General anxiety disorder

Question 1

Generalized anxiety disorder

Answer 1

• Feelings of dread or doom with physical stress and irritability for 3+months
• Associated with catastrophising: expecting worst-case scenario and magnification

Question 2

DSM-5 diagnostic criteria

Answer 2

• Excessive/uncontrollable anxiety and worry about two (or more) domains e.g. family or work, occurs for more days than not for three months or more
• Physical symptoms: Muscle tension, fatigue, poor concentration and restlessness
• Associated behaviors: Avoiding activities or events with possible negative outcomes, Spending time and effort preparing for such events, Procrastinating due to worry, Repeatedly seeking reassurance
• Causes clinically significant distress or impairs functioning
• Cannot be accounted for by the physical effects of a substance, medical condition or mental disorder

Question 3

Aetiology

Answer 3

• Biological theories
• Dispositional characteristics of worriers
• Information processing bias

Question 4

Biological theories

Answer 4

• There is evidence that anxiety and GAD have inherited components
• Neuroimaging evidence suggests prefrontal brain regions may be involved
• There are abnormalities in emotional regulation in GAD sufferers

Question 5

Dispositional characteristics of worriers

Answer 5

-Worrying is maintained by Intolerance of uncertainty, high perfectionism, feelings of responsibility for negative outcomes and poor problem-solving confidence.

Question 6

Information processing bias

Answer 6

-Individuals with GAD preferentially allocate attention (both conscious and unconscious) to threatening stimuli e.g. angry faces as shown in dot probe task (faster reaction times to dot presented in same location as angry face was suggesting attention was already focused there). Attentional bias may cause anxiety

Question 7

Treatment

Answer 7

• Attention bias modification
• Pharmacological
• Stimulus control treatment
• Cognitive behaviour therapy

Question 8

Attention bias modification

Answer 8

-Dot probe task is used: two words are presented one negative and one neutral, probe always appears for the neutral word which trains individual to attend more rapidly to the neutral word to correct the attentional bias

Question 9

Pharmacological

Answer 9

• 50% of GAD sufferers receive antidepressants (SSRIs or SNRIs) and only 35% receive anxiolytics such as the benzodiazepines as GAD has comorbidity with depression
• For short term relief

Question 10

Stimulus control treatment

Answer 10

• Distinguish worrying thoughts from necessary or pleasant thoughts
• Control context: half an hour at the same time and place every day for worrying

Question 11

Cognitive behaviour therapy

Answer 11

• Increase awareness of behaviour patterns and triggers that may cause worry
• Relaxation training
• Cognitive restructuring: challenge biases to become more realistic
• Behavioural rehearsal: Adaptive coping responses for when trigger is encountered
• For Long term management