Generalised Anxiety Disorder
Original Editors - Ellen Baumann from Bellarmine University's Pathophysiology of Complex Patient Problems project.
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Definition/Description[edit | edit source]
According to Goodman and Fuller, anxiety can be defined as a heightened emotional state of concern, worry, or apprehension. It can lead to physiologic arousal causing an increase in heart rate and sweat gland activity.[1]
Anxiety is a normal feeling to encounter; however when one experiences excessive worry, tension, and anxious feelings on a daily basis then he/she may have generalized anxiety disorder (GAD). This disorder is diagnosed with a person demonstrates anxious feelings and constant worry over daily activities for a six-month time frame.[1][2][3]
Prevalence[edit | edit source]
Generalized Anxiety Disorder affects nearly 6.8 million American adults. GAD is a gradually progressing disorder and can occur at any point throughout the lifespan, however is most often occurs between childhood and midlife. Women are two times more likely to develop GAD than men.[4][2]
Characteristics/Clinical Presentation[edit | edit source]
There are many characteristics/symptoms assosciated with generalized anxiety disorder. The most common include: [1][2][3][4][5]
- Constant worrying and excessive anxiety (about small or large concerns)
- Difficulty concentrating
- Excessive sweating
- Palpitations or rapid heart beat
- Shortness of breath
- Stomach/intestinal symptoms
- Nausea or diarrhea
- Fatigue
- Irritability
- Muslce tension/ muslce aches
- Headaches
- Restlessness/ feeling 'on edge'
- Trembling or easily startled
- Sleep disturbance: difficulty falling asleep, staying asleep, or restless, unsatisfying sleep
Anxiety disocrders are often associated with depression and substance abuse. [5]
Goodman and Snyder state that "Anxiety amplifies physical symptoms." [3] The text also states that anxiety increases muslce tension. This increase in tension can reduce blood flow and oxygen to the tissue and in turn cause a buildup of celluar metabolites. This statement demonstrates that musculoskeletal complaints (headaches, back pain, muslce tension/aches, and fatigue) can be caused from anxiety-caused tension or heightened sensitivity to pain. [3]
People who have a general anxiety disorder place an increased attention on physical and emotional pain. This increased focus can be in the form of the person noticing pain more or interpreting the pain as more significant. Goodman and Fuller state that disability, pain behavior ( limping and facial grimacing), and the seeking of medication could develop with anxiety diosrders. Physical, behavioral, cognitive, and/or psychologic symptoms may be present.[1]
The autonomic nervous system can refer pain to the somatic systems of the body. These symptoms incluse chest pain, pelvic pain, dyspnea, palpatations, parasthesia, and possible digestive, bowel, or bladder disorders. [1]
Goodman and Fuller explain that anxiety can become self-generating. This can be expalined in that the symptoms of anxiety reinforce the reaction and in turn cause a 'spiral effect'. Certain items can stimulate the spiral effect and trigger anxiety disorderes; these include caffeine, cocaine, or other stimulant drugs, medications containting caffiene, and even stimulants used for the treatment of asthma.[1]
Associated Co-morbidities[edit | edit source]
Co-morbidies play an essential role in describing and understanding general anxiety diosrders. The conditions of GAD may not be recognized as an emotional problem until the secondary disorder/ co-morbidity develops. Hoyer et al. states that epidemiological studies have found high rates of co-morbidity in GAD. [6]
Generalized anxiety disorder is most often associated with other disorders which can include other anxiety disorders, depression, and substance abuse. GAD can also lead to or worsen pre-existing conditions such as insomnia, digestive or bowel problems, headaches, and bruxism (teeth grinding). [2][4]
Other associated anxiety disorders can include panic disorder, phobias, obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD), or adjustment disorder with anxious mood (those with an organic illness).[1][3]
In a study of GAD in young women, Hoyer et al found that the timing of the co-morbidities can either appear later in the course of the general anxiety disorder or they may appear early in the developmental stages of the disorder. [6]
Medications[edit | edit source]
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Diagnostic Tests/Lab Tests/Lab Values[edit | edit source]
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Causes[edit | edit source]
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Systemic Involvement[edit | edit source]
The symptoms of anxiety can manifest in several ways incorporating physcial, behavioral, cognitive, and psychologic aspects of life.
Physical: [3]
- Increased signing
- Increased blood pressure
- Tachycardia
- Shortness of breath
- Dizziness
- Lump in throat
- Muscle tension
- Dry mouth
- Diarrhea
- Nausea
- Clammy hands
- Profuse sweating
- Restlessness, pacing, irritability, difficulty concentrating
- Chest pain
- Headache
- Low back pain
- Myalgia (which consists of muscle pain, tension, or tenderness)
- Arthralgia (joint pain)
- Abdominal distress
- Irritable bowel syndromw (IBS)
Behavioral:[3]
- Hyperalertness
- Irritability
- Uncertainty
- Apprehension
- Difficulty with memory or concentration
- Sleep disturbance
Cognitive: [3]
- Fear of losing mind
- Fear of losing control
Psychologic:[3]
- Phobias
- Obsessive-compulsive behavior
Anxiety can also affect the systemic systems throughout the body. These can include:
- Cardiopulmonary System
- Musculoskeletal System
- Gastrointestinal
- Neurologic
- General/ multiple system involvment
There are screening tools that can differential between systeminc involvement versus psychogenic symptoms. These include the McGill Pain Questionnaire, Illness Behavior Syndrome and Symptom Magnification, and Waddell's Nonorganic Signs. [3]
To help differentiate between these two sources (systemic and psychogenic) of symptoms,
Medical Management (current best evidence)[edit | edit source]
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Physical Therapy Management (current best evidence)[edit | edit source]
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Alternative/Holistic Management (current best evidence)[edit | edit source]
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Differential Diagnosis[edit | edit source]
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Case Reports[edit | edit source]
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Resources
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Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Goodman CC, Fuller KS. Pathology: Implications for the Physical Therapist. 3rd edition. St. Louis, Missouri: Saunders Elsevier, 2009.
- ↑ 2.0 2.1 2.2 2.3 Medical Foundation for Medical Education and Research. Mayo Clinic: Generalized anxiety disorder. http://www.mayoclinic.com/health/generalized-anxiety-disorder/DS00502. Updated September 11, 2009. Accessed February 21, 2010.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 Goodman CC and Snyder TK. Differential Diagnosis for Physical Therapists: Screening for Referral. 4th edition. St. Louis, Missouri: Saunders Elsevier, 2007.
- ↑ 4.0 4.1 4.2 National Institute of Mental Health. Health and Outreach: Generalized Anxiety Disorder. http://www.nimh.nih.gov/health/publications/anxiety-disorders/generalized-anxiety-disorder-gad.shtml. Updated July 7, 2009. Accessed February 21, 2010.
- ↑ 5.0 5.1 Ballas, Christos, MD. U.S. National Library of Medicine and National Institutes of Health. Medline Plus: Generalized Anxiety Disorder. http://www.nlm.nih.gov/medlineplus/ency/article/000917.htm. Updated January 15, 2009. Accessed February 21, 2010.
- ↑ 6.0 6.1 Hoyer J., Becker E., Margraf J.. Generalized anxiety disorder and clinical worry episodes in young women. Psychological Medicine [serial online]. 2002;32:1227-1237. Available from: Health Module. Accessed February 21, 2010, Document ID: 1410761401.
