• anxiety = normal human emotion

  • becomes disorder when of greater intensity or duration

  • leads to impairment or disability

• mild and transient -> severe and persisitent with significant impact on fucntion and QOL

• most frequently seen mental disorder in primary care

• more common F>M

• wide range of anxiety disorders

  • presentation can vary

  • vague

    • sleeplessness

    • headache

    • dizziness

    • GI disturbance

    • somatic symptoms

  • consider medical conditoins

    • hyp(o/er) thyroidism

    • angina

    • asthma

    • depression

    • substance misuse

    • medications

  • discuss

    • start of anxiety

    • associated life events

    • nature

    • impact

    • medication use

    • etoh/caffeine/cannabis

  • Predominant sympotm

    • trauma history and flash backs

      • PTSD

    • obsessions +- compulsions

      • OCD

    • uncontrollable worry about several areas

      • GAD

    • fear of social scrutiny

      • consider social phobia

    • fear of discrete object/situation

      • specific phobia

    • uncued/spont

      • panic disorder

        • unexpected discrete periods of intense fear or ddiscomfort

        • reach peak wihin 10mins and last 30-45mins

        • feel like MI

        • recurrent panic attacks

Generalised anxiety disorder

1. excessive anxiety and worry about a number of events or activities occuring more days than not for at least 6mo and are out of proportion to likelihood or impact of feared events

2. worry pervasive and difficult to control

3. anxiety and worry associated with ≥ 3 of following:

4. restlessness or feeling keyed up or on edge

5. easily fatigued

6. difficulty concentrating or mind going blank

7. irritability

8. muscle tension

9. sleep disturbance

10. anxiety, worry or physical symptoms cause clinically significant distress/impairment

• 35-60% of people with major depression also meet criteria for GAD

• increase risk of suicidal behaviour

  • ten times higher compared to noraml population

  • co-exisiting mental disorder further increase risk

• GAD 7:

  • mild 5-9

  • moderate 10-14

  • severe 15-21

  • link

treatment

• decision;

  • severity and persistence of symptoms

  • level of disability and impact on social functioning

  • co-eisting mental or physical disorder

  • current medications

• Physchyological

  • CBT most widely used

  • may be beneficial

    • moodgym

    • E-couch

• Drug therapy

  • SSRI

    • first line

    • well tolerated

    • transient increase in anxiety initially

      • low doses and slowly increase

      • co-prescribe bdz for first few weeks

        • make clear that short term only

    • can cause sexual dysfunction

      • sildenafil may be hellpful

    • discontinuation syndrome

      • dizziness, nausea, anxiety, vivid dreams, headache

  • Benzos

    • widely used

    • rapid onset

    • short term

    • taper dose to avoid rebound anxiety

  • betablockers

    • propranolol

      • no more effective than placebo