Anxiety disorder- generalised

Question 1

What is the NICE central feature of anxiety

Answer 1

excessive worry about a number of different events associated with heightened tension

Question 2

What is the epidemiology of GAD

Answer 2

more common in women
patients aged 30-50years

Question 3

What are general symptoms associated with GAD

Answer 3

long term excessive worry
recognise worries as inappropriate but not able to control them

Question 4

What investigations can be carried out

Answer 4

clinical diagnosis

always look for potential physical causes

Question 5

What are some important differentials for GAD

Answer 5

hyperthyroidism
cardiac disease
medication induced anxiety

Question 6

What are examples of medications that can induce anxiety

Answer 6

salbutamol
theophylline
corticosteroids
antidepressants
caffeine

Question 7

What is the DSM 5 criteria for GAD

Answer 7

• excessive anxiety and worry occuring more days than not for at least 6 months about a number of events
• individual finds it difficult to control the worry
• anxiety is associated with at least 3 or more of following symptoms
  -restlessness/ feeling keyed up
  -easily fatigued
• difficulty concentrating
  -irritability
  -muscle tension
  -sleep disturbance

-causes clinically significant distress in important areas of functioning

-cannot be explained by anythung else

Question 8

What is step wise management approach for GAD

Answer 8

step 1- educate about GAD and actively monitor

step 2 - low psychological intervention

step 30 high intensity psychological interventions or drug treatments

step 4 - highly specialist input

Question 9

What drug treatment can be offered

Answer 9

Sertraline is first line

if not effective
can offer another SSRI or SNRI - duloxetine

can offer pregabalin next