Generalised anxiety

Question 1

DSMV definition of General anxiety disorder

Answer 1

Over 6months
of excessive, difficult to control worry about every day issue -disproportionate
at least 3 of -
restlessness, irritability, being easily fatgued, poor concentration, sleep disturbances, anxiety attacks

Question 2

RF, protective factors of general anxiety disorder

Answer 2

RF -divorced, lone parent, living alone, 35-54

protective -16-24, married, cohabitating

Question 3

What are the Sx of general anxiety disorder

Answer 3

Key features - definied with free floating anxiety -no specific threat >6m
Sx -phscho and physical
Coping -avoidance, ETOH, depression

ANS sx- palps, sweat, tremor, dry mouth, tachy
CHest - SOB, choking sensation, pain, nausea
Brain -dizzy, derealise/deprerson, fear of dying
General -hot/cold, numb
Tension -muscle
Other -startled, difficult to focus, irriotable, difficulty sleeping

Question 4

Ix for general anxiety disorder

Answer 4

GAD7 questionnare (5-mild, 10 moderate, 15 severe
Becks anxiety inventory
Hospital anxiety and depression scale

TSH

Question 5

Mx of general anxiety disorder

Answer 5

Step1 - written info of GAD and active monitoring+regular exercise

Step 2 - low intensity psych intervention
self help -indiv, non guided 6weeks
Self help -indiv, guided-6w + therapy
Psychoeducational groups -6w, 12< per group

Step 3- if pregnant skip to taht
High intensity -
CBT - 12-15w, 16h per week (test the causes and look into further errors of thinking
Applied relaxation 12-15w

Medication -
1) SSRI -sertraline (1st), or paroxetine (weekly follow up for 3 weeks)
2) different SSRI
3) Switch to SNRI (venlafaxine)
4) pregabalin
5) Quietapine (atypical antipsychotic)
propanalol can be used as adjunct

NEVER give BDZ