5 - GAD

Question 1

is anxiety normal?

Answer 1

yes from an evolutionary view point - adaptive function
* alerts orgnaism to threats to survival
* prepares for fight/flight

Question 2

when may anxiety be abnormal?

Answer 2

• disproportionate to stimulus
• triggered by harmless situations
• can’t be controlled
• impairs functioning

Question 3

to have an operational diagnoses, what criteria must be met?

Answer 3

• pt must exprience a certain no of symptoms for at least a minimum specified period
• symptoms must cause - distress + be associated with impairment in everyday function

Question 4

what are the assesment criteria of GAD?

Answer 4

• persistent fear + worry
  at least 3 of:
• poor concentration
• restlessness
• fatigue
• muscle tension
• initial insomnia

symptoms last for >6months

Question 5

what is initial insomnia?

Answer 5

trouble getting to sleep

Question 6

what is terminal insomia?

Answer 6

waking up early + unable to get back to sleep

Question 7

what type of insomnia is more common in GAD?

Answer 7

initial insomnia

Question 8

what type of insomnia is more common in depression?

Answer 8

terminal insomnia

Question 9

when diagnosing GAD, what must you exclude?

Answer 9

• alcohol or street drug misuse
• hyperthyroidism
• phaeochromocytoma

Question 10

what is phaeochromocytoma?

Answer 10

• benign tumour of adrenal medulla
• leads to hypertension + anxiety due to release of catecholamines into circulation

Question 11

symptoms of GAD can be split into?

Answer 11

psychological
physical
behavioural

Question 12

what are the psychological symptoms of GAD?

Answer 12

• constant worries + intrusive thoughts
• feeling or apprehension + dread
• poor concentration
• depersonalisation + derealisation

Question 13

what are some physical symptoms of GAD?

Answer 13

• tremor, sweatiness, palpatations
• muscular tension + tension headache
• hyperventilation

Question 14

chest pain is ‘atypical’ in GAD - what does this mean?

Answer 14

• sharp + stabbing rather than crushing
• left sided rather than central
• won’t radiate

Question 15

how can GAD lead to parasthesiae in hands, feet and lips?

Answer 15

• hyperventilation
• leads to respiratory alkalosis
• causes changes in Cl- + Ca2+ channels in peripheral nerves

Question 16

what are some of the behavioural symptoms of GAD?

Answer 16

• putting things off because of anxiety
• avoidance
• self medication through drugs and alcohol

Question 17

is GAD more common in women or men?

Answer 17

women

Question 18

what is the median age of onset of GAD?

Answer 18

30 years

Question 19

what genetic factors can contribute to GAD?

Answer 19

• first degree relative
• risk genes
• overactive amygdala

Question 20

what environmental factors can contribute to GAD?

Answer 20

• parental rejection or over-control
• childhood trauama
• major life stress, eg. physical illness

Question 21

what is the main inhibitory neurotransmitter in the CNS?

Answer 21

GABA - 1/3 synapses

Question 22

how is GABA synthesised?

Answer 22

decarboxylation of amino acid glutamic acid

Question 23

GABA has a major role in the regulation of what?

Answer 23

• neuronal excitability and muscle tone

Question 24

GABA is the endogenous agonist at what two main receptors?

Answer 24

GABA A - multiple ligand binding sites - more important in brain
GABA B - more important in muscles and used clinically as a muscle relaxant

Question 25

what is the arrangement of the GABA A receptor?

Answer 25

* five subunits arranged around a central chloride channel * commonent mammamilian structure is - alpha x2, beta x2, gamma x1

Question 26

what happens when GABA binds to a GABA A receptor?

Answer 26

* binds to binding pocket between alpha and beta subunits * causes Cl- to flow into neuron * leads to hyperpolarisation - reduced change of AP

Question 27

if GAD is not severe, what may a doctor suggest?

Answer 27

simple lifestyle changes before adopting 'formal' treatment: * exercise * work/life balance * avoid caffeine and other drugs * avoid excess alcohol

Question 28

what is the NICE guidance for GAD care?

Answer 28

1. recognition and diagnosis GAD 2. offer treatment in primary care 3. non-response - reveiw and offer alternative 4. review and offer referral to secondary care 5. care specialist mental health services

Question 29

what psychological treatments may be offered for GAD?

Answer 29

* counselling * CBT * mindfulness

Question 30

what is the aim of CBT?

Answer 30

identify unhelpful patterns of thinking and replace them with more realistic and balanced ones

Question 31

what are the NICE recommendations around CBT?

Answer 31

12-15 hour long sessions of CBT over 4 months

Question 32

which is more effective for GAD treatment - psychological vs pharmacological?

Answer 32

similarly effective - pt choice is crucial