GAD Flashcards
Key features of GAD
Long term condition
Anxiety about a wide range of situations - free floating
Excessive, uncontrollable worry about everyday things
When does anxiety become abnormal
Excessively intense Continues beyond exposure to danger Triggered by harmless sit Cant be controlled Causes distress Impairs functioning
Epidemiology
More common in women 2:1
Onset is 20s
1 in 20 adults in britain
Some possible causes
Genetic makeup Anxious personality Negative life events Childhood trauma Physical illness
Signs and sympotoms of GAD
Psychological
Physical
Behavioural
Psychological symptoms
Constant intrusive worries
Feeling of dread
Poor concentration
Irritability
Physical symptoms
Trembling Sweating Nausea Headaches Shortness of breath Difficulty swallowing Muscle aches and twitching
Behavioural symptoms
Putting things off as feel overwhelmed
Avoidance (leaving home, using public transport)
Drug taking to relieve anxiety
Diagnosing GAD
Excessive anxiety about range of things for at least 6 months
Not restricted to particular situation
Ohysical or psychological symptom
Can coexist with MDD
NICE guidelines for GAD
- Diagnose
- Offer treatment in primary care (CBT, meds- SSRI, self help)
- Review and offer alternative treatment
- Offer referral to secondary care (if 2 interventions given yet person still has symptoms)
- Care in specialist mental health services (holistic reassessment)
Core elements of CBT
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
Meds prescribed for GAD
SSRI TCA Other antidepressants Pregabalin Benzodiazepines
SSRIs for GAD
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
Common SSRI side effects
GI disturbance Sex dysfunct Diziness Dry mouth Loss of appetite Sweating Agitation Insomnia
Pregabalin for GAD
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
Benzodiazepines for GAD
Reduces feeling of anxiety within 30 to 90 minutes
Acts at GABA-a receptor
Strict guidance on prescribing FOR LESS THAN 4 WEEKS!
GABA overview
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.
Baclofen
GABA analog which acts as a selective agonist at GABA-b receptors.
Used as muscle relaxant
GABA-a receptor
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
Commonest mammalian GABA-a structure
(Alpha1)2 (beta2)2 (gamma1)
GABA on the GABA-a receptor
GABA binds to binding pocket between alpha and beta subunits.
Causes Cl- ions to move into neurone, decreasing chance of AP
Benzodiazepines on GABA-a receptor
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
Side effects of benzodiazepines
Sedation Respiratory depression Tolerance Dependance Inpaired cognition
Beta blockers for GAD
Antagonists at adrenergic beta receptors in heart muscle, smooth muscle and other muscles of symp NS
EFFECTIVE ONLY TO TREAT PHYSICAL GAD
Buspirone
Serotonin 1A receptor partial agonist
Delayed onset
Only modest effect
How long to keep on medication?
Continue medication for further 6 months after remission to reduce risk of relapse
