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Two brief peer review on visual presentation

Two brief peer review on visual presentation.

Need help with my Nursing question – I’m studying for my class.

Peer review is an important process in graduate education where we offer constructive criticism of the work of our peers. For this discussion, post a draft of your Evidence-Based Presentation. It does not need to be a video and can be the visual presentation only. After you have posted your initial posting (your rough draft) by the third day of the module, respond substantively to at least two peers with suggestions for improvement by the end of the module.

Please post an initial posting with at least two references using correct APA STYLE (this will be expected for all if not of your work in the program). After you have posted your initial posting by the third day of the module, respond substantively to at least two peers by the end of the module (this will be the basic discussion format for the course please use APA style in you response reference or references).




Anxiety Disorder

Anxiety disorders include disorders that share features of excessive fear and anxiety and related behavioral disturbances. Fear is the emotional response to real or perceived imminent threat, whereas anxiety is anticipation of future threat. Obviously, these two states overlap, but they also differ, with fear more often associated with surges of autonomic arousal necessary for fight or flight, thoughts of immediate danger, and escape behaviors, and anxiety more often associated with muscle tension and vigilance in preparation for future danger and cautious or avoidant behaviors. Sometimes the level of fear or anxiety is reduced by pervasive avoidance behaviors. Panic attacks feature prominently within the anxiety disorders as a particular type of fear response. Panic attacks are not limited to anxiety disorders but rather can be seen in other mental disorders as well (APA, 2013).

Anxiety disorders are the most prevalent psychiatric disorders and are associated with a high burden of illness.1-3 with a 12-month prevalence of 10.3%, specific (isolated) phobias are the most common anxiety disorders, although persons suffering from isolated phobias rarely seek treatment. Panic disorder with or without agoraphobia (PDA) is the next most common type with a prevalence of 6.0%, followed by social anxiety disorder (SAD, also called social phobia; 2.7%) and generalized anxiety disorder (GAD; 2.2%). Women are 1.5 to two times more likely than men to receive a diagnosis of anxiety disorder ( Bandelow, Michaelis, & Wedekind, 2017).

Generalized Anxiety Disorder

Generalized Anxiety Disorder (GAD) is a common mental disorder marked by persistent anxiety and worries, which are excessive and difficult to control, as well as multiple psychological and physical symptoms. GAD often has a chronic course with a lifetime prevalence rate for DSM-IV criteria estimated at approximately 6 % . Persons suffering from GAD present significant impairments in work, social and family functioning, and health-related quality of life. There is also increasing evidence regarding the economic burden of GAD in terms of lost work productivity and medical costs due to high utilization of medical services. GAD is highly associated with comorbid psychiatric disorders, with major depressive disorder being the most frequent, and comorbid physical illness (Roberg et al., 2015).

Diagnostic Criteria

According to APA (2013), diagnostic criteria for GAD include the following:

  1. Excessive anxiety and worry, occurring more days than not for at least 6 months, about a number of events or activities such as work or school performance.
  2. The individual finds it difficult to control the worry.
  3. The anxiety and worry are associated with three or more of the following six symptoms with at least some symptoms having been present for more days than not for the past 6 months; restlessness or feeling keyed up or on edge, being easily fatigued, difficulty concentrating or mind going blank, irritability, muscle tension, and sleep disturbance.
  4. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  5. The disturbance is not attributable to the physiological effects of a substance such as a drug of abuse, a medication or another medical condition such as hyperthyroidism.
  6. The disturbance is not better explained by another mental disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder [social phobia], contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

Treatment Options

Medication or psychotherapy is a reasonable initial treatment option for GAD. Some studies suggest that combining medication and psychotherapy may be more effective for patients with moderate to severe symptoms. Compassionate listening and education are an important foundation in the treatment of anxiety disorders. The establishment of a therapeutic alliance between the patient and physician is important to allay fears of interventions and to progress toward treatment. Common lifestyle recommendations that may reduce anxiety-related symptoms include identifying and removing possible triggers (e.g., caffeine, stimulants, nicotine, dietary triggers, stress), and improving sleep quality/quantity and physical activity. Physical activity is a cost-effective approach in the treatment of GAD and PD.16,17 Exercising at 60% to 90% of maximal heart rate for 20 minutes three times weekly has been shown to decrease anxiety16; yoga is also effective ( Locke, Kirst, & Shultz, 2015).


