Felicia Heyward CFNP 90
Katrin Moskowitz CFNP 91
Maria Sanchez, a 34 year old married, mother of four young children,
comes to your office for a complaint of headaches. She tells you she
hasn’t been able to sleep. She works full time as a house mom, takes
care of her sick mother-in-law who lives with her. She cooks all the
meals every night and handles all household duties. Her husband is
looking for full time work and spends most days doing odd jobs. She
finds that she can't keep from worrying "about everything" and she has
been unable to control this worry. Although on the surface she appears
outgoing, she dreads being in social situations.
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Generalized anxiety disorder is characterized by persistent, excessive, and unrealistic worry about
everyday things.
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The exact cause of GAD is unknown but research has shown that there is evidence that biological
factors, family background, and life experiences, particularly stressful ones, play a role.
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GAD affects 6.8 million adults, or 3.1% of the U.S. population, in any given year. Women are twice
as likely to be affected.
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People with the disorder, which is also referred to as GAD, experience exaggerated worry and
tension, often expecting the worst, even when there is no apparent reason for concern. They
anticipate disaster and are overly concerned about money, health, family, work, or other issues.
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Source: Schmucker, W.W., (2008).
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EKG to assess for arrhythmias and tachycardia
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Pulmonary function tests for asthma patients to rule out respiratory compromise
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Labs that may need to be done include:
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CBC
CMP
Thyroid levels—T3, T4 and TSH
Blood Glucose/Hgb A1C
Urinalysis and urine pregnancy
Urine drug toxicology screen
Prolactin
Folic acid
Parathyroid levels
Aldosterone
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Source: March,P.D. & Schub, T., (2011)
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Cardiac Conditions
Central Nervous System disorders
Hyperglycemia/Hypoglycemia
Hyperparathyroidism
Hyperthyroidism
Medications
Nutritional problems
Pheochromocytoma
Respiratory disorders
Stimulants (caffeine)
Temporal lobe epilepsy
Vestibular dysfunctions
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Acute situational anxiety
Adjustment reaction
Alcohol and drug dependencies
Borderline personality disorder
Delirium
Dementia
Depression
Dysthymia
Factitious disorder
Generalized anxiety disorder
Malingering
Panic disorder
Phobias
Posttraumatic Stress Disorder
Psychosis
Schizophrenia
Somatization disorder
Source: Schmucker, W.W. (2008).
Medical Diagnoses
Psychiatric Disorders
Drug Therapy
Psychotherapy
Behavioral
Medicine
Stress
Management
Relaxation
An indication for hospital treatment would be a patient with suicidal or homicidal ideations. These
patients hold a threat to themselves or others and need to be under supervision.
Another reason for hospitalization would be alcohol or drug abuse requiring treatment. Many times
patients self treat with other substances that maybe need to be ceased before appropriate therapy
can begin.
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Source: Anxiety disorder, 2011.
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A recent of 200 depressed and low income Latinos in Los Angeles showed that greater than 50%
felt that depressed people were not trustworthy and would be unwilling to socialize with someone
who is depressed.
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When Latinos think mental illness, they often think…………. LOCO!
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Family members shrug off mental illness as nervious (or “nerve problems”).
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By not taking care of the physical issues they will become mentally “crazy”.
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Hispanic patients may view mental health problems as a sign of weakness, and these problems
may carry stigma as with many cultures.
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Consequently, physical symptoms may be a more appropriate conduit for support. Hispanics have
a high incidence of mental health problems, particularly depression, anxiety, and substance
abuse.
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Source: HealthWatch, 2012.
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Religion is very important to Latino community.
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Many turn to Espiritualistas which are folk healers.
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Many feel that they have to resolve issues themselves as not to be a burden.
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Many Hispanic patients tend to avoid disagreeing or expressing doubts to their health care
provider about the treatment they are receiving. They may even be reluctant to ask questions or
admit they are confused about their medical instructions or treatment.
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Associated with this is a cultural taboo against expressing negative feelings directly. This taboo
may manifest itself in a patient's withholding information, not following treatment orders, or
terminating medical care.
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The desire for a personalismo provider -patient relationship.
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Lack of trust because of provider rotations within the clinics.
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Source: : U.S. Department of Health and Human Services (USDHHS), 2012
Lack of health insurance
(According to a 2006 American Psychological Association survey, nearly 1/3 of all Latinos had no
health insurance in comparison to 10% of Whites.)
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Underinsured
(Only 41% of those insured, had mental health benefits compared to 65% of Whites and 63% African
Americans.)
