CC (chief complaint): The patient is suffering from recurring anxiety attacks whenever she has to leave her house, which is why she has been largely unable to perform basic tasks, as well as communicate with her family members: “I just can’t go any further.”
HPI:
Past Psychiatric History:
General Statement: N/A
Caregivers (if applicable): N/A
Hospitalizations: N/A
Medication trials: N/A
Psychotherapy or Previous Psychiatric Diagnosis: N/A
Substance Current Use and History: the patient does not use any substances
Family Psychiatric/Substance Use History: the patient does not have any family psychiatric/substance use history
Psychosocial History: the patient confirms having had issues communicating with others recently due to the fear of leaving the house
Assessment: Mental Status Examination: The brief assessment of the patient’ mental status based on the information that she has supplied indicates that she is experiencing significant distress. There are obvious indications of anxiety present in the evidence that she provides, including both the statements that she makes and the manner in which she speaks. Namely, her being out of breath is representative of anxiety; moreover, the facts that she presents about herself point to the presence of a mental health concern (Simning et al., 2019). Specifically, the fact that she cannot walk long distances due to the presence of obvious fear signifies that she is suffering from anxiety and the associated mental health concerns.
Differential Diagnoses: General Anxiety Disorder (GAD): In the DSM-V, GAD is defined as the condition involving excessive fear, the presence of a continuous sense of anxiety, and the relevant mental health issues (American Psychiatric Association, 2014).
Agoraphobia: According to the DSM-V description, agoraphobia can be described as the fear of open space, which is definitely an issue in Mrs. Weidre’s case.
PTSD: The patient may be suffering from long-term PTSD as a result of her history of relationships with her verbally abusive mother. However, while clearly having served as an important contributor to the current state, the patient’s PTSD is unlikely to be the main reason for her to fear to leave the house.
Reflections: The case under analysis has provided substantial information for further reflection. Specifically, it has demonstrated the necessity of the consistent and continuous dialogue between community members, and, by extension, communication, in general. Namely, the provided scenario allows examining the nature of anxiety, particularly, its sociocultural and biologic prerequisites. Specifically, the case proves the utter necessity of the active dialogue not only on an interpersonal level, but also on that one of the community (Wong et al., 2020). Though Mrs. Weidre has been communicating with her husband, she has still acquired the disorder, which le to0 her further alienation from her community. Thus, to reintegrate into it, she will have to focus on overcoming the fear of leaving her house and integrate back into her sociocultural environment.
Furthermore, the case at hand introduces the necessity for aging patients to receive appropriate care and support, including the one required for maintaining proper mental health. In the case under analysis, the patient’s PTSD caused by childhood trauma has caused her to develop agoraphobia and, as a result, GAD. Therefore, to ensure that mental health issues are managed carefully and thoroughly, patient education coupled with active support for the further prevention of mental health issues in aging adults is required.
References
American Psychiatric Association. (2014). The diagnostic and statistical manual of mental disorders (5th ed.). APA.
The paper seeks to determine whether there is a relationship between gender, age and level of education in patient anxiety from MRI scans. This is however done by conducting interviews on patients at King Abdul Aziz Medical City in Riyadh. The main causes of anxiety were seen to be the physical surrounding of the examination room, curiosity, beliefs, and the idea of having their brains scanned.
However, with communication, a little distraction and reassurance of their safety, the patients relaxed. Despite being among the major innovation made in the medical sector, people have still come to terms with the idea of how the procedure works. However, it is through the provision of adequate information that people are more informed, and understand the details of the MRI scanning.
Statement of problem
A study to assess the relationship between gender, age and level of education in patients undergoing Magnetic Resonance Imaging in King Abdul Aziz Medical City in Riyadh.
Introduction
Magnetic resonance imaging (MRI) is an imaging technique used by medical specialists to scan interior body organs and tissues. It is a diagnostic tool that screens the body by using radio waves and magnetic fields, transferring the images to a computer for thorough screening.
This is currently the best diagnostic technique offered in medical institutions as it offers more detailed results, and better imaging compared to other methods. Unlike other methods, there is no exposure to x-rays, making the method even safer.
During the examination, the patient usually lies on a table that is slide in a cylindrical container where the diagnoses are performed. Due to the nature of the procedure, the patient can stay in the cylinder for up to an hour depending on the criticality of the examination. In order to receive quality imaging from the scanner, the patient is usually expected to stay calm so as to allow critical imaging.
As calming as the environment may be, the MRI scanner normally produces disturbing noises such as clicks, loud bangs and knock, which most of the times scares patients (Shannon, 2002). It is for this reason that most patients develop anxiety from MRI scan.
However, studies have shown that music can be used to distract patient from the disturbing noises produced by the scanner, calming them down throughout the procedure. A technique that was first invented for mentally challenged individuals is now a solution to a problem that faces most patients (Stephens, Pait & Sheehan, 2003).
Literature review
Advancement in technology both in diagnosis and treatment has proved to manage diseases effectively. The Magnetic Resonance Imaging is among the most important medical innovations made over the century.
The MRI scanner was developed by Mr. Raymond Vahan Damadian, the founder of FONAR Co-operation. This technology has proven to be critically useful in cardiovascular, musculoskeletal, neurological (brain), and oncology imaging.
A number of researches revealed individuals are fearful of the equipment in relation to the loud acoustic noise delivered during imaging creating difficulties in communication. There have also been a range of complaints relating to a lack of information regarding the duration of the scanning and the temperature within the scan.
Patients also anticipate pain, discomfort, loss of sense of control and anxiety related symptoms of panic experiences while being scanned.
MRI can be problematic psychologically; respiration and swallowing may be increased in apprehensive patients, and motion artefacts arising from such increased movement result in images of no diagnostic value (Stern, 2010). Severe anxiety would result in cancellation of the procedure rescheduling that would increase costs and delaying evaluation (Morris & Liberman, 2005).
Studies have shown that 25% of the normal population entails patients that suffer moderate and severe anxiety while undergoing MRI scans (Stern, 2010). For this, MRI scanning has been looked at various perspectives, trying to figure out the best way to handle patients without agitating them. By looking at the scanning environment, it is clear why most patients are never at ease.
To begin with, one is slide in a container where there is only one outlet. This is usually scary to patients as some of them get frightened picturing a situation whereby the only opening is blocked, and one is locked in the chamber.
The temperature of the chamber is usually well moderated and oxygenated in order to make the patient feel as comfortable as possible. However, some say that this is what scares them because they cannot imagine the system failing and getting suffocated in the chamber.
The other thing is to examine the psychology of the patient before, and after the scan. With everyone saying how horrible it is to be in the scanning chamber, first timers are usually frightened of the experience. The best way is to take them through the process explaining the details of the procedure, ensuring that they understand that their safety is your concern.
This way, they are relaxed, making the procedure a success. To enhance this, some institutions have tried using attractive stencils and calming colors in the waiting and scanning room so as to calm down patients. Calming music has also proven to be relaxing and helps in avoiding triggering anxieties (Zlatkin, 2003).
