Anxiety - revision notes PDF

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Anxiety https://cks.nice.org.uk/topics/generalized-anxiety-disorder/ [NICE guidance ref] Definition: Generalized anxiety disorder (GAD) is characterized by disproportionate, pervasive, uncontrollable, and widespread worry and a range of somatic, cognitive, and behavioural symptoms that occur on a continuum of severity.  Onset of symptoms is insidious, often unremitting, and can be lifelong.  While some people will present with obvious anxiety, others will initially present with somatic symptoms such as muscle tension or insomnia. Diagnosis: The GAD-2 scale is used for diagnoses in primary practise whilst the GAD-7 scale is used by specialists.

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Score 3 or more consider anxiety

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The DSM-V diagnostic criteria for GAD include: o At least 6 months of excessive, difficult to control worry about everyday issues, that is disproportionate to any inherent risk, and causes distress, or impairment. o The worry is not confined to features of another mental disorder, or as a result of substance abuse, or a general medical condition. o The person experiences at least 3 of the following symptoms most of the time: restlessness/nervousness, being easily fatigued, poor concentration, irritability, muscle tension, or sleep disturbance. The ICD-10 diagnostic criteria for GAD include: o Anxiety which is generalized and persistent but not restricted to, or even strongly predominating in, any particular environmental circumstances. o Variable dominant symptoms including persistent nervousness, trembling, muscle tension, sweating, lightheadedness, palpitations, dizziness, and epigastric discomfort. o Expression of fears such as that the person or a relative will shortly become ill or have an accident

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Management:  Ask about the use of: o OTC/prescribed medicines which can cause anxiety-albutamol, theophylline, beta-blockers, herbal medicines (including ma huang, St. John's wort, ginseng, guarana, belladonna), corticosteroids, and some antidepressants. o Alcohol or illicit substances that can cause anxiety acutely and in withdrawal.

This must be a combination of both pharmacological and non-pharmacological treatments [CBT]. https://cks.nice.org.uk/topics/generalized-anxietydisorder/management/management/

Pharmacological treatment: 1. Drugs which increase the release of GABA. This is an inhibitory neurotransmitter which will depress the activity of the CNS  Benzodiazepines: rapid relief of acute anxiety but have side effects  Pregabalin is an option for GAD 2. Drugs which increase the release of serotonin  SSRIs (selective serotonin reuptake inhibitors) - first line but there is a delay in effect of 2-4 weeks  SNRIs (serotonin and norepinephrine reuptake inhibitors) o Be aware that in a minority of people aged under 30 years of age, SSRIs and SNRIs are associated with an increased risk of suicidal thinking and self-harm. Anyone in this age group receiving an SSRI or SNRI should therefore be seen within 1 week of first prescribing, and the risk of suicidal thinking and self-harm should be monitored weekly for the first month.

 TCAs (tricyclic antidepressants)  Buspirone 3. Beta blockers for physical symptoms, e.g. tachycardia, tremor and sweating...