A number of medications are available for treating anxiety, selective serotonin reuptake inhibitors (SSRIs) are generally considered first-line therapy for GAD. Second line of treatment includes tricyclic antidepressants (TCAs) such as Amitriptyline, Imipramine (Tofranil), Nortriptyline (Pamelor). Antiepileptics such as Pregabalin (Lyrica), and antipsychotics such as quetiapine (seroquel) are considered second line of treatment. For third line of treatment, Monoamine oxidase inhibitors especially Isocarboxazid (Marplan), Phenelzine (Nardil), and Tranylcypromine (Parnate) can be used. Lastly for augmentation treatment, Benzodiazepines especially Alprazolam (Xanax), Clonazepam (Klonopin), Diazepam (Valium), and Lorazepam (Ativan) can be used. Medications should be titrated slowly to decrease the initial activation. Because of the typical delay in onset of action, medications should not be considered ineffective until they are titrated to the high end of the dose range and continued for at least four weeks. Once symptoms have improved, medications should be used for 12 months before tapering to limit relapse. Some patients will require longer treatment. Benzodiazepines are effective in reducing anxiety, but there is a dose-response relationship associated with tolerance, sedation, confusion, and increased mortality. When used in combination with antidepressants, benzodiazepines may speed recovery from anxiety-related symptoms but do not improve longer-term outcomes. The higher risk of dependence and adverse outcomes complicates the use of benzodiazepines. National Institute for Health and Care Excellence (NICE) guidelines recommend only short-term use during crises. Benzodiazepines with an intermediate to long onset of action such as clonazepam (Klonopin) may have less potential for abuse and less risk of rebound ( Locke, Kirst, & Shultz, 2015).

Risk and Prognostic Risk Factors

According to APA (2013), this can be categorized as:

(i)Temperamental where by behavioral inhibition, negative affectivity (neuroticism), and harm avoidance has been associated with generalized anxiety disorder.

(ii) Environmental where by childhood adversities and parental overprotection have been associated with generalized anxiety disorder, no environmental factors have been identified as specific to generalized anxiety disorder or necessary or sufficient for making the diagnosis.

(iii) Genetic and physiological where by one-third of the risk of experiencing generalized anxiety disorder is genetic, and these genetic factors overlap with the risk of neuroticism and are shared with other anxiety and mood disorders, particularly major depressive disorder.


American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders

DSM-5 (5th ed.). Washington, DC: American Psychiatric Publishing.

Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders. Dialogues in clinical

neuroscience, 19(2), 93–107.

Locke, A.B., Kirst, N., & Shultz, C.G. (2015). Diagnosis and Management of Generalized Anxiety Disorder

and Panic Disorder in Adults. American Family Physician, 91(9), 617-624.

Roberge, P., Normand-Lauzière, F., Raymond, I. et al. (2015). Generalized anxiety disorder in primary

care: mental health services use and treatment adequacy. BMC Family Practice, 16, 146.



Anxiety Disorder Due to Another Medical Condition 293.84 specify (F06.4)

“Diagnostic Criteria

  1. Panic attacks or anxiety is predominant in the clinical picture.
  2. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition.
  3. The disturbance is not better explained by another mental disorder.
  4. The disturbance does not occur exclusively during the course of a delirium.
  5. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Coding note: Include the name of the other medical condition within the name of the mental disorder” (DSM-5 2019. Pgs. 230-231.)

The DSM-5 (2017) goes on to report that, It is important to note that this particular anxiety disorder is related to another medical condition where it is judged that the best explanation for anxiety is due to the physiological effects of another medical condition. This diagnosis must be made from the clinicians’ judgment based on history, physical exam, and or other laboratory findings. The clinician must determine that symptoms are not better accounted for by another mental disorder such as an adjustment disorder with anxiety in which the stressor is the medical condition. It seems obvious but the clinician must also establish the presence of another medical condition and that anxiety symptoms can be etiologically related to that medical condition. Associated symptoms include chronic conditions of an endocrine disease, cardiovascular disorders, respiratory illness, metabolic disturbances, and neurologic illnesses. The development and course of an anxiety disorder due to another medical condition arrives from the underlying medical illness.

There’s also extensive research that adding physical activity to the treatment of anxiety and other medical conditions that are associated with anxiety. Pedersen & Saltin (2015), discuss 26 different chronic diseases that have anxiety overlying symptoms and the benefits of physical activity for each of these diseases. Understandably we have been trained to write a prescription, but writing a prescription for exercise is not out of the question due to the abundance of research.

In a meta-analysis, Stubbs et. al., (2017) shows that exercise should be considered an evidence-based option for treatment of anxiety symptoms and other stress related disorders. It is also quite prevalent in the treatment of chronic diseases such as respiratory issues and cardiovascular problems.

Diagnostic and statistical manual of mental disorders: DSM-5. (2017). Arlington, VA: American Psychiatric Association.

Pedersen, B. K., & Saltin, B. (2015). Exercise as medicine – evidence for prescribing exercise as therapy in 26 different chronic diseases. Scandinavian Journal of Medicine & Science in Sports, 25, 1-72. doi:10.1111/sms.12581

Stubbs, B., Vancampfort, D., Rosenbaum, S., Firth, J., Cosco, T., Veronese, N., Schuch, F. B. (2017). An examination of the anxiolytic effects of exercise for people with anxiety and stress-related disorders: A meta-analysis. Psychiatry Research, 249, 102-108. doi:10.1016/j.psychres.2016.12.020

Two brief peer review on visual presentation