Pages 8 (1952 words)
In recent times, the importance for the need to systematically study and research in psychological disorders has been brought to consideration. The reported cases of various such cases have been steadily increasing and various research is being done to understand the causes and ensure effective diagnoses. Out of all the mental disorders the anxiety disorder are the most common ones constituting about 30 percent of the adult patient cases. People with anxiety disorders tend to avoid things which involve triggering the anxiety and thus reduced performance is observed in various day to day activities.
‘Although anxiety disorders are common, with a lifetime prevalence of up to 31%, they are often unrecognized and underdiagnosed.’ (4). The General anxiety disorder is one of such anxiety-based disorder, which is mainly characterized by unsustainable high levels of persistent anxiety that interferes with the day to day activities.
General anxiety disorder is very common disorder in India with more than 1 crore cases reported per year. It is observed that about 65% of the people in USA experience GAD at some point in their life.
The statistics show that women are more likely to be victims of this disorder than men. The disorder can come at any point in the life cycle i.e., child or adult, but the risk of getting it is observed to be high between teen and middle ages.
The people having GAD can show signs of the following symptoms:[footnoteRef:2] [2: The symptoms have been summarized after refering     ]
- Excessive worrying about routine things without proper reasoning especially about things like wealth, job, family, security, societal status etc.
- Increased Pacifistic thoughts about everything
- Difficulty in concentrating and sleeping
- Indecisiveness, dyspepsia and panic of going wrong in decision making
- Feeling restless, tired, irritated and ‘on the edge’
- Considering only the worst-case outcomes despite the odds against its occurrence
- Feeling overwhelmed easily and trying to avoid things which worsen the anxiety
- Increased heart rate and Hyperventilation increased and persistent precipitation.
- Increased occurrences of Muscle tension, headaches and fatigue.
- Nausea and many other gastrointestinal problems
- Loss of diet
In addition to these teenagers and children are observed to show the following symptoms. The concerning things in this case, primarily revolve around family, personality, past and future events and performance at school. It’s the responsibility of the parent to keep an eye for such symptoms:
- Fear of not fitting in
- Seeking perfectionism and repetition of tasks only considering the possibility of failure despite the odds
- Feeling insecure and frequent thought of ‘What if’
- Decline in activeness and participation because of the negative fear.
- Loss of confidence and requires lot of reassurance and motivation.
The symptoms of GAD may look similar to other mental disorders like depression, but it is important to differentiate between proper disorders for efficient diagnosis. Despite the high reported cases of people developing general anxiety disorder, patients getting diagnosed with GAD was very less in the past. This is explained by considering the fact that it was less likely for a GAD patient to understand the symptoms and seek doctor’s help. Now, in modern times, GAD is the most frequent anxiety disorder due to spread of awareness.
The exact causes of GAD are yet unknown but there is a constant study and research about the same. There can be many causes for development of GAD which include Biological, Behavorial, emotional and environmental factors.
Risks and Complications
- GAD could be a chronic condition and needs to be properly treated with. Many cases of GAD have been observed to occur along with other mental disorders like Phobias, panic disorders, PTSD, OCD, substance abuse making the identification of GAD quite complicated.
- There is a risk of physical health conditions getting worsened.
- ‘Generally, the risks of not treating anxiety, particularly risk of cardiovascular consequences, diabetes II, secondary depressive episodes, and self-medication with alcohol, outweigh the risks of serious drug adverse effects ‘(12).
- There are chances of having consequences to the fetus during pregnancy of GAD diagnosed patient
Various Level of Analysis
- Familial studies indicate that GAD has a modest level of heritability. Identical twins have been found have very high concordance i.e. the percentage of twins that share the same characteristic of having GAD or not having GAD, together, is very high.
- It was reported by Gerra in his research that patients with GAD have significant increase in serum sodium levels.
- The biological studies have shown a dependency with neurotransmitter imbalances with the key neurotransmitters responsible being Serotonin and dopamine. Thus, common neurotransmitters simulator like Benzodiazepines are used which show signs of improvement in few cases. But interestingly it has been observed that prolonged abuse of these can worsen the condition of the patient.
- It is observed that people diagnosed with GAD have shown a consistent increase of grey matter in certain regions of brain with consistent increase observed in the right ‘putamen’
- According to  The Structures implicated in aetiology and cognitive dysfunction of GAD are Amygdala, medial Prefrontal Cortex. Impaired processing of aversive stimuli was observed as the attention dysfunctionality associated.
- ‘The GAD patient can be conceptualized as in a state of meta-cognitive dissonance in which positive beliefs about worrying and negative beliefs co-exist’ (6). And have a Intolerance of uncertainty.
- Highly levels of GAD are generally attributed to people who experience high anxiety-provoking situations. People who have low income levels living in big cities have relative higher rates of GAD. People living in areas of war and economic hardships have been found to be very prone to GAD.
- GAD risk is higher after experiencing a situation that implies, danger in the perceived future, e.g.: loss of housing, after a foreclosure. Experiments have shown that the risk of developing GAD, is dependent on personal vulnerability.
- It is often argued that anxiety could be a learned behavior from people around us or our family especially in children 
- A set of questions are posted in  which help in self-assessing one’s mental condition.
- We use the guidelines from Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by American psychology association.
- Medical tests like blood, urine etc. to further investigate medical disorders. This is to remove the underlying medical causes before proceeding further.
