Generalised anxiety disorder Flashcards
what is GAD?
chronic, excessive worry for at least 6 months that causes distress or impairment.
what key symptoms are required to make a diagnosis?
3/6 needed to make a diagnosis according to the DSM-5 criteria
these include
- restlessness
- nervousness
- being easily fatigued
- poor concentration
- irritability
- muscle tension
- sleep disturbance
other symptoms include
- headache
- sweating
- dizziness
- GI symptoms
- muscle aches
- increased HR
- SOB
- trembling
what are the risk factors?
- FH
- female
- increased stress
- history of physical/emotional trauma
- comorbid depression
- substance abuse/dependence
- other anxiety disorder
what investigations can be considered?
diagnosis is clinical using DSM 5 criteria
to rule out differentials, can do -
- TFT
- Urine drug screen is suspected cases of substance misuse
- ECG
- Pulmonary function test
- 24-hour urine for vanillylmandelic and metanephrines to rule out phaechromocytoma
how are patients with GAD monitored?
After an acute trial of pharmacotherapy over 12 weeks, effective treatment should be continued for at least 12 months.
Patients should be monitored throughout this period to ensure continued benefit.
A trial taper from the medication may be made at that time, with treatment reinstated if relapse occurs.
what are the complications of GAD?
- comorbid depression
- comorbid substance abuse/dependence
- inappropriate utilisation of healthcare resources
how can GAD patients be managed non pharmacologically?
guided self help
psychoeducational groups
Psychotherapy should be given for at least 6-8 sessions. Gains with psychotherapy have been shown to be maintained for up to 24 months.
what drug treatment can be suggested?
first-line treatment is usually with a selective serotonin reuptake inhibitor (SSRI) such as sertraline, paroxetine, or escitalopram.
A selective serotonin-noradrenaline reuptake inhibitor (SNRI), such as duloxetine or venlafaxine is a possible alternative.
Pregabalin can be offered if SSRIs or SNRIs are contraindicated or not tolerated
for people where CBT therapies and self help methods haven’t worked alone at alleviating symptoms
what assessment tools can be used for the severity of GAD?
the GAD-7 questionnaire can be use to determine GAD severity
Scores of 5, 10, and 15 are taken as the cut-off points for mild, moderate and severe anxiety, respectively. When used as a screening tool, further evaluation is recommended when the score is 10 or greater.
how should SSRI and SNRI use be monitored?
Be aware that in a minority of people aged under 30 years of age, SSRIs and SNRIs are associated with an increased risk of suicidal thinking and self-harm.
Anyone in this age group receiving an SSRI or SNRI should therefore be seen within 1 week of first prescribing, and the risk of suicidal thinking and self-harm should be monitored weekly for the first month.
