Generalised anxiety disorder

Question 1

What is generalised anxiety disorder?

Answer 1

Generalised anxiety disorder is characterised by excessive, persistent, unreasonable anxiety about everyday things

Question 2

Epidemiology of GAD

Question 3

Cause of generalised anxiety disorder

Answer 3

Exact cause not fully understood

• overactivity in areas of the brain involved in emotions and behaviour (eg amygdala)
• an imbalance of serotonin and noradrenaline
• genetic factor - someone is 5 times more likely to develop GAD if they have a close relative with the condition
• having a history of stressful or traumatic experiences, such as domestic violence, child abuse or bullying
• having a painful long-term health condition, such as arthritis
• having a history of drug or alcohol misuse

Question 4

Symptoms of GAD

Answer 4

Autonomic arousal symptoms

1. palpitations or pounding heart, or accelerated heart rate
2. sweating
3. trembling or shaking
4. dry mouth (not owing to medication or dehydration)

Symptoms concerning chest and abdomen

5. difficulty breathing
6. feeling of choking
7. chest pain or discomfort
8. nausea or abdominal distress (e.g. churning in stomach)

Symptoms concerning brain and mind

9. feeling dizzy, unsteady, faint or light-headed
10. feelings that objects are unreal (derealisation), or that one’s self is distant or ‘not really here’ (depersonalisation)
11. fear of losing control, going crazy or passing out
12. fear of dying

General symptoms

13. hot flushes or cold chills
14. numbness or tingling sensations

Symptoms of tension

15. muscle tension, or aches and pains
16. restlessness and inability to relax
17. feeling keyed up, or on edge, or of mental tension
18. a sensation of a lump in the throat, or difficulty with swallowing

Other non-specific symptoms

19. exaggerated response to minor surprises or being startled
20. difficulty in concentrating, or mind going blank, because of worrying or anxiety
21. persistent irritability
22. difficulty getting to sleep because of worrying

Question 5

ICD-10 diagnostic criteria for GAD

Answer 5

A - A period of at least six months with prominent tension, worry and feelings of apprehension, about every-day events and problems

B - At least four symptoms out of the following list of items must be present, of which at least one from autonomic arousal symptoms

C - The disorder does not meet the criteria for panic disorder, phobic anxiety disorders, obsessive–compulsive disorder or hypochondriacal disorder

D - Most commonly used exclusion criteria: not sustained by a physical disorder, such as hyperthyroidism, an organic mental disorder or psychoactive substance-related disorder, such as excess consumption of amphetamine-like substances, or withdrawal from benzodiazepines

Question 6

Treatment of GAD

Answer 6

• Psychotherapy
  
  • CBT
• Medication
  
  • benzodiazepines
  • antidepressants (eg SSRI)
• Lifestyle
  
  • Stop smoking
  • Reduce alcohol and caffeine intake
  • Exerecise regularly