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Introduction to Psychological Disorders

Psychological disorders, frequently called psychiatric disorders or mental disorders are a range of various conditions that impact a person’s behaviour, mood, emotion, perception, or thinking (Malla et al., 2015). These are characterized by varied psychological symptoms that influence numerous areas of a person’s life and can create distress for the person who has this condition. There are many psychological disorders as described in the DSM (Diagnostic and Statistical Manual of Mental Disorders), the latest edition of which is the DSM-5 which was released in May 2013 (Cherry, 2020). The various types of psychological orders include neurodevelopmental disorders, bipolar disorders, anxiety disorders, stress-related disorders, dissociative disorders, somatic symptom disorders, eating disorders, sleep disorders, disruptive disorders, depressive disorders, substance-related disorders, schizophrenia, obsessive-compulsive disorder, and personality disorders. The purpose of this paper is to discuss anxiety disorder which is a mental condition that causes persistent and excessive anxiety, worry, and fear in the patient. There are many different types of anxiety disorders that include Generalized Anxiety Disorder, agoraphobia, social anxiety disorder, specific phobias, separation anxiety disorder, and panic disorder. The paper will explore the symptoms and diagnosis of the disorder along with its DSM 5 diagnostic criteria. Additionally, the paper will include the treatment options of the anxiety disorder including pharmacological and psychotherapy treatments. Finally, there is a summary of a peer-reviewed journal article on anxiety disorders in cancer patients along with a discussion about how it relates to the selected diagnosis.

Anxiety disorder is a mental health condition characterized by persistent fear and dread of certain situations or events (Leigh & Clark, 2018). It is normal for humans to be anxious about some situations like a job interview or while taking an important decision or when in danger and may even be beneficial. However, when it goes beyond regular nervousness and the occasional feeling of fear, it might be considered an anxiety disorder. Conditions that are associated with an anxiety disorder include: (1) anxiety interferes with a person’s ability to function; (2) the person overreacts when their emotions are triggered; (3) the person cannot control their responses to situations.

People who have personality traits like shyness and those who feel uncomfortable in unfamiliar settings and with unknown people are at a higher risk of developing an anxiety disorder. Moreover, people who have experienced a traumatic or stressful event and those who have a family history of mental health conditions might also be potential risk factors (Parekh, 2017). The disorder can also be developed in people with certain health conditions like thyroid or heart arrhythmias. It is also caused by environmental factors and chemical imbalance (stress over a long time).

The symptoms of anxiety disorder vary based on the type of the disorder (GAD, phobias, panic disorder, or separation anxiety) a person has, but the common symptoms can be classified into 3 types: physical, mental, and behavioural. Physical symptoms include muscle tension, sweaty or cold palms, dry mouth, nausea, heart palpitations, shortness of breath, and tingling or numbness in hands or feet (Munir & Takov, 2019). Mental symptoms include nightmares, feeling of fear, uneasiness, or panic, repeated thoughts of traumatic events, and obsessive, uncontrollable thoughts. Behavioural symptoms include trouble in sleeping, inability to be calm, and ritualistic behaviours (e.g., repeatedly washing hands).

What is Anxiety Disorder?

Specific criteria to assist professionals in diagnosing generalized anxiety disorder has been outlined in the DSM-5. This criterion sets certain standards against which it becomes easy for the professional to accurately diagnose any mental health concerns in clients and initiate an effective treatment plan for managing the condition. This criterion for GAD involves the following (Substance Abuse and Mental Health Services Administration, 2016):

  • Experiencing excessive and uncontrollable worry and anxiety about numerous events for more days than not for a minimum of 6 months.
  • The anxiety is associated with 3 or more of the following symptoms (only 1 required for children):
  1. Restlessness or a feeling of being on edge
  2. Easy fatigue
  3. Difficulty in concentration/mind goes blank
  4. Irritability
  5. Muscle tension
  6. Disturbance in sleep
  • The disturbance is not attributable to some other mental disorder or to the physiological effects of substance abuse or some other medical condition.
  • Anxiety is not confined to Axis I disorder, for instance, the anxiety of panic attack (panic disorder) or anxiety of being contaminated (obsessive-compulsive disorder).