Children, pregnant women and mentally challenged people are usually considered exceptions, and can be medicated in order to ensure that they stay calm throughout the examination.
There is the Neuro-Linguistic Programming (NLP), an approach that is meant to assure the patient that their safety is highly considered. It is basically all about communication but with a four-principled formula.
Building a rapport with the patient is extremely vital and can be developed by positively empowering them on the procedure, but at the same time distracting them with other experiences that may take their mind off the subject. With people having different ways of processing information, there are various approaches that can be used to ease them up.
For example, there are those that need calming music, some a certain aromas and others a friend to accompany them in the examining room. However, there are those that prefer staying alert throughout the process experiencing the usual noises, which assures them that the machines are working properly.
With the high number of patients suffering from anxiety during MRI scans, it has become habitual for everyone else to be frightened of these procedures. For this, the use of testimonials from people who have successfully undergone the process without any hitches may be helpful in calming their nerves.
Professionalism from the staff also goes a long way in ensuring that one is calm as the key to this is to gain patient’s trust and making them feel comfortable (Guzzetta, 1998).
It has been proven that MRI scan poses no risk to anyone; in fact, it is considered the safest diagnostic technique. The procedure is painless and apart from the fact that it doesn’t involve x-rays, the positioning of the patient during the examination is usually made comfortable (Fatemi & Clayton, 2008).
Due to the magnetic energy used in the procedure, one is expected to remove any jewellery, and metals than could be pulled towards the scanner. For this, the procedure is unsuitable for people who have metal implants. For instance, the procedure is never safe for someone with a heart pacemaker.
In order to avoid situations that patients are injured because of insufficient information on how the MRI scan works, there is the need to determine the association of MRI scan anxiety and;
Level of knowledge
Gender
Age
Methodology
A randomized prospective study was conducted among patients who underwent the MRI scan, out of 106 patients 55 patients received oral instruction and 51 patients received information pamphlet. Anxiety was measured just before colonoscopy by using STAI scale.
Out of the 106 participants 40 patients were men while women covered the rest of the populace. 90 percent of women and 30 percent of men participants suffered anxiety from the MRI scan. The age groups of the patients were; <20, 20-30 years, 31-50, and 51-70. 50 percent and 30 percent of patients who suffered anxiety were from the <20 and 20-30 years age groups consecutively.
In terms of the level of education, 67 percent of the patients were high school graduates, 21 percent were still in school and the remaining 11 percent had more than a college degree.
The younger patients were seen to be anxious due to their greenness in medical institution, which contributed to their anxiety. Also, the more the educated the patients were the less they suffered from anxiety; therefore, it was obvious that the level of education contributed in the reduction of the anxiety.
While the female were seen to hold the highest number of those that suffered anxiety, this can be explained by the nature of women whereby their emotions are easily triggered compared to those of men. The study revealed that the information pamphlet was more effective in reducing anxiety than the oral information.
To sum up, the anxiety experienced by patients from the MRI scan was evidently based on gender, age and level of education.
Data Collection Method
After obtaining administrative permission, the samples will be identified as per inclusion and exclusion criteria using purposive sampling technique. The samples will be randomly allocated into the experimental group by lot method. Initial rapport will be established, the purpose of the study will be explained to the subjects, and informed consent will be obtained.
The demographic data will be collected and knowledge and anxiety will be assessed by using standard questionnaire and STAI anxiety scale. The knowledge and pre procedural anxiety levels will be assessed by the investigator just before shifting the patient for Magnetic resonance imaging.
Findings
After the assessment of the results from the interview, it was evident that patients suffered anxiety from the MRI scan. Though the number of patients who suffered anxiety varied based on gender, age, and level of education, it clearly showed that the majority of the patients suffered moderate anxiety. As indicated on the analysis table, the study proved that patients were afraid of the procedure, which contributed to their anxiety.
Magnetic resonance imaging is a (MRI) is a non-invasive diagnostic procedure; it is considered painless, but between 25% and 37% of patients undergoing MRI experience moderate to high levels of anxiety and 1.5% to 6.5% terminate their scan prematurely.
Besides patient discomfort it is known that patients who experience anxiety move more during scanning than do calm patients, and this may have an effect on image quality (Dougherty, Rauch & Rosenbaum, 2004).
A study was done to assess the subjective experiences of patients undergoing MRI, using a questionnaire before and after imaging. Patients who experienced problems like fear, discontinuation of procedure during MRI had pre-imaging anxiety level similar to that of pre operative anxiety (Tasman et al., 2011).
Basically, lack of enough information, discouraging beliefs, and the screening environment develops the relentless to pre mature scanning. With the study completed, it is obvious that patient anxiety of MRI scan is not associated in any way with age, gender or level of education. However, the level of education may matter in terms of the information one has on the examination.
Our study reviewed, out of 40 patients undergoing MRI 95% of the patients completed the procedure and 37% reported moderate to severe anxiety (Burghart & Finn, 2011). People are never patient with the procedure, and for this, they decline further screening before complete examinations. Hospital setting itself makes the person anxious (Dougherty, Rauch & Rosenbaum, 2004).
Discussions
Having identified that patient anxiety from MRI scan is a problem that people in Riyadh are faced, implementation of strategic plans to control this is the way to go.
However, patient anxiety from MRI scans is not an issue that is based on gender, age or level of education, but with awareness. For this, the level of education may seem to weigh a little, but the fact that anyone can be informed of the details of the procedure makes the level not an exception.
As seen, curiosity and beliefs are the major cause that triggers these anxieties because of being misinformed. Therefore, by giving people the right information, there is the possibility of turning around the situation, making better perceptions of the procedure.
Even though the study showed that most of the women seemed to be the victims of the MRI scan anxiety, it does not mean that gender is factor that defines the outcome of the procedure; it only happens that women tend to be nervous than men not just in this procedure, but also in other ventures.
Also, when it comes to age, it can be tricky is the patient is an infant or just a baby that is incontrollable. In this case, there is special medication used to help them relax, and stay calm throughout the screening so as to get quality results.
To sum up, anxieties associated in MRI scans are in no way linked to age, gender or level of education; it is the psychology of the patient, and the environment on which the procedure is performed that controls the feelings and outcome of the results.
Conclusion and Recommendation
Having identified the factors that facilitate MRI scan anxiety, coming up with solution to curb this problem is not difficult. As seen, it would be nicer, and a whole lot comfortable if the MRI scanner is placed in the center of a room, and has an exit that assure the patient that they can be removed if anything goes wrong.
Also, lying for up to an hour can be agitating, and therefore, the machines should be made to accommodate other positions such as sitting, and standing. With positions such as sitting, patients can be distracted by exciting visual contents such as movies, or television. It is all about patient psychology and control of the surrounding, making it pleasant.
References
Burghart, G., & Finn, C. A. (2011). Handbook of MRI scanning. St. Louis, Mo: Mosby.
Dougherty, D. D., Rauch, S. L., & Rosenbaum, J. F. (2004). Essentials of neuroimaging for clinical practice. Washington, DC: American Psychiatric Pub.
Fatemi, S. H., & Clayton, P. J. (2008). The medical basis of psychiatry. Totowa, NJ: Humana Press.
