anxiety Flashcards
what is generalised anxiety disorder (GAD)
excessive anxiety occurring most days for at least 6 months
the anxiety is hard to control and is about a number of events
what symptoms are associated with the anxiety/worry in GAD
restlessness easily fatigued difficulty concentrating irritability muscle tension sleep disturbance
3+ of these for most days in past 6 months
what is GAD-7
screening tool used to grade anxiety 0-5 = mild 6-10 = moderate 11-15 = moderately severe 15-21 = severe
what are alternate causes of anxiety to consider before diagnosing GAD
medication induced anxiety
hyperthyroidism
cardiac problems
how do patients with GAD normally present
worry
frequent health concerns
step one of GAD management
identify and assess the level of distress, functional impairment, number/severity/duration of symptoms
educate patient
active monitoring
treat any primary disorder first e.g. depression
step two of GAD management
low intensity psychological interventions - individual guided CBT and self-help
direct to psychoeducational groups
step three of GAD management
for people with marked functional impairment or who haven’t responded to step 2
high intensity intervention - (121 CBT), applied relaxation
SSRIs (sertraline is first line)
can use betablockers like propranolol for physical symptoms
what can you use if sertraline is ineffective in step three
use another SSRI - fluoxetine
swap to a SNRI - venlafaxine or duloxetine
pregabalin as last resort - has potential for abuse
what drugs should you not use for GAD in primary care
benzodiazepines (except short term during a crisis)
anti-psychotics
what is step 4 of GAD treatment
if it is still not responding this is a severe anxiety disorder and the patient needs to be referred
they could be at risk of self-harm/suicide, comorbidity, self-neglect
need a specialist review - community mental health team (CMHT)
what is panic disorder
recurring panic attacks with 1+ months of persistent worry/change in behaviour related to the attacks
what is a panic attack
an abrupt sensation of intense fear/discomfort
usually last a few minutes
what symptoms may be experienced in a panic attack
at least 4 of: palpitations sweating tight throat/choking SOB chest pain/discomfort nausea/vomiting dizziness, fainting, instability derealization fear of losing control numbness/tingling chills/hot flushes fear of dying
how do you manage panic disorder
mild/moderate - CBT/self-help/exercise
moderate/severe - CBT/psychological therapy and medications
what medications are used in panic disorder
SSRIs are first line (except fluoxetine)
imipramine or clomipramine if SSRIs arent working (TCAs)
what is social anxiety disorder
persistent fear of social or performance situations
exposure to situation causes anxiety +/- panic attack
patient recognises fear is unreasonable
avoidance of situations
lasts 6+ months
not attributable to anything else
what are features of social anxiety disorder
fear of social or performance situations
anxiety + panick attacks related to this
patient knows the fear is excessive
avoidance of situations
interruption of normal routine
the fear/anxiety/avoidance lasts >6months
how can you manage social anxiety
CBT
sertraline or escitalopram if not responding to CBT
continue for 6 months once treatment is effective
