among the current population is anxiety disorders. It is evident that there is a rise of anxiety disorder among the Western World. There are three main factors that contribute to this, they include our education system, technology and media, and the treatment and decreasing criticism anxiety patients receive.
The symptoms that one face during GAD include: worry all the time, irritation, feeling of insecurity, depression, dizziness, tension, restless, sleeping disorder, headaches, mental disorder, nausea, and muscle aches. It happens continually for more than 6 months. The symptoms of worry vary during General Anxiety Disorder, worry about family, finance, and always thinking about negative outcomes of any action. Although worrying about family is normal, but in GAD case, the patient think whole day about the way of living of his family, their future, their finance and calculate negative outcomes.
Depression is a mental illness, which affects millions of Americans each year. Currently there are many prescription drugs, called anti-depressants that have been proven to successfully treat it. The causes of depression are somewhat of a medical enigma, however, it is known that depression is associated with a change in the brains chemistry involving the function of neurotransmitters (Reichert). This chemical change occurs in healthy brain’s, which experience sadness, but ends after the unpleasant stimulus is removed. In people suffering from depression this chemical change does not correspond to any particular stimulus. Symptoms of depression are often incapacitating and include severe and extended sadness, feelings of worthlessness, feelings of emptiness, irritability and anxiety (Reichert, Spake).
Rosen, The Serious Suicide Attempt: Five Year Follow Up Study of 886 Patients, 235 J.A.M.A. 2105, 2105 (1976).
This is when an individual suffers from extreme, irrational and uncontrolled worries. Certain situations cause feelings of apprehension and negative expectations, it is common for individuals with GAD to envision disaster or expect the worst case scenario, they also tend to worry continuously about everyday issues linked to family, work, finances etc. Headaches, irritability, nausea, breathing difficulties, insomnia, muscle tension/pain and fatigue are a few of the many symptoms caused by GAD.
New Haven: Yale University Press, 2004. Print. The. Suicide and Suicidal Behaviors. Suicide : Medline Plus.