Generalised Anxiety Disorder (GAD) and Homeostasis

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This assignment will define a mental health condition known as Generalised Anxiety disorder (GAD) and the statistics around how many adults this condition affects in the UK. Firstly, this assignment will aim to provide an explanation and discussion on the method of homeostasis and how it works to achieve the correct levels needed in a young adult, and how this is altered with a person who has GAD. This assignment will then continue to indicate a psychosocial factor that may result from living with this condition. The assignment will then outline how the central nervous system (CNS) and other systems in the body, work together using the process of homeostasis and feedback systems to control, regulate and adapt to change. Secondly, the assignment will then discuss different ways a nurse will intervene with the adult to educate, support and empower adults living with the condition by using different strategies and methods available. Including, any pharmacological approaches that may be used or needed. Lastly, a single medication will be outlined in this assignment, of which evidence-based guidance supports the use, with a discussion around the reason for this drug being suggested. Together with; the recommended dose, administration route, what the medication does, how it works, the potential side effects and the contra-indications it may have on the adult. (215/250)

GAD is one of the most common mental health disorders (NICE, 2011). GAD impacts on average around 6 in every 100 people in England (Anxiety Care, 2017) overall anxiety disorders affect ‘10 million people’ throughout the UK (MQ: Transforming Mental Health, 2019). Stansfield et al. (2014) reported that GAD is more prevalent in young women, with it affecting 9% aged between 16 and 24 years. In comparison to 4% of men in the same age category recorded to be affected by GAD. Walker (2014) described anxiety as a sensation felt by a person when a threat is sensed, with every person experiencing anxiety in some way during their lifetime. Anxiety, job-related stress and depression were responsible for the loss of more than 15 million working days in Great Britain at a cost of over 5 billion pounds (HSE, 2019). Greener (2014) expressed that GAD is very under-diagnosed, this being an indicator that this condition may be much more common than is currently presented in statistics. This is often due to professionals concentrating on the adult’s physical symptoms until the condition gets to an overpowering state for that person, and they can no longer cope with their daily activities (NICE, 2011).

Homeostasis according to Colbert et al (2012) is a control system that corrects any discrepancies found in the body, it then works to keep the levels balanced and variations recognised are then brought back to their baseline. Waugh and Grant (2006) also stated that control systems inside the body are required to have a ‘tightly controlled’ boundary (Waugh and Grant, 2006:4), This boundary is likely to be different with each person Hendry et al. (2012).

Hendry et al. (2012) also explained that homeostasis can only be maintained and sustained by other mechanisms within the body. These then work to even out any differences by using positive and negative feedback loops, to detect, change and implement ways to correct and return the fluctuations to the original baseline (Toole and Toole, 1995). The two feedback loops that are used within homeostasis are positive feedback where there is temporary control in a single body system moving it rapidly away from the baseline intensifying the original stimulus (Tortora and Derrickson, 2017) whereas, negative feedback which works to reverse the detected change and return it to its baseline to maintain homeostatic control and prevent ill health in adults (Waugh and Grant, 2008).

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The normal homeostatic regulation consists of: a sensor to acknowledge any fluctuation in levels, which then signals the control centre situated in the hypothalamus. The control centre (hypothalamus) then determines the level of alteration required and responds to the appropriate system to adjust accordingly to bring levels back within range to the pre-determined values set (Modell et al, 2015). The effector then implements the change needed to return the control system to its baseline, once corrected the feedback loop then reports back to the detector informing it of the changes made to the system by the effector, which then switches off the feedback system until the next time it is activated, representing the process of negative feedback (Toole and Toole, 1995).

The ordinary homeostatic regulation in reaction to stress or anxiety activates within two parts of the brain: the cerebral cortex and the amygdala. The decision making takes place in the cerebral cortex to determine whether the situation is threatening (Colbert et al. 2012) The hypothalamus is in control when a stress response is required and it sends the messages to other parts of the brain, the pituitary gland and adrenal medulla (McLeod, 2010). The amygdala will monitor the body’s reactions to the situation which then sends an urgent message to the hypothalamus (Harvard Health, 2011). This is known as the ‘flight or fight’ response which is the reaction the body makes when faced with perceived dangerous situations (Cherry, 2019).

The nervous system and endocrine system often referred to as neuroendocrine Martin et al. (2009) work simultaneously responding to stress. There are two parts to the nervous system: the central nervous system (CNS) which controls the brain and spinal cord responses and the Peripheral nervous system (PNS) which controls all the nerves outside of the CNS through the autonomic and somatic control systems. (Colbert et al. 2012) The systems responsible for adapting to the increased response to the physical or mental activity are the autonomic nervous system (ANS) consisting of sympathetic (the alerting system) and parasympathetic (responsible for homeostasis and maintenance) Waugh and Grant, (2008:142) along with the endocrine system which is responsible for regulating hormone changes (Cherry, 2019). When a stressor is detected that threatens to disrupt homeostasis the hypothalamus then stimulates the central adrenal gland, the adrenal medulla which produces important hormones adrenaline and noradrenaline which get the body prepared for action (Toole and Toole,1995), These hormones then release into the bloodstream from the stimulated adrenal medulla to get ready for a short-term flight or fight response. It does this by increasing the heart rate and blood pressure (Waugh and Grant, 2008)

Sherbourne et al. (2010) expressed that Gad is a least disabling condition compared to other anxiety disorders. However, Greener (2014) argues that a person with GAD has heightened awareness and alerts to potential threats and danger. In an adult a major factor that contributes to an adult having generalised anxiety disorder is stress. A person who has chronic stress the usual response mechanism is activated in the same way as for fight or flight response, over time it becomes sensitive and responds to minor situations that aren’t life threatening as though they are never turn off (Scott-Mumby, 2018) this often compromising work performance and contributing to the person being increased to further complications and co-morbid conditions such as physical health problems occurring, depression, digestive and gastro-intestinal conditions (Greener, 2014)

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