Generalized Anxiety Disorder 1 Flashcards
What are
“Anxiety
Disorders”
p to 40% of those diagnosed
with anxiety or related disorders
are untreated!
- Generalized Anxiety Disorder
- Substance/Medication-Induced Anxiety Disorder
- Anxiety Disorder Due to Another Medical Condition
The common feature of these disorders is the presence of: - Excessive fear and anxiety and related behavioural disturbances
What differs among them are:
* types of objects or situations that induce fear, anxiety, or avoidance
behaviours, and the associated cognitive ideation
Anxiety disorders differ from developmentally normal fear or anxiety
by being excessive or persisting beyond appropriate periods
Fear is the emotional response to a real or perceived imminent threat. And anxiety is the anticipation of a future threat.
*Anxiety conditions are highly comorbid with each other
“Panic attacks” are a particular
type of fear response (not an
anxiety disorder, but can be seen in
them)
Comorbidity
of Anxiety
Disorders
- Anxiety disorders frequently co-occur with other
psychiatric disorders - > 50% of people with an anxiety disorder have multiple anxiety
disorders - ~ 30% will have 3 or more comorbid anxiety or related disorders
- often comorbid with substance use, mood disorders, and ADHD
- Comorbidity with other anxiety/depressive disorders
is associated with: - poorer treatment outcomes
- greater severity and chronicity
- more impaired functioning
- Pts with anxiety disorders have a higher prevalence of:
- cardiovascular conditions (like HTN), gastrointestinal disease,
arthritis, thyroid disease, respiratory disease, migraines, and
allergic conditions
GAD Burden
of Illness
- Excessive worrying impairs capacity to quickly and
efficiently complete required tasks (personal,
professional) - There is an expense of energy and time to be in a
state of “worry” - Muscle tension
- Feeling “on edge”
- Tiredness
- Concentration difficulties
- Sleeping difficulties
- Excessive worry may impair the ability to encourage
“confidence” in their children - Associated with significant disability and distress
- 110 million disability days / year (USA)
Course of
GAD
Many people with GAD claim they have felt “anxious
and nervous their whole lives”
* Excessive worry and anxiety may start early in life, but
manifest into an anxious temperament over time
* Symptoms tend to be chronic, but wax and wane over
the lifespan
* Rates of full remission are very low
* The earlier in life that symptoms meet diagnostic
criteria, the higher the rates of comorbidity and
impairment
Diagnosis
Criteria A - C
Excessive anxiety and worry (apprehensive
expectation), occurring more days than not for at least 6
months, about a number of events or activities (such
as work or school performance).
The individual finds it difficult to manage the worry.
The anxiety and worry are associated with three or
more of the following symptoms (only 1 symptom is
required in children)
Anx/Worry / More than Not
X 6 months
About # Events
Assoc. with 3+ symps
Diagnostic
Symptoms
1) Restlessness or feeling keyed up or on edge
2) Being easily fatigued
3) Difficulty concentrating or mind going blank
4) Irritability
5) Muscle tension
6) Sleep disturbance (difficulty falling or staying asleep,
or restless, unsatisfying sleep)
There can be additional
symptoms outside of what is
diagnostic
MRS. FIC
Muscle tension
Restlessness
Sleep �/�
Fatigue
Irritability
Concentration
Diagnosis
Criteria D - F
The anxiety, worry, or physical symptoms cause
clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
The disturbance is not attributable to the physiological
effects of a substance or another medical condition
The disturbance is not better explained by another
mental disorder
Notice that in DSM all the time, if something doesn’t impair function, it’s very often not diagnosable. So we always need to have that functional impairment.
Medications
Associated
with Anxiety
Anticonvulsants Carbamazepine, phenytoin
Antidepressants SSRIs, SNRIs, bupropion, TCAs
Antihypertensives Felodipine, clonidine
Antibiotics Quinolones, isoniazid
Bronchodilators Salbutamol, theophylline
Corticosteroids Prednisone
Dopamine agonists Levodopa, amantadine
Herbals Ma Huang, ginseng, ephedra
Recreational Subs. Cannabis, ecstasy
NSAIDs Ibuprofen, indomethacin
Stimulants Amphetamines, methylphenidate, caffeine, cocaine, nicotine
Sympathomimetics Pseudoephedrine, phenylephrine
Thyroid Hormones Levothyroxine
Toxicity Anticholinergics, antihistamines, digoxin
Withdrawal Alcohol, sedatives
Risk Factors
for Anxiety
Disorders
family hx
personal hx of anxiety or mood disorder
childhood stressful life events or trauma
being female
chronic med illness
behavioural inhibition
- Factors “associated” with GAD:
- Childhood adversities
- Overprotective parenting
GAD
Screening
Questions
- For GAD, consider asking a question(s) similar to:
- During the past 4 weeks, have you been bothered by feeling
worried, tense, or anxious most of the time? - Are you frequently tense, irritable, and having trouble sleeping?
- During the past two weeks how much have you been bothered
by the following problems? - Feeling nervous, anxious, frightened, worried, or on edge?
- Feeling panic or being frightened?
- Avoiding situations that make you anxious?
Commonly Used Scales
- Clinician-Rated (ex: pharmacist asks patient questions)
- Hamilton Anxiety Rating Scale (HAM-A, AKA “HARS”)
- Clinical Global Impression (CGI) Scale
- Patient-Rated (ex: patient records answers to questions)
- Patient Health Questionnaire-9 (PHQ-9)
- Generalize Anxiety Disorder-7 (GAD-7)
HAM-A, 14Q
2 components: CGI-Severity (CGI-S), CGI-Improvement (CGI-I)
More specific to the DSM-V diagnostic symptoms
HAM-A
Each item is scored on a scale of 0 (not
present) to 4 (severe)
Total score range of 0–56
< 17 = MILD
18 – 24 = MILD – MODERATE
25 – 30 = MODERATE – SEVERE
31 + = VERY SEVERE
CGI Scale
CGI-S rates illness SEVERITY
CGI-I rates illness IMPROVEMENTS
When assigning CGI-S scores you
compare to INITIAL BASELINE
SCORE ASSIGNED
GAD-7
Each item is scored on a scale of 0 (not at all)
to 4 (nearly every day)
Total score range of 0–21
0 - 4 = MINIMAL anxiety
5 - 9 = MILD anxiety
10 - 14 = MODERATE anxiety
15 - 21 = SEVERE anxiety
asking how diff have the problems made if your you to work, take care of things at home?
So we can always have a score, but if it’s not, if it’s not impacting us functionally, we can’t make a diagnosis about it.
This is asking abt FUNCTIONAL IMPAIRMENT!
