Generalized Anxiety Disorder (GAD) is a chronic condition characterized by excessive and uncontrollable worry, affecting approximately 20% of adults annually, with a notably high prevalence among doctors. GAD can lead to severe consequences, including suicidal ideation, and is differentiated from other anxiety disorders by its persistent nature and associated symptoms like restlessness, fatigue, and difficulty concentrating. Treatment typically involves psychotherapy and medication to manage symptoms effectively.

1. GENERAL ANXIETY DISORDER
(GAD)

2. TABLE OF CONTENT
• Introduction
• Definition
• About GAD
• Physician anxiety disorders
• Etiology
• Clinical features
• Diagnostic criteria: DSM V
• Differential diagnosis
• Treatment
• Physiotherapy
• Medications

3. DEFINITION OF GAD
It is a persistent
anxiety brought about
by continual day-to-
day concern and worry[1]
Can be likened to
overthinking!
[1] Anxiety, Generalized Anxiety Disorder (GAD), Sadaf Munir; Veronica Takov
https://www.psychologytoday.com/us/blog/what-mentally-strong-people-dont-do/201602/6-tips-stop-overthinking

4. INTRODUCTION[1,6]

5. • GAD is part of a spectrum of disorders known as anxiety
disorders.[1,6]
• It may be referred to as Anxiety disorder. [1,6]
• Can be mistaken with other anxiety disorders such as.[1,6]
• Differs from other types of Anxiety disorders in that it is persistent,
invasive and uncontrollable anxiety or worry towards any issue or
situation. [1,6]
[1] Anxiety, Generalized Anxiety Disorder (GAD), Sadaf Munir; Veronica Takov [6] https://ada.com/conditions/generalized-anxiety-disorder/
https://www.mindful.org/high-anxiety-2/

6. •Those who suffer from
GAD are at high risk of
•Suicidal ideation/commit
suicide.[4]
• Drug use disorders[5]
• Substance abuse [5]
• Sociopathy[4,5]
• Psychopathy [4,5]
4 https://www.cnbc.com/2019/05/21/stress-and-rigorous-work-push-a-doctor-to-commit-suicide-every-day-in-us.html 5 https://www.transformationstreatment.center/co-occurring/anxiety-disorder/

7. • 20% of adults suffer from GAD
annually, in the general population. [1]
• Doctors make up a majority of GAD
cases.[4]
• About 80% of doctors have some sort
of mental disorder including GAD. [10]
http://mandegar.info/?l=Cornishway+Group+Practice++Information+about+the+doctors
1 Anxiety, Generalized Anxiety Disorder (GAD), Sadaf Munir; Veronica Takov 4 https://www.cnbc.com/2019/05/21/stress-and-rigorous-work-push-a-doctor-to-commit-suicide-every-day-in-us.html
10 https://www.bmj.com/content/365/bmj.l1861
INTRODUCTION:
PHYSICIAN ANXIETY DISORDERS[4,12]

8. https://www.eventbrite.com.au/e/townsville-qld-educating-the-nurse-of-the-future-consultation-
workshop-tickets-58822296071
• GAD leading to physician suicide is
common. [4]
• According to the American Medical
Student Association, medical
students are 3 times more likely to
commit suicide compared to their
peers. [12]
4 https://www.cnbc.com/2019/05/21/stress-and-rigorous-work-push-a-doctor-to-commit-suicide-every-day-in-us.html
12 https://www.amsa.org/2017/06/21/suicide-is-more-common-in-medical-school-than-in-any-other-school-setting/

9. ETIOLOGY[6,9,16]

10. • No single cause exists [6,9]
• However, GAD has been associated with:
 Gender [6]
o Females are twice as likely to be diagnosed with GAD as
men.
Presence of physical or emotional trauma [9]
o Bullying is associated with increased risk.
https://www.verywellmind.com/gad-causes-risk-factors-1392982

11. Genetic factors [9]
o A significant number of patients and their first-degree relatives develop GAD,
Polymorphisms on chromosome 8.
Neurotransmitters [9]
o Variations in benzodiazepines, serotonin, N-methyl-D-aspartate, cholecystokinin.
•“Challenging parenting” is found to reduce risk of
GAD. [16]
9 https://www.healthguideinfo.com/generalized-anxiety-disorder/p109654/
6 https://ada.com/conditions/generalized-anxiety-disorder/

