Patients in primary care commonly experience Anxiety problems and most of them develop similar symptoms of anxiety. Worry, behavioral changes, and additional somatic symptoms can also be observed. Anxiety related issues are challenging for both patients and health providers. While anxiety conditions are common or usual, with a long term prevalence of nearly 31 per cent, these health issues are not recognize or diagnosed sometimes (Lader, 2015). Generalized anxiety disorder is a psychological or mental disorder. This health condition takes place due to the excessive worries associated with the real circumstances, event or conflict that happens in daily life. The normal worries of daily life can be controlled. Worries that are associated with GAD are considered distressing, longer lasting and may occur for no apparent reason. This health condition characterized by a feeling constant unreasonable worrying about the potential threat to the person and their family or loved ones (Roest, Zuidersma, & de Jonge, 2012). Every year in Australia, nearly 14 per cent of the total population experiences a form of anxiety and around 3 percent have GAD. It is estimated that nearly 6.8 million youngsters or 3.1 percent of people from the United States affected by these health conditions and only 43.2 percent receives treatment for GAD. Women are twice likely to develop this disease compare to the males (Sunderland, Newby, & Andrews, 2013).
The pathophysiology of GAD has two different types of theories for pathophysiology, one neurological and other one is psychological. The generalized anxiety disease has been associated with the disordered fictional connectivity of the brain part called amygdala and its management of distress and anxiety. The sensual info enters inside the amygdala by the nuclei of a basolateral complex. This complex interprets the sensory-associated fear remembrances and affects their threat to the remembrance and the sensory handling in other parts of the brain like cortex of medial prefrontal area and the sensory cortices. Alternative part called adjacent chief nucleus of Amygdala manages species-particular fear reactions in its relations to the brainstem, cerebellum areas, and hypothalamus. In people with GAD, their relations appear less functionally dissimilar. There is a high grey matter inside the central nucleus. Dissimilarity is that the regions of amygdala have reduced connectivity with the areas of the insula, and a cingulate that regulates the overall stimulus salience. Whereas having the advanced linkage with the parietal cortex and the prefrontal cortex circuits that constant with the cognitive philosophies, it proposes a compensations approach for the dysfunctional amygdala handling of the anxiety (Patriquin, & Mathew, 2017).
The psychological theories of this disorder suggest that Fear and the anxiety deliver different characteristics and can be hard to distinguish. One favorable way to hypothesize them is to think about the fear as the reaction against an instant threat. On the other hand the anxiety is commonly an anticipatory reaction to the perceived and real upcoming events. Worry is considered as the cognitive reaction to panic and anxiety. It comprises negative psychological pictures and sensations. However certain people may also think the worry as the result of anxiety, it is also considered as the attempt of self-protection against the most catastrophic concerns of the feared object. The person may incorrectly observe worry as the efficacious coping mechanism. Worry although turn into pathologic when it is highly extreme and is the main characteristics of GAD (Brewin, Gregory, Lipton, & Burgess, 2010).
Symptoms associated with generalized anxiety disorder include tenacious or persistent worrying about different parts that are out of fraction to the effects of the situation or happenings, overthinking. The symptoms may also appear when the person perceives the events and situations as the threatening even in the safe circumstances, difficult managing uncertainty, inconclusiveness, and fear of creating the unfavorable decision. The person may also experience an inability to avoid the worry, unable to feel relaxed, restlessness, and feeling of difficulty in concentrating or the sense that their mind goes blank (Gentes, & Ruscio, 2011).
Some of the physical impacts associated with the GAD include fatigue, shuddering, nervousness, tension or being frightened easily, vomiting, diarrhea, petulant bowel syndrome, irritability, muscles tensions, and muscle aches, and trouble in sleeping. The children and adolescents might have the similar worries as the youth population; however, the teenagers may have the highly excessive worries which might be linked to performance at the institute or sporting occasions, the safety of family member, being on the time, nuclear war, earthquake or any other catastrophic events. The kid or adolescent with additional worries or excessive worries may also feel highly anxious to fit in, redo works as they are not accurate at the first time, lack of confidence, strive got the approval, require high reassurance related to the performance, have common stomach aches or other different physical complaints. They may also avoid going to the institute or school and ignore any social interactions (Olatunji, & Wolitzky-Taylor, 2009).
