Anxiety Disorders Key Info • • Fear serves as an adaptive mechanism to facilitate appropriate reactions to external threats. Anxiety is considered as a pathological fear when: - Fear is greatly out of proportion of the risk/severity of threat - Response continues beyond existence of threat or becomes generalised to similar and dissimilar situations. - Social or occupational functioning is impaired. Generalised Anxiety Disorder Definition • • • Characterised by excessive and persistent anxiety for at least 6 months. Can be triggered in various situations with or without an identified trigger Causes social or occupation dysfunction Epidemiology • • Usually adult onset Affects females more than males Clinical Features • • • • • • • • • • Prolonged, excessive, pervasive worrying and anxiety Nervousness Restlessness Irritability Muscle tension Somnolence Fatigue Concentration difficulties Insomnia Medical unexplained physical symptoms Diagnosis Exclusion of Organic Causes • • • • • Thyroid function -> exclude thyroid disease CBC to rule out anaemia ECG to rule out ACS Drug urine screen -> rules our substance use or poisoning Plasma free metanephrines in patients with a family history or clinical features of pheochromocytoma DSM V DIAGNOSIS IS CONFIRMED IF THEY MEET ALL OF THE FOLLOWING CRITIERIA • • • • • Excessive anxiety and worry about multiple evens and/or cities on most days for at least 6 months. Worry that is difficult to control At least 3 months in adults ot at least 1 month in children of the following symptoms occurring on most days over the past 6 months: - Sleep disturbances - Muscle tensions - Irritability - Difficulty concentrating - Easy fatigue - Restlessness Symptoms cause significant distress or impairment in the professional, social or other important areas Symptoms cannot be attributed to substance use, medical disorder such as pheno and thyroid, or psychiatric conditions such as panic disorder, PTSD, somatic symptom and related disorders. DDX • • • • • • Other forms of anxiety Acute stress disorder PTSD OCD Mood disorders Substance withdrawal Management Psychotherapy • • • CBT – preferred option Relaxation therapy Biofeedback Pharmacotherapy • • First line - SSRIs e.g. escitalopram, paroxetine - SNRIs e.g. duloxetine, venlafaxine If first line causes no improvement - Buspirone - Benzodiapines e.g. alprazolam, diazepam for short term use only - TCAs e.g. imipramine Key Info Long term use of benzothiazines -> significant adverse effects -> motor and cognitive impairments and a risk of dependence