Colleagues response week 6 | NURS 6670 – Psychiatric Mental Health Nurse Practitioner Role II: Adults and Older Adults | Walden University

ASSIGNMENT:

Respond to at least two of your colleagues by comparing the differential diagnostic features of the disorder you were assigned to the diagnostic features of the disorder your colleagues were assigned.

Support your responses with evidence-based literature with at least two references in each colleague’s response with proper citation in APA Format. 

Colleagues Response # 1

Differences between Adjustments Disorders and Anxiety Disorders

Adjustment disorder (AjD) and Anxiety disorders (AD) are among the most often diagnosed mental disorders in clinical practice. AjD is recognized as a stress-response syndrome, which is defined as a maladaptive reaction to an identifiable stressor (Zelviene & Kazlauskas, 2018). It is a condition that can occur when you have difficulty coping with a specific, stressful life event – for example, a death or illness in the family, getting fired or laid off from a job, significant relationship issues like break-ups or divorce, or sudden change in social settings such as the pandemic.  Five basic diagnostic criteria of AjD are presented in DSM-5. The first criterion indicates that AjD might only be diagnosed if symptoms occurred within 3 months in the context of identifiable stressor(s). The second criterion specifies clinical significance of AjD symptoms meaning that stress reactions should be out of proportion to the normal reactions of the identified stressor according to the social or cultural context, and there should be significant disturbances in important areas of life. The last 3 criteria point out that 3) the disturbance should not meet criteria or represent a worsening condition of another mental disorder; 4) AjD should not be considered in cases of normal bereavement reactions; and 5) AjD has a tendency to dissipate during 6 months after the stressor has ended (Zelviene & Kazlauskas, 2018).

           Individuals with AD often have a lengthy and consistent history of anxiety and excessive worry, whereas individuals with Adjustment Disorder only experience their symptoms in times of or in response to stress or change. Anxiety Disorder can be made worse by stressors such as change or adjusting to new routines. But if you have Adjustment Disorder, you’ll typically see a reduction in your anxiety as you adapt to the change or learn to cope with the stressor, while anxiety and related symptoms are continual for those with GAD.

Diagnostic Criteria for Generalized Anxiety Disorders (GAD)

According to the DSM IV, “GAD is defined by the following diagnostic criteria:

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance)

B. The individual finds it difficult to control the worry

C. The anxiety and worry are associated with three (or more) of the following six symptoms: Restlessness or feeling keyed up or on edge, being easily fatigued, difficulty concentrating or mind going blank, irritability, muscle tension, sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep)” (The history of generalized anxiety disorder as a diagnostic category, 2017).

The DSM IV makes it clear that GAD is largely an exclusion diagnosis. GAD cannot be diagnosed if the anxiety is better explained by other anxiety disorders (panic, phobic, social anxiety, or obsessive compulsive disorder) (The history of generalized anxiety disorder as a diagnostic category, 2017). Also, GAD cannot be caused directly by stressors or trauma, contrary to adjustment disorders and PTSD (The history of generalized anxiety disorder as a diagnostic category, 2017).

Evidenced-based Psychotherapy and Psychopharmacologic Treatment for GAD

All patients with anxiety disorders require supportive talks and attention to the emotional problems that are associated with the anxiety disorder. Psychoeducation includes information about the physiology of the bodily symptoms of anxiety reactions and the rationale of available treatment possibilities (Treatment of anxiety disorders, 2017). Cognitive-behavioral therapy (CBT) is also one of the best-established psychotherapy treatments for GAD.

Due to their positive benefit/risk balance, selective serotonin reuptake inhibitors (SSRIs) and selective serotonin norepinephrine reuptake inhibitors (SNRIs are recommended as first-line drugs (Treatment of anxiety disorders, 2017). SSRIs for GAD include: Escitalopram, Paroxetine and Sertraline. Pregabalin is a calcium modulator that is also effective in treating GAD (Treatment of anxiety disorders, 2017). However, there have been concerns about the abuse of pregabalin in individuals suffering from substance abuse and also withdrawal syndromes after abrupt discontinuation (Treatment of anxiety disorders, 2017). Buspirone, a 5-hydroxytryptamine receptor 1A (5HT1A) agonist, has been shown in some controlled studies to be effective in the treatment of GAD (Treatment of anxiety disorders, 2017).

