Anxiety Disorders 3

Question 1

What is 2nd line tx for GAD?

Answer 1

• SNRI → 2nd line
• Venlafaxine (Effexor) – 37.5 mg/day – increase dosage after 2-4 weeks

Question 2

A score over 3 for GAD (generalized anxiety disorder) has a sensitivity of ___ and a specificity of ____.

Answer 2

• Sensitivity = 86%
• Specificity = 83%

Question 3

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.

Answer 3

Generalized Anxiety Disorder

Question 4

• Feeling nervous, anxious or on edge
• Not being able to stop or control worrying

Answer 4

Generalized Anxiety Disorder

Question 6

•Essential feature → excessive anxiety and worry (apprehensive expectation) about a number of events or activities

Answer 6

Generalized Anxiety Disorder

Question 7

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

Answer 7

Generalized Anxiety Disorder

Question 8

How is Generalized Anxiety Disorder “scored?”

Answer 8

• 0= not at all
• 1= several days
• 2= more than half the days
• 3= nearly everyday

Question 9

What is 1st line tx for GAD?

Answer 9

CBT → 1st line

SSRI → 1st line

• Sertraline (Zoloft) – 50mg/day – increase dosage after 2-4 weeks
• Considering tapering after ~1 year

Question 10

• Chronic in many patients with >50% having disorder for ____ years.
• Tends to wax and wane
• Rates of full remission are very low

Answer 10

over 2 years

GAD

Question 11

•1/3 of the risk of developing generalized anxiety disorder is _____.

Answer 11

Genetic

Question 12

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

Answer 12

Generalized Anxiety Disorder

Question 13

•Children tend to worry about their competence or the quality of their performance

Answer 13

Generalized Anxiety Disorder

Question 14

•Difficult to control worrisome thoughts from interfering with tasks at hand

Answer 14

Generalized Anxiety Disorder

Question 15

• 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

Answer 15

Generalized Anxiety Disorder

Question 16

• Increased risk of developing major depressive disorder, unipolar or bipolar disorders
• Some risk of developing substance use disorder and psychotic disorders

Answer 16

Comorbidities of GAD

Question 17

• Is generalized anxiety disorder more common in females or males?
• What is the median age of onset of Generalized Anxiety Disorder?

Answer 17

• F:M 2:1
• Median age of onset is 30 y/o

Question 18

Additional tx options for GAD

Answer 18

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

Question 19

•Anxious temperament → many report that they have felt anxious and nervous all of their lives

Answer 19

Generalized Anxiety Disorder