Guzzetta, C. E. (1998). Essential readings in holistic nursing. Gaithersburg, Md: Aspen Publishers.
Morris, E., & Liberman, L. (2005). Breast MRI: Diagnosis and intervention. New York: Springer.
Shannon, S. M. (2002). Handbook of complementary and alternative therapies in mental health. San Diego: Academic Press.
Stephens, J. T., Pait, T. G., & Sheehan, J. (2003). Golf forever: The spine and more : a health guide to playing the game. Las Vegas, Nev: Stephens Press.
Stern, T. A. (2010). Massachusetts General Hospital handbook of general hospital psychiatry. Philadelphia: Saunders/Elsevier.
Tasman, A., Kay,. J., Lieberman, J. A., First, M. B., & Maj, M. (2011). Psychiatry. Hoboken: John Wiley & Sons.
Zlatkin, M. B. (2003). MRI of the shoulder. Philadelphia: Lippincott Williams & Wilkins.
Appendix
Table 1: Age.
Suffered anxiety
Did not suffer anxiety
Total
<20 years
35
7
42
20-30 years
21
15
36
31-50 years
9
9
18
51-70 years
5
5
10
Total
70
36
106
Chi-square = 9.77; df = 8, p = 0.2815, Cramer’s V = 0.1073
Table 2: Gender.
Suffered anxiety
Did not suffer anxiety
Total
Men
12
28
40
Women
56
10
66
Total
68
38
106
Chi-square = 32.58; df = 4, p = <.0001, Cramer’s V = 0.196
Table 3: Level of education.
Suffered anxiety
Did not suffer anxiety
Total
Students
50
21
71
High school graduates
12
10
22
Colleges and University graduates
5
8
13
Total
67
39
106
Chi-square = 5.72; df = 6, p = 0.4553, Cramer’s V = 0.0821
Anxiety disorders are characterized by excessive and persistent fear and anxiety. Anxiety disorders are common in the United States affecting between 25% to 30% of the adult population (Ciccarelli & White, 2021). According to DSM-5, anxiety disorders include specific phobia, social anxiety disorder, panic disorder, and general anxiety disorder (Ciccarelli & White, 2021). This discussion post will expound more on specific phobias. Specific phobia describes the fear of a specific object, item, or animal. It could include the fear of heights, insects, enclosed spaces, dogs, and snakes, among many others. Despite a realization that their phobia is irrational, people with a specific phobia go to great lengths to avoid their phobia stimulus. Specific phobias are common in the US because at least twelve percent of the adult population meets the criteria for a specific phobia at some point in their lives.
Specific phobias develop as a result of classical conditioning, vicarious learning, and verbal transmission. In classical conditioning, a previously neutral stimulus produces a conditional response when paired with an unconditional response (Oar et al., 2019). For example, an individual who was previously bitten by a dog may develop a fear of dogs because of their experience with dogs. In vicarious learning, a child who observes someone bitten by a dog develops a fear of dogs. On verbal transmission, a child whose parents tell them how fearful and disgusting spiders are may develop a fear of spiders. To be diagnosed with a specific phobia, one must exhibit several symptoms, including excessive fear, panic, and anxiety. The excessive fear and anxiety must cause significant distress and persist for more than two weeks. Specific phobias harm the physical, emotional, and social well-being of an individual.
Due to fear and anxiety, people with specific phobias take extreme measures to avoid situations that could trigger their fear which leads to them becoming social outcasts. Other illnesses such as heart disease, high blood pressure, and others are comorbid with specific phobias affecting the physical health of an individual. Finally, specific phobia is also comorbid with other mental health disorders, such as major depressive disorder, further exacerbating the deterioration of an individual’s mental well-being.
Reference
Ciccarelli, S. K., & White, J. N. (2021). Psychology. Pearson.
Oar, E. L., Farrell, L. J., & Ollendick, T. H. (2019). Specific phobia. Pediatric Anxiety Disorders, 127–150.
Disorder (GAD) is a mental health situation that makes the patient constantly worry about issues. It interferes with the ability to concentrate, affects sleeping patterns, and increases the feeling of possible terror. In the case of the male client, aged 46 years, he narrated experiencing cases of impending doom. In addition, the patient iterates the need to run to escape the situations within his surroundings. The client uses ethanol alcohol (ETOH) to enable him to withstand the worries he encounters at work. Furthermore, the patient consumes a significant amount of beer each night to slow down his nervous system and make him feel relaxed. According to the provided background information and the results of the mental diagnosis, it is clear that the client is suffering from GAD. The use of ETOH, impending doom, and feeling of nervousness are critical factors that I will consider while prescribing the medication.
Decision #1: Begin Paxil 10 mg PO Daily
Based on the patient’s background details and the Hamilton Anxiety Rating Scale (HAM-A) outcome that indicated 26, I will prescribe Paxil 10 mg PO daily to the client. I chose to administer Paxil since it is appropriate for treating GAD. The patient’s condition and HAM-A results showed that he was suffering from GAD, which can be managed by the drug (Strawn et al., 2018). Paxil is categorized among the antidepressants known as selective serotonin reuptake inhibitors (SSRIs).
I did not pick the Imipramine 25mg PO BID since the dosage is less for adults, and the drug does not treat GAD symptoms effectively. Similarly, Buspirone 10 mg PO BID is not an appropriate choice since it offers short-term management of the disorder (Rappaport et al., 2021). The patient responded effectively to the medications, and there was no need to add other forms of augmentation to the treatment.
By opting to use Paxil, I was hoping to manage and reduce the GAD symptoms exhibited by the patient. Paxil medication can induce a significant change in the client’s mood, which is essential for reducing anxiety (Giatti et al., 2021). Furthermore, I wanted to decrease the HAM-A rating from the previous 26. In addition, I was hoping to reduce the aspect of worries that the client has been having.
On matters of ethical concern, I will have to enhance autonomy by engaging the patient in decision-making on the possible treatment. In order to make the client corporative, I have to give him assurance of the confidentiality of his medical information (Mohsenabadi et al., 2019). Furthermore, I will engage in decision-making on issues such as changing medication to enhance his autonomy in the treatment process.
Decision #2: Increase the Dose to 20 mg PO Daily
Increasing the dose to 20mg is essential because it allows the monitoring of possible side effects associated with the drug. The slight adjustment will enable the patient’s body to adapt effectively to the medication. It will reduce the GAD symptoms and make the client feel relieved of the terror of anxiety (Strawn et al., 2018). In addition, the patient has been taking alcohol; therefore, having more dosage might negatively affect the health.
I did not increase the dosage to 40mg PO daily since the patient responded positively to the treatment. Furthermore, the symptoms reduced significantly, and the HAM-A reached 10. Increasing the dosage to 40 mg PO might enhance the occurrence of side effects. When the patient overdoses Paxil, he can experience nausea, vomiting, and headache, affecting his overall health outcome (Rappaport et al., 2021). Similarly, I did not opt to replace the drug since the patient already had no record in the client’s assessment that would prompt the change.