12. CLINICAL
FEATURES[15]

13.  Clinical features of GAD are:-
Psychological and cognitive features.
Physical Features.

14. PSYCHOLOGICALAND COGNITIVE FEATURES.
• Worrying or anxiety.

15. PSYCHOLOGICALAND COGNITIVE FEATURES.
• Worries that are difficult to control.
https://www.google.com/search?biw=1407&bih=613&tbm=isch&sa=1&ei=wSM5XcLIK4785gLhn5-
ACw&q=Worrying+or+anxiety.+gif&oq=Worrying+or+anxiety.+gif&gs_l=img.3...76232.78893..79334...0.0..0.171.526.0j4......0.
...1..gws-wiz-

16. https://giphy.com/gifs/week-finals-summed-mRh4cLIYhrs9G https://www.google.com/search?biw=1422&bih=678&tbm=isch&sa=1&ei=4nk4XcjvAa2t5wKj
5ov4Dw&q=difficulty+concentrating&oq=difficulty+con&gs_l=img.1.0.0l2j0i5i30l3j0i8i30l3j0i
24l2.357281.382298..384183...0.0..6.351.8085.42j25j5j1......0....1j2..gws-wiz-
img.....0..35i39j0i67j0i10j0i10i24.po2cXCxQfaA#imgdii=zkvHUBDY4sv6CM:&imgrc=oX0F5Z
pPJtgZDM:
• Poor Concentration.
PSYCHOLOGICALAND COGNITIVE FEATURES.

17. • Feeling keyed up or on edge.
PSYCHOLOGICALAND COGNITIVE FEATURES.
https://www.google.com/search?q=on+edge+feeling+gif&source=lnms&tbm=isch&sa=X&ved=0a
hUKEwih6Z7SlM_jAhXDrFkKHYLpDd0Q_AUIESgB&biw=1407&bih=613#imgrc=spwVj_y9W
eYDSM:

18. PHYSICAL FEATURES
https://www.indiatvnews.com/lifestyle/health-sleeping-less-than-6-hours-or-restlessness-at-
night-may-harden-your-arteries-460048
https://www.buzzfeed.com/tahliapritchard/walk-and-talk-please
• Restlessness.

19. PHYSICAL FEATURES
https://giphy.com/gifs/will-smith-fresh-prince-of-bel-air-ypW86tTXxGh0s
https://giphy.com/gifs/smelling-KtPsCn9wjUx1e
• Headaches & Nausea.

20. • Fatigue.
https://www.google.com/search?biw=1407&bih=613&tbm=isch&sa=1&ei=ESQ5Xa_TOsfc5gKK4aKQBQ&q=Fat
igue+gif&oq=Fatigue+gif&gs_l=img.3..0j0i5i30j0i7i30l3j0i7i5i30j0i8i7i30l2j0i30l2.79372.88236..90006...0.0..1.1
93.1958.7j9......0....1j2..gws-wiz-
img.b5dop00MZEA&ved=0ahUKEwjvn4y1ks_jAhVHrlkKHYqwCFIQ4dUDCAY&uact=5#imgrc=wU3YAGGMo
oTbRM:
PHYSICAL FEATURES

21. PHYSICAL FEATURES
• Trouble sleeping.
https://www.google.com/search?biw=1407&bih=613&tbm=isch&sa=1&ei=aiY5XcTPNcib5gKB4rCwAQ&q=Trou
ble+sleeping+gif&oq=Trouble+sleeping+gif&gs_l=img.3...541938.543616..544665...0.0..0.215.1683.5j8j1......0....1
j2..gws-wiz-
img.......0i67j0.vOCKmAQCT8k&ved=0ahUKEwjErNHTlM_jAhXIjVkKHQExDBYQ4dUDCAY&uact=5#imgrc=
YFdCLoNXBl-mcM:

