Anxiety can be normal from time to time, but excessive ongoing anxiety and worry that someone might have difficulty in controlling and interfere with day-to-day activities may be a sign of generalized anxiety disorder (Mayo Clinic Staff, 2018, p. 1). This disease is a chronic condition with exacerbations and suicide risk is higher than in the general population.
40 million adults in the United States are affected by anxiety (Dunphy, Winland-Brown, Porter, & Thomas, 2015). In the primary care setting accounting form 6-9% of patients seen, effecting women more than men. It is more predominant in women in a 2:1 ratio but may present for treatment less often 3:2 female/male. In addition, the presentation of the complaints is seen more in men than women (Ferri, 2018). Onset is reported before the age of 11 at 30% and 50% have onset before the age of 18. The median age of onset is 30 years old (Ferri, 2018, p. 110).
Patients present with several symptoms from affective, cognitive, behavioral, and somatic (Dunphy, Winland-Brown, Porter, & Thomas, 2015). Patients will display feelings of dread, panic, increased heart rate, irritability, nail biting, restlessness, tense, headaches, and may affect their hygiene and groom (Collins-Bride, Saxe, Duderstadt, & Kaplan, 2017). The key is to obtain the best subjective and objective data as possible during the HPI to assist in the diagnosis of anxiety. Differential diagnosis associated with anxiety are; post-traumatic disorder, other anxiety disorders (GAD, OCD), and mood disorders. I feel it is important to point out that worrying must be more intense than what one would expect for a situation and that a patient is unable to be diagnosed if the symptoms of anxiety occurs only in context of depression, PTSD, or anxiety (Ferri, 2018).
The work up can use two screening tools, the GAD-2 and the GAD-7, both are very helpful in diagnosing this disease.
Treating anxiety can be approached with non-pharmaceutical methods such as acupuncture, yoga, relaxation techniques, guided imagery, music therapy, physical activity, or change in diet (Dunphy, Winland-Brown, Porter, & Thomas, 2015). Pharmaceutical agents would start with SSRIs and SNRIs as first line of treatment (Collins-Bride, Saxe, Duderstadt, & Kaplan, 2017). Patient education plays into the aspects of the treatment options. Education must include the risks and benefits of medications, overuse, dependency, potential adverse effects. The importance of avoiding alcohol while on these medications and the risks involved (Collins-Bride, Saxe, Duderstadt, & Kaplan, 2017).
Collins-Bride, G.M., Saxe, J.M., Duderstadt, K.G., & Kaplan, R. (2017). Clinical Guidelines for Advanced Practice Nursing: An Interprofessional Approach (3rd ed). Jones & Bartlett Learning, Burlington, MA.
Dunphy, L.M., Winland-Brown, J.E. Porter, B.O., & Thomas, D.J. (2015). Primary Care: The Art and Science of Advanced Practice Nursing (4th ed). F.A. Davis Company. Philadelphia, PA.
Ferri, F. F. (2018). Ferri’s clinical advisor 2018 E-book: 5 books in 1.
Mayo Clinic Staff. (2018). Generalized anxiety disorder. Retrieved from https://www.mayoclinic.org/diseases-conditions/generalized-anxiety-disorder/symptoms-causes/syc-20360803