Anxiety Disorder: generalised

Question 1

Definition

Answer 1

Disproportionate, pervasive, uncontrollable and widespread worry and a range of somatic, cognitive and behavioural symptoms.

Question 2

Epidemiology and risk factors

Answer 2

• Female
• FHx
• Current physical or emotional stress
• Hx of physical or emotional trauma
• Hx of other anxiety disorders e.g. panic disorder
• Chronic pain or physical illness e.g. arthritis
• Hx or substance abuse

Question 3

Pathophysiology

Answer 3

Low serotonin system activity
Elevated noradrenergic system activity

Question 4

Clinical features and diagnostic criteria

Answer 4

DSM-V diagnostic criteria:
- At least 6 months of excessive, difficult to control worry about everyday issues that is disproportionate to any inherit risk -> distress or impairment
- The worry is not confined to features of another mental disorder or as a result of substance abuse or a general medical condition
- At least 3 of the following symptoms most of the time:
= restlessness/nervous
= being easily fatigued
= poor concentration
= irritability
= muscle tension
= sleep disturbance

Question 5

Diagnosis

Answer 5

Diagnosis of exclusion
GAD-7 = self reported screening questionnaire

Question 6

Treatment

Answer 6

Step 1: Education
Step 2: Low-intensity psychological interventions e.g. individual guided self-help
Step 3: High intensity P.I e.g CBT OR drug treatment = SSRI = sertraline
Step 4: specialist treatment = complex drug +/- pyschological interventions

Question 7

SSRI warning

Answer 7

Px aged < 30 years starting an SSRI and SNRI should be informed of increased risk of suicidal thinking and self-harm
Anyone in this age group recieving an SSRI or SNRI should be seen within 1 week of initiation and monitored weekly for the first month.

Question 8

Complications

Answer 8

• Depression
• Substance abuse
• Other anxiety disorder
• Suicidal ideation and attempts
• Other co-morbidities