The pharmaceutical intervention to address GAD has been changed over time. The different classes of drugs for the management of GAD has been raised as the first line defense against these health issues. Some of the drug therapies that target the SSRIs, SNRIs and the pregabalin are becomes the primary option for GAD. Antidepressants, specifically the choosy serotonin reuptake inhibitors are broadly applied to treat and stop a range of anxiety disorder. Some of the examples of SSRIs that are used in chronic anxiety include citalopram, escitalopram, paroxetine, fluoxetine, and sertraline. Other antidepressants like duloxetine also called Cymbalta and venlafaxine, SNRIs or serotonin and norepinephrine reuptake inhibitor that works on the chemical serotonin and norepinephrine of brain, and certain the tricyclic anti-depressants such as imipramine can also be used in GAD (Baldwin, Woods, Lawson, & Taylor, 2011). Antihistamines (for example hydroxyzine) and the beta-blockers (like propranolol) may assist in mild issues of anxiety in addition to performance anxiety, a kind of social anxiety illness (Davidson, Feltner, & Dugar, 2010). Antidepressants like SSRIs or SNRIs being taken every day whether or not patient have a worry on that specific day, as recommended by the health care professional (Hoge, Ivkovic, & Fricchione, 2012). Antihistamines or the beta-blockers are typically taken simply when desired for anxiety, or instantly beforehand an anxiety-aggravating occasion (for example, consuming propranolol soon formerly giving a speech). Lastly, some anticonvulsant drugs, like gabapentin (Neurontin) and the pregabalin (Lyrica), are likewise starting to show worth in handling some patterns of anxiety (Lader, 2015).
The physician may also prescribe anti-anxiety medications like high-strength benzodiazepines release the GAD symptoms rapidly and have some side effects; however, drowsiness can be an issue. Since individuals can grow a tolerance issues and may have to remain increasing the drug dosage to have some effects. Benzodiazepines are commonly prescribed by the physicians for some days or weeks (Bandelow, Sher, Bunevicius, Hollander, Kasper, Zohar, & WFSBP Task Force on Anxiety Disorders, OCD and PTSD, 2012). The individuals who experienced with alcohol or drug addiction are commonly advised to use these medicines carefully, as they might become dependent. Some of the people face withdrawal signs when they stop consuming benzodiazepine abruptly rather than tapering off, and worry or anxiety can reoccur once the particular medicine is stopped. The potential issues with benzodiazepine allow the doctor to prescribe these medicines in improper doses, even when the dosages provide potential advantages to the patient. Alprazolam is the benzodiazepine drug that is favorable for panic diseases and GAD. Clonazepam is also applied for social phobias and GAD (Koen, & Stein, 2011). Buspirone, a type of medicines named azapirones, is the anti-anxiety medicine applied to address GAD-related issues. Likely side effects comprise dizziness, pains, and nausea. Dissimilar to the benzodiazepines, buspirone should be taken constantly for a minimum of two weeks to accomplish the anti-anxiety consequence (Davidson, 2009).
Nurses have a vital Role in the medicinal management of GAD. The nurses are the core member of the team assigned for the patient with GAD. In any healthcare setting the nurses are the main healthcare professional that spent more time with the patients compare to the other healthcare team members. As discussed earlier GAD is the psychological disorder that needs extra care and attention. In the meditational treatment of Gad should be provided more carefully to avoid the medicinal errors (Orthwein, 2017). Nurses should consider the rights of the persons and build a therapeutic communication with the patient in order to provide a successful administration of the medicine. They should assess the patient for any allergic reactions associated with the drug or drug elements before the administration of anti-anxiety or anti-depressants. Nurses need to follow the five rights of medication that are right patients, right medicine, right time, right dosage, and right route (Arnold, & Boggs, 2015). Nurses are responsible to teach the patient and their family members about the treatment or other home care methods. After the administration of medicines nurses are responsible to assess any physical symptoms or side effects, report to the physician after noting the issues in patient record sheets (Yamamoto-Mitani, Noguchi-Watanabe, & Fukahori, 2016).
Some of the psychological therapies for GAD include cognitive behavioral therapy, psychodynamic therapy, and supportive therapy. Cognitive behavioral therapy is the most widely used therapy in generalized anxiety disorder. It is considered as the presently concentrated psychotherapy that has the strong evidence base to help its usage in the youngsters along with the kids and teenagers. It has been linked with the reduction of medicine requirements in certain people. Cognitive behavioral therapy is usually a temporary, structured therapy that focuses on the interplay among the conscious ideas, senses, and personal behaviors that reduce anxiety. CBT and other behavioral therapies for the GVD include a range of techniques that might be used separately or collaboratively (Aviram, & Alice Westra, 2011). Excessive and uncontrolled worry is the main cause of GAD. It is found that this can be managed by using maladaptive thinking related to the utility of worrying, a propensity to recurrent worries rather than problem-solving, problems in relaxing, and unhealthy habits, involving attempted avoidance of unfavorable thoughts and pictures, including situations that may aggravate worry. The CBT technique concentrates on altering the negative thinking pattern (Dugas, & Robichaud, 2012). The psychodynamic therapy applies the therapeutic relationship with the patient to explore and solve the unconscious conflicts including the growth of negative perception and circumscribed character alterations as the therapeutic aims, and reduce the symptoms. Supportive therapy is also implemented in the treatment process of the patient with generalized anxiety disorder. This particular therapy is classified into active and inactive events, the active supportive therapy is comprised in the comparison of every psychological treatment. Different researchers found that combining the therapies is more beneficial instead of using the single therapy for the treatment of GAD (Shedler, 2010).
Role of psychiatric nurses in providing psychological therapies is more important as other health professionals. As discussed above the nurses are the core member of the healthcare team for GAD patients, they play a key role in making a therapeutic relationship with the patients in order to the successful implementation of psychological therapies (Orthwein, 2017). They need to make healthy communication with the patients so that the patients listen to them easily and cooperate in the treatment process. In the psychological problems patients often very aggressive or silent, they do not commonly cooperate in the treatment process. Here the nurses play a major role to make a healthy relationship and allow the patient to feel that somebody cares for them and they can share their actual situation (Videbeck, & Videbeck, 2013). Nurses help the patient to perform effective activities associated with the treatment process. They can guide the person to follow the instructions and involved in the decision-making process (Arnold, & Boggs, 2015). The consent form should be filled before starting the treatment, the nurses are responsible to make a favorable relationship with the patient’s family members and ask them to provide the consent form in case the patient is not able to provide (Fortinash, & Worret, 2014).
References
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Aviram, A., & Alice Westra, H. (2011). The impact of motivational interviewing on resistance in cognitive behavioral therapy for generalized anxiety disorder. Psychotherapy Research, 21(6), 698-708.
Baldwin, D., Woods, R., Lawson, R., & Taylor, D. (2011). Efficacy of drug treatments for a generalized anxiety disorder: systematic review and meta-analysis. Bmj, 342, d1199.
Bandelow, B., Sher, L., Bunevicius, R., Hollander, E., Kasper, S., Zohar, J., & WFSBP Task Force on Anxiety Disorders, OCD and PTSD. (2012). Guidelines for the pharmacological treatment of anxiety disorders, obsessive-compulsive disorder and posttraumatic stress disorder in primary care. International journal of psychiatry in clinical practice, 16(2), 77-84.
Brewin, C. R., Gregory, J. D., Lipton, M., & Burgess, N. (2010). Intrusive images in psychological disorders: characteristics, neural mechanisms, and treatment implications. Psychological Review, 117(1), 210.
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Davidson, J. R., Feltner, D. E., & Dugar, A. (2010). Management of generalized anxiety disorder in primary care: identifying the challenges and unmet needs. Primary care companion to the Journal of clinical psychiatry, 12(2).
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Fergus, T. A., Valentiner, D. P., McGrath, P. B., & Jencius, S. (2010). Shame-and guilt-proneness: Relationships with anxiety disorder symptoms in a clinical sample. Journal of anxiety disorders, 24(8), 811-815.
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