By choosing to increase the dosage to 20mg PO per day, I hope to measure and record the reaction of increased Paxil to the GAD symptoms. In addition, I expect severe symptoms such as work worries and nervousness to decline (Rappaport et al., 2021). The overall aim is to make the HAM-A rating drop significantly to indicate a reduction in the patient’s state of anxiety disorder.
Dealing with patients suffering from GAD is challenging, and precaution is necessary to ensure the individual completes medication. Several ethical aspects, such as the client’s safety concerns, determine the treatment method (Mohsenabadi et al., 2019). Failure to communicate effectively with the client on issues such as the type of medication or a change in medication may make them less corporative, leading to poor healthcare outcomes.
Decision #3: Maintain the Current Dose
The patient showed signs of improvement and a positive response to the dose. The client’s body is adapting accordingly, and the level of anxiety is decreasing. The GAD symptoms have already reduced, and the patient is no longer experiencing impending doom and other critical issues. Allowing the patient to continue with the same dose makes it easier to trace the side effects of the drug (Strawn et al., 2018). The HAM-A declined to the desired level; thus, there was no urgent need to increase the dosage. Furthermore, the patient might still be taking beer; hence, maintaining the dose will ensure no significant impact.
I choose not to increase the dose to 30 mg PO daily because of the possible side effects of the drug. Similarly, adding an augmentation agent such as Buspar (buspirone) is not appropriate since the combination of Paxil and Buspar might cause a serious condition known as serotonin syndrome. The imbalance of the chemical in the body might cause muscle rigidity and fevers (Giatti et al., 2021). The patient was already experiencing chest pain; thus, giving him Buspar might increase the problem.
By choosing to maintain the current dose, my focus is to fully evaluate the possible side effects of the drug. The current dosage of 20 mg PO daily has proven effective in treating the patient’s condition. In addition, I intend to limit possible side effects that might occur upon using excessive dosage or combining different medications (Giatti et al., 2021). Increasing the medication to 30 mg PO daily might increase negative effects, thus making the patient suffer.
In order to maintain the treatment approach, I must consider possible side effects that might be detrimental to the health of the patient. For instance, I will discuss with the client impacts of misusing the medication on his well-being. In case of increasing the dosage to 30 mg PO daily, I will discuss together with the patient to make him aware of the changes (Mohsenabadi et al., 2019). Furthermore, before making any change in the treatment method, I have to inform the client to make him feel part of the process
Conclusion
After examining the patient’s condition, the preferred treatment is Paxil 10 mg PO daily. The medication is directly linked with reducing the symptoms of GAD. Paxil facilitates the creation of serotonin chemicals needed by the brain to improve a person’s mood. After some time, the dosage should be increased to 20 mg PO daily. The sight adjustment is aimed at enabling the body of the client to adjust to the treatment for a better outcome. Finally, maintaining the dosage is crucial in preventing possible side effects that might complicate the health of the patient, such as serotonin syndrome.
References
Giatti, S., Diviccaro, S., Cioffi, L., Falvo, E., Caruso, D., & Melcangi, R. C. (2021). Effects of paroxetine treatment and its withdrawal on neurosteroidogenesis. Psychoneuroendocrinology, 132, 105364.
Mohsenabadi, H., Shabani, M. J., & Zanjani, Z. (2019). Factor structure and reliability of the mindfulness attention awareness scale for adolescents and the relationship between mindfulness and anxiety in adolescents. Iranian Journal of Psychiatry and Behavioral Sciences, 13(1).
Rappaport, L. M., Hunter, M. D., Russell, J. J., Pinard, G., Bleau, P., & Moskowitz, D. S. (2021). Emotional and interpersonal mechanisms in community SSRI treatment of social anxiety disorder. Journal of Psychiatry and Neuroscience, 46(1), E56-E64.
Strawn, J. R., Geracioti, L., Rajdev, N., Clemenza, K., & Levine, A. (2018). Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: An evidence-based treatment review. Expert Opinion on Pharmacotherapy, 19(10), 1057-1070.
Anxiety disorders fall within the category of mental health issues. It is challenging to get through the day when one is anxious, which means that this type of disorder can be very disruptive to one’s life. Sweating and a fast heartbeat are symptoms, along with feelings of unease, panic, and terror. Medication and cognitive behavioral therapy are forms of treatment most commonly used to treat this condition. The focus of this paper is on one of the most common types of anxiety disorder, which is generalized anxiety disorder (GAD), characterized by a continuous feeling of fear or anxiety that might interfere with day-to-day activities.
GAD is not the same as occasionally worrying or feeling anxious as a result of demanding life situations. For months or perhaps years, people with GAD endure regular anxiety. Both children and adults can experience a generalized anxiety disorder. Although panic disorder, obsessive-compulsive disorder, and other forms of anxiety have some symptoms with generalized anxiety disorder, they are all distinct medical diseases (NIH, n.d.). It can be difficult to manage generalized anxiety disorder over the long run. It frequently co-occurs with other mood or anxiety disorders. With psychotherapy or medications, generalized anxiety disorder often gets better. Altering one’s way of life, developing coping mechanisms, and employing relaxation techniques can all be beneficial.
Symptoms of GAD might vary, and they may consist of: persistent anxiety or worry over a lot of things that are out of proportion to how the events have affected you. Additionally, considering plans and remedies for all potential worst-case scenarios and trouble handling ambiguity, and the tendency to see threats where none exist in situations and events is a sign of GAD (Mayo Clinic, n.d.). Next, uncertainty and concern about choosing poorly. The inability to ignore or let go of concern and feeling tense or on edge, unable to unwind, and restless. The inability to focus or the sensation that one’s mind goes blank are also signs of this disorder.
The etiology of GAD is complex and is linked to several factors, including genetics. Generalized anxiety disorder is likely caused by a complex interaction of biological and environmental factors, as is the case with many mental health illnesses. These causes may include variations in the chemistry and function of the brain. Genetics or variations in how threats are viewed are another possible cause (ADAA, n.d.). GAD is diagnosed when a person exhibits three or more symptoms and finds it difficult to control worry on more days than not for at least six months. This distinguishes GAD from worry that may be particular to a particular stressor event for a shorter duration. 6.8 million adult Americans, or 3.1% of the country’s population, struggle with GAD each year (John Hopkins Medicine, n.d.). Two times as many women are likely to be impacted. The illness develops gradually and can start at any stage of life; however, the risk is greatest from childhood through middle age. There is evidence that biological variables, a person’s family history, and life experiences—particularly stressful ones—play a part in the development of GAD, even though its exact etiology is unknown.
As a teacher, it is important to understand that GAD can seriously undermine the performance of the student and cause them negative thoughts. Any educator’s top priority is to create a learning-friendly environment in the classroom. Additionally, even though there is a national increase in mental health awareness, it can be challenging to spot pupils who may be experiencing mental health issues like anxiety (Cleveland Clinic, n.d.). It is critical to comprehend what anxiety looks like and to develop helpful, successful classroom methods for assisting pupils who battle with it, whether or not they have been diagnosed. For example, removing distractions, such as bright colors or loud sounds, can help children with GAD. Also, giving clear instructions about the expectations is another classroom modification that can help.
