Generalised anxiety disorder

Question 2

What is GAD?

Answer 2

Condition that causes excessive and disproportional anxiety and worry that negatively impacts the person’s everyday activity.

Question 3

How long do symptoms have to present for GAD?

Answer 3

At least 6 months and not caused by substance use or another condition.

Question 4

What is panic disorder?

Answer 4

Recurrent panic attacks that are unexpected and result in worry about further attacks and maladaptive behaviour changes relating to the attacks (e.g., avoiding activities).

Question 5

What are some secondary causes of anxiety?

Answer 5

• Substance use (e.g., caffeine, stimulants
• bronchodilators, cocaine), substance withdrawal (e.g., alcohol
• benzodiazepine withdrawal)
• hyperthyroidism
• phaechromocytoma
• Cushing’s disease.

Question 6

How do patients with GAD present?

Answer 6

• Excessive worrying
• unable to control the worrying - restlessness
• difficulty relaxing
• easily tired
• difficulty concentrating.

Question 7

What are some physical symptoms of GAD and why do they occur?

Answer 7

Caused by overactivity of the sympathetic nervous system:
- muscle tension
- palpitations,
- sweating
- tremor
- GI symptoms (e.g., abdominal pain, diarrhoea)
- headaches
- sleep disturbances.

Question 8

What are panic attacks?

Answer 8

Sudden onset of intense physical and emotional symptoms of anxiety that come on quickly (within minutes) and last a short time (10 mins) before the symptoms gradually fade.

Question 9

What are some physical and emotional symptoms of panic attacks?

Answer 9

Physical symptoms:
- tension
- palpitations
- tremors
- sweating
- dry mouth
- chest pain
- shortness of breath
- dizziness
- nausea.
Emotional symptoms:
- feelings of panic
- fear
- danger
- depersonalisation (feeling separated or detached)
- and loss of control.

Question 10

What is used to assess the severity of GAD?

Answer 10

GAD-7, which consists of 7 questions.

5-9 indicates mild anxiety, 10-14 indicates moderate anxiety, 15-21 indicates severe anxiety.

Question 11

What are some lifestyle changes for managing GAD?

Answer 11

Active monitoring, self-help strategies (e.g., meditation), sleep, diet, exercise, avoiding alcohol, caffeine, and drugs.

Question 12

How can moderate to severe anxiety be managed?

Answer 12

Cognitive Behavioral Therapy (CBT) and medications.

Question 13

What is the first line medication for GAD?

Answer 13

SSRIs (e.g., sertraline).

Question 14

What are some other drugs used for GAD?

Answer 14

SNRIs (e.g., venlafaxine) and pregabalin.

Question 15

What medication can be used for the physical symptoms of anxiety and what is a contraindication?

Answer 15

Non-selective beta-blockers (e.g., propranolol) help reduce sympathetic nervous system overactivity.

Contraindicated in asthma (can cause bronchoconstriction).

Question 16

When can benzodiazepines be used and how do they work?

Answer 16

Benzodiazepines (e.g., diazepam) work by stimulating GABA receptors, providing relief from anxiety.

Not recommended for GAD due to tolerance and dependence; only for short duration during a crisis.

Question 17

What is a phobia?

Answer 17

Extreme fear of certain situations or things, causing symptoms of anxiety and panic.

Question 18

What are some examples of specific phobias?

Answer 18

• Claustrophobia
• acrophobia (fear of heights)
• arachnophobia
• glossophobia (fear of public speaking)
• trypanophobia (fear of needles).

Question 19

What is agoraphobia?

Answer 19

Fear of situations in which they may be unable to escape if something goes wrong (e.g., fear of busy places, public transport, anywhere outside their home).

Question 20

What is social phobia?

Answer 20

Fear of social situations, also known as social anxiety disorder.