Shumona RahmanGP VTS ST2

frequent distressing worry that’s difficult to control about many things that might go wrong in the future

restlessness, irritability, muscle tension, fatigue,difficulty concentrating,and sleep disturbance

more ‘freeze’ than ‘fight or flight’: thoughts more than images, unhappy but not strongly in

touch with emotions, or with the present moment

GAD is a syndrome of ongoing anxiety and worry about many events or thoughts that the patient generally recognises as excessive and inappropriate

More common in women

Risk factors are:◦ Being aged between 35 and 54 ◦ Being divorced or separated ◦ Living alone or as a lone parent

1. Educate and actively monitor

2. Low-intensity psychological interventions- www.anxietyuk.org.uk

- www.nopanic.org.uk-www.ntw.nhs.uk/pic/selfhelp-

www.moodjuice.scot.nhs.uk/anxiety.asp

3. Benzodiazepines should not usually be used as a short term measure during crises

CBT“Utilises cognitive techniques (e.g. to challenge “automatic negative thoughts” and maladaptive beliefs) and structure approaches to modify dysfunctional patterns of behaviour.”

- Online- NHS (New Thoughts)- Private

self-monitoring for early signs of anxiety and tension

training in calming skills, application during daily life, and coming into the present

using imaging to encourage use of calming skills and cognitive coping strategies

cognitive coping strategies include worry tree, worry outcome diary, worry problem solving times, worry-free zones, beliefs about worry, etc

Pharmacotherapy (SSRIs)

- Sertraline : most cost effective, but does not have UK marketing authorisation

- Paroxetine and venlafaxine in extended release formulation have marketing authorisation

The efficacy and side-effects should be reviewed within 2 weeks of starting treatment and again at 4, 6 and 12 weeks.

If the patient is showing improvement on treatment the drug should be continued for at least 6 months after the optimal dose is reached (monitor every 8-12 wks), after which the dose can be tapered

Those at risk of self-harm Hx of substance misuse

Combination therapy may be warranted- If there is no improvement after a 12-week course,

another SSRI or another form of therapy should be offered