In summary, GAD is a continuous feeling of fear or anxiety that might interfere with day-to-day activities. Sweating and a fast heartbeat are symptoms, along with feelings of unease, panic, and terror. Medication and cognitive behavioral therapy are most commonly used to treat this condition. 6.8 million adult Americans struggle with GAD, or 3.1% of the population, each year. GAD can seriously undermine the performance of a student and cause them negative thoughts. It can be challenging to spot pupils who may be experiencing mental health issues like anxiety.
The symptoms Beatrice is manifesting align with 300.02 (F41.1) DSM V classification, namely Generalized Anxiety Disorder. The disease is characterized by excessive anxiety and negative expectations that manifest themselves for a period of over 6 months. The other symptoms of Generalized Anxiety Disorder, not listed in the given case, include restlessness, fatigue, irritability, difficulties in concentrating on work or studies, and sleep disturbance (American Psychiatric Association, 2018, p. 222). Moreover, in patients diagnosed with Generalized Anxiety Disorder, their anxious state severely impairs their everyday functioning and has a pronounced effect on everyday routine tasks. Associated symptoms of the disease comprise “muscle tension, trembling, twitching, feeling shaky, and muscle aches or soreness” as well as somatic symptoms and enhanced startle response (American Psychiatric Association, 2018, p. 223). Moreover, patients may experience conditions associated with stress such as headaches, increased heartbeat rate, and some others.
To help the diagnostics, the following questions may be asked:
Were you very nervous, anxious or worried about something in the last 14 days?
Were you unable to cope with the excitement and calm down on any occasion in the last 14 days?
Was it difficult for you to relax in the last 14 days?
Were you on any occasion so restless that it was hard for you to sit still?
Are you easily annoyed or irritated?
Have you ever experienced fear, as if something bad was going to happen?
Have you ever been unable to finish work due to the anxiety and worries you experienced? If yes, on what occasions?
All the above listed questions serve to determine the level of anxiety and stress in an individuum as well as allow to conclude to what extent this stress impacts a person’s quality of life.
Currently, there are several pharmacological options for the management of General Anxiety Disorder (GAD). First of all the treatment may include the use of serotonergic or norepinephrinergic antidepressants (Garakani et al., 2020). Among the approved selective serotonin reuptake inhibitors (SSRIs) is Escitalopram; approved selective norepinephrine reuptake inhibitors (SNRIs) are Duloxetine and Venlafaxine (Garakani et al., 2020; Stein, 2021). SSRIs and SNRIs are “considered as first-line agents for GAD; each agent has a specific adverse event profile” (Stein et al., 2021, p. 54). The most widespread medication for GAD in the world is gamma aminobutyric acid (GABA), including Benzodiazepines, which is often prescribed before SSRIs due to their effectiveness. However, these drugs have an increased risk of developing dependence, tolerance, and misuse episodes (Ansara, 2020; Garakani et al., 2020). Hydroxyzine is the only antihistamine medication approved by the FDA for the treatment of GAD. It can be used to safely manage the condition in children and adolescents (Ansara, 2020; Garakani et al., 2020). Other drugs used in the world for the treatment of GAD are not approved for use by the FDA.
Factors that may alter the expected response to pharmacological treatment include primarily the individual tolerability of the components. For many patients, SSRIs and SSNIs are ineffective, requiring the inclusion of second-line inhibitors (Ansara, 2020). The factors influencing the effectiveness of treatment are mainly the age and genetic characteristics of patients (Ansara, 2020). Additionally, the outcomes of pharmacological treatment may be affected by the patient’s behavior and discipline in taking the prescribed treatment. With the development of resistance, the most effective means of pharmacological treatment are drugs of the GAMA class as a second-line treatment option (Ansara, 2020). To overcome the development of resistance to first-line drugs, the duration of the course and dosage should be selected depending on individual indicators.
J. N. is a 13-year-old African American male who suffers from Generalized Anxiety Disorder (GAD) and the processing disorder. J. N. is brought up in an extended family; six family members live in a small house in a low-income African American community. The client constantly feels anxious regarding his performance at school, relations in the family, which are described as negative, and relations and conflicts with peers. He experiences difficulties with concentrating during lessons, and he needs more time to complete different types of assignments as well as do homework in comparison to classmates. Family members do not help the adolescent with completing his home tasks.
Problem #1: Generalized Anxiety Disorder (GAD)
Nature of Problem: J. N. was diagnosed to have GAD as he has been suffering from constant anxiety and associated fears about different situations for six months. GAD is characterized by a person’s constant feeling anxious about various daily activities, routines, and events regardless of their importance. An adolescent individual can worry about anything, even if there are no reasons or specific triggers; they cannot sleep, relax, feel positive, and concentrate.
AEB: Minor symptoms, such as troubles with relaxing, worries, and distress, became observed for the client a year ago. However, six months ago, when the family of the mother’s sister moved to their house, major symptoms became noticed: irritability, depressed mood, sleep problems, and the constant sense of dread. Currently, J. N. sleeps only five hours a day and experiences headaches and muscle tension minimum four times per week.
Goal: To reduce the intensity and frequency of anxiety episodes by 50% within 6 weeks with the help of developing coping skills.
Objectives
Objective 1: During two sessions, the client will identify 6-9 situations, triggers, stressors, actions, thoughts, and feelings that mostly provoke or are associated with his anxieties and worries.
Intervention 1: The counselor will apply Cognitive Behavioral Therapy (CBT) in order to identify potential triggers, specific situations, stressors, actions, thoughts, and feelings that are associated with anxiety for the client (Lee et al., 2019; Robinson et al., 2015). Thus, the client will be asked to describe past experiences of anxiety and worries and related situations or factors that could provoke those feelings. J. N. will discuss how those feelings influenced his functioning and what could help to cope with anxiety in those situations.
Intervention 2: The counselor will use the Consequence-Activating Event-Belief method related to the Adapted-Coping with Stress Course as a CBT-based intervention. The client will be able to recognize different activating events (triggers), certain associated cognitions, and specific feelings that need to be reshaped in the context of a person’s coping mechanisms (Robinson et al., 2015). As a result, J. N. will be ready to reshape the feeling about possible triggers of his anxiety, as well as actions and behaviors.
Objective 2: The client will learn and implement five appropriate coping skills to manage his anxiety symptoms and reduce anxiety levels.
Intervention 1: The counselor will apply the CBT techniques to develop anxiety coping skills in the client. These techniques include the thought stopping technique and the “worry time” approach. The client will be taught how he can stop thinking about a certain situation and redirect his attention to another subject (Robinson et al., 2015). The client will also learn how to apply the “worry time” approach and recognize worries in his daily activities to be able to think about them during a specifically scheduled time period.
Intervention 2: The counselor will apply the Mindfulness-Based Intervention (MBI) with a focus on teaching the client how to use relaxation techniques for coping with anxiety and worrying. The client will learn how to use mindfulness meditation and breathing, muscle relaxation, and biofeedback (Zoogman et al., 2015). These coping techniques will help the client to develop skills in overcoming anxiety on a daily basis as the client will be stimulated to use these approaches every time when feeling anxious and worrying about something.
