GAD

Question 0

Key features of GAD

Answer 0

Long term condition
Anxiety about a wide range of situations - free floating
Excessive, uncontrollable worry about everyday things

Question 1

When does anxiety become abnormal

Answer 1

Excessively intense
Continues beyond exposure to danger
Triggered by harmless sit
Cant be controlled
Causes distress
Impairs functioning

Question 2

Epidemiology

Answer 2

More common in women 2:1
Onset is 20s
1 in 20 adults in britain

Question 3

Some possible causes

Answer 3

Genetic makeup
Anxious personality
Negative life events
Childhood trauma
Physical illness

Question 4

Signs and sympotoms of GAD

Answer 4

Psychological
Physical
Behavioural

Question 5

Psychological symptoms

Answer 5

Constant intrusive worries
Feeling of dread
Poor concentration
Irritability

Question 6

Physical symptoms

Answer 6

Trembling
Sweating
Nausea
Headaches
Shortness of breath
Difficulty swallowing
Muscle aches and twitching

Question 7

Behavioural symptoms

Answer 7

Putting things off as feel overwhelmed
Avoidance (leaving home, using public transport)
Drug taking to relieve anxiety

Question 8

Diagnosing GAD

Answer 8

Excessive anxiety about range of things for at least 6 months
Not restricted to particular situation
Ohysical or psychological symptom
Can coexist with MDD

Question 9

NICE guidelines for GAD

Answer 9

1. Diagnose
2. Offer treatment in primary care (CBT, meds- SSRI, self help)
3. Review and offer alternative treatment
4. Offer referral to secondary care (if 2 interventions given yet person still has symptoms)
5. Care in specialist mental health services (holistic reassessment)

Question 10

Core elements of CBT

Answer 10

Identifies unhelpful and unrealistic beliefs and behavioural patterns
Aims to change behaviour and replace unhelpful beliefs with ideal and balanced ones
Focuses on current problems
12-15 one hour sessions
50% of GAD sufferers recover with CBT

Question 11

Meds prescribed for GAD

Answer 11

SSRI
TCA
Other antidepressants
Pregabalin
Benzodiazepines

Question 12

SSRIs for GAD

Answer 12

Block serotonin (5-HT) reuptake from synapse
1st line med treatment
- escitalopram
- sertraline
- paroxetine
Not addictive, cause fewer side effects than TCAs and less toxic in overdose

Question 13

Common SSRI side effects

Answer 13

GI disturbance
Sex dysfunct
Diziness
Dry mouth
Loss of appetite
Sweating
Agitation
Insomnia

Question 14

Pregabalin for GAD

Answer 14

Anticonvulsant drug used in epilepsy and neuropathic pain
Also used for GAD
Binds to alpha-2-delta subunit of voltage gated Ca2+ channel in CNS

Decreases release of neurotransmitters glutamate, noradrenaline and substance P

Question 15

Benzodiazepines for GAD

Answer 15

Reduces feeling of anxiety within 30 to 90 minutes
Acts at GABA-a receptor

Strict guidance on prescribing FOR LESS THAN 4 WEEKS!

Question 16

GABA overview

Answer 16

Main inhibitory neurotransmitter in CNS
Present in 30% brain synapses
Synth by decarboxylation of glutamic acid
Regulates neuronal excitability and muscle tone
Acts on 2 receptors GABA-a and b.

Question 17

Baclofen

Answer 17

GABA analog which acts as a selective agonist at GABA-b receptors.
Used as muscle relaxant

Question 18

GABA-a receptor

Answer 18

Transmembrane, ligand gated ion channel receptor
Has 5 subunits
Types of subunits are alpha, beta, gamma, delta and p

Alpha- 6 variations
Beta- 4 variations
Gamma- 3 variations

Question 19

Commonest mammalian GABA-a structure

Answer 19

(Alpha1)2 (beta2)2 (gamma1)

Question 20

GABA on the GABA-a receptor

Answer 20

GABA binds to binding pocket between alpha and beta subunits.
Causes Cl- ions to move into neurone, decreasing chance of AP

Question 21

Benzodiazepines on GABA-a receptor

Answer 21

Bind to separate site between alpha and gamma subunits.
Adds to the action of GABA and increases the influx of Cl- ions into the neurone.
Positive allosteric modulator at the GABA-a receptor
GABA-a receptors without gamma subunit are insensitive to benzodia

Question 22

Side effects of benzodiazepines

Answer 22

Sedation
Respiratory depression
Tolerance
Dependance
Inpaired cognition

Question 23

Beta blockers for GAD

Answer 23

Antagonists at adrenergic beta receptors in heart muscle, smooth muscle and other muscles of symp NS

EFFECTIVE ONLY TO TREAT PHYSICAL GAD

Question 24

Buspirone

Answer 24

Serotonin 1A receptor partial agonist
Delayed onset
Only modest effect

Question 25

How long to keep on medication?

Answer 25

Continue medication for further 6 months after remission to reduce risk of relapse