22. PHYSICAL FEATURES
• Muscle aches.
https://giphy.com/gifs/woman-toenails-GnHt6DuQiUtMc

23. PHYSICAL FEATURES
• Sweating.
https://giphy.com/gifs/gif-this-vwjAf1EsSG7k1Jbtkx

24. PHYSICAL FEATURES
• Irritability.
https://www.google.com/imgres?imgurl=https://thumbs.gfycat.com/HairyAdvancedHowlermonkey-
size_restricted.gif&imgrefurl=https://gfycat.com/hairyadvancedhowlermonkey&tbnid=wJDzaxXxKccOzM&vet=
1&docid=0yC0V5rem49nJM&w=534&h=251&itg=1&hl=en&source=sh/x/im

25. • GAD patients often suffer from other anxiety disorders such as social anxiety disorder and
substance abuse such as excessive alcohol consumption, among other symptoms.
https://www.google.com/search?biw=1407&bih=613&tbm=isch&sa=1&ei=oSk5XcenJaKw5wLeiangCg&q=alcohol+consumpti
on+gif&oq=alcohol+consumption+gif&gs_l=img.3...698724.712706..713230...0.0..3.272.4129.3j21j4......0....1..gws-wiz-
img.....0..35i39j0i67j0j0i10j0i8i30j0i24.Uwu8IdLSKoU&ved=0ahUKEwiH_Pjbl8_jAhUi2FkKHd5ECqwQ4dUDCAY&uact=5#
imgrc=PtRLJRC0d2ETJM:

26. DSM -5 CRITERIA

27. DIAGNOSTIC CRITERIA:
ACCORDING TO THE DSM-5[13,14]
A. Excessive anxiety and worry (apprehensive
expectation), occurring more days than not for at
least 6 months, about a number of events or
activities.
B. The individual finds it difficult to control the
worry.
http://seniorcarepsychological.com/anxiety-disorders-and-related-dsm-5-diagnostic-codes/
13 https://dsm.psychiatryonline.org/doi/10.1176/appi.books.9780890425596.dsm05
14https://www.ihs.gov/california/tasks/sites/default/assets/File/GPRA/C5_%20Anxiety%20Disorders%20(Liu)_508.pdf

28. DIAGNOSTIC CRITERIA:
ACCORDING TO THE DSM-5[13,14]
C. The anxiety and worry:
– 1. Restlessness or feeling keyed up or on edge.
– 2. Being easily fatigued.
– 3. Difficulty concentrating or mind going blank.
– 4. Irritability.
– 5. Muscle tension.
– 6. Sleep disturbance. https://www.123rf.com/photo_53896742_gad-generalized-
anxiety-disorder-disease-abbreviation-.html
13 https://dsm.psychiatryonline.org/doi/10.1176/appi.books.9780890425596.dsm05
14https://www.ihs.gov/california/tasks/sites/default/assets/File/GPRA/C5_%20Anxiety%20Disorders%20(Liu)_508.pdf

29. DIAGNOSTIC CRITERIA:
ACCORDING TO THE DSM-5[13,14]
D. The anxiety, worry, or physical symptoms cause
clinically significant distress or impairment in social
occupational.
E. The disturbance is not attributable to the
physiological effects of a substance.
F. The disturbance is not better explained by another
mental disorder.
https://www.123rf.com/photo_16629177_abstract-word-cloud-for-
generalized-anxiety-disorder-with-related-tags-and-terms.html
13 https://dsm.psychiatryonline.org/doi/10.1176/appi.books.9780890425596.dsm05
14https://www.ihs.gov/california/tasks/sites/default/assets/File/GPRA/C5_%20Anxiety%20Disorders%20(Liu)_508.pdf

30. DIFFERENTIAL DIAGNOSIS[15]

31. • Differential diagnosis of GAD is rather complicated for
a number of reasons:
• Many conditions have similar presentations such as
• Other psychiatric disorders e.g. major depressive
disorder.
• Endocrine conditions like hyperthyroidism.
• Cardiopulmonary conditions such as obstructive
pulmonary disease.
• Use of substances, for example, caffeine, or
• Substance withdrawal.
15 https://www.aafp.org/afp/2015/0501/p617.html#sec-3
https://fr.123rf.com/photo_17957672_illustration-de-la-d%C3%A9coupe-des-lettres-imprim%C3%A9es-dispos%C3%A9es-pour-former-les-mots-c-est-compliqu

32. • It is further complicated in that conditions that are a
part of GAD differential diagnosis are also common
comorbidities.
• Patient history, physical examination, laboratory
findings and more are helpful in diagnosing GAD.
https://www.tumblr.com/search/its%20complicated%20ly
rics

