Generalised Anxiety Disorder

Anxiety that is generalized and persistent but not restricted to, or even strongly predominating in, any particular environmental circumstances (i.e. it is "free-floating")

Aetiology

  • Typical age of onset between 20-40
  • 2:1 female:male ratio
  • 90% are co-morbid with other psychiatric disorders, e.g. depression, substance abuse, other anxiety disorders

Clinical presentation

  • Persistent nervousness, trembling, muscular tensions, sweating, lightheadedness, palpitations, dizziness, and epigastric discomfort
  • Fears that the patient or a relative will shortly become ill or have an accident are often expressed
  • Needs to be severe enough to be:
    • Long-lasting (most days for at least 6 months)
    • Not controllable
    • Causing significant distress/impairment in function
  • Typically associated with:
    • Restlessness or feeling keyed up or on edge
    • Being easily fatigued
    • Difficulty concentrating or mind going blank
    • Irritability
    • Muscle tension
    • Sleep disturbance (difficulty falling or staying asleep, restless unsatisfying sleep)

Investigations

  • Clinical diagnosis - ICD-10

Management

  1. Psychoeducation
  1. Self-help/psychoeducation groups
  1. High intensity psychological intervention (CBT) OR drug treatment (SSRI e.g. sertraline)
    1. Consider short term use of benzodiazephines <2 weeks
  1. SNRI e.g. duloxetine
  1. Pregabalin
  1. Combination of CBT and drug treatment