Colleagues Response # 2

Anxiety disorders are among the most prevalent psychiatric and mental health discoveries globally. Specific phobia is an anxiety disorder characterized by persistent fear and avoidance. Specific phobias are associated with childhood-onset (Eaton, Bienvenu, & Miloyan, 2018). It has high comorbidity with other mental health illnesses and can be highly disabling if left untreated. The most common types of specific phobias include fear of the different types of animals, fear of heights, and claustrophobia.

Adjustment disorders vs. anxiety disorders

The main cause of adjustment disorder is external stressors and life changes whereas anxiety disorder are caused by a combination of genetics, developmental, and behavioral factors. Individuals living with anxiety disorder tend to present with a repeated and persistent pattern of excessive worrying whereas those with adjustment disorders only have excessive worry when experiencing a stressful life event. Better coping and adaptation to the stressor among people living with adjustment disorder tend to reduce the excessive worry as opposed to those with an anxiety disorder as their symptoms are continuous in nature. For example, to make a diagnosis of adjustment disorder the client must present with distress that is out of proportion with expected reactions to the stressor within 3 months of the onset of the stressor (APA, 2013). When the stressor is removed, the client begins to cope and the symptoms reduce within 6 months. On the other hand, anxiety disorders is characterized by excessive fear and anxiety.

Diagnostic criteria for Specific Phobia

According to the DSM V diagnostic criteria (APA, 2013), Specific Phobia is characterized by marked fear or anxiety about a specific situation or object. The dreaded situation or object elicits

intense fear or anxiety. The phobic object or situation is avoided or at times endured with intense fear/anxiety. The fear is always excessive and out of proportion in relation to the threat of danger posed. The excessive worrying or fear must be present for a period of at least 6 months. The fear, excessive anxiety, and avoidance of the dreaded situation or object must be attributed to significant interference in the person’s social and occupational functioning among other important areas of functioning. The presenting symptoms should not be attributed to other mental disorders such as Social Phobia, OCD, PTSD, and separation anxiety disorder.

Evidence based-psychotherapy and psychopharmacologic treatment of Specific Phobia

Specific Phobia is treatable through the use of both psychotherapy and psychopharmacology. Treatment of the disorder aims at minimizing fear, phobic avoidance, and improve impaired functionality (Eaton, Bienvenu, & Miloyan, 2018). The use of psychotherapy is a first-line treatment followed by pharmacotherapy. The evidence-based psychotherapy for the disorder involves the use of Exposure Therapy which is the treatment of choice (Thng, et al., 2020). The use of Cognitive Behavioral Therapy is another psychotherapy approach used in the management of specific phobias. Exposure therapy involves gradual exposure to the feared situation/object repeatedly until the object/situation does not elicit a fear response. The use of exposure therapy is based on the rationale that continuous and gradual exposure to a safe but frightening situation or object result in reduced anxiety levels thus reducing avoidance behavior (Böhnlein, et al., 2020). Exposure therapy is also used in combination with Cognitive Behavioral Therapy for increased efficacy. CBT is essential in helping the client identify the irrational thoughts and beliefs that may contribute to symptom presentation (Eaton, Bienvenu, & Miloyan, 2018). Irrational thoughts such as catastrophizing are identified through the use of CBT thus helping the client appreciate new realistic and rational thinking.

Pharmacological treatment is used to complement exposure therapy. The various pharmacological modalities that are used in the treatment of specific phobias include beta-blockers and psychotropic medications such as benzodiazepines (Amray, et al 2019). The beta-blockers are used to control increased heart rate associated with specific phobia. The psychotropic is administered to minimize the emotional disturbance associated with the disorder.