GAD Flashcards
1
Q
GAD
What is the DSM definition of GAD?
A
excess worry out of proportion to likelihood/impact of feared event, occurs more days than not > 6+ months
2
Q
GAD
GAD epidemiology (age, sex, prevalence, risk factors)
A
- 20’s to 30’s
- women > men
- 18% adults
- other MH conditions (mood, SUD), often missed in older adults
- non-white, single, poverty, early childhood trauma
3
Q
GAD
Patho/etiology behind GAD
A
- unconscious unresolved conflict
- behavioural anxiety = conditioned response
- neurotransmitters: norepinephrine, serotonin
4
Q
GAD
What is panic disorder?
A
- episodic unexpected panic attacks that occur without a clear trigger
- rapid onset of intense fear (peak in 10 min)
- most common physical symptom: palpitations
5
Q
GAD
What does SWIGECAPS stand for?
A
Sleep Worthlessness Interest Guilt Energy Concentration Appetite Psychomotor changes Suicidal/Safety
6
Q
GAD
Most common somatic symptoms and other associated symptoms
A
Somatic: dizziness GI upset nausea chest pain SOB sweating chronic HA
Other: poor sleep fatigue difficulty relaxing - often present for long-standing symptoms that are medically unexplained
RED FLAGS
homicidal/suicidal ideation
7
Q
GAD
Medical conditions that need to be excluded include
A
hyperthyroidism pheochromocytoma hyperparathyroidism tumours Cushing's hypoglycemia epilepsy
8
Q
GAD
Ddx (psych)
A
depression hypochondriasis any other anxiety disorder adjustment disorder OCD ADHD
9
Q
GAD
DSM criteria for dx
A
3 of the following over last 6 mo - muscle tension - restless/keyed up - easy fatigue - difficulty concentrating - trouble sleeping - irritability * must cause significant distress/impair functioning * not attributed to effect of substance use or medication not explained by another mental disorder
10
Q
GAD
Management & Follow-up schedule for GAD
A
- psychotherapy (CBT)
- SSRIs
- compassionate listening
- f/u 1-2 weeks, then Q2-4 weeks
- safety/suicide assessment every visit
11
Q
GAD
SSRI’s - what is the MOA, S/E, precautions. name some examples
A
- fluoxetine, venlafaxine, paroxetine, sertraline, (es)citalopram
- inhibits reuptake serotonin
- use 12 mo before tapering to avoid relapse
- nausea, drowsiness, insomnia, dry mouth, sexual dysfunction (sertraline)
- monitor for serotonin syndrome!
12
Q
GAD
Serotonin syndrome
A
Triad
- altered mental status (agitation, anxiety, restlessness)
- neuromuscular abnormalities (hyperreflexia, rigidity, tremors)
- autonomic hyperactivity ( hypertension, tachycardia, mydriasis, tachypnea, hyperthermia, flushed, vomiting, etc)
