1. GENERALIZED ANXIETY DISORDER
CAMELITA MORRIS
MSIII

2. OVERVIEW
 Definition
 Epidemiology
 Signs & Symptoms
 Causes
 Diagnosis
 Management
 Prevention

3. DEFINITION
Generalized anxiety
disorder is characterized
by chronic feelings of
excessive worry and
anxiety without a specific
cause. It's often an
irrational worry about
everyday things that is
disproportionate to the
actual source of worry

4. EPIDEMIOLOGY
 Generalized anxiety disorder appears to be highly
prevalent.
 In the United States, the lifetime prevalence of
DSM-IV GAD is estimated to be about 5% and the
current prevalence to be about 2% to 3%. The
disorder is differentially prevalent across gender and
ethnic and social groups

5. EPIDEMIOLOGY CONT...
 The prevalence of GAD in children is approximately
3%;
 The prevalence in adolescents is reported as high as
10.8%.
 The age of onset for children and adolescents with
GAD is between ages 10 and 14.

6. EPIDEMIOLOGY CONT...
 It has a lifetime prevalence of 5.7% and an annual
prevalence of 3.1% in the United States.
 But, these rates could increase dramatically if new
diagnostic criteria for GAD are established.

7. EPIDEMIOLOGY CONT...
 Populations that are at an increased risk of GAD are
individuals with low and middle socio-economic
status, separated, divorced, and widowed
individuals.
 Women are twice as likely to develop GAD as men.
This is primarily because women are more likely
than men to live in poverty, and are more subject to
discrimination, and sexual and physical abuse.

8. SIGNS & SYMPTOMS
 Do you worry all the time? Have you had the following
symptoms for at least the past 6 months?
I never stop worrying about things big and small.
I have headaches and other aches and pains for no
reason.
I am tense a lot and have trouble relaxing.

9. SIGNS & SYMPTOMS CONT...
I have trouble keeping my mind on one thing.
I get crabby or grouchy.
I have trouble falling asleep or staying asleep.
I sweat and have hot flashes.
I sometimes have a lump in my throat or feel
like I need to throw up when I am worried.

10. SIGNS & SYMPTOMS CONT...
 GAD often coexists with common physical disorders, such
as
IBS, insomnia, headache
Depression, anorexia nervosa substance abuse,
ADHD

11. CAUSES
 Although the exact cause of GAD is unknown, there
is evidence that biological factors, family
background, and life experiences, particularly
stressful ones, play a role.

12. CAUSES – Substance Induced
 Long term use of Benzos
 Long term alcohol use
 Sometimes anxiety pre-existed
alcohol or benzodiazepine
dependence, but the dependence was
acting to keep the anxiety disorders
going and often progressively
making them worse.

13. CAUSES – Psychological Cont...