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Time for care
(Many Latinos have manual labor or service jobs that require odd hours, long shifts, and overtime.)
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Language Barrier
(Shortage of Spanish speaking psychiatrists, psychologists, and therapists. There are on 29 Latino
mental health professional to every 100,000 Latinas compared to 173 White providers per
100,000 whites.)
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Cultural Stressors
(Cultural transition caused by immigration, acculturation, and biculturalism. These stressors are
often manifest in feelings of irritability, anxiety, helplessness, and despair. Hispanics may mourn
the loss of family, friends, language, and culturally determined values and attitudes. These
reactions are not signs of individual pathology, but rather normal responses to the oftendisruptive process of change.)
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Source: USDHHS, 2012.
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Health care professionals
◦ Work within the structured medicine
◦ Physical and mental health separated
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Latinos/Hispanics
◦ Synergistic point of view
◦ Spirit (espiritu), body, and mind – continuum of care
◦ Source: USDHHS, 2012
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Patients need to be educated about their illness, treatment options, that
treatments may be needed long term, and expectations.
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Educate patients that some people do better with cognitive behavior therapy,
while others do better with medication.
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Still others do better with a combination of the two.
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Many patients with anxiety add a natural medicine along with their conventional
treatment. (Follow up care needs to include a thorough assessment of all
medications – prescribed and alternative)
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Caution patients that many of the natural products can be sedating and could
be unsafe to use before driving or performing other dangerous tasks.
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Sources: National Institute of Mental Health (2012) &
 Prescriber’s Letter (2012)
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Brazilian Native
Assistant Professor at the University of Florida College
of Nursing
Received the Research in Minority Health Award from
Southern Nursing Research Society.
Honored for research on the mental health of rural
Latinos and her mentorship of minority students.
Her research focuses on restoring the strong Latino
cultural belief of “familismo” or rebuilding family bonds
to promote mental wellness.
Research: Dr. Stacciarini research interests are in the
area of mental health promotion among minorities,
community-based participatory research for minorities
and international population.
Area of expertise: Dr. Stacciarini has clinical
expertise in Psychiatric Nursing and Mental Health.
Education: Dr. Stacciarini received her BSN in
Nursing at the Catholic University of Goiás (Brazil). She
received her master in Psychiatric Nursing and Mental
Health at the University of São Paulo/ College of
Nursing Ribeirão Preto and her PhD in Psychology at
the University of Brasilia (Brazil). During her PhD she
received a Fulbright Scholarship and came to the US as a
visitor scholar at the Psychology department/University
of Massachusetts.
Source: University of Florida, 2012
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Dr. Jeanne-Marie
Stacciarini, PhD, RN

Anxiety disorder. (2011). Essential Evidence Plus. Retrieved from http://www.essential
evidenceplus.com.ezproxy.midwives.org/content/ebmgebm/729.
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Healthwatch (2012).CNN. Retrieved from http:www.cnnhealthwatch.com
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March, P.D, & Schub, T.(2011). Generalized Anxiety Disorder in Women. CINAHL Nursing Guide,
Retrieved from
http://search.ebscohost.com/login.aspx?direct=true&db=nrc&AN=5000002773&site=nrc-live.
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National Institute of Mental Health (2012). Generalized Anxiety Disorder (GAD): When Worry Gets
Out of Control. Retrieved from http://www.nimh.nih.gov/health/publications/generalized-anxietydisorder-gad/complete-generalized-anxiety-disorder-gad-when-worry-gets-out-of-control.shtml
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Prescriber's Letter. (2009). Natural medicines in the clinical management of anxiety, 8(29),
#08029. Retrieved from
http://prescribersletter.therapeuticresearch.com.ezproxy.midwives.org/ce/ceCourse.aspx?cs=FRO
NT~CEPDA&s=PRL&pv=1&pc=08-29&quiz=1
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Schmucker, W.W. (2008). Anxiety Disorders. In T.M. Buttaro, J. Trybulski, P.P. Bailey,
& J. Sandberg-Cook (Eds.), Primary Care: A collaborative practice (3rd ed.,
pp.1378-1383). Philadelphia, PA: Mosby Elsevier.
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Shearer, S.L. (2011). Generalized Anxiety Disorder. Essential Evidence Plus.
Retrieved from
http://www.essentialevidenceplus.com.ezproxy.midwives.org/content/eee/623
The Providers Guide to Quality and Culture (2012). U.S. Department of Health and
Human Services (USDHHS). Retrieved from
http://erc.msh.org/mainpage.cfm?file=5.2.0f.htm&module=provider&languag
e=english