Generalized anxiety disorder


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Generalized anxiety disorder

  2. 2. OVERVIEW  Definition  Epidemiology  Signs & Symptoms  Causes  Diagnosis  Management  Prevention
  3. 3. DEFINITION Generalized anxiety disorder is characterized by chronic feelings of excessive worry and anxiety without a specific cause. It's often an irrational worry about everyday things that is disproportionate to the actual source of worry
  4. 4. EPIDEMIOLOGY  Generalized anxiety disorder appears to be highly prevalent.  In the United States, the lifetime prevalence of DSM-IV GAD is estimated to be about 5% and the current prevalence to be about 2% to 3%. The disorder is differentially prevalent across gender and ethnic and social groups
  5. 5. EPIDEMIOLOGY CONT...  The prevalence of GAD in children is approximately 3%;  The prevalence in adolescents is reported as high as 10.8%.  The age of onset for children and adolescents with GAD is between ages 10 and 14.
  6. 6. EPIDEMIOLOGY CONT...  It has a lifetime prevalence of 5.7% and an annual prevalence of 3.1% in the United States.  But, these rates could increase dramatically if new diagnostic criteria for GAD are established.
  7. 7. EPIDEMIOLOGY CONT...  Populations that are at an increased risk of GAD are individuals with low and middle socio-economic status, separated, divorced, and widowed individuals.  Women are twice as likely to develop GAD as men. This is primarily because women are more likely than men to live in poverty, and are more subject to discrimination, and sexual and physical abuse.
  8. 8. SIGNS & SYMPTOMS  Do you worry all the time? Have you had the following symptoms for at least the past 6 months? I never stop worrying about things big and small. I have headaches and other aches and pains for no reason. I am tense a lot and have trouble relaxing.
  9. 9. SIGNS & SYMPTOMS CONT... I have trouble keeping my mind on one thing. I get crabby or grouchy. I have trouble falling asleep or staying asleep. I sweat and have hot flashes. I sometimes have a lump in my throat or feel like I need to throw up when I am worried.
  10. 10. SIGNS & SYMPTOMS CONT...  GAD often coexists with common physical disorders, such as IBS, insomnia, headache Depression, anorexia nervosa substance abuse, ADHD
  11. 11. CAUSES  Although the exact cause of GAD is unknown, there is evidence that biological factors, family background, and life experiences, particularly stressful ones, play a role.
  12. 12. CAUSES – Substance Induced  Long term use of Benzos  Long term alcohol use  Sometimes anxiety pre-existed alcohol or benzodiazepine dependence, but the dependence was acting to keep the anxiety disorders going and often progressively making them worse.
  13. 13. CAUSES – Psychological Cont...  Anxiety is less likely to occur, as well as quicker to remit, among those who are religious.  It is not always clear which factors are causes and which are effects of anxiety;
  14. 14. CAUSES – Psychological Cont...  Anxiety is less likely to occur, as well as quicker to remit, among those who are religious.  It is not always clear which factors are causes and which are effects of anxiety;
  15. 15. CAUSES: Social  Poverty and social isolation are associated with increased risk of mental health problems in general.  Child abuse (physical, emotional, sexual, or neglect) is also associated with increased risk of developing depressive disorders later in life.
  16. 16. CAUSES: Social cont...  Lack of social support can also increase the likelihood for one to experience anxiety  Neighborhood social disorder  Adverse work condition  Prejudice
  17. 17. DIAGONOSIS  Clinical assessment  DSM-V  Differential diagnoses
  18. 18. Diagnosis: Clinical Assessment  Clinical assessment: (A diagnostic assessment may be conducted) by a suitably trained general practitioner, or by a psychiatrist or psychologist, who records the person's current circumstances, biographical history, current symptoms and family history.  The main purpose of assessment is to identify the main stressors
  19. 19. Diagnosis: DSM V CRITERIA  Excessive anxiety and worry, occurring more days than not for at least 6 months, about a number of events or activities (such as school or work performance)  Individual finds it difficult to control worrying
  20. 20. Diagnosis: DSM V CRITERIA  Anxiety and worry are associated with three (3) or more of the following six symptoms (with some symptoms having been present for more days than not for the past 6 months) Restlessness or feeling keyed up or on edge Being easily fatigued, difficulty concentrating Irritability Muscle tension Sleep disturbance
  21. 21. Diagnosis: Differential Diagnosis Acute Respiratory Distress Syndrome •Adrenal Crisis •Alcoholism, Delirum Tremens •Amphetamine-Related Psychiatric Disorders •Anaphylaxis •Anorexia Nervosa, bulimia •Apnea, Sleep disorders •Asthma •Body Dysmorphic Disorder •Caffeine-Related Psychiatric Disorders •Cannabis Compound Abuse •Depression •Diabetes Mellitus, Type 1, •Diabetic Ketoacidosis •Factitious Disorder, Malingering •Gastritis, •Hyperaldosteronism, Primary •Hypercalcemia •Hyperparathyroidism •Irritable Bowel Syndrome •Phobic Disorders •Somatoform Disorders
  22. 22. MANAGEMENT  Cognitive Behavioral therapy  Motivational interviewing  Medication
  23. 23. MANAGEMENT: CBT  The goal of the therapy is to change negative thought patterns that lead to the patient's anxiety, replacing them with positive, more realistic ones.  Elements of the therapy include exposure strategies to allow the patient to confront their anxieties gradually and feel more comfortable in anxiety-provoking situations, as well as to practice the skills they have learned. CBT can be used alone or in conjunction with medication.
