Anxiety Disorders 3 Flashcards
What is 2nd line tx for GAD?
- SNRI → 2nd line
- Venlafaxine (Effexor) – 37.5 mg/day – increase dosage after 2-4 weeks
A score over 3 for GAD (generalized anxiety disorder) has a sensitivity of ___ and a specificity of ____.
- Sensitivity = 86%
- Specificity = 83%
The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):
Note: Only one item is required in children.
- Restlessness or feeling keyed up or on edge.
- Irritability.
- Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).
- Being easily fatigued.
- Difficulty concentrating or mind going blank.
- Muscle tension.
Generalized Anxiety Disorder
- Feeling nervous, anxious or on edge
- Not being able to stop or control worrying
Generalized Anxiety Disorder
•Essential feature → excessive anxiety and worry (apprehensive expectation) about a number of events or activities
Generalized Anxiety Disorder
Excessive worrying impairs the individuals capacity to do things quickly and efficiently → work and home
- Worrying takes time and energy
- Associated symptoms (e.g. muscle tension, fatigue, difficulty concentrating) contribute to impairment
- May impair ability to encourage confidence in their children
Generalized Anxiety Disorder
How is Generalized Anxiety Disorder “scored?”
- 0= not at all
- 1= several days
- 2= more than half the days
- 3= nearly everyday
What is 1st line tx for GAD?
CBT → 1st line
SSRI → 1st line
- Sertraline (Zoloft) – 50mg/day – increase dosage after 2-4 weeks
- Considering tapering after ~1 year
- Chronic in many patients with >50% having disorder for ____ years.
- Tends to wax and wane
- Rates of full remission are very low
over 2 years
GAD
•1/3 of the risk of developing generalized anxiety disorder is _____.
Genetic
Adults often worry about everyday routine life circumstances
- Job responsibilities
- Finances
- Health of family member
- Misfortune to their children
- Minor maters → household chores, turning lights off, shutting garage door
Generalized Anxiety Disorder
•Children tend to worry about their competence or the quality of their performance
Generalized Anxiety Disorder
•Difficult to control worrisome thoughts from interfering with tasks at hand
Generalized Anxiety Disorder
- Autonomic hyperarousal (e.g. ↑ HR, shortness of breath, dizziness) features are less prominent in comparison to panic disorder
- Trembling, twitching, feeling shaky, blepharospasm
- Muscle aches or soreness
- Sweating, nausea, diarrhea
- Exaggerated startle response
Generalized Anxiety Disorder
- Increased risk of developing major depressive disorder, unipolar or bipolar disorders
- Some risk of developing substance use disorder and psychotic disorders
Comorbidities of GAD
- Is generalized anxiety disorder more common in females or males?
- What is the median age of onset of Generalized Anxiety Disorder?
- F:M 2:1
- Median age of onset is 30 y/o
Additional tx options for GAD
Anxiolytic options
- Buspirone (Buspar) – twice daily dosing, takes ~2 weeks to reach efficacy level
- Clonazepam (Klonopin) – screen for SUD, short term use only
- Hydroxyzine (Vistaril) – rapid onset, can be taken every 6 hours prn
Reduce stimulants
•Caffeine, nicotine, decongestants
•Anxious temperament → many report that they have felt anxious and nervous all of their lives
Generalized Anxiety Disorder
