Generalized Anxiety Disorder

Question 1

How would you describe general anxiety disorder?

Answer 1

It is characterised by a disproportionate, pervasive, uncontrollable and widespread worry about everyday things
The patient would have a range of somatic, cognitive, and behavioural symptoms

Question 2

According to DSM five, how long should anxiety symptoms last for a diagnosis? How does this differ to ICD – 10 guidelines?

Answer 2

Six months For more days than not

ICD 10 recommend several months for most days

Question 3

Describe the epidemiology of general anxiety disorder

Answer 3

Females affected more
Most common between ages of 35 and 55
The estimate provided his 5%
Anxieties are most common psychiatric disorders
Probably under diagnosed

Question 4

Name Some biological risk factors for anxiety

Answer 4

Female
Family history of psychiatric disorders
Family history of anxiety

Question 5

Describe the psychological risk factors for anxiety

Answer 5

Previous maltreatment, physical/sexual abuse
Parental problems (intimate partner violence, alcoholism, drug use)
Exposure to harsh/protective parenting
Bullying/peer victimisation
Chronic illness

Question 6

Describe some social risk factors for general anxiety disorder

Answer 6

In unemployment
Low socio-economic status
Substance dependence

Question 7

Name some symptoms of general anxiety disorder

Answer 7

– Restlessness/nervousness
– easily fatigued
– poor concentration
– irritability
– muscle tension
– Sleep disturbances
– trembling
– sweating
– lightheaded
– palpitations
– dizziness
– epigastric discomfort

Question 8

How might patient who is presenting to a GP with no obvious symptoms of anxiety present, if they actually have general anxiety disorder?

Answer 8

In primary care, people with general anxiety disorder often present with physical symptoms such as:
– headaches
– muscle tension
– GI symptoms
– backpain
– insomnia

Question 9

What medications should you check for in patients he might have a general anxiety disorder?

Answer 9

Salbutamol, theophylline, beta-blockers, herbal medicines, corticosteroids, some antidepressants

Alcohol and illicit drugs

These substances may cause anxiety themselves

Question 10

What might you find from conducting a physical examination on a patient with general anxiety disorder?

Answer 10

And increased heart rate, shortness of breath, trembling, and exaggerated differential diagnosis

Question 11

Name some questionnaires that you can conduct in primary care for patients who are suspected of having anxiety?

Answer 11

GAD 2 or GAD 7

Question 12

Go through a step-by-step treatment plan for patient presenting with general anxiety disorder

Answer 12

– Treat underlying medical conditions/underlying medical mental health problems/substance abuse and give practical advice to help with the anxiety
– if the patient does not improve following step one, provide a low intensity psychological intervention based on CBT such as
– non-facilitated self-help, individual guided self-help or psycho educational groups
-If the patient does not improve following step two
Provide a high intensity psychological intervention or a drug treatment
– high intensity psychological interventions: CBT or applied relaxation
– first line drug treatment: SSRI (paroextine, sertraline or escitalopram
- 2nd LINE SNRI, 3rd line pregbalin
-If drug effective carry on for at least one year to prevent relapse