Subtopics are introduction, etiology, clinical feature, DSM 5, Differential diagnosis, treatment. presented in american university of Barbados by Yogesh Vishwakarma.

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!!