 Figure 1

Figure 1 

Source: (Glasofer, 2021)

Timely diagnosis of anxiety disorder is necessary to ensure early interventions to manage and control the condition. Anxiety can be effectively managed through learning about anxiety, relaxation techniques, mindfulness, counselling, behaviour therapy, exercise, breathing techniques, medications, building self-esteem, support groups, learning to be assertive, and cognitive therapy. It can be treated with pharmacological treatments, psychotherapies, or a combination of both.

Over the past century, the pharmacological treatment options for anxiety have increased and become more accessible. These options include antidepressants such as serotonin-norepinephrine reuptake inhibitors (SNRIs) and Selective serotonin reuptake inhibitors (SSRIs). These medications are considered the first-line treatment of anxiety disorder. However, SSRIs are believed to have some side effects including headache, diarrhoea, insomnia, jitteriness, nausea, and restlessness (Marazziti et al., 2018). Anxiety patients are more susceptible to jitteriness because of these agents. To minimize these effects, a low dose is prescribed at the start and then it is increased gradually over 3-4 weeks. Non-response to treatment can occur due to poor adherence, treatment resistance, and insufficient dose or duration (Batelaan et al., 2017).

Additionally, TCAs have also shown similar efficacy as SSRIs or the treatment of GAD and panic disorder. Nonetheless, TCA overdose can be lethal and they have broader and less tolerable side effects in comparison to SSRIs. These side effects include blurred vision, urinary retention, dry mouth, tachycardia, postural hypotension, headache, and dizziness.

Medications like azapirones like buspirone, antihistamines like hydroxyzine, mixed antidepressants like mirtazapine, antipsychotics, GABAergic medicines like pregabalin, benzodiazepines, and gabapentin, and alpha and beta-adrenergic medicines like propranolol and clonidine are also used for treating anxiety disorders (Garakani et al., 2020).

Cognitive behavioural therapy is a widely used therapy for the treatment of anxiety disorders. It has been shown to be effective in treating social anxiety disorder, panic disorder, GAD, and phobias. CBT is used to address the distortions and negative patterns in the way patients of anxiety disorder look at the world. It has two main elements: (1) cognitive therapy that is used to examine how cognitions or negative thoughts contribute to anxiety; and (2) behaviour therapy that is used to examine how patients behave or react in situations that trigger their anxiety (Lener, 2021).

In CBT, negative thought patterns that are contributing to anxiety are challenged and replaced with more realistic and positive thoughts (Kaczkurkin & Foa, 2015). This is done through a process of 3 steps that include first identifying the negative thoughts, then challenging those thoughts by questioning the evidence or rationale behind them, and then finally replacing these negative thoughts with rational, realistic, and positive thoughts. CBT also includes learning to realize when one’s anxious, learning how to cope with anxiety (through relaxation or breathing techniques), and confronting real-life or imaginary fears.

Causes and Risk Factors for Anxiety Disorders

Additionally, there is exposure therapy that exposes the patient to the situation or things that are causing fear. This is done by first exposing to mildly threatening situations and gradually increasing the degree. The rationale behind this is that repeated exposures will ultimately help the patient to gain control over the situation and be less scared of it (Benbow & Anderson, 2019).

The selected peer-reviewed journal article for this section is “The Generalized Anxiety Disorder Screener (GAD-7) and the anxiety module of the Hospital and Depression Scale (HADS-A) as screening tools for generalized anxiety disorder among cancer patients by (Esser et al., 2018).

In this article, research was conducted on 2141 cancer patients to diagnose their GAD. For investigating diagnostic accuracy, GAD Screener (GAD-7) and Hospital Anxiety and Depression Scale module (HADS-A) was used. The article establishes that it is understandable for cancer patients to be stressed and have anxiety about their physical condition. But in some patients, the anxiety rises to levels higher than normal, in which case the patient may be diagnosed with an anxiety disorder. Anxiety disorders in patients with ongoing chronic medical conditions such as cancer can lead to an increased burden of symptoms, poorer treatment adherence, and poorer health outcomes.

