GAD

Question 1

Px

Answer 1

Excessive worry and aprehension about everyday events. Worries about future, feeling on edge.
Generalised and persis.
Muscle and psychic tension- restless, fidget, headache.
Significant distress or functional impairment. Interf with norm activ.
Prim symps of anx for most days for several weeks or months.
Autonomic overactiv- dizzy, sweat, tachyc.
Resp to incorrec and inaccurately perceived danger. Anx is symp of unresolved conflict.

Question 2

ICD 10

Answer 2

AT LEAST 4 OF (incl at least one autonomic arousal)-

• autonomic arousal eg palpit, sweat, shaking, dry mouth.
• physical symps eg SOB, CP, nausea.
• mental state symps eg dizzy, derealisat or depersonalisation, fear of loss control/crazy/die.
• general- hot and cold, numb, tingling.
• tension- muscle tension or pain, restless, on edge, lump in throat.
• exagg startle resp.
• concentration- anx, irritabil, insomnia.

Question 3

Prevalence

Answer 3

Lifetime prevalence 5.7%.
Highest 45-59 yo.
Females more 2 to 1.

Question 4

Aetiology

Answer 4

Genetic
?NA, HPA eg high cortisol, amygdala, 5HT dysregulation.
Low sense of control, over protec parents.
Stressful life event eg trauma, family rels.

Question 5

Diffs

Answer 5

Normal worries
Depression
Mixed anx and dep
Other ADs
Drug ad alc probs
Medical conds
S/e

Question 6

Mx

Answer 6

-bio- SSRI 1st line. 
Buspirone for psychic symps. 
BDZs for somatic.
TCA, trazodone, SNRI, SSRI for dep. 
BB or pregabalin for CVS effects. 
Psychosurgery. 
-psycho-
CBT- exposure, applied relaxation, education, correct think errors. 
Self help.

Question 7

Prognosis

Answer 7

Chronic and disabling
Prog gen poor
68% mild residula after 6yr
9% sev persis