Generalized Anxiety Disorder

Question 1

Diagnostic criteria for GAD

Answer 1

• Persistent, excessive, uncontrollable anxiety/worry > 6 months
• Person struggles to control the worry
• At least three of these symptoms:
  
  • Disrupted sleep
  • Fatigue
  • Impaired concentration
  • Irritability
  • Muscle tension
  • Restlessness

Question 2

GAD, in one line

Answer 2

Persistent, excessive, uncontrollable anxiety about various domains of life for the majority of a period of time at least 6 months long that causes social/functional impairment

Question 3

Treatment of GAD

Answer 3

Most effective approach utilizes pharmacotherapy and psychotherapy

CBT is most effective for psychotherapy.

SSRIs are the first-line pharmacotherapy. If these fail, SNRIs or TCAs may be tried. Other possibilities for augmentation include benzodiazepines, hydroxyzine, buspirone, mirtazapine.

Benzodiazepines may be utilized as a bridging therapy until the SSRI or other medication becomes therapeutic.

Treatment plan should also consider comorbid disorders.

Question 4

What are the main risks of benzodiazepines in patients with anxiety?

Answer 4

1. Abuse
2. Rebound anxiety (withdrawal worsening anxiety symptoms)
3. Precipitating falls or delirium