Problem #2: Processing Disorder
Nature of Problem: The processing disorder can be associated with auditory and visual processing disorders as well as the slow processing disorder. When having this disorder, adolescents need time in order to concentrate on and understand visual or auditory information. As a result, the speed of learning and completing academic tasks becomes slower. This disorder can be provoked by certain impairments, stress factors, and other disorders, among possible triggers.
AEB: At school and at home, J. N. experiences problems when learning new information, following teachers’ instructions and explanations, and completing different tasks. It is rather difficult for J. N. to concentrate in order to perform an assignment effectively. In many cases, the client asks the teacher to repeat some information, and he works on a task better if he has visual cues. If J. N. has enough time for completing tasks, he can better concentrate and succeed. Nevertheless, he experiences problems with timed tests, and he fails in 8 out of 10 timed tests taken.
Goal: To learn and implement techniques that help become more concentrated and less distracted in 70% of study situations within 8 weeks.
Objectives
Objective 1: The client will verbalize his problems associated with cognitive, physiological (auditory and visual), and behavioral aspects when completing tasks at school and at home.
Intervention 1: The counselor will apply the technique of active listening in order to provide the client with an opportunity to focus on the nature of his problems when learning new material and completing tasks at school and at home (Lee et al., 2019). The counselor will help the client to identify possible physical aspects or changes in vision and hearing, changes in the adolescent’s physical stage associated with worrying, as well as emotional and behavioral reactions to the situation of being impossible to concentrate on the task or understand it. The counselor will focus on understanding how the client’s cultural group can influence his experience.
Intervention 2: The counselor will focus on the specifics of the client’s self-talk in the situations when he feels anxious about not being able to understand the teacher’s instructions and complete tasks on time (Lee et al., 2019; Robinson et al., 2015). The client will be taught to identify negative thoughts and redirect attention on routine tasks to feel more organized.
Objective 2: The client will learn how to implement four techniques in order to remove distractors and concentrate on understanding auditory and visually presented information.
Intervention 1: The counselor will teach the client how to organize his work on academic tasks at school and at home in order to be concentrated. The client will be expected to develop a routine of preparing for completing home tasks or timed tests (Robinson et al., 2015). The counselor will help in developing the most effective routine depending on such external factors as the home and school environment in the African American community.
Intervention 2: Referring to the MBI, the counselor will assign the home tasks during which the client will be expected to learn how to use relaxation breathing and quick muscle relaxation technique in order to be able to concentrate on the task when feeling disorganized, worried, distracted, and being able to make quick decisions (Zoogman et al., 2015).
Successful Development of a Treatment Plan
The research from the treatment plan research paper was effectively incorporated in this proposed treatment plan. The interventions and techniques that are useful to address the objectives related to the first problem (Generalized Anxiety Disorder) were selected depending on the results of the previous research. As a consequence, the interventions proposed to achieve the two objectives to complete the first goal were grounded in the principles of CBT and MBI (Robinson et al., 2015; Zoogman et al., 2015).
In addition, some of the techniques that are usually applied in the context of the MBI, such as relaxation approaches, were also offered to help the client decrease the symptoms of his processing disorder that is closely associated with GAD. The problem is that GAD often provokes the development of the processing disorder. In their turn, difficulties with concentrating and processing information cause adolescents’ being more anxious and worry about their academic achievements. In this context, techniques and strategies used in CBT and MBI are effective to be applied to treating the client’s both problems.
References
Lee, P., Zehgeer, A., Ginsburg, G. S., McCracken, J., Keeton, C., Kendall, P. C., Birmaher, B., Sakolsky, D., Walkup, J., Peris, T., & Albano, A. M. (2019). Child and adolescent adherence with cognitive behavioral therapy for anxiety: Predictors and associations with outcomes. Journal of Clinical Child & Adolescent Psychology, 48(sup1), S215-S226.
Robinson, W. L., Droege, J. R., Case, M. H., & Jason, L. A. (2015). Reducing stress and preventing anxiety in African American adolescents: A culturally-grounded approach. Global Journal of Community Psychology Practice, 6(2), 1-12.
Zoogman, S., Goldberg, S. B., Hoyt, W. T., & Miller, L. (2015). Mindfulness interventions with youth: A meta-analysis. Mindfulness, 6(2), 290-302.
CC (chief complaint): The patient is being evaluated for severe sadness and anxiety. For the past four months, she has suffered from depression, lethargy, insomnia, decreased appetite, anxiety, and poor focus. She has previously thought of and tried suicide but has been unsuccessful.
HPI: M.S is a 30-year-old American woman brought into this facility for psychiatric evaluation for severe sadness and anxiety. Her PCP referred her for this evaluation and treatment.
Past Psychiatric History
General Statement: At the age of 20, when her parents were going through a divorce, the woman sought help for her sadness. Due to these sessions, she started visiting a therapist weekly and was given medicine for her depression. She kept up with her counseling sessions and remained on the medication prescribed for her depression well into her early twenties. She started consuming alcohol when she was 26 and eventually sought detoxification treatment.
Hospitalizations: The patient has had three separate hospitalizations throughout her life. The most recent time she was admitted to the hospital was in September 2016. She has completed one residential treatment program in addition to two detoxification programs. The final residential treatment program occurred in August 2016, and the last detoxification program occurred in July 2016. She has a history of suicidal ideation, but she does not have an account of any real attempts at suicide or actions that involve self-harm.
Medication trials: The patient in the past has attempted treatment with haloperidol, which resulted in a dystonic reaction; risperidone, which caused hyperprolactinemia; and olanzapine, which was effective; however, her insurance company refused to pay for it.
Psychotherapy or Previous Psychiatric Diagnosis: The patient is an American woman who is 30 years old and has been attending therapy for quite some time. Both anxiety and depression have been identified as being present in her life. She believes that therapy has helped her better understand her feelings and thoughts, making it easier for her to manage her symptoms (Kirsh et al., 2019). She has found the cure to be beneficial in controlling her symptoms.
Substance Current Use and History
Caffeine, nicotine, and alcohol have all been used by women in the past. She utilizes these substances daily, and her most recent use was today. She employs them by inhaling and snorting them. She has a history of tremors, Delirium Tremens, and seizures resulting from withdrawal.
Family Psychiatric/Substance Use History
The woman’s mother was treated for depression and anxiety with medication and counseling. Her father was a heavy drinker who died of liver illness. When the woman was 19, her sister committed suicide. There is no history of mental illness or substance misuse in the woman.
Psychosocial History
The patient’s US-born parents raised her and the patient has two brothers. Her husband and two children are her immediate family. Her husband is a doctor and she has a bachelor’s degree in psychology. The patient enjoys reading, cooking, and spending time with family. Violence or trauma were not in the patient’s medical history.
Medical History
The patient is a 30-year-old American lady with seizures and head trauma. She also underwent surgery to fix a deviated septum.
Current Medications: The woman has been using oral contraception for the past five years. She’s been taking them to avoid becoming pregnant. Every day, she takes one medication.
