Download Anxiety disorders * generalised anxiety disorder

generalized anxiety disorder
Shehana al-shammmari
111221018
DEFINITION
Generalized and persistent anxiety, excessive
anxiety or worry (apprehensive expectation)
about a number of events (e.g. work, school
performance) that the individual finds difficult to
control, not restricted to, or predominating in ,
any particular circumstances (free-floating).
lasting for at least six months or longer
AETIOLOGY
. Genetic
predisposition
. Current stress
. Life events
organic causes such as thyrotoxicosis, parathyroid disease,
hypoglycaemia
ASSOCIATIONS/RISK FACTORS
Childhood experiences characterised
.
° subjective apprehension (fears, worries)
° increased vigilance
° feeling restless and on edge
° sleeping difficulties (initial/middle insomnia, fatigue on
waking)
° motor tension (tremor, hyperactive deep reflexes)
° autonomic hyperactivity (e.g. tachycardia).
• GAD may be comorbid with other anxiety disorders,
depression,alcohol and drug abuse.
EPIDEMIOLOGY
Lifetime prevalence is 5%. F > M. Onset is in
adolescence to early adulthood.
° generalized anxiety disorder (GAD) (2–4%)
HISTORY
The symptoms should be present most days for at least
several weeks at a time.
These symptoms should involve elements of:
. apprehension (worries about future misfortunes, feeling
on edge, difficulty concentrating)
. motor tension (restlessness, fidgeting, tension
headaches, trembling)
. autonomic overactivity (sweating, tachycardia or
tachypnoea, dizziness, dry mouth).
EXAMINATION
Tachycardia and
tachypnoea.
Differential diagnoses
°
excessive caffeine consumption
° depression
° psychotic disorders
° withdrawal from drugs or alcohol
MANAGEMENT
Cognitive behavioral therapy
• CBT (self-help material or face to face) for GAD seeks to:
Psychoeducation , distraction techniques ,cognitive control ,
breathing/relaxation techniques
Medication . Benzodiazepines may be useful in the short term.
- Other pharmacological treatments include:
-beta blocker to control some physical symptoms
-° serotonin noradrenaline reuptake inhibitors (SNRIs)
° pregabalin° buspirone
COMPLICATIONS
Half will develop a depressive illness.
May misuse alcohol or illicit
substances to cope with anxiety.
PROGNOSIS
Course may be chronic, worse at
times of stress. Poor prognosis is
associated with longer duration of
illness, co-morbid psychiatric
disorder and poor premorbid
personality.
summary
GAD is persistent anxiety, excessive anxiety or 
worry
Causes of anxiety :- 
1-biological

2-environmental

3- integrative perspective

4- brain chemistry

Symptoms of anxiety 
motor tension

sleeping difficulties 
Shortness of breath 
feeling restless 
cont
INVESTIGATIONS: 
FBC, U þ Es, LFTs, Ca, TFTs. 
MANAGEMENT: 
CBT 
medication 
references