Generalised Anxiety Disorder

• What is GAD?

  Generalised Anxiety Disorder

  Excessive worry about everyday issues that are disproportionate to any inherent risk

  Symptoms should be persistent, occurring most days for at least 6 months
• What is the diagnostic process for GAD?

  Take a Hx

  Consider using validated assessment tool (GAD-2 or GAD-7)

  Assess risk

  Physical examination -> to rule out other conditions

  Consider DDx
• What is the ICD-11 diagnostic criteria for GAD?

  Marked symptoms of anxiety

  Anxiety & general apprehensiveness/worry + additional symptoms (muscle tension, sweating, disturbed sleep etc.)

  Symptoms persist for at least several months & are not better accounted for by another disorder/condition

  Symptoms lead to signif distress about experiencing persistent anxiety symptoms
• What are the DDx of GAD?

  Situational anxiety

  Adjustment disorder

  Depression

  Panic disorder

  Social phobia

  OCD

  PTSD

  Somatoform disorders

  Anorexia nervosa

  Substance or drug-induced anxiety disorder

  CNS depressant withdrawal

  Cardiac disease

  Pulmonary disease

  Hyperthyroidism

  Infection

  IBS

  Phaeochromocytoma
• What are the RFs for GAD?

  Female

  Comorbid anxiety disorder (e.g. panic disorder)

  FHx of anxiety disorders

  Childhood adverse experiences

  Hx of physical, sexual, or emotional trauma

  Sociodemographic factors

  Substance misuse/dependence

  Chronic physical condition (CVD, COPD, diabetes etc.)
• What are the secondary causes of anxiety?

  Substance use

  Substance withdrawal

  Hyperthyroidism

  Phaeochromocytoma

  Cushing's disease
• What is Phaeochromocytoma?

  Rare tumour of the adrenal glands
• What are the physical symptoms of anxiety?

  Nausea

  Abdominal discomfort

  Lightheadedness

  Sweating

  Dry mouth

  Paraesthesia (pins & needles)

  Muscle tension

  Restlessness

  SOB

  Palpitations

  Chest pains

  Headache

  Insomnia
• What are the cognitive responses to anxiety?

  High state of alertness

  Cognitive distortions

  • polarised ('black or white'/'all or nothing') thinking
  • negative mental filtering/disqualifying the positive
  • overgeneralization
  • catastrophizing
  • fallacy of control (internal/external)
  • 'should' statements
• What is the emotional state in response to anxiety?

  Apprehension of danger

  Dread/foreboding

  Tense 'jumpy' or 'nervous'

  Irritability
• What is the treatment of GAD?

  Self help

  Psychoeducational groups

  CBT

  Medications (SSRIs (1st line), SNRIs)