GAD

Question 1

GAD

What is the DSM definition of GAD?

Answer 1

excess worry out of proportion to likelihood/impact of feared event, occurs more days than not > 6+ months

Question 2

GAD

GAD epidemiology (age, sex, prevalence, risk factors)

Answer 2

• 20’s to 30’s
• women > men
• 18% adults
• other MH conditions (mood, SUD), often missed in older adults
• non-white, single, poverty, early childhood trauma

Question 3

GAD

Patho/etiology behind GAD

Answer 3

• unconscious unresolved conflict
• behavioural anxiety = conditioned response
• neurotransmitters: norepinephrine, serotonin

Question 4

GAD

What is panic disorder?

Answer 4

• episodic unexpected panic attacks that occur without a clear trigger
• rapid onset of intense fear (peak in 10 min)
• most common physical symptom: palpitations

Question 5

GAD

What does SWIGECAPS stand for?

Answer 5

Sleep
Worthlessness
Interest 
Guilt
Energy
Concentration 
Appetite
Psychomotor changes
Suicidal/Safety

Question 6

GAD

Most common somatic symptoms and other associated symptoms

Answer 6

Somatic: 
dizziness
GI upset
nausea
chest pain 
SOB
sweating
chronic HA

Other: 
poor sleep
fatigue 
difficulty relaxing 
- often present for long-standing symptoms that are medically unexplained 

RED FLAGS
homicidal/suicidal ideation

Question 7

GAD

Medical conditions that need to be excluded include

Answer 7

hyperthyroidism 
pheochromocytoma 
hyperparathyroidism 
tumours 
Cushing's 
hypoglycemia
epilepsy

Question 8

GAD

Ddx (psych)

Answer 8

depression 
hypochondriasis 
any other anxiety disorder
adjustment disorder
OCD
ADHD

Question 9

GAD

DSM criteria for dx

Answer 9

3 of the following over last 6 mo
- muscle tension
- restless/keyed up
- easy fatigue 
- difficulty concentrating 
- trouble sleeping 
- irritability
* must cause significant distress/impair functioning
* not attributed to effect of substance use or medication 
not explained by another mental disorder

Question 10

GAD

Management & Follow-up schedule for GAD

Answer 10

• psychotherapy (CBT)
• SSRIs
• compassionate listening
• f/u 1-2 weeks, then Q2-4 weeks
• safety/suicide assessment every visit

Question 11

GAD

SSRI’s - what is the MOA, S/E, precautions. name some examples

Answer 11

• fluoxetine, venlafaxine, paroxetine, sertraline, (es)citalopram
• inhibits reuptake serotonin
• use 12 mo before tapering to avoid relapse
• nausea, drowsiness, insomnia, dry mouth, sexual dysfunction (sertraline)
• monitor for serotonin syndrome!

Question 12

GAD

Serotonin syndrome

Answer 12

Triad

• altered mental status (agitation, anxiety, restlessness)
• neuromuscular abnormalities (hyperreflexia, rigidity, tremors)
• autonomic hyperactivity ( hypertension, tachycardia, mydriasis, tachypnea, hyperthermia, flushed, vomiting, etc)