COMPREHENSIVE NURSING

SCIENCE (VCNS351)
Mental Health Related Conditions: Anxiety disorders and
Mood disorders
PRESENTER: N. MRWETYANA-MLUNGU
 INTRODUCTION

GAD is an acronym used The answer is no, but

for generalized anxiety OCD and GAD share since there are some
Is OCD an anxiety
disorder, while OCD is similarities, including similarities between the
disorder?
used for obsessive- symptoms of anxiety two conditions,
compulsive disorder confusion can happen
• Historically, both generalized anxiety disorder (GAD) and obsessive-
compulsive disorder (OCD) were considered anxiety disorders
• The Diagnostic and Statistical Manual of Mental Disorders (DSM), a
diagnostic reference guide used by clinicians to classify psychiatric
conditions, once grouped GAD and OCD within the same section
• The fifth edition of the DSM, published in May 2013, separated these
diagnoses into different chapters
• This remains the same in the edition currently in use, the DSM-5-TR.
• The primary behavioral difference between OCD and GAD involves the presence of compulsions
• People with OCD engage in compulsive behaviors to cope with anxiety, while people with GAD do not
• What Is a Compulsion?
• A compulsion is a repetitive behavior or ritual that people feel compelled to perform in response to an
obsession
• Common compulsions in OCD include checking, counting, cleaning, ensuring order, seeking
reassurance, or repeating word sequences
• An example of this would be handwashing excessively and ritualistically to prevent contamination
• In GAD, people tend to worry a lot and sometimes seek reassurance from others
• However, they don't typically engage in compulsive, ritualistic behaviors to cope with their
anxiety
Worry
• People with GAD tend to worry about real-life concerns
• And while these topics are appropriate to worry about, the degree of anxiety is clearly
excessive
• Concerns may be about major life issues like health, finances, or relationships, but they're also
about many minor, day-to-day stresses that other people wouldn't tend to perceive as intensely
—like giving a work presentation or being unable to predict what their daily schedule will be
• Pathological worry, the kind that meets the threshold for a diagnosis of GAD, is
pervasive and uncontrollable and tends to involve a lot of catastrophizing (imagining the
worst possible outcome)
• or other distortions in thinking and decision making (aka biased thinking)
Obsessions
• However, in contrast to GAD, these thoughts or mental impulses extend far beyond
everyday worries and problems
• Obsessions are the hallmark thought processes of OCD and are also difficult for people
with OCD to control
 What Are Obsessions?

• Obsessions are thoughts, ideas, or mental images that are persistent, unwanted,
and extremely distressing
• Obsessive thinking is more unrealistic and sometimes even has a perceived
magical quality
• For example, a student with OCD might believe that they have to line up items
on their desk in perfect symmetry and count a specific number of times to keep
from failing a test
• Or, a parent with OCD might believe that they need to say a particular phrase
repeatedly throughout the day to keep their children safe
 Assessment
When assessing for GAD, clinical professionals are looking for the following:
• The presence of excessive anxiety and worry about a variety of topics, events, or activities
• Worry occurs more often than not for at least six months and is clearly excessive
• The worry is experienced as very challenging to control
• The worry in both adults and children may easily shift from one topic to another
• The anxiety and worry are accompanied by at least three of the following physical or cognitive symptoms (In children,
only one of these symptoms is necessary for a diagnosis of GAD):
• Edginess or restlessness
• Tiring easily; more fatigued than usual
• Impaired concentration or feeling as though the mind goes blank
 Symptoms of GAD

