Generalised anxiety disorder (GAD) is a common mental health condition characterised by excessive and persistent worry about various aspects of life, often without a specific cause or trigger.
Risk Factors
- Female sex
- Family history
- Emotional trauma
- Stressful life events: E.g. losing employment
Clinical Features
Cognitive
- Reduced concentration
- Rumination
- Sense of dread/fear
- Feeling on edge
Somatic
- Sweating
- Palpitations
- Shortness of breath
- Nausea
- Epigastric discomfort
- Chest pain
- Light-headedness
- Muscle tension and aching
- Shaking
- Paraesthesia
- Insomnia
- Fatigue
Differential Diagnosis
- Alterative anxiety disorder: OCD, PTSD, Panic disorder
- Excess caffeine
- Hyperthyroidism
- Adjustment disorder: An excessive response to a stressful life event which typically ceases 6 months after the end of a stressor
Investigations
- Thyroid function tests can be useful to rule out hyperthyroidism as a cause.
- Additionally, the GAD-7 questionnaire can be a useful tool to assess the severity of GAD.
Management
NICE recommend a stepped model of management for GAD. Individuals with marked functional impairment are started at step 3.
- Step 1: Communicating the diagnosis, providing information, and monitoring the symptoms
- Step 2: Offering a low-intensity psychological intervention based on CBT principles
- Self-help (guided/non-facilitated)
- Psychoeducational groups
- Step 3: Individual high-intensity psychological intervention e.g. CBT/applied relaxation plus drug management
- Drug management:
- An SSRI is first-line.
- If an SSRI fails, an alternative SSRI or an SNRI can be tried.
- Pregabalin is usually used where SSRIs and SNRIs are not tolerated.
- Step 4: Referral for specialist assessment. This is for individuals with GAD that is treatment-refractory, are high risk of self-harm, or have a very marked functional impairment
General Advice
- Regular exercise
- Sleep hygiene: Trying to go to bed at the same time every day, reducing caffeine intake after 3pm
- Avoiding caffeine
References
https://cks.nice.org.uk/topics/generalized-anxiety-disorder/management/management/
https://www.nhs.uk/mental-health/conditions/generalised-anxiety-disorder/diagnosis/
https://www.nice.org.uk/guidance/cg113/chapter/Recommendations#stepped-care-for-people-with-gad