Many cancer patients with anxiety disorders remain undetected but screening can improve referrals to psychological or psychiatric care leading to positive health outcomes. The risk of GAD increases when a person deals with a serious life stressor like cancer and the symptoms of GAD such as extensive worrying about the future is deteriorated by more realistic fears of the development and reappearance of the disease. The authors of the article cite the work of (Andersen et al., 2014) to propose that there is a need to screen cancer patients for GAD because of its comorbidity and high prevalence with other disorders.

Moreover, in the screening of anxiety disorders, a score equal to or less than 8 signifies a reasonable cut-off score to identify potential cases of GAD. The authors in the article suggest that to identify GAD in oncological settings through HADS, the cut-offs should be lowered. They conclude that HADS-A and GAD-7 are suitable for the screening of GAD in cancer patients, however, there is a need to revise the cut-off score to ensure that the maximum number of patients with a need for psychological interventions are detected.  

As per the DSM-5 criterion, a life-threatening illness or medical condition is not a traumatic event unless sudden catastrophic events are involved. Hence, this criterion excludes the diagnosis of PTSD in cancer patients but establishes that if a person is experiencing persistent and heightened stress reactions, alternative diagnosis for anxiety disorders might be considered based on the symptoms’ duration and profile (Kangas, 2013). The DSM-5 also proposes that if a cancer patient is eliciting symptoms like distressing dreams and future-oriented fear, then they might be assessed for anxiety disorder. With the inclusion of anxiety disorder in Trauma and Stress-Related Disorders, the psycho-oncology field should consider anxiety disorder’s utility in the screening of clinical stress in patients of cancer. The DSM-5 specifies that anxiety disorders usually accompany chronic medical illness and is perhaps the major psychological response to a medical condition (American Psychiatric Association, 2013, p. 289).

Symptoms and Diagnosis of Anxiety Disorder

Conclusion

To conclude, anxiety disorder is a mental health disorder characterized by a feeling of persistent fear and worry. It interferes with a person’s normal functioning and the person loses control over his/her emotional reactions. Certain behavioural, environmental, hereditary, and chemical factors can increase a person’s risk of developing the disorder.

The disorder is accompanied by various physical, mental, and behavioural symptoms. The DSM-5 criterion establishes some standards for accurate diagnosis of the disorder. These standards include excessive and uncontrollable worry and fear for more than 6 months, 3 or more listed symptoms (restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbances), disturbances cannot be attributed to some other mental disorder or to substance abuse. The treatment options for anxiety disorder include various pharmacological treatments like SSRIs, SNRIs, TCA, buspirone, GABAergic medicines, etc. and psychotherapy treatments like CBT and exposure therapy.

Furthermore, the above paper discussed a journal article on the diagnosis of anxiety disorder in cancer patients. It was established that it is understandable of people with chronic and life-threatening illnesses to develop symptoms of various stress and anxiety disorders. It is important to screen cancer patients (showing stress and anxiety symptoms) for GAD. This will help to initiate necessary psychological interventions in their treatment and will lead to better health outcomes. The authors of the chosen article proposed that HADS-A and GAD-7 models are appropriate for GAD screening in an oncological setting, however, the cut-off scores need to be revised. The DSM-5 criterion also stipulates that life-threatening conditions (though cannot be related to PTSD) can be diagnosed for anxiety disorders if the patient is feeling persistent future-oriented worry and fear for his health.  

References

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed., p. 289). American Psychiatric Association.

