Generalised Anxiety Disorder (GAD)

Last updated 20.09.12

 

Features

-  Anxiety disorder of chronic pathological worry w fluctuations

-  Usually occurs w SAD, panic disorder or depression

-  Life time prevelance 2-10%

-  Most common anxiety disorder in elderly

-  Female 2:1 Male

-  Lengthy delay between onset of S/S & medical Mx

-  Medical help usually for complicating problem

 

Associated S/S

-  Worry

-  Out of proportion to problem

-  Uncontrollable, pervasive, repetitive & present most of time

-  Several themes: everyday life circumstances & remote future

-  Causes much distress w impaired functioning

-  Belief of benefit in worrying

-  Tension

-  Psychological

-  Nervousness, on edge, restless, hypervigilance, exaggerated startle response, irritiable, poor concentration

-  Somatic

-  Muscle tightness, stiff neck, headache, back pain, muscle spasms/tics, tremor, dysphagia (globus hystericus)

-  Poor sleep, agitation, fatigue, exhaustion

 

Mx

-  CBT

-  Symptom control techniques

-  Challenge belief in benefit of worry

-  Pharmacotherapy

-  1st line: SSRIs or Venlafaxine (SNRI)

-  2nd line: Imipramine (TCA)

-  3rd line: antidepressant + BZD 6-12/52 --> antidepressant

-  4th line: BZDs

-  Buspirone

-  Beta blockers: symptomatic (ie: tremors)

 

 

References