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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