Allergies: The woman has a history of drug, food, and environmental sensitivities. Angioedema, anaphylaxis, and other allergic responses have occurred in her.
Reproductive Hx: The American lady has a history of menstruation. She is neither pregnant nor is she breastfeeding or lactating. She does not use contraception and has no sexual issues.
ROS:
GENERAL: The patient is a 30-year-old female American.
HEENT: The patient reports hazy vision and eye pain.
SKIN: The patient complains of a rash.
CARDIOVASCULAR: The patient complains of chest discomfort and palpitations.
RESPIRATORY: The patient complains about the shortness of breath and trouble breathing.
GASTROINTESTINAL: Complains of nausea and vomiting.
GENITOURINARY: Mentions pelvic pain.
NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control.
MUSCULOSKELETAL: No muscle, back pain, joint pain, or stiffness
HEMATOLOGIC: No anemia, bleeding, or bruising.
LYMPHATICS: No enlarged nodes. No history of splenectomy.
ENDOCRINOLOGIC: No reports of sweating, cold, or heat intolerance. No polyuria or polydipsia.
Physical exam
Diagnostic results
She has been taking 20mg of Fluoxetine (Prozac) daily for the previous two weeks with no relief. The patient’s medical history includes depression, anxiety, and an eating issue. History of mental illness: The patient has a history of sadness and anxiety (Ran et al., 2019). She has been diagnosed with an eating disorder and has previously sought therapy for it. Medications: The patient takes Fluoxetine (Prozac) at 20mg daily. Allergies: The patient has no known allergies. Physical exam suggests slight distress. She’s attentive to the person, place, and situation. Normal head and neck. Her pinkish extremities have strong pulses. Her abdomen is pain-free and lump-free. Based on the patient’s history, physical exam, and mental health history, his sorrow and anxiety are likely worsening. Her medicine may be causing her current state.
Assessment
Mental Status Examination: The patient’s age seems accurate. She’ll take the test. The patient is clean, well-groomed, and dressed for the setting. The patient denies abnormal motor activity. Her volume and tone are appropriate. The patient’s thoughts are rational and goal-oriented. No data suggests concept flight or loose connection. Her affect is euthymic; hence her mood is euthymic. She grinned when appropriate. She denies having auditory or visual hallucinations. Delusions are unproven. She has no suicidal or homicidal ideas currently. She’s smart and savvy. Recent and distant memories are unaffected.
Differential Diagnoses: Major depressive disorder, generalized anxiety disorder, panic disorder. Acute depression, anxiety, and lack of interest rule out MDD. Generalized anxiety disorder is caused by the patient’s worries. Panic disorder involves anxiety and panic attacks.
Reflections
I agree with my preceptor’s patient diagnosis. The patient’s symptoms suggest depression and GAD. I think the patient needs antidepressant and anxiety-reducing drugs (Alessio et al., 2020). Counseling and therapy could help the patient with her despair and anxiety. This taught me to examine all factors while screening for mental health issues. Age, ethnicity, socioeconomic determinants of health, and other risk factors are considered. Consider the patient’s medical history and other factors that may be causing mental health issues.
Ran, M. S., Weng, X., Liu, Y. J., Zhang, T. M., Yu, Y. H., Peng, M. M.,… & Xiang, M. Z. (2019). Changes in treatment status of patients with severe mental illness in rural China, 1994–2015. BJPsych open, 5(2). doi: 10.1192/bjo.2019.13
Anxiety is a severe condition affecting many people in the world, including children. It is crucial to study and address anxiety disorders and their causes because it may help to prevent the prevalence of such conditions in young people and adults. Thus, the topic selected for the research is anxiety disorders in children. This paper aims at exploring why children may suffer from anxiety. The report provides information about possible signs and symptoms of anxiety in young people and offers insight into possible treatment methods, including traditional and holistic approaches. Moreover, it features vital information about the potential causes of anxiety disorders in children, addressing the role of parents and the environment in the development of the symptoms. The paper concludes that family members should pay attention to young people’s behavior and well-being, as they can contribute to both the development of symptoms and the recovery of their child.
Anxiety Disorder in Children: Background Information
Anxiety disorders may be considered a significant concern, especially among young people. Creswell, Waite, and Cooper (2014) report that they are some of the most common conditions affecting children and adolescents, with a prevalence of up to around 30% during childhood. It is crucial to mention that anxiety is normal, as it is one of the cognitive, behavioral, and affective responses to danger in humans (Bhatia & Goyal, 2018). However, anxiety can be considered excessive when it leads to impairment or significant emotional distress or is disproportional to the challenge associated with it. In children, some of the common anxiety disorders include social and specific phobias, generalized anxiety disorder, and separation anxiety disorder (Bhatia & Goyal, 2018). The less prevalent cases are post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and agoraphobia.
Notably, boys typically develop anxiety symptoms earlier than girls do. The signs typically occur between 7 and 12 years of age in males and around 13-19 in females (Ewing et al., 2015). Anxiety is also known for being more common for older individuals than younger ones. Notably, girls are found to respond to some nonpharmacological types of treatment better than boys do (Creswell et al., 2014). The possible approaches to treatment and their benefits will be discussed in detail below.
Possible Causes of Anxiety in Children
Studies report several possible factors leading to anxiety disorders in young people. One of the causes is emotional neglect, characterized by the cold or critical parenting style and intentional or unintentional overlook of the child’s need for attention (Ventola, Lei, Paisley, Lebowitz, & Silverman, 2017). Moreover, anxiety disorders may be caused by genetics, which means that if a family member has this condition, it is likely that children will inherit it (Smoller, 2016; Eley et al., 2015). It is crucial to mention that anxiety may be related to learned behaviors. For instance, if a parent worries about something, especially a child, excessively, the young person is also likely to develop a habit of worrying about life situations.
In general, parents and the environment play a significant role in the development of anxiety in children. For instance, Bhatia and Goyal (2018) report that, in today’s world, these factors have a crucial role in a child’s well-being because continual performance is considered key to success, which results in additional pressure. In the long run, parents’ expectations may be highly harmful to the young person’s development and mental health state, and the consequences can be as severe as suicide (Bhatia & Goyal, 2018). Moreover, as mentioned above, the anxious parenting style associated with overprotection, intrusiveness, and expressed anxiety, may lead to the signs of the disorder in young people (Eley et al., 2015). Thus, it is crucial for parents to pay attention to the aspects of both their behavior and children’s environment to prevent the signs of anxiety in them, as well as possible adverse outcomes.
Signs and Symptoms
There are some specific signs and symptoms of anxiety in children, which depend on the type of anxiety disorder a child has. For instance, young people having social anxiety may experience the need to seek admiration from others, be sensitive to criticism, and avoid being the center of attention (Inam, Mahjabeen, & Abiodullah, 2017). Moreover, children with anxiety may have panic attacks, nightmares about separation, and avoid places where escape may be challenging (Freidl et al., 2017). It is crucial to mention that, unlike older individuals, children are unlikely to present for help individually; parents are usually the ones raising concerns about their well-being (Creswell et al., 2014). It means that adults should pay attention to the possible changes in young people’s behavior and consult a professional if concerns occur. The diagnosis of anxiety may be difficult due to the presence of non-specific symptoms, too. For instance, children having an anxiety disorder may show signs of headaches, restlessness, and difficulty concentrating (Freidl et al., 2017). These symptoms may occur due to other health-related causes and are not linked to anxiety disorders exclusively.
