Anxiety disorder: generalised (PSY) Flashcards
Define generalised anxiety disorder.
At least 6 months of excessive worry about everyday issues that is disproportionate to any inherent risk, causing distress or impairment
What are some contributing factors to generalised anxiety disorder? (3)
- increase in minor life stressors
- presence of physical or emotional trauma
- genetic factors
What are some risk factors for generalised anxiety disorder? (8)
- Fx anxiety
- female
- increased stress
- Hx physical/emotional trauma
- comorbid depression/other anxiety disorder
- chronic physical health condition
- substance misuse/dependence
- divorced/separated/living alone/single parent
What is the main clinical feature of generalised anxiety disorder?
Excessive worry for >6 months
What are the 6 core Sx of generalised anxiety disorder (DSM-V criteria)?
Excessive worry for >6 months AND 3/6 of following:
- muscle tension (common)
- irritability (common)
- restlessness (common)
- sleep disturbance
- fatigue
- poor concentration
What are some other symptoms of generalised anxiety disorder (not needed for diagnosis)? (5)
- headache
- sweating
- dizziness
- GI symptoms
- trembling
What other diagnoses do we need to rule out before diagnosing generalised anxiety disorder?
Hyperthyroidism - TFTs (anxiety Sx may be a sign of thyroid disease) - if unexplained weight loss, goitre, exophthalmos or Fx
What other investigations can we do for generalised anxiety disorder? (2)
- urine drug screen
- ECG (arrhythmia)
What type of diagnosis is generalised anxiety disorder?
Clinical diagnosis of exclusion
What screening questionnaire can we use in general practice for generalised anxiety disorder?
GAD-7 score from 0-21
(0-4 minimal, 5-9 mild, 10-14 moderate, 15-21 severe)
What are some differential diagnoses for generalised anxiety disorder? (6)
- panic disorder (recurrent episodes of sudden-onset anxiety with 4+: SOB, palpitations, shakiness, nausea, hot/cold flushes, fear of dying)
- social phobia
- OCD (directly related to anxiety)
- PTSD
- somatoform disorders (anxiety directly related to specific physical complains, but normal o/e)
- depression
What are the 4 steps to generalised anxiety disorder management?
- step 1: education and monitoring
- step 2: low-intensity psychological interventions (individual self-help or psychoeducational groups)
- step 3: high-intensity psychological interventions (CBT or pharmacology)
- step 4: highly specialist input (multi-agency teams)
What is the first-line psychological management of generalised anxiety disorder?
Cognitive behavioural therapy (CBT) along with relaxation/mindfulness/sleep hygiene/exercise
What drug is first-line (to fourth-line) for generalised anxiety disorder?
- 1st line: SSRI (sertraline or escitalopram) or mirtazapine
- 2nd line: SNRI (duloxetine or venlafaxine)
- 3rd line if these not tolerated: pregabalin or buspirone
- 4th line: TCA e.g. imipramine / BZ
What drug can be used for somatic Sx (tremor, shaking, palpitations) in generalised anxiety disorder?
Beta blockers
