GAD is not exclusively associated with an early age of onset. For instance, the lowest prevalence of GAD occurred in the 15- to 24-year age group (Wittchen et al., 1994).

1. GENERALIZED ANXIETY
DISORDER
PRESENTED BY
Mrs. AMRITA ROY
M.SC PSYCHIATRIC NURSING
NIMHANS,BANGALORE

2. ONSET AND COURSE
 Onset is usually in adolescence or
childhood years; however, it may also
first appear in early adult years.
 GAD is not exclusively associated with
an early age of onset. For instance, the
lowest prevalence of GAD occurred in
the 15- to 24-year age group (Wittchen
et al., 1994).
 Symptoms tend to evolve gradually and
insidiously.

3. PREVALENCE
 The lifetime prevalence of generalized
anxiety disorder has been estimated
at about 5%, and the female to male
ratio at about 2:1.
 Common disorders in the elderly -
17% of elderly men and 21.5% of
elderly women

4. ETIOLOGY
 Findings from genetics, neurobiology
and psychology infer a multifactorial
etiology for GAD.
 Several findings support the presence
of abnormalities in GABAergic and
noradrenergic activity.

5. CLINICAL FEATURES
 complains of anxiety, sometimes with
bitterness
 unable to relax, the patient may spend
restless hours at night waiting for sleep.
 complains of a sense of shakiness and
may have a fine tremor of the hands.
 The heart may race uncomfortably

6. CLINICAL FEATURES
 lump in the throat, cold clammy skin,
indigestion and cramping.
 They may have constipation or
diarrhea.
 complain of lightheadedness.
 feeling exhausted and of being unable
to concentrate.

7. DIAGNOSIS
F41.1 Generalized anxiety disorder
A. A period of at least six months with
prominent tension, worry and feelings
of apprehension, about
every-day events and problems.
B. At least four symptoms out of the
following list of items must be present, of
which at least one from items (1) to (4).

8. Autonomic arousal symptoms
 (1) Palpitations or pounding heart, or
accelerated heart rate.
 (2) Sweating.
 (3) Trembling or shaking.
 (4) Dry mouth (not due to medication or
dehydration).
Symptoms concerning chest and abdomen
 (5) Difficulty breathing.
 (6) Feeling of choking.
 (7) Chest pain or discomfort.
 (8) Nausea or abdominal distress (e.g.
churning in stomach).

9. Symptoms concerning brain and mind
 (9) Feeling dizzy, unsteady, faint or light-
headed.
 (10) Feelings that objects are unreal
(derealization), or that one's self is
distant or "not really here"
 (depersonalization).
 (11) Fear of losing control, going crazy,
or passing out.
 (12) Fear of dying.
 General symptoms
 (13) Hot flushes or cold chills.
 (14) Numbness or tingling sensations.

10. Symptoms of tension
 (15) Muscle tension or aches and pains.
 (16) Restlessness and inability to relax.
 (17) Feeling keyed up, or on edge, or of mental
tension.
 (18) A sensation of a lump in the throat, or
difficulty with swallowing.
Other non-specific symptoms
 (19) Exaggerated response to minor surprises or
being startled.
 (20) Difficulty in concentrating, or mind going
blank, because of worrying or anxiety.
 (21) Persistent irritability.
 (22) Difficulty getting to sleep because of
worrying.

11. C. The disorder does not meet the criteria
for panic disorder (F41.0), phobic anxiety
disorders (F40.-), obsessive-compulsive
disorder (F42.-) or hypochondriacal
disorder (F45.2).
D. Most commonly used exclusion criteria:
not sustained by a physical disorder,
such as hyperthyroidism, an organic
mental disorder (F0) or psychoactive
substance-related disorder (F1), such as
excess consumption of amphetamine-
like substances, or withdrawal from
benzodiazepines.

12. COMORBIDITY
 75% of patients with a current principal
diagnosis of GAD have other co-
occurring anxiety or mood disorders
(Brawman-Mintzer et al)
 substance use disorders are common
(16%) in current GAD.
 GAD may be the most commonly
occurring disorder in persons presenting
for treatment of physical conditions
associated with stress

13. DIFFERENTIAL DIAGNOSIS
 An agitated depressive episode or an
agitated dysthymia may present with a
very similar clinical picture
 Patients with specific phobia, social
phobia, or obsessive compulsive
disorder may likewise experience
considerable anxiety

14. DIFFERENTIAL DIAGNOSIS
 Patients dependent on alcohol or
sedative-hypnotics may repeatedly
find themselves in the midst of
withdrawal symptoms characterized
by anxiety and autonomic symptoms
 A variety of drugs if taken chronically
may produce a constant set of side
effects that may mimic GAD

15. TREATMENT
Medications
 Benzodiazepines - Among the benzodiazepines,
effective agents include diazepam (15–25 mg
daily), alprazolam (1 to 4 mg) and lorazepam (1
to 4 mg).
 Hydroxyzine, an antihistamine similar to
diphenhydramine, is more effective than placebo
when given in a total daily dose of approximately
50 mg.
 Propranolol may relieve the “peripheral”
manifestations of anxiety, such as tremor and
tachycardia; the effective dose ranges between
60 and 240 mg.

16. TREATMENT
Psychological treatment
 supportive psychotherapy, relaxation therapy,
biofeedback and CBT.
 CBT has been found associated with clinically
significant improvements in many RCT’s. It
consists of psychoeducation about the nature
of anxiety, symptom monitoring , relaxation
training, exposure and cognitive restructuring.
 Recent developments in psychosocial
treatments for GAD have integrated
mindfulness approaches into traditional CBT.

17. THANK YOU