Generalised anxiety disorder

Question 1

screening questions for GAD

Answer 1

SUBJECTIVE EXPERIENCE OF NERVOUSNESS
- Are you the type of person to worry
about things?
o What makes you anxious / what do you
worry about?
+ What’s the worst case scenario?

o Do you find it difficult to control or stop the worry?

o When you are anxious, do you often feel other symptoms ?
- Fatigue
- sleep problems
- irritable, Restlessness
- reduced concentration or mind going blank
- muscle tension,
- depersonalisation
+ what is the duration?

Question 2

What are the questions after GAD screen u need to ask

Answer 2

How has this had an impact on your life?”
- “Does it bother you?”
- “Has it affected your job, marriage, school,
social life etc.”
- “Does it interfere with you completing your daily activities or chores?

• Suicide risk
• Ask about substance abuse: Use of caffeine and caffeine products
  Substance (e.g. amphetamines, cocaine, cannabis, hallucinogens) and alcohol use
  Nicotine withdrawal

Question 3

what is the DSM criteria of GAD

AND I C REST

Answer 3

A. Excessive anxiety/worry occurring more
days than not for ≥6 months and occurring
in the context of a number of events or
activities (e.g. work or school performance)

B. Individual finds it difficult to control the
worry

C. Anxiety and worry are associated with
≥3/6 of:
- Restlessness or feeling keyed up/on edge
- Easily fatigued
- Difficulty concentrating, mind going blank due to worry
- Irritability
- Muscle tension
- Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep)

D. Clinically significant distress or impairment in social, occupational or other
important areas of functioning

E. Disturbance not attributable to substance (drug of abuse, medication) or medical condition (e.g. hyperthyroidism)

F. Not better explained by another
psychiatric disorder

Question 4

What are the differential dx and investigations for GAD

Answer 4

DDx:
- hyperthyroidism
- TFTS, - TSH, free t3 and t4.
- thyroid antibodies
Phaeochromocytoma,
- plasma free metanephrine , urinary metaneprhien and normetanephrine levels

Social anxiety disorder : anticipatory anxiety for evaluation by others

substance - eg. caffiene induced

Adjustment disorder: (not meeting the criteria for any disorder. occurs in response to identifiable stressor within 3 months of onset and no persist for more than 6 months after termination or stressor/ or its consequences

Question 5

Management of GAD

Answer 5

1. Safety :
2. Lifestyle: diet less caffeine and sugary drinks, exercise, sleep and hygiene.

Psych
- CBT, mindfulness,
relaxation techniques,
psychoeducation

Bio
- SSRI - first-line
- Sertraline (50mg OD increasing to 100mg
over several weeks)
SNRI - venlafaxine
- Benzodiazepine - can be used until SSRI takes effect (2-4 weeks)
- Rapid response - can aid adherence/response to SSRI
- Avoid if high-risk of abuse

Others
- Buspirone, BB (propanolol), hydroxyzine, pregabalin

Question 6

Explain GAD to a layman - bio psycho social factors

Answer 6

Anxiety is a normal response to situations which we perceive as dangerous.
Generalised anxiety disorder is a long-term condition that causes you to feel anxious about a wide range of situations and issues, rather than 1 specific event. It can feel difficult to control

Bio
- some people are predisposed to developing the illness through genes passed on by their parents.
-with long term illness there is overaction of the primitive brain (amygdala) which causes the stress response. Overtime the frontal cortex which helps to modulate this response can grow thin

Psycho
- in anxiety a maladaptive coping mechanism of avoidance of a specific triggering situation which can also affect mood and reinforce anxiety
- also pavlovian response which is where negativity is associated with previous experience but then tcan further generalise to other aspects non related
- it can be made worse with stress life factors
- alcohol/ benzos work on the GABA receptors which help to dampen the stress response so there is risk of sud

The main treatment for these disorders is graded exposure desensitisation therapy , implosion (full exposure), CBT to help people question their own negative thoughts about the
Medication can help dampen the brains reactivity to the fight flight so can help frontal lobe to recover