5 - GAD Flashcards
is anxiety normal?
yes from an evolutionary view point - adaptive function
* alerts orgnaism to threats to survival
* prepares for fight/flight
when may anxiety be abnormal?
- disproportionate to stimulus
- triggered by harmless situations
- can’t be controlled
- impairs functioning
to have an operational diagnoses, what criteria must be met?
- pt must exprience a certain no of symptoms for at least a minimum specified period
- symptoms must cause - distress + be associated with impairment in everyday function
what are the assesment criteria of GAD?
- persistent fear + worry
at least 3 of: - poor concentration
- restlessness
- fatigue
- muscle tension
- initial insomnia
symptoms last for >6months
what is initial insomnia?
trouble getting to sleep
what is terminal insomia?
waking up early + unable to get back to sleep
what type of insomnia is more common in GAD?
initial insomnia
what type of insomnia is more common in depression?
terminal insomnia
when diagnosing GAD, what must you exclude?
- alcohol or street drug misuse
- hyperthyroidism
- phaeochromocytoma
what is phaeochromocytoma?
- benign tumour of adrenal medulla
- leads to hypertension + anxiety due to release of catecholamines into circulation
symptoms of GAD can be split into?
psychological
physical
behavioural
what are the psychological symptoms of GAD?
- constant worries + intrusive thoughts
- feeling or apprehension + dread
- poor concentration
- depersonalisation + derealisation
what are some physical symptoms of GAD?
- tremor, sweatiness, palpatations
- muscular tension + tension headache
- hyperventilation
chest pain is ‘atypical’ in GAD - what does this mean?
- sharp + stabbing rather than crushing
- left sided rather than central
- won’t radiate
how can GAD lead to parasthesiae in hands, feet and lips?
- hyperventilation
- leads to respiratory alkalosis
- causes changes in Cl- + Ca2+ channels in peripheral nerves
what are some of the behavioural symptoms of GAD?
- putting things off because of anxiety
- avoidance
- self medication through drugs and alcohol
is GAD more common in women or men?
women
what is the median age of onset of GAD?
30 years
what genetic factors can contribute to GAD?
- first degree relative
- risk genes
- overactive amygdala
what environmental factors can contribute to GAD?
- parental rejection or over-control
- childhood trauama
- major life stress, eg. physical illness
what is the main inhibitory neurotransmitter in the CNS?
GABA - 1/3 synapses
how is GABA synthesised?
decarboxylation of amino acid glutamic acid
GABA has a major role in the regulation of what?
- neuronal excitability and muscle tone
GABA is the endogenous agonist at what two main receptors?
GABA A - multiple ligand binding sites - more important in brain
GABA B - more important in muscles and used clinically as a muscle relaxant
what is the arrangement of the GABA A receptor?
- five subunits arranged around a central chloride channel
- commonent mammamilian structure is - alpha x2, beta x2, gamma x1
what happens when GABA binds to a GABA A receptor?
- binds to binding pocket between alpha and beta subunits
- causes Cl- to flow into neuron
- leads to hyperpolarisation - reduced change of AP
if GAD is not severe, what may a doctor suggest?
simple lifestyle changes before adopting ‘formal’ treatment:
* exercise
* work/life balance
* avoid caffeine and other drugs
* avoid excess alcohol
what is the NICE guidance for GAD care?
- recognition and diagnosis GAD
- offer treatment in primary care
- non-response - reveiw and offer alternative
- review and offer referral to secondary care
- care specialist mental health services
what psychological treatments may be offered for GAD?
- counselling
- CBT
- mindfulness
what is the aim of CBT?
identify unhelpful patterns of thinking and replace them with more realistic and balanced ones
what are the NICE recommendations around CBT?
12-15 hour long sessions of CBT over 4 months
which is more effective for GAD treatment - psychological vs pharmacological?
similarly effective - pt choice is crucial