  24. 24. MANAGEMENT: CTB  Therapy also includes psychoeducation, self-monitoring, stimulus control techniques, relaxation, self-control desensitization, cognitive restructuring, worry exposure, worry behavior modification, and problem-solving.  The first step in the treatment of GAD is psychoeducation which involves giving information to the patient about the disorder and the treatment.  The purpose of psychoeducation is to provide some relief, destigmatization of the disorder, enhance motivation for treatment based on a rationale of the components of the treatment, and increasing compliance by developing realistic expectations about treatment.
  25. 25. MANAGEMENT: MOTIVATIONAL INTERVIEWING  A promising innovative approach to improving recovery rates for the treatment of GAD by combining CBT with Motivational Interviewing (MI).
  26. 26. MANAGEMENT: MOTIVATIONAL INTERVIEWING  Motivational Interviewing is a strategy centered on the patient that aims to increase intrinsic motivation and decrease ambivalence about change due to the treatment. MI contains four key elements;  (1) express empathy,  (2) heighten dissonance between behaviors that are not desired and values that are not consistent with those behaviors,  (3) move with resistance rather than direct confrontation, and  (4) encourage self-efficacy
  27. 27. MANAGEMENT: Medication  Antidepressants: are mainly used for depression but is also used for GAD:  Selective serotonin re-uptake inhibitors (SSRIs), including fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), citalopram (Celexa), and escitalopram (Lexapro).
  28. 28. MANAGEMENT:Benzodiazepines  Are most often prescribed to patients with Generalized Anxiety Disorder.  Research suggests that these drugs give some relief, at least in the short term.  However, they carry some risks, mainly impairment of both cognitive and motor functioning, and psychological and physical dependence that makes it difficult for patients to stop taking them.
  29. 29. MANAGEMENT: Benzos cont...  alprazolam (Xanax, Xanax XR, Niravam, Alprax)  chlordiazepoxide (Librium)  clonazepam (Klonopin)  clorazepate (Tranxene)  diazepam (Valium)  lorazepam (Ativan
  30. 30. MANAGEMENT: Other  Psychotropic drugs:  Buspirone (BuSpar) is a serotonin receptor partial agonist,  Duloxetine (Cymbalta)- SNRI - type antidepressant  Imipramine (Tofranil) is a (TCA). Other tricyclic antidepressants - as clomipramine,etc. TCAs are thought to act on serotonin, norepinephrine, and dopamine in the brain.
  31. 31. Other cont...  Venlafaxine (Effexor XR) is a serotonin- norepinephrine reuptake inhibitor (SNRI). SNRIs alter the chemistries of both norepinephrine and serotonin in the brain.  Non-psychotropic drugs  Propranolol (Inderal, avlocardyl) -BB  Clonidine - Sympatholytic  Prazosin - Sympatholytic, alpha-adrenoblocker
  32. 32. PREVENTION  Abstain from alcohol or use illegal drugs. These substances can make depression worse and might lead to thoughts of suicide.  Be compliant with medication and also be aware of what side effects to expect. Learn to recognize the early signs that your depression is getting worse.
  33. 33. PREVENTION CONT...  Talk to someone you trust about how you are feeling  Try to be around people who are caring and positive  CTB for persons who are at risk  Meditation  Trust
  34. 34. References  anxiety-related-illness/    gad