Overview

• DSM-V → >6 months of excessive, difficult to control, worries about everyday issues, that is disproportionate to any inherent risk, and causes distress, or impairment – with worries not due to mental disorder, substance abuse, other condition.

  • ≥3 of the following, most of the time:

    • Restlessness/nervousness
    • Irritability
    • Being easily fatigued
    • Muscle tension
    • Poor concentration
    • Sleep disturbance

    Not triggered by a specific stimulus.

• Risk Factors → aged 35-54, being divorced or seperated, living alone, being a lone parent.

  • Protective Factors → aged 16-24, being married or cohabiting.

Making Diagnosis

Clinical Features

• Autonomic (activation of SNS causes symptoms) → palpitations, sweating, trembling, dry mouth, tachypnoea, muscle tension, headaches, GI upset.

Investigations

• GAD-7 Questionnaire → 5=mild, 10=moderate, 15=severe.
• TFTs → rule out hyperthyroidism.
• ECG.

Management Plan

Initial: low-Intensity psychological interventions → self-help and psychoeducational groups (if marked functional impairment, go straight to high-intensity psychological interventions or drug treatment).

• Step 1 → CBT over 4-12 weeks.
  • Can have applied relaxation training, meditation training, sleep hygiene education, exercise and self-help information provided.
• Step 2 → Drug treatment.
  • 1st → sertraline (SSRI). With usual F/U for SSRI.
  • 2nd → different SSRI after 8 weeks of 1st.
  • 3rd → SNRI (venlafaxine).
  • 4th → pregabalin.
• Step 3 → Specialist assessment.
• Beta-Blockers (Propanolol) → sometimes used to treat adrenergic symptoms (eg. tremor, palpitations).