Makindo Medical Notes

Related Subjects: |Psychiatric Emergencies |Depression |Mania |Schizophrenia |Suicide |Panic Disorder |Acute Psychosis |General Anxiety Disorder |Obsessive-Compulsive disorder |Wernicke Korsakoff Syndrome |Medically Unexplained symptoms |Post-Traumatic Stress Disorder (PTSD) |Personality Disorders |Eating Disorders

Generalized Anxiety Disorder is characterized by chronic, excessive worry that is difficult to control and impacts daily functioning.

Epidemiology

• GAD affects approximately 6% of people at some point in their lives.
• More common in women than in men.
• Typically begins in early adulthood but can occur at any age.

Etiology and Risk Factors

• Genetics: Family history of anxiety disorders increases the risk.
• Biological Factors: Dysregulation of neurotransmitters such as serotonin, dopamine, and GABA.
• Environmental Stressors: Chronic stress, trauma, and adverse life events.
• Personality: People with a tendency toward pessimism or excessive worry are at higher risk.

Diagnostic Criteria (DSM-5)

• Excessive anxiety and worry, occurring more days than not for at least six months, about a variety of events or activities.
• The person finds it difficult to control the worry.
• Associated with three or more of the following symptoms:
  • Restlessness or feeling keyed up.
  • Being easily fatigued.
  • Difficulty concentrating or mind going blank.
  • Irritability.
  • Muscle tension.
  • Sleep disturbances (difficulty falling or staying asleep, or restless, unsatisfying sleep).
• These symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning.

Clinical Features

• Constant, chronic worry about everyday life events.
• Physical symptoms such as headaches, muscle tension, stomachaches.
• Feeling on edge or easily startled.
• Avoidance of stressful situations or environments.
• Often associated with other mental health disorders like depression.

Differential Diagnosis

• Panic Disorder.
• Social Anxiety Disorder.
• Obsessive-Compulsive Disorder.
• Major Depressive Disorder.
• Medical conditions such as hyperthyroidism or substance-induced anxiety.

Investigations

• Generally clinical diagnosis; no specific tests for GAD.
• Thyroid function tests, electrolytes, and drug screens to rule out other causes.

Management

• Psychotherapy:
  • Cognitive Behavioral Therapy (CBT): Focuses on identifying and modifying negative thought patterns and behaviors.
  • Mindfulness and relaxation techniques.
• Medications:
  • SSRIs (Selective Serotonin Reuptake Inhibitors): First-line treatment (e.g., sertraline, paroxetine).
  • SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors): Alternative first-line treatment (e.g., venlafaxine).
  • Buspirone: Specifically indicated for GAD but may take a few weeks to work.
  • Benzodiazepines: Short-term use for severe cases due to risk of dependence.
• Lifestyle Modifications:
  • Regular exercise and a balanced diet.
  • Minimizing caffeine and alcohol intake.
  • Practicing good sleep hygiene.

Prognosis

• Many patients experience chronic symptoms, but treatment can improve functioning.
• Early diagnosis and intervention lead to better outcomes.
• May have recurrent episodes of anxiety over the lifespan.