- Psychiatric history and intensity of symptoms are made a note of to accurately conclude the disorder.
- Over a period of 6 months, the frequency of occurrence of these symptoms are taken into consideration along with their effects of daily chores.
Treatment of Generalized Anxiety Disorder is not so simple because of the etiology that is underlying is not simple and involves neuropsychological abnormalities along with learned responses. There is no ‘applicable to all’ treatment available. The treatment varies for various patients like children, pregnant women, older adults, patients with substance abuse etc.
- It involves counselling/talking sessions with a trained /professional psychiatrist/psychologist to talk about dealing with the issues faced
- CBT (Cognitive behavioral therapy) is considered to be one of the most effective and best studied for treatment of GAD.
- ‘Cognitive behavioral therapy is based on social and cognitive psychology. It emphasizes the role of thoughts on the patient’s mood and actions.’ (4)
- ‘The cognitive dimension helps people change the thinking patterns that support their fears, and the behavioral dimension helps people change the way they react to anxiety-provoking situations’ (16)
- Psychodynamic psychotherapy and applied relaxation are some other approaches.
Medical Treatments (Pharmacotherapy)
- Use of antidepressant drugs-the drugs that have been shown to be effective for depression are shown to be effective even to anxiety patients. SSRIs and SNRIs which are known to act on serotonin(a chemical messenger)are prescribed as the first drug of choice for patients diagnosed with GAD.
- Use of antianxiety drugs-as discussed earlier in the biological aspects, Benzodiazephenes are shown to fast and effective in controlling the symptoms but they are prescribed only for short-term usage as the patient tends to develop dependency with them. Alprazolam and Clonazepam are some of the examples.
- Due to advent of the modern tools like social media many creative measures have been practiced to diagnose General anxiety issues .For example consider  ,this is social media tool connecting many GAD diagnosed patients around the world, In this people share their stories about their problem concerning the disorder and a have a conversation with the rest.
- In , the use of virtual reality technology to treat GAD has been attempted. But it was quite difficult because its difficult to generate a standard virtual reality scene to handle every case.
- Modern applications are used to asses a disorder based on the responses for the questionnaire by the customer
- Many informative websites have made the details about every disorder quite handy and thus creating awareness and early diagnosis.
- Breathe2relax  (developed by NACBT), Happify are the apps that help us in coping up with our anxiety issues.
- MoodtrackDiary , helps us in tracking our psychological state throughout the day which enables easy and proper evaluation for the concerned Psychiatrist.
- Research in cognitive computer science have been growing at a rapid pace. Applications like Happify are built based on the factual claim that playing interactive games have shown to distract people and enable them to manage their stress and anxiety levels.
- Using the virtual reality, we can simulate a false world as per the customer requirements. So, designing a virtual reality based interactive game which is based on factor responsible for the development of the disorder in the patient could give rewarding results and provide a breakthrough in the treatment.
- Source: Newman, M. G., Zuellig, A. R., Kachin, K. E., Constantino, M. J., Przeworski, A., Erickson, T., & Cashman-McGrath, L. (2002). Preliminary reliability and validity of the Generalized Anxiety Disorder Questionnaire-IV: A revised self-report diagnostic measure of generalized anxiety disorder. Behavior Therapy, 33, 215-233. doi:10.1016/S0005-7894(02)80026-0
- Kehoe, William A. ‘Generalized Anxiety Disorder.’ Neurologic/Psychiatric Care 2 (2017): 7-27.
- Ferreri, Florian, Leann K. Lapp, and Charles-Siegfried Peretti. ‘Current research on cognitive aspects of anxiety disorders.’ Current Opinion in Psychiatry 24.1 (2011): 49-54.
- Wells, Adrian. ‘Meta-cognition and worry: A cognitive model of generalized anxiety disorder.’ Behavioural and cognitive psychotherapy 23.3 (1995): 301-320.
- Barlow, David H., et al. ‘Co-morbidity and depression among the anxiety disorders: Issues in diagnosis and classification.’ Journal of Nervous and Mental Disease (1986).
- Allgulander, Christer. ‘Generalized anxiety disorder: a review of recent findings.’ Journal of Experimental & Clinical Medicine 4.2 (2012): 88-91.
- Nitschke JB, Sarinopoulos I, Oathes DJ, Johnstone T, Whalen PJ, Davidson RJ, Kalin NH. Anticipatory activation in the amygdala and anterior cingulate in generalized anxiety disorder and prediction of treatment response. Am J Psychiatry 2009 166:302e10.
- Etkin A, Prater KE, Hoeft F, Menon V, Schatzberg AF. Failure of anterior cingulate activation and connectivity with the amygdala during implicit regulation of emotional processing in generalized anxiety disorder. Am J Psychiatry 2010 167:545e54.
- Brambilla P, Como G, Isola M, Taboga F, Zuliani R, Goljevscek S, Ragogna M, et al. White-matter abnormalities in the right posterior hemisphere in generalized anxiety disorder: a diffusion imaging study. Psychol Med 2011 42:427e34.
- Maples-Keller, Jessica L., et al. ‘The use of virtual reality technology in the treatment of anxiety and other psychiatric disorders.’ Harvard review of psychiatry 25.3 (2017): 103.
- Burstein M, Ginsburg GS. The effect of parental modeling of anxious behaviors and cognitions in school-aged children: an experimental pilot study. Behav Res Ther. 2010 48(6):506–515. doi:10.1016/j.brat.2010.02.006