Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) is characterized by excessive, uncontrollable worry about multiple life domains (health, finances, work, family) occurring more days than not for at least 6 months, causing significant distress and functional impairment. The pathophysiology involves dysregulation of the fear circuitry: the amygdala (threat detection center) becomes hyperactive, while the prefrontal cortex (rational thought and emotion regulation) has diminished inhibitory control over the amygdala. Neurotransmitter imbalances include decreased GABA (the primary inhibitory neurotransmitter that normally dampens anxiety), decreased serotonin (which modulates mood and anxiety), and increased norepinephrine (heightened sympathetic arousal). The HPA axis is chronically activated, producing elevated cortisol that maintains a state of hypervigilance. Autonomic nervous system dysregulation results in chronic sympathetic activation producing the physical symptoms of anxiety: muscle tension, GI disturbance, insomnia, tachycardia, and fatigue. The practical nurse assesses anxiety severity, monitors medication effects, and provides supportive care including relaxation techniques.