Mental Health

Question 1

What is Generalised Anxiety Disorder?

Answer 1

Anxiety is a common disorder that can present in multiple ways.

NICE define the central feature as:
“an excessive worry about a number of different events associated with heightened tension”

Question 2

H&E of GAD

Answer 2

Long-term excessive worry about activities, events and thoughts.

Often recognise worries as inappropriate but are not able to control them.

MC in F and in patients aged 30-50

Question 3

Investigations for GAD

Answer 3

Look for potential physical causes when considering psychiatric diagnosis and rule them out first

Question 4

What physical conditions can mimic GAD symptoms?

Answer 4

Hyperthyroidism, cardiac diseases and medication-induced anxiety

Question 5

What medications can mimic GAD symptoms?

Answer 5

Salbutamol, theophylline, corticosteroids, antidepressants and caffeine

Question 6

Management of GAD

Answer 6

Step wise approach:

1. education about GAD + activity monitoring
2. low-intensity psychological interventions (individual + guided self-help, psychoeducational groups)
3. CBT, drug treatment
4. Highly special input e.g. multi-agency teams

Question 7

Drug management for GAD

Answer 7

Sertraline is first-line SSRI

If ineffective offer alternative SSRI or SNRI

If both in-tolerated, offer pregabalin

For patients under age of 30 years, warn them of increased risk of suicidal thoughts + self harm, weekly follow up for first month