Summary
Anxiety clinical summary
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Summary of 2 pages for the course pharmacy at UBir (Lecture notes)
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Anxietyhttps://cks.nice.org.uk/topics/generalized-anxiety-disorder/ [NICE guidance ref]
Definition: Generalized anxiety disorder (GAD) is characterized by disproportionate,
pervasive, uncontrollable, and widespread worry and a range of somatic, cognitive, and
behavioural symptoms that occur on a continuum of severity.
Onset of symptoms is insidious, often unremitting, and can be lifelong.
While some people will present with obvious anxiety, others will initially present
with somatic symptoms such as muscle tension or insomnia.
Diagnosis:
The GAD-2 scale is used for diagnoses in primary practise whilst the GAD-7 scale is used by
specialists.
Score 3 or more consider anxiety
The DSM-V diagnostic criteria for GAD include:
o At least 6 months of excessive, difficult to control worry about everyday
issues, that is disproportionate to any inherent risk, and causes distress, or
impairment.
o The worry is not confined to features of another mental disorder, or as a
result of substance abuse, or a general medical condition.
o The person experiences at least 3 of the following symptoms most of the
time: restlessness/nervousness, being easily fatigued, poor concentration,
irritability, muscle tension, or sleep disturbance.
The ICD-10 diagnostic criteria for GAD include:
o Anxiety which is generalized and persistent but not restricted to, or even
strongly predominating in, any particular environmental circumstances.
o Variable dominant symptoms including persistent nervousness, trembling,
muscle tension, sweating, lightheadedness, palpitations, dizziness, and
epigastric discomfort.
o Expression of fears such as that the person or a relative will shortly become ill
or have an accident
Management:
Ask about the use of:
o OTC/prescribed medicines which can cause anxiety-albutamol, theophylline,
beta-blockers, herbal medicines (including ma huang, St. John's wort,
ginseng, guarana, belladonna), corticosteroids, and some antidepressants.
o Alcohol or illicit substances that can cause anxiety acutely and in withdrawal.
This must be a combination of both pharmacological and non-pharmacological
treatments [CBT].
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