• The DSM-5-TR outlines specific criteria to help professionals diagnose generalized anxiety
disorder. Having a standard set of symptoms to reference when assessing clients helps them to
more accurately diagnose mental health concerns and, in turn, create a more effective plan of care.
Criteria for Diagnosing GAD
• When assessing for GAD, clinical professionals are looking for the following:
• The presence of excessive anxiety and worry about a variety of topics, events, or activities. Worry
occurs more often than not for at least six months and is clearly excessive.
• The worry is experienced as very challenging to control. The worry in both adults and children
may easily shift from one topic to another.
• The anxiety and worry are accompanied by at least three of the following physical or cognitive
symptoms (In children, only one of these symptoms is necessary for a diagnosis of GAD):
• Edginess or restlessness
• Tiring easily; more fatigued than usual
• Impaired concentration or feeling as though the mind goes blank
• Irritability (which may or may not be observable to others)
• Increased muscle aches or soreness
• Difficulty sleeping (due to trouble falling asleep or staying asleep, restlessness at night, or
unsatisfying sleep)
• Irritability (which may or may not be observable to others)
• Increased muscle aches or soreness
• Difficulty sleeping (due to trouble falling asleep or staying asleep, restlessness at night,
or unsatisfying sleep)
• Excessive worry means worrying even when there is no specific threat present or in a
manner that is disproportionate to the actual risk
• Someone struggling with GAD experiences a high percentage of their waking hours
worrying about something
• The worry may be accompanied by reassurance-seeking from others
• In adults, the worry can be about job responsibilities or performance, one’s own health or the health of
family members, financial matters, and other everyday, typical life circumstances
• In children, the worry is more likely to be about their abilities or the quality of their performance (for
example, in school)
• Many people with GAD also experience symptoms such as sweating, nausea, or diarrhea
• The anxiety, worry, and other associated symptoms make it hard to carry out day-to-day activities and
responsibilities
• They may cause problems in relationships, at work, or in other important areas of life
• In order to give a diagnosis of GAD, these symptoms also must be unrelated to any other medical
conditions and cannot be explained by a different mental disorder or by the effect of substance use,
including prescription medication, alcohol, or recreational drugs
 Treatment
• Treatments for the two conditions are similar and often involve the use of
psychotherapy and medications
• Cognitive Behavioral Therapy (CBT) and Selective Serotonin Reuptake
Inhibitors (SSRIs) can be effective, particularly when they are utilized
together
• While the treatments are similar, anxiety may respond better to cognitive
restructuring while OCD is better treated using exposure and response
prevention
 Treatment
• The treatments for GAD and OCD overlap as well, although there are also some important differences
• Both conditions respond well to cognitive behavioral therapy (CBT)
• CBT is a type of therapy that involves learning to identify and change the automatic negative thoughts
that contribute to symptoms
• The specific CBT techniques used to treat OCD may differ from those used to treat GAD, however.
For example:
Cognitive restructuring:
• People with GAD may benefit from a technique known as cognitive restructuring, where people learn
to identify thoughts that produce anxiety, challenge these thoughts, and develop a new perspective
 Exposure and response prevention
• For OCD, a focused type of cognitive behavioral treatment called
exposure and response prevention has been shown to work best
• This approach utilizes aspects of exposure therapy to gradually expose
people with OCD to the things that provoke their fears and anxieties
• Over time, the fear response lessens
 Medications
• Many medications are helpful for both OCD and GAD
• Selective serotonin reuptake inhibitors (SSRIs) and serotonin and
norepinephrine reuptake inhibitors (SNRIs) are often the first choice for
treating both OCD and GAD
• They are often most effective when they are utilized in conjunction with
CBT
Medications for GAD:
• E.g. Paxil (paroxetine) the treatment of generalized anxiety disorder (GAD), although
others may also be prescribed as well
Medications for OCD:
• E.g. Anafranil (clomipramine), Prozac (fluoxetine), Luvox (fluvoxamine), Paxil
(paroxetine), and Zoloft (sertraline) are approved to treat OCD
• While the treatments for the two conditions often include the use of SSRIs, research
suggests that OCD may take longer to respond to these medications than anxiety
disorders
Coping with generalized anxiety disorder

Social Coping Strategies

• For some people, social coping strategies can help manage symptoms, overcome fear, and even improve
social life for an overall better quality of life.
Effective options include the following:
• Get Involved
• When we feel anxious it is common to want to pull away from others and disconnect.
• This leads us to feeling removed from others, our family, and our community.
• Finding events to participate in can help foster a sense of belonging and allow us to feel purposeful.
• Not only are we keeping our bodies busy, but our minds as well.
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