Generalised Anxiety Disorder

Question 1

What is GAD?

Answer 1

A persistent feeling of anxiety to pretty much everything for a few months

Question 2

Typical presentation of GAD?

Answer 2

” 25 y/o woman presents complaining of muscle tension in the shoulders and neck leading to headaches. She has had it for 4/12 and is sleeping less. She is very restless and has been struggling at work, feeling like she can’t concentrate. “

Sometimes GAD doesn’t present with just “I’m anxious”. The patient might not know they’re anxious or might not disclose worrying in a history

Question 3

DDx of GAD?

Answer 3

IMPORTANT ONES

• Thyrotoxicosis
• Arrhythmia
• Pheochromocytoma
• Hypoglycaemia

PSYCHIATRIC

• Depression (commonly presents with anxiety)
• Schizophrenia
• Substance abuse

Question 4

1st line treatment of GAD?

Answer 4

Counselling + meds

Question 5

What is the focus of counselling in anxiety?

Answer 5

CLEAR MANAGEMENT PLAN
Advise
- Caffeine 
- Alcohol 
- Relaxation
- Exercise --> been shown to reduce anxiety

Question 6

What medications can be used in GAD?

Answer 6

SSRIs first line

+

Anxiolytic if very severe

Question 7

What anxiolytic can be used and why is it good?

Answer 7

Buspirone

Is independent of serotonin release

Question 8

What psychotherapy can help in GAD with depression?

Answer 8

CBT