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Anxiety
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<<forEachTiddler where 'tiddler.tags.contains(context.inTiddler.title)' sortBy tiddler.title ascending write '"*[["+tiddler.title+"]]\n"'>> <<tiddler AutoRefresh with: force>> common - only 50% consult GP due to stigma - 8% GP consults, 1.5-3% prevalence in 18-64yr, F:M 2:1 pervasive severe worry about several things but may present with somatic Sx may co-exist with depression / substance misuse - needs separate diagnosis as causes sig morbidity worry is severe, out of proportion to event, intrusive (unable to do other things), shifts from topic to topic - "free floating" - but chronic stressors may be seen DD Phobia - narrow focus - triggered by specific situation Panic attack - intense abrupt worry - peaks within 10 mins Generalized anxiety - different topics, overwhelming worry, hard to control Depression, alcohol misuse, thyroid, risk factors - weak links major life event, bullying as child, controlling parents, FH Sx - use GAD7 questionnaire Autonomic - palps, nausea, sweating, light headed, dry mouth, dizzy Behaviour - headache, restless, sleep disturb, trembling, aches and pains, shakiness Cognitive - poor concentration, irritable, xs worry over minor things (but not sudden panic attack) also - N&D, clammy hands, urinary frequency, difficulty swallowing Think about thyroid, depression Mx - CBT, Antidepressants recognise and diagnose treat in primary consider alternatives refer to secondary specialized mental health services limit caffeine, stop alcohol support and info help pt to self empower benzodiazepine for acute (2-4/52 max) sedating antihistamine - hydroxyzine effective - CBT (most), antidepressants, self help CBT - treatment of choice - weekly 12-16 sessions Antidepressants - long term Mx - Paroxetine (NOT as hard to stop) / escitalopram - start lower dose and inc (not in epilepsy) Others - Buspirone (takes week to be effective) Pregabalin (anticonvulsant) BB - help with autonomic Sx but not with anxiety Refer If 2 modes tried and no success or if severe - eg suicidal Ask about suicidal FUp - need support Prognosis - long term problem - wax and wane - Rx manage rather than cure Explore underlying fears and encourage self help - may be all that is required
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