Notably, some children may show signs of anxiety while not having this disorder. It can happen because several medical conditions, including hyperthyroidism, may mimic the symptoms of anxiety disorders (Bhatia & Goyal, 2018). Moreover, it is crucial for medical professionals to distinguish between excessive worries, responses to stressors, and fears from developmentally appropriate ones. When the diagnosis is made, appropriate treatment methods should be selected to minimize the symptoms of anxiety in a child while ensuring that the chosen approach is not harmful to a young person.
It is crucial to note that if a child shows the signs of anxiety, they may not have them when they are older. Bhatia and Goyal (2018) report that childhood anxiety disorders are transitory, which means that it can be mitigated in the future. At the same time, the symptoms in young individuals may be persistent, and they may experience syndrome shifts, which means that they will show signs of the disorder from time to time. In some cases, the symptoms of anxiety disorders may become less present in the future with the development of secondary psychopathologies, including depression and substance use (Bhatia & Goyal, 2018). In any case, it is crucial to see a medical professional to prevent the possible development of adverse symptoms in a child in the future.
Treatment Methods
There are several approaches to the treatment of anxiety symptoms in children, including pharmacological and holistic ones. One of the commonly used and most effective methods is cognitive-behavioral therapy (CBT). Higa-McMillan, Francis, Rith-Najarian, and Chorpita (2016) report that this type of treatment is highly useful for mitigating the symptoms of anxiety. Ewing et al. (2015) add that children are around nine times more likely to recover from the condition using CBT compared to those receiving other treatment methods. It is crucial to add that combining nonpharmacological approaches to pharmacotherapy may be useful for eliminating the symptoms in young people, too. For instance, the combination of CBT with sertraline has shown better results compared to CBT alone (Bhatia & Goyal, 2018). Evidently, nonpharmacological treatment methods are preferable for children, as they do not have side effects and are unlikely to be harmful to an individual. At the same time, pharmacotherapy can be employed in case the disorder is in the severe stage (Bhatia & Goyal, 2018). Thus, the choice of treatment methods for anxiety should depend on the particular patient and situation.
CBT is not the only nonpharmacological approach that can be used to eliminate the signs of anxiety disorders. Some other holistic approaches include relaxation training and coping self-talk (Ewing et al., 2015). These treatment methods allow children to gain the ability to feel more confident in stress-provoking situations and learn how to manage them better. Treatment methods may also depend on the type of anxiety disorder a young person has. For instance, for those suffering from social anxiety, CBT combined with social skills training may be highly effective, and children having the symptoms of OCD may benefit from OCD-specific CBT (Ewing et al., 2015). Generally, anxiety treatment should involve a generic or transdiagnostic CBT package, which aims at managing symptoms common for all anxiety disorders.
As for exclusively pharmacological methods, there are several medications that can be used for eliminating anxiety. For instance, the use of selected serotonin reuptake inhibitors (SSRIs) is considered one of the most appropriate and effective approaches for the treatment of children, as it has a good safety profile (Creswell et al., 2014). At the same time, benzodiazepines, often used to treat anxiety symptoms in adults, are not recommended for using in young people due to possible adverse side effects. As mentioned above, the combination of pharmacological and nonpharmacological methods shows high effectiveness in the elimination of the signs of anxiety.
As anxiety may be closely related to the parenting style and adults’ attitude towards their children, parents may contribute to improving a child’s well-being, too. Khanna, Carper, Harris, and Kendall (2017) report that family members may become change-agents for young people. First, a positive change in the parenting style can be crucial for the improvements in a child’s well-being. The facts presented above reveal that parents should abstain from being overcontrolling or worrying about their child extensively. Second, family members can participate in CBT along with young people, discussing children’s symptoms with them and addressing their concerns (Higa-McMillan et al., 2016). Notably, both young people and their parents can participate in online CBT sessions as well as undergo therapy sessions simultaneously. Such an approach not only eliminates the signs of anxiety in children but also teaches parents how to avoid inappropriate upbringing methods.
Conclusion
The presented report reveals that anxiety is highly common in children; however, it may be difficult to diagnose it due to some non-specific symptoms. Parents should pay attention to their children’s behavior and well-being while being aware that the parenting style and the environment play a crucial role in a young person’s mental health state. Treatment methods for anxiety in children include CBT, SSRIs, and the combination of pharmacological and non-pharmacological ones. Moreover, the participation of family members may contribute to the child’s recovery positively.
References
Bhatia, M. S., & Goyal, A. (2018). Anxiety disorders in children and adolescents: Need for early detection. Journal of Postgraduate Medicine, 64(2), 75-76.
Creswell, C., Waite, P., & Cooper, P. J. (2014). Assessment and management of anxiety disorders in children and adolescents. Archives of Disease in Childhood, 99(7), 674-678.
Eley, T. C., McAdams, T. A., Rijsdijk, F. V., Lichtenstein, P., Narusyte, J., Reiss, D.,… Neiderhiser, J. M. (2015). The intergenerational transmission of anxiety: A children-of-twins study. American Journal of Psychiatry, 172(7), 630-637.
Ewing, D. L., Monsen, J. J., Thompson, E. J., Cartwright-Hatton, S., & Field, A. (2015). A meta-analysis of transdiagnostic cognitive behavioural therapy in the treatment of child and young person anxiety disorders. Behavioural and Cognitive Psychotherapy, 43(5), 562-577.
Freidl, E. K., Stroeh, O. M., Elkins, R. M., Steinberg, E., Albano, A. M., & Rynn, M. (2017). Assessment and treatment of anxiety among children and adolescents. Focus, 15(2), 144-156.
Higa-McMillan, C. K., Francis, S. E., Rith-Najarian, L., & Chorpita, B. F. (2016). Evidence base update: 50 years of research on treatment for child and adolescent anxiety. Journal of Clinical Child & Adolescent Psychology, 45(2), 91-113.
Inam, A., Mahjabeen, A., & Abiodullah, M. (2017). Causes of social anxiety among elementary grade children. Bulletin of Education and Research, 39(2), 31-42.
Khanna, M. S., Carper, M. M., Harris, M. S., & Kendall, P. C. (2017). Web-based parent-training for parents of youth with impairment from anxiety. Evidence-Based Practice in Child and Adolescent Mental Health, 2(1), 43-53.
Smoller, J. W. (2016). The genetics of stress-related disorders: PTSD, depression, and anxiety disorders. Neuropsychopharmacology, 41, 297-319.
Ventola, P., Lei, J., Paisley, C., Lebowitz, E., & Silverman, W. (2017). Parenting a child with ASD: Comparison of parenting style between ASD, anxiety, and typical development. Journal of Autism and Developmental Disorders, 47(9), 2873-2884.