Andersen, B. L., DeRubeis, R. J., Berman, B. S., Gruman, J., Champion, V. L., Massie, M. J., Holland, J. C., Partridge, A. H., Bak, K., Somerfield, M. R., & Rowland, J. H. (2014). Screening, Assessment, and Care of Anxiety and Depressive Symptoms in Adults With Cancer: An American Society of Clinical Oncology Guideline Adaptation. Journal of Clinical Oncology, 32(15), 1605–1619.

https://doi.org/10.1200/jco.2013.52.4611

Batelaan, N. M., Bosman, R. C., Muntingh, A., Scholten, W. D., Huijbregts, K. M., & van Balkom, A. J. L. M. (2017). Risk of relapse after antidepressant discontinuation in anxiety disorders, obsessive-compulsive disorder, and post-traumatic stress disorder: systematic review and meta-analysis of relapse prevention trials. BMJ, 358, j3927. https://doi.org/10.1136/bmj.j3927

Benbow, A. A., & Anderson, P. L. (2019). A meta-analytic examination of attrition in virtual reality exposure therapy for anxiety disorders. Journal of Anxiety Disorders, 61, 18–26. https://doi.org/10.1016/j.janxdis.2018.06.006

Cherry, K. (2020, March 19). A List of Psychological Disorders. Verywell Mind; Verywellmind. https://www.verywellmind.com/a-list-of-psychological-disorders-2794776

Esser, P., Hartung, T. J., Friedrich, M., Johansen, C., Wittchen, H.-U., Faller, H., Koch, U., Härter, M., Keller, M., Schulz, H., Wegscheider, K., Weis, J., & Mehnert, A. (2018). The Generalized Anxiety Disorder Screener (GAD-7) and the anxiety module of the Hospital and Depression Scale (HADS-A) as screening tools for generalized anxiety disorder among cancer patients. Psycho-Oncology, 27(6), 1509–1516. https://doi.org/10.1002/pon.4681

Garakani, A., Murrough, J. W., Freire, R. C., Thom, R. P., Larkin, K., Buono, F. D., & Iosifescu, D. V. (2020). Pharmacotherapy of Anxiety Disorders: Current and Emerging Treatment Options. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.595584

Glasofer, D. (2021, February 15). Generalized anxiety disorder: Symptoms and diagnosis. Verywell Mind; Verywellmind.

https://www.verywellmind.com/dsm-5-criteria-for-generalized-anxiety-disorder-1393147

Kaczkurkin, A., & Foa, E. (2015). Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence. Anxiety, 17(3), 337–346.

https://doi.org/10.31887/dcns.2015.17.3/akaczkurkin

Kangas, M. (2013). DSM-5 Trauma and Stress-Related Disorders: Implications for Screening for Cancer-Related Stress. Frontiers in Psychiatry, 4. https://doi.org/10.3389/fpsyt.2013.00122

Leigh, E., & Clark, D. M. (2018). Understanding Social Anxiety Disorder in Adolescents and Improving Treatment Outcomes: Applying the Cognitive Model of Clark and Wells (1995). Clinical Child and Family Psychology Review, 21(3), 388–414.

https://doi.org/10.1007/s10567-018-0258-5

Lener, M. S. (2021, September 20). How Cognitive Behavioral Therapy Can Treat Your Anxiety. Healthline.

https://www.healthline.com/health/anxiety/cbt-for-anxiety

Malla, A., Joober, R., & Garcia, A. (2015). “Mental illness is like any other medical illness”: a critical examination of the statement and its impact on patient care and society. Journal of Psychiatry & Neuroscience, 40(3), 147–150. https://doi.org/10.1503/jpn.150099

Marazziti, D., Mucci, F., & Fontenelle, L. F. (2018). Immune system and obsessive-compulsive disorder. Psychoneuroendocrinology, 93, 39–44. https://doi.org/10.1016/j.psyneuen.2018.04.013

Munir, S., & Takov, V. (2019, February 4). Anxiety, Generalized Anxiety Disorder (GAD). Nih.gov; StatPearls Publishing.

https://www.ncbi.nlm.nih.gov/books/NBK441870/

Parekh, R. (2017). What Are Anxiety Disorders? Psychiatry.org. https://www.psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders

Substance Abuse and Mental Health Services Administration. (2016, June). Table 3.15, DSM-IV to DSM-5 Generalized Anxiety Disorder Comparison. Nih.gov; Substance Abuse and Mental Health Services Administration (US).

https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t15/

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