GAD updated as per DSM-V and ICD-11

1. Generalized Anxiety Disorder
Prof. Dr.S.Balachandar. PhD
Vice Principal
SCPM College of nursing and
paramedical science

2. NEUROTIC DISORDERS
6B00-6B0Z Anxiety or fear-related disorders
6B20-6B2Z Obsessive-compulsive or related disorders
6B40-6B4Z Disorders specifically associated with stress
6B60-6B6Z Dissociative disorders

3. Anxiety or fear-related disorders
6B00 Generalized anxiety disorder
6B01 Panic disorder
6B02 Agoraphobia
6B03 Specific phobia
6B04 Social anxiety disorder
6B05 Separation anxiety disorder
6B06 Selective mutism
6B0Y Other specified anxiety or fear-related disorders
6B0Z Anxiety or fear-related disorders, unspecified

4. What is GAD?
Generalized anxiety disorder (or GAD) is characterized by
excessive anxiety and worry about everyday life events with out
reasons.

5. Prevalence of generalized anxiety disorder
 Prevalence for the disorder ranges from 0.4% to 3.6%.
 Females are twice risk than males about 55%–60% case
are female.
 High in middle age and reduce in later years of life.

6. symptoms of anxiety
PHYSICAL SYMPTOMS
GASTROINTESTINAL
 Dry mouth
 Difficulty in swallowing
 Nausea and vomiting
 Loose motion
 Abdominal discomfort
RESPIRATORY
 Dyspnea
 Hyperventilation
CARDIOVASCULAR
 Palpitation
 Chest discomfort
 Tachycardia
GENITOURINARY
 Polyuria
 Amenorrhea
NEUROMUSCULAR
 Tremor
 Dizziness
 Headache
 Muscle ache
 Restless
 Sleep disturbance
 Sweating

7. symptoms of anxiety
PSYCHIC SYMPTOMS
 Poor concentration
 Distractibility
 Fearfulness
 Inability to relax
 Irritability
 Sadness
 Depersonalization
 Derealization

8. DSM 5 Criteria for GAD
A. Excessive anxiety and worry for at least 6 months
B. The individual finds it difficult to control the worry.
C. The anxiety and worry are associated with three (or
more) of the following symptoms
1. Restlessness or feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance

9. DSM 5 Criteria for GAD
D. It cause impairment in social, occupational, or
other important areas of functioning.
E. Not due to substance or another medical condition
F. The disturbance is not better explained by another
mental disorder (e.g., panic disorder, social phobia,
OCD, separation anxiety disorder, PTSD, Anorexia
nervosa etc.,)

10. Causes of GAD
The exact cause of GAD is not known,
Genetics:
1/3 of the risk genetic. Risk among family members
Brain chemistry:
• Overactivity in areas of the brain involved in emotions and
behavior
• Imbalance in serotonin and Noradrenaline.
Environmental factors:
Parental overprotection, Trauma and stressful events,
such as abuse, the death of a loved one, divorce, changing
jobs or schools

11. TreatMENT
Medication:
Anti-Anxiety drugs:
 It can help to reduce the symptoms of anxiety, panic attacks, or
extreme fear and worry.
 The most common anti-anxiety medications are called
benzodiazepines include Xanax, Librium, Valium and Ativan
Antidepressants: Escitalopram and paroxetine (SSRIs) for people
with GAD
Therapies:
 Psychotherapy
 Psychoanalysis
 Cognitive-behavioral therapy
 Mindfulness therapy

12. Prevention of GAD
Stop or reduce your consumption of coffee, tea, cola
and chocolate.
Exercise daily and eat a healthy, balanced diet.
Seek counseling and support after a traumatic
experience.
Stress management
Yoga
Meditation
Deep breathing
Dance, music therapy
Guided imagery techniques
Vigorous exercise (Treadmill for 30 mins in high speed)
Stop smoking and drinking alcohol

13. Common Nursing Diagnoses and Interventions
 ANXIETY
 Maintain a calm, nonthreatening manner
 Reassure client of his or her safety and security
 Do not leave client alone at this time
 Use simple words and brief messages, spoken calmly
and clearly
 Keep immediate surroundings low in stimuli (dim
lighting, few people, simple decor)
 Encourage client to talk about traumatic experience
 Administer Anti-anxiety medication, as ordered by
physician

14.  FEAR
• Reassure client of his or her safety and security
• Discuss reality of the situation with client
• Include client in making decisions related to selection of
alternative coping strategies
• Encourage client to explore underlying feelings
 INEFFECTIVE COPING
 POWERLESSNESS
 SOCIAL ISOLATION
 SELF-CARE DEFICIT