Anxiety Flashcards
Describe the typical presenting features of generalised anxiety disorder in adults
Persistent worrying or anxiety about a number of areas that are out of proportion to the impact of the events
Overthinking plans and solutions to all possible worst-case outcomes
Perceiving situations and events as threatening, even when they aren’t
Difficulty handling uncertainty
Indecisiveness and fear of making the wrong decision
Inability to set aside or let go of a worry
Inability to relax, feeling restless, and feeling keyed up or on edge
Difficulty concentrating, or the feeling that your mind “goes blank”
Physical signs and symptoms may include:
Fatigue
Trouble sleeping
Muscle tension or muscle aches, trembling, feeling twitchy, sweating
Nervousness or being easily startled
What is a GAD 7 questionnaire?
How would you interpret your results?
Over the last 2 weeks, how often have you been bothered by any of the following problems?
Feeling nervous, anxious or on edge?
Not being able to stop or control worrying?
Worrying too much about different things?
Trouble relaxing?
Being so restless that it is hard to sit still?
Becoming easily annoyed or irritable?
Feeling afraid as if something awful might happen?
GAD-7 score /21:
5- mild
10- moderate
15- severe
When used as a screening tool, further evaluation with a score greater than 10.
Sometimes use GAD-2
Develop appropriate management plans for generalised anxiety disorder which incorporate the NICE recommended “stepped approach”.
Step 1 - consider other factors and provide education about the nature of GAD with the options for treatment. Monitor the person’s symptoms and functioning (known as active monitoring).
Step 2 - Low intensity psychological interventions for GAD
Individual non-facilitated self-help- written/electronic materials, CBT based principles, minimal therapist contact
Individual guided self help – supported by a trained practitioner who reviews outcome, 20-30 minute sessions
Psycho education groups – one therapist to 12 participants, six 2 hour weekly sessions
Step 3 - High intensity psychological intervention:
CBT – 1 hour/week, 12-15 sessions
Applied relaxation
Drug treatment:
First line – SSRI e.g. sertraline
Alternative – SNRI e.g. paroxetine
If not tolerated offer pregabalin
Step 4- If severe functional impairment and high-risk of self harm
Specialist mental health services
Complex combination drugs and interventions
What are some differentials for anxiety?
Anaemia Adjustment disorder Stimulant use – coffee Substance use disorders Endocrine conditions – hyperthyroidism, phaeochromocytoma Cardiopulmonary conditions– arrhythmia’s Neurological disorders- TIA , epilepsy