33. TREATMENT[7]

34. TREATMENT[7]
• Treatments focus on managing symptoms
• Classified into:
• Psychotherapy
• Medications
https://en.ra6.org/finding-the-right-depression-treatment.htm

35. PSYCHOTHERAPY[7]
Psychotherapy [7]
Also known as talk therapy conducted in therapy sessions
Does psychotherapy work?
 75% of patients to receive psychotherapy benefit from it
 Shown to improve
Emotional health.
Behavior.
Brain and body function.
In the fall of 2016, the song-
writer admitted on his social
media account that he had
checked himself into rehab to
help manage his anxiety
disorder.
https://www.billboard.com/articles/columns/hip-
hop/8466037/kid-cudi-interview-billboard-cover-story-
2018

36. PSYCHOTHERAPY[7]
Types of psychotherapy
Cognitive behavioral therapy (CBT).
Interpersonal therapy (IPT).
Dialectical behavior disorder therapy.
Support therapy.

37. MEDICATIONS[8]
Based on the belief that mental illness come from chemical imbalances in
the brain
Types of medications
Antipsychotic
Commonly prescribed antipsychotics :
 Typical:- haloperidol, loxapine, chlorpromazine, etc.
 Atypical:- clozapine, risperidone, aripiprazole, etc.
 Side effects: Drowsiness, upset stomach, increased appetite, weight
gain, and seizures (rare).
In January of 2015 the
actress took to social
media to disclose
being on medication
for general anxiety
disorder
https://www.indiatimes.com/entertainment/celebs/8-
celebrities-who-spoke-about-coping-up-with-
depression-and-gave-us-an-important-message-
275032.html

38. Antidepressants
Atypical antidepressants: Bupropion, Nefazodone, Trazodone, etc.
 Side effects: Insomnia, constipation, tremors, dry mouth.
Mood stabilizers
Commonly prescribed Mood stabilizers: Lithium, valproic acid,
Carbamazepine, etc.
 Side effects: Weight gain, dizziness, blurred vision, confusion, stomach
problems

39. MEDICATIONS[8]
TYPES CONTINUED
Tranquilizers and sleeping pills
 Common tranquilizers and sleeping pills are : Benzodiazepines, lorazepam,
flurazepam, etc
 Side effects: Headaches, slurred speech, confusion
Stimulants and related medicines
 Example of stimulants are: methylphenidate, amphetamines, etc.
 Side effects: Decreased appetite, weight loss, rapid pulse, trouble sleeping

40. REFERENCES
•Health guide. (20014). Health guide info.com. Retrieved from URL
https://www.healthguideinfo.com/generalized-anxiety-disorder/p109654/
•M. Mirjana. (2018). The Structure of Challenging Parenting Behavior and Associations With Anxiety in Dutch and
Australian Children. Journal of Clinical Child & Adolescent Psychology (282-295). Retrieved from URL
https://www.tandfonline.com/doi/full/10.1080/15374416.2017.1381915
Generalized anxiety disorder. (2017, October 13). Retrieved from https://www.mayoclinic.org/diseases-
conditions/generalized-anxiety-disorder/symptoms-causes/syc-20360803
•American psychiatry association.(2019). Psychiatry online. Retrieved from URL
https://dsm.psychiatryonline.org/doi/10.1176/appi.books.9780890425596.dsm05
•Mental health America.(2019). Mental health treatments. Retrieved from URL
https://www.mentalhealthamerica.net/medication
•B. Locke, K. Nell & G. Shultz(May,2015). Diagnosis and Management of Generalized Anxiety Disorder and Panic
Disorder in Adults. American Family Physician. Retrieved from URL
https://www.aafp.org/afp/2015/0501/p617.html#sec-3

41. • Melemis, S. (n.d.). Benzodiazepines, Tranquilizers, Sleeping Pills: Information. Retrieved
from https://www.addictionsandrecovery.org/benzodiazepine.htm
• 20158 Mood Stabilizing Medications. (n.d.). Retrieved from https://www.camh.ca/en/health-
info/mental-illness-and-addiction-index/mood-stabilizing-medication

42. THANK YOU!!