The Epidemiological Catchment Area study and the National Commodity Survey are two major studies that were carried out in the U. S to estimate the prevalence rates for GAD. According to them the prevalence rates of GAD was placed at 4- 6 %. The studies found that there were no major differences in the rates among the blacks, whites and Hispanics. However they found that the ratio of the women suffering from the disorder was higher than that of men. Also the study showed that most of these disorders start to manifest in childhood, adolescence and early adulthood.
A twin research carried out on GAD, sought to find out the environmental and genetic influences on GAD and the variation in GAD of genetic and environmental factors shared with neuroticism in twins. The study showed that GAD and neurotism were both inheritable and also determined by the unique environmental factors an individual is exposed to. The study also indicated that women and women had different frequencies in a lifetime in GAD and, neuroticism levels (Nutt, Argyropoulos & Forshall, 2001).
A familial study on GAD also indicated that the disorder occurred at a higher rate in first degree relatives of subjects with GAD than of the relatives of those without the disorder. These studies shows some relation to Maria’s case in which case her anxiety disorder started at her teen years and that possibly she inherited some form of disorder from her mother. Though the disorder might not have been GAD necessarily the defective genes from her mother could have been modified by the environmental factors around her resulting to GAD. Maria’s disorder is probably also the cause of her children’s disorders.
Which could either be genetic or the environment she is exposing them to could be the cause of their disorders. Biological Aspects of GAD It is however not yet known what exactly causes this disorder. Theories have been postulated to the probable cause of GAD and the most common ones indicate that it runs in families and that the genetic hereditary factor is the most probable cause. Brain chemistry and varying environmental factors have also been indicated to play a role in the development of GAD. It is also thought that GAD can be caused by abnormal secretion of certain neurotransmitters found in the brain.
These are special chemical messengers that help in carrying information from one nerve cell to another. Incase of improver secretion of these messengers their balance in the brain is thrown off balance and this can cause altered brain response to certain situation leading to mental abnormalities. GAD has been linked to the imbalance of certain brain neurotransmitters like noradrenaline, Gamma- aminobutyric acid and serotonin by several studies. These brain transmitters are thought to control anxiety and incase of an imbalance abnormalities occur.
The forebrain is one of the major brain structure affected in the people with GAD. The hypothalamus is also another brain structure is thought to contribute to the pathogenesis of the disorder. The basal nuclei of the brain often show an increased activity in the people with obsessive compulsive disorder. The most important system in the brain that controls anxiety is the serotoninergic system. So disruption of this system leads to GAD and other anxiety related disorders. A full understanding on the relationship of serotonin and anxiety has not been very well established.
The discovery of selective serotonin uptake inhibitors has been of much help in the diagnosis and treatment of GAD (Weiner, Freedheim, Stricker, Schinka, Widiger & Velicer, 2003). Various theories have shown that the proper function of serotonin and its receptors is important in the action of anti- anxiety drugs. Researchers have performed manipulations on serotonin secretion in the brain to show that an increase in serotonin increases anxiety and a decrease in serotonin levels reduces anxiety. This is enough evidence to associate serotonin levels with anxiety.
Confusion arises however when other studies indicate that the serotonin receptors adopt to the new levels of serotonin and also by indicating that the secretion of serotonin can be down regulated by an inhibitor leading to an excess in the flow of neural impulse. GAD can be treated by a class of antidepressants known as selective serotonin uptake inhibitors (SSRL). This antidepressant alters the abnormal serotonin secretion to a more balanced and normal level. As we saw earlier, serotonin helps in communication between cells in the brain for proper functioning.
Examples of the SSRLs include Prozac fluoxetine, Zoloft (sertraline), Paxil (paroxetine) and Lexapro. Venlafaxine is a drug that is commonly used to treat GAD and it is closely related to SSRL. Hidalgo and Davidson have also indicated that GABA (gamma- aminobutyric acid) is related to GAD. This transmitter helps the brain to work slower by slowing it down. The people with GAD have defect in this neurotransmitter in that it is either not secreted or it is secreted in low amounts and this makes the brain work faster generating anxiety (2001).
They have also shown that overproduction of epinephrine can alter the way one responds to stress and therefore anxiety because it keeps one alert and it is also an important factor that helps in response to stress. Most studies provide evidence indicating that GAD mostly runs in most family chains. Some have shown that there is genetic contribution to GAD by studying twins. In general it is not the disease that is genetically inherited but the tendency to suffer from anxiety.
Therefore one can not be said to have inherited a GAD gene specifically but it can be said that they inherited a gene that predisposes them to suffer from anxiety. For example with Maria, her mother never suffered from GAD but had an abnormality in her genes that made her to be excessively superstitious. She predisposed her daughter to a defective gene which in combination with the environment caused the anxiety. More studies have shown that other mental conditions also increase the prevalence of anxiety disorders like GAD.
Patients of other mental conditions show different rates to process stimuli and other instructions by the brain and therefore are more predisposed to anxiety disorders than normal individuals. Environmental Aspects of GAD Different environmental factors have bee linked with GAD. It has been postulated that these factors lead or cause GAD. Some of these environmental factors include the family environment or the situations and condition is exposed at home. These factors are the greatest contributors to how an individual views the world and themselves. The main environmental factor researchers have shown to cause GAD is abuse.
The other major environmental stressor that can cause this condition is chaotic and disorganized family situations like a parent can be a drug addict or when an individual experiences divorce in the family (Heimberg, Turk, Mennin, 2004). These kinds of experiences can cause psychological disturbance in an individual and also fear. An individual starts viewing the world and people as a prominent threat or even other situations present in the community and thus whenever they meet with any they are encompassed with anxiety as their way of dealing with the situation.
