Generalised anxiety disorder

Question 1

Define GAD

Answer 1

syndrome of ongoing, uncontrollable, widespread worry about everyday events/thoughts that the patient recognises as excessive and inappropriate. Sx’s must be present on most days for 6+ months

Question 2

Epidemiology

Answer 2

Prev: 2-4%
W:M 2:1

Question 3

Pathophysiology + aetiology GAD

Answer 3

Triple vulnerability model

1. Biological vulnerability
   a. Genetic (GAD in 1st degree relative)
   b. Neurobiological/neurophysiological: dysfunction of autonomic NS [NAd], HPA axis, amygdala, BDZ/GABA system, dysreg. Of 5-HT systems…
2. Generalised psychological vulnerability
   a. Diminished sense of control
   b. Parenting (overprotective or lacking warmth)
3. Specific psychological vulnerability
   a. Stressful life event (trauma) or dysfunctional marital/family relationships

Question 4

CF’s GAD

Answer 4

WATCHERS
Worry (excessive + uncontrollable)
Autonomic hyperactivity (sweating, ^ pupil size, ^ HR)
Tension in muscles + Tremor
Concentration difficulty + Chronic aches
Headaches + Hyperventilation
Energy loss
Restlessness
Startled easily + Sleep disturbance (difficult getting to sleep + nightmares/waking u)

Question 5

Chest and abdo sx’s GAD

Answer 5

• Difficulty breathing
• Feeling of choking
• Chest pain + discomfort
• Nausea
• Abdo distress or pain
• Loose stools

Question 6

Brain + mind Sx’s GAD

Answer 6

• Feeling dizzy or light headed
• Fear of dying
• Dear of losing control
• Derealisation
• Depersonalisation

Question 7

General sx’s GAD

Answer 7

• Hot flushes or cold chills
• Numbness or tingling
• Headache

Question 8

Tension Sx’s GAD

Answer 8

• Muscle tension, aches or pains
• Restlessness
• Feeling on edge
• Difficulty swallowing
• Sensation of lump in throat (LIKE PATIENT YOU SAW)

Question 9

Non-specific Sx’s GAD

Answer 9

• Being startled
• Conc. Difficulty + mind blanks
• Persistent irritability
• Sleep problems

Question 10

Ix GAD

Answer 10

1. Bloods: TFTs, FBC (anaemia), glucose (hypoglycaemia)
2. ECG (sinus tachycardia)
3. Urine catecholamines (rule out Phaeochromocytoma - tumour of the adrenal glands)
4. Questionnaires: GAD-2, GAD-7 [SCREENING]…

Question 11

Rx GAD Biopsychosocial model

Answer 11

PSYCHOLOGICAL
• Low intensity: Psychoeducational groups
• High intensity: CBT + applied relaxation (practicing techniques that lead to muscular/bodily relaxation and apply them to situations triggering the anxiety)

BIOLOGICAL
• First line: SSRI (sertraline → anxiolytic effect)
• Second line: SNRI (duloxetine or venlafaxine)
• Third line: Pregablin
• During crisis (short term): BDZ
• Beta blockers (atenolol) for CV/autonomic symptoms

SOCIAL
• Self-help methods (individual + guided)
• Support groups
• Exercise (ENCOURAGE!)