Generalised Anxiety Disorder

Question 1

What is a key feature of Generalised Anxiety Disorder according to DSM IV classification?

Answer 1

Excessive anxiety for ≥ 6 months

This is a primary diagnostic criterion for GAD.

Question 2

How many symptoms must be associated with anxiety to meet the criteria for Generalised Anxiety Disorder?

Answer 2

≥3 symptoms

Symptoms include restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbance.

Question 3

List three psychiatric conditions that should be considered in the differential diagnosis of anxiety disorders.

Answer 3

• Depression
• Schizophrenia
• Dementia

Question 4

What is the GAD-7 score range for mild anxiety severity?

Answer 4

0-5

GAD-7 is a tool used to assess the severity of anxiety.

Question 5

What are the first-line drugs for treating Generalised Anxiety Disorder?

Answer 5

• SSRI e.g. sertraline
• SSRI e.g. fluoxetine

Question 6

What is the second-line treatment option for Generalised Anxiety Disorder if the first-line is ineffective?

Answer 6

Alternative SSRI or SNRI (venlafaxine/duloxetine)

These are considered if the first-line SSRI does not provide relief.

Question 7

What is the third-line treatment option for Generalised Anxiety Disorder?

Answer 7

Pregabalin (if SSRI or SNRI not tolerated)

Pregabalin should be used cautiously due to potential for abuse.

Question 8

What is the first step in the stepwise approach to Generalised Anxiety Disorder?

Answer 8

Diagnosis, Education and Active Monitoring

Question 9

What type of interventions are offered in Step 2 if active monitoring is insufficient?

Answer 9

• Low-intensity psychological interventions
• Individual non-facilitated self-help
• Individual guided self-help
• Psychoeducational groups

Question 10

What therapy is provided in Step 3 for marked functional impairment?

Answer 10

• High-intensity psychological intervention
• Drug therapy

Question 11

What type of psychological therapy is indicated in high-intensity interventions?

Answer 11

Cognitive Behavioral Therapy (CBT)

Typically involves one-to-one sessions lasting 1 hour each, run weekly for 12–15 weeks.

Question 12

True or False: Benzodiazepines should be used for long-term treatment of anxiety disorders.

Answer 12

False

Benzodiazepines should only be used for short-term measures during a crisis.

Question 13

What conditions warrant a referral to CMHT in Step 4?

Answer 13

• Severe anxiety disorder with marked functional impairment
• Risk of self-harm or suicide
• Significant comorbidity
• Self-neglect
• Failure to respond to step 3 interventions

Question 14

What should be considered in CMHT referrals?

Answer 14

• Thorough assessment of the problem and risks
• Previous treatments
• Impact
• Combined drug and psychological interventions