Anxiety
DIAGNOSIS
suspect in any person with excessive worry >6months duration
worry not linked to another mental disorder or as a result of substance abuse or general medical condition
at least 3 from - restlessness/nervousness, easily fatigued, poor concentration, irritability, muscle tension, sleep disturbance
OBSERVE : anxiety in people with persistent physical health problems eg headache, muscle tension, gastrointestinal symptoms, back pain, insomnia who may not report psychological distress
RISK FACTORS
female
FMx
current physical or emotional stress
Hx of physical trauma or emotional trauma
chronic pain, cancer, coronary heart disease, arthritis, CVA, COPD
substance abuse
QUESTIONS
over use of over counter medication eg st johns wort, ginseng
prescribed medication - salbutamol, beta-blockers
alcohol or illicit drug use
EXAMINATION
increased pulse rate
SOB
trembling
easily startled
if high GAD 7 score assess suicide risk https://patient.info/doctor/generalised-anxiety-disorder-assessment-gad-7
TREATMENT
CBT
group therapy
SSRI sertraline 50mg
lifestyle advice - reduce caffeine, exercise, bedtime routine
Generalised anxiety disorder is characterised by disproportionate, pervasive, uncontrollable and widespread worry and a range of somatic, cognitive and behavioural symptoms that occur on a continuum of severity