GAD-7 scale i.e. General Anxiety Disorder-7 scale is a 7 item anxiety scale developed by Spitzer and colleagues which has good readability, criterion, construct, factorial and procedural validity (Spitzer et al., 2016). It is a screening tool and is also a severity indicator for GAD (Rutter et al., 2017). It can be scored easily and was created initially to increase GAD recognition in primary care settings (Spitzer et al., 2016). The benefits of the GAD-7 scale are that it is a tool with a strong criterion validity which is useful for identifying probable causes of GAD.
With other measures of anxiety and depression, GAD-7 has better convergent and discriminant validity (Rutter et al., 2017). It is an excellent severity measure. This is because multiple domains of functional impairment and disability days can be associated with high scores of GAD-7. It is useful particularly in assessing severity symptoms and monitoring changes with time (Spitzer et al., 2016). The limitations of the GAD-7 scale are that this scale focuses only on single anxiety disorder (Spitzer et al., 2016). In terms of reliability and validity, it has strong psychometric properties and a latent structure which is one-dimensional and is invariant between patients of both the gender (Rutter et al., 2017). It does not provide a confirmative diagnosis.
For those people who are having symptoms of GAD or having GAD and marked functional impairment and not responding adequately to step 2 interventions, either an individual high-intensity psychological intervention or drug treatment is offered (Rutter et al., 2017). If a person having GAD makes a choice of high-intensity psychological intervention, either cognitive behavioural therapy (CBT) or applied relaxation is offered. CBT should be based on the treatment manual which is used in the clinical trials of CBT for GAD (NICE, 2019). It should be delivered by trained and competent practitioners. It consists of one hour session for 12-15 weeks depending on the recovery of person.
Similarly applied relaxation should be based on the treatment manual which is used in the clinical trials of applied relaxation for GAD. It also consists of one hour session for 12-15 weeks and should be delivered by trained and competent practitioner (Spitzer et al., 2016). In both the therapies, supervision is important to monitor fidelity to the treatment model. If the individual choses drug treatment, a selective serotonin reuptake inhibitor is offered. Sertraline is the first offered drug as it is cost effective. The person should be monitored carefully for adverse reactions. If sertraline is ineffective, another serotonin reuptake inhibitor should be preferred. (NICE, 2019).
a) The psychopharmacological justification
Benzodiazepines are given for short-term but GAD has a chronic nature. That is why, benzodiazepines are not preferred. Also, with benzodiazepines side effects such as somnolence, fatigue, increased swelling and jitteriness are seen (Strawn et al., 2018). On discontinuation of benzodiazepines, withdrawal effects such as anxiety, tremor and diaphoresis are noted in the patients. As compared to SSRIs, their tolerability is low especially among youth and side-effects such as irritability; drowsiness and oppositional behaviour have been noted in youth (Spitzer et al., 2016). As compared to benzodiazepines, SSRIs are better tolerated and has broad spectrum efficacy in both short term and long term treatment (Rutter et al., 2017).
b) The psychosocial justification
Escitalopram or other SSRIs are recommended as the first line treatment for generalised anxiety disorders over benzodiazepines because with the use of certain benzodiazepines there is tendency of possible misuse by the patients resulting in benzodiazepine dependence (Guina & Merrill, 2018). Further, it aids faster improvement of symptoms enabling recovery within weeks of beginning the treatment in some cases.
The benefits of considering a differential diagnosis include improved and precise diagnosis through the use of notable classification tools. The clarity of thoughts and opinions in forming the diagnosis is improved by considering alternate diagnosis for the patient (Cook & Décary, 2020). It enables critical analysis and thinking providing a trajectory to the treatment. It helps practitioner also understand a patient’s prognosis in a better manner due to a deeper understanding of their diagnosis. The understanding of relation of clinical utility of tests along with diagnosis can help better in providing final diagnosis. For differential diagnosis, common test metrics are used which include sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ration and negative likelihood ratio (Jain, 2017).
Their use inadvertently increases the value of diagnosis. Based on the test metrics and the intuitive approach of the doctor, diagnostic tests are advised to the patient indicating that additional tests which would not have otherwise been prescribed to the patient are used in these cases establishing a more clear diagnosis. The results of these diagnostic tests are analysed by the physician based on clinical reasoning and further decision is taken, so, the treatment process is also enhanced. Thus, higher order thinking through the analysis of differential diagnosis reduces the risks of misdiagnosis and poor treatment outcomes (Cook & Décary, 2020).
Cook, C., & Décary, S. (2020). Higher order thinking about differential diagnosis. Brazilian Journal of Physical Therapy, 24(1), 1-7
Guina, J., & Merrill, B. (2018). Benzodiazepines I: Upping the Care on Downers: The Evidence of Risks, Benefits and Alternatives. Journal of clinical medicine, 7(2), 17. https://doi.org/10.3390/jcm7020017
Jain, B. (2017). The key role of differential diagnosis in diagnosis. Diagnosis, 4(4), 239-240
NICE guideline (2019). Generalised anxiety disorder and panic disorder in adults: management. 1-41
Rutter LA, Brown TA (2017). Psychometric properties of the Generalized Anxiet Disorder Scale-7 (GAD-7) in Outpatients with Anxiety and Mood Disorders. J Psychopathol Behav Assess 39(1):140-146
Spitzer RL, Kroenke K, Williams JW, Lowe B (2016). A brief measure for assessing Generalized Anxiety Disorder. Arch Intern Med 166;1092-1097.
Strawn JR, Geracioti L, Rajdev N, Clemenza K (2018). Pharmacotherapy for Generalized Anxiety Disorder in Adults and Pediatric Patients : An Evidence Based Treatment Review . Expert Opin Pharmacother. 19(10):1057-1070.
Remember, at the center of any academic work, lies clarity and evidence. Should you need further assistance, do look up to our Psychology Assignment Help
Proofreading and Editing$9.00Per Page
Consultation with Expert$35.00Per Hour
Live Session 1-on-1$40.00Per 30 min.
Doing your Assignment with our resources is simple, take Expert assistance to ensure HD Grades. Here you Go....