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Maria is hospitalized as she is suffering from generalized anxiety disorder that is interfering with her ability to function
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1Q).

Generalized anxiety disorder (GAD) is a psychological illness characterized by unusual events of anxiety regarding different aspects of life such as personal and social relationships, workforces, financial matters, and others.

The common symptoms of GAD in the given patient are,

  1. Worrying all the time about every day and everything
  2. Lack of appropriate sleep
  3. Difficulty in concentrating on studies and constantly worrying about school, grades, meeting her financial responsibilities, and her parents

The patient had chronic anxiety as the symptoms are continuous and the anxiety is related to almost all the situations, but not to a particular event.

Cortisol is the major glucocorticoid released from the adrenal cortex during the stress. Chronic stress increase the levels of corticosteroids, which also act as immunosuppressant, and anti-inflammatory molecules. As patients with GAD have severe stress, their cortisol levels are expected to raise. The morning cortisol levels range from 10 – 20 µg/dl, and the patient’s cortisol levels are, 10 µg/dl, which indicates that it is at the lower end.

2Q).

Treatment for GAD:

  • Relaxation training (breathing exercises, reality testing exercises)
  • Benzodiazepines
  • Selective serotonin reuptake inhibitors (SSRIs)

Benzodiazepines (BDZs) are the commonly prescribed drugs for the treatment of anxiety disorders. Examples include diazepam, alprazolam, and clonazepam. Although these drugs cause drug dependence, they are less likely abuse than it is actually assumed. BDZs cause psychological dependence due to their rapid onset of action, which gives a sensation of intoxication.

The sudden withdrawal of BDZs causes withdrawal symptoms (physical and psychological) that include, seizures, anxiety, tremors, hallucinations, and delirium. The withdrawal symptoms occur after a few days of taking the last dose. So, the dose should be gradually reduced by 25% per week to avoid the withdrawal symptoms.

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