Traumatic events are also other environmental situations that can trigger GAD. GAD is a complex mental disorder and for this reason it is difficult to pinpoint exactly what factors contribute more to the manifestation of the disease; that is whether the environmental factors are more important than the biological factors in causing the disease. Studies therefore have shown that an interrelation of factors both biological and environmental play a role in causing to cause GAD.
Research has studied several biological and environmental interactions that usually cause GAD. These interactions involve environmental stressors like sleep deprivation, childhood trauma, work, home and school related stress and genetic factors (Rygh & Sanderson, 2004). An individual who was born with an inherited genetic defect has a high probability to suffer from GAD if exposed to various environmental stressors like trauma. In this case the genetic defect is modified by the environmental stressor into the GAD condition.
For example we can assume that Maria inherited some form of genetic defect from her excessively superstitious mother and then the strict upbringing she was exposed to and the high expectations of her to be perfect interacted to cause the kind of anxiety she suffers. Also the same defect she might have passed to her children to cause their disorders. Treatment Approaches There are various types of treatments presently available for GAD. It is important that different approaches be used for effective treatment of GAD. Treatment usually combines medicines and cognitive behavior therapy.
Medication is particularly used to treat the physical effects of GAD like panic attacks and mostly they are just used for a few months. Psychotherapy however identifies the cause of the problem and teaches how to cope with such situations. It is also important to realize that these drugs can result or cause addiction like Xanax so the physician should be careful and observative. Psychotherapy for GAD aims to the anxiety attacks. These attacks are characterized by difficulties in relaxing and sometimes breathing, inability to plan and stress. A psychotherapist can teach relaxation skills as a single skill or in combination with a biofeedback.
One is taught how to relax by breathing deeply as a start of psychotherapy. At later stages relaxation of muscles and imaginary techniques can be used (Hazlett-Stevens, 2008). Though it can be demanding at the first stages teaching a patient how to relax at any place and under different circumstances is the key to reducing anxiety. Once one completes a therapy treatment successively, they can lead a very productive and normal life. However if the patient does not practice the teachings of a psychotherapy session, it is very easy for the treatment to fail.
Clients should therefore be encouraged to create their own schedules when to practice what they have been taught for example practicing twice a day for at least thirty minutes can be very effective. Hypnotherapy in combination with other techniques of relaxing can also be used as a treatment for GAD. It can be used for patients who hyperventilate when anxiety attacks. A patient is directed to breath into a paper bag to increase their percentage of carbon dioxide because when hyperventilating they take in too much oxygen that tips off their carbon dioxide oxygen balance.
Fried suggests that the physician should aim at teaching the patient to slow down their respiration rates without the use of the paper bag (1987). Though not many physicians are involved in them, self help methods are effective ways of treating GAD. There are different groups present in different communities that support each other to solve problems however the patient should not be forced to attend such groups if they are not willing to because this can serve to worsen their condition. Treatment using medication usually involves drugs like benzodiazepines.
This drug however can lead to addiction therefore if it is to be stopped it should be done so slowly rather than stopping the administration abruptly. It is a very effective drug whose use outweighs the side effects. Another drug commonly used for the treatment of GAD is buspirone. Though it does not cause drug dependence it takes some time for it to start being effective usually more than two weeks. Others include effexor, paxil and some other types of serotonin inhibitors. Many doctors at first prescribe benzodiazepine together with an antidepressant but withdraw the benzodiazepine as soon as the antidepressants start working.
Some herbal prescriptions have been indicated to reduce anxiety but their effectiveness and safety has not been completely established. Examples include kava and valerian (Nutt, Rickels & Stein, 2002). Cognitive behavior therapy is also another form of treatment that can be incorporated into the treatment of GAD. It is a technique that helps patients see what they think is reality as distorted (Dugas & Robichaud, 2006). This helps them to control their way of thinking and to modify their behavior. As indicated in project two, cognitive behavior therapy would the best treatment for Maria.
A physician would try to make her see that her excessive cleanness is unnecessary since her house is already clean and also a physician should try to make her see that spiritual holiness is totally different from the physical treatment. Self help groups could also help Maria and her family if she invited them and they shared what her distance makes them feel. Project two also emphasized that cognitive behavior therapy is much more important because it lasts longer than the medications and it also has no side effects. Conclusion
The behavioral model explains the tendencies that become evident in people as a result of their personal behaviors. In this case Maria developed a mental disorder probably from the behaviors she had gotten used to overtime. As a child she was taught on being holy as a catholic and as she grew older probably in association with the environmental factors this behavior turned into an obsession. She could not differentiate or know when too much cleanness was enough. This model is important in helping to treat disorders that come up as a result of personal behaviors.
A physician can therefore recognize the cause as obsessive behavior and move to treat the patient by trying to correct those behaviors mainly by the use of cognitive behavior therapy which conditions the patient to know how to respond and cope with different situations. Studies are underway to discover more about what causes GAD exactly and therefore what treatment is more appropriate. A new drug duloxetine HCL has been approved by Health Canada recently. It is a type of serotonin and norepinephrine reuptake inhibitor that that regulates the uptake of norepinephrine and serotonin that relieves anxiety.
Incase more drugs and other methods of treatment are discovered then GAD patients and other patients of anxieties like Maria could live more comfortable and productive lives (Rees, 1997).
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