Psychiatry >
Generalised Anxiety Disorder

“Disproportionate, pervasive, uncontrollable, and widespread worry and a range of somatic, cognitive, and behavioural symptoms that occur on a continuum of severity”

Risk Factors
  • Family history of psychiatric disorders
  • Chronic and/or painful illness
  • Female sex
  • Environmental stressors such as physical or emotional trauma, domestic violence, unemployment, or low socioeconomic status
  • Childhood adversities
  • Psychosocial causes
  • Substance dependence
  • Multifactorial with both genetic and environmental factors
  • Neurological:
    • Connections between the amygdala and prefrontal cortex not regulated appropriately for the experience of fear leading to clinical symptoms of anxiety
  • Genetic predisposition:
    • Exacerbates response to stress
  • Social:
    • Life events (losing or gaining a spouse or job, moving house)
Clinical Presentation
  • Major symptoms – present for at least 6 months according to DSM-V:
    • Excessive anxiety and worrying for many events and activities
    • Difficulty controlling the worry
  • Additional symptoms:
    • Cognitive:
      • Agitation
      • Feelings of impending doom
      • Poor concentration
      • Difficulty getting to sleep (insomnia)
    • Somatic:
      • Trembling
      • Hyperventilation
      • Headaches
      • Sweating
      • Palpitations
      • Nausea
    • Behavioural:
      • Reassurance seeking
      • Avoidance
      • Dependence on a person or object
  • GAD-7 questionnaire to determine severity
  • Step 1:
    • Assess severity of GAD and any other comorbidities
  • Step 2:
    • Low-intensity psychological interventions (individual non-facilitated self-help, individual guided self-help, psychoeducation)
  • Step 3:
    • High-intensity psychological intervention) or pharmacological
      • First line: SSRI (sertraline, paroxetine, citalopram)
      • SNRI (venlafaxine, duloxetine) if SSRI not tolerable
      • Pregabalin if a patient cannot tolerate SSRI or SNRI
  • Step 4:
    • Refer for specialist treatment if patient has not improved with step 3 intervention and/or is exhibiting or at risk of self-harm, self-neglect, suicide, or a significant comorbidity such as substance misuse
  • Serious disability and impaired quality of life
  • Impaired social and occupational functioning
  • Comorbidities such as increased risk of major depression, social anxiety disorder, and alcohol and drug misuse, and physical health problems such as chronic pain Suicidal ideation and attempts

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