Generalized anxiety disorder (GAD) 

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Generalized anxiety disorder (GAD) is a common disorder that the PMHNP will encounter. Understanding the diagnosis criteria and differentiating it from other disorders is important for the client’s well-being. Diagnostic criteria according to the DSM-5 is described as 3 or more symptoms of anxiety which include easily fatigued, concentration difficulties, irritability, sleep difficulties, muscle tension, and restlessness for more days than not over a 6 month period causing significant impairment not explained by other disorders or drug use (American Psychiatric Association, 2013).

Adjustment disorder is described as a stress related disorder that includes one or more of an identified stressor causing excessive worrying, preoccupation or distressful thoughts or rumination causing significant impairment in important life areas (Zelviene, Kazlauskas, and Maercker, 2020). There are some similar symptoms between anxiety and adjustment disorder such as the excessive worrying but differences are identified as well. The adjustment disorder is more specific to an unpleasant event or stressful situation where the GAD is not associated with a certain event.

    Generalized anxiety disorder (GAD)

Treatment for generalized anxiety disorder can involve psychopharmacology and psychotherapy. According to Stefan et al. (2019), cognitive behavioral therapy has been identified as the most effective psychotherapy for GAD. Incorporating this can be helpful to change the client’s anxious thoughts and beliefs to improve feelings. According to Slee et al. (2019), SSRI’s  and SRNI’s have been shown to be most effective in treatment of GAD with the current study showing efficacy from duloxetine, pregabalin, venlafaxine, escitalopram, fluoxetine, sertraline and buspirone. Properly assessing and choosing one of these medications as well as the psychotherapy could give the client the best chance at a reduction in symptoms.

Resources

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Slee, A., Nazareth, I., Bondaronek, P., Liu, Y., Cheng, Z., & Freemantle, N. (2019). Pharmacological treatments for generalised anxiety disorder: A systematic review and network meta-analysis. The

Lancet, 393(10173), 768–777. https://doi-org.ezp.waldenulibrary.org/10.1016/S0140-6736(18)31793-8

Stefan, S., Cristea, I. A., Szentagotai Tatar, A., & David, D. (2019). Cognitive‐behavioral therapy (CBT) for generalized anxiety disorder: Contrasting various CBT approaches in a randomized clinical trial. Journal

of Clinical Psychology, 75(7), 1188–1202. https://doi-org.ezp.waldenulibrary.org/10.1002/jclp.22779

Zelviene, P., Kazlauskas, E., & Maercker, A. (2020). Risk factors of ICD-11 adjustment disorder in the Lithuanian general population exposed to life stressors. European Journal of Psychotraumatology, 11(1).

https://doi-org.ezp.waldenulibrary.org/10.1080/20008198.2019.1708617