anxiety Flashcards
what is it
excessive worry about every day issues that is inproportionate to inherent risk
how long should symptoms be present for to have GAD (and cause clinically significant distress, impairment in social, occupational or other important areas of functioning)
at least 6 months
at least 3 of the following symptoms are present most of the time
restlessness or nervousness
easily fatigues
poor concentration
irritability
muscle tension
sleep disturbance
it is defined by, and its severity characterised, by one of two main classification systems
- DSM5TR
- ICD11
What to do if pt has GAD + comorbid depressive or other anxiety disorder
treat primary disorder first i.e. the one that is more severe and in which is it more likely that treatment will improve overall functioning
NICE stepped approach in management of GAD (step 1)
- communicate diagnosis, provide into about it, arrange active monitoring of pt symptoms and functioning at intervals based on clinical judgement, if other comorbid anxiety or depression then treat the primary disorder
NICE stepped approach in management of GAD
step 2
- if symptoms not improved, offer low-intensity psychological interventions guided by pt pref
- e.g. individual non-facilitated self help, individual guided self help, psychoeducational groups
This AED can be given in GAD management if 1st line options fail
pregabalin
drug treatment of GAD (step 3 of NICE stepped approach)
include 1st line options + alternatives
1st line SSRI
if sertraline ineffective, offer alternative or SNRI (dulox, venla)
If above not tolerated then consider pregabalin
NICE stepped approach in management of GAD - step 3
- if GAD + marked functional impairment, of GAD that has not improved following step 2 (low intensity psychological intervention)
- offer individual high intensity psychological intervention e.g. CBT or applied relaxation
- or can offer drug treatment
If pt is being given SSRI or SNRI for GAD, what should you counsel them on?
adverse effects early in treatment with SSRI or SNRI may include increased anxiety, agitation, sleeping problems
will be gradual improvement in symptoms over 1 week or more before they experience full anxiolytic effect
modest benefit (for drug treatment) is seen usually within ….
6 weeks and continues to increase over time
how often to review drug treatment
- review effectiveness and adverse effects every 2-4 weeks during first 3 months
- every 3 months thereafter
- SSRI/SNRI and under 30: review within 1 week of prescribing and monitor risk of suicidal thinking and self harm weekly for the first month
can you use BZPN for treatment of GAD in primary care
do not offer this except as short term measure during crises
Ideal treatment (step 3) for pregnant woman with GAD
- ideally offer high intensity psychological intervention
- decision on drug treatment should take into account benefit and harms of treatment in pregnancy incl risk of not treating condition and risks to woman and baby
