Generalised Anxiety Disorder and Panic Disorder

Question 1

What is the central feature of generalised anxiety disorder?

Answer 1

Excessive worry about a number of different events associated with heightened tension

Question 2

What PHYSICAL causes of anxiety should you check when considering a psychiatric diagnosis?

Answer 2

Hyperthyroidism
Cardiac disease
Medication-induced anxiety

Question 3

What MEDICATIONS can trigger anxiety?

Answer 3

Salbutamol
Theophylline
Corticosteroids
Antidepressants
Caffeine

Question 4

What is the 4 step management of generalised anxiety disorder (GAD)?

Answer 4

Step 1 - education about GAD + active monitoring
Step 2 - low-intensity psychological interventions
Step 3 - high-intensity psychological interventions (CBT/applied relaxation) or drug treatment
Step 4 - highly specialist input

Question 5

How do you treat GAD with drugs?

Answer 5

Give sertraline first-line
If ineffective, give another SSRI or an SNRI (duloxetine or venlafaxine)
If can’t tolerate SSRI/SNRI then pregabalin

Question 6

What important monitoring step must you take when prescribing SSRIs/SNRIs to patients under 30?

Answer 6

Warn them of increased risk of suicidal thinking/self-harm

Weekly follow-up in the first month

Question 7

What is the step-wise method to manage panic disorder?

Answer 7

Step 1 - recognition + diagnosis
Step 2 - treatment in primary care (CBT/drugs - SSRIs then/or imipramine or clomipramine)
Step 3 - review and consideration of alternative treatments
Step 4 - review and referral to specialist MH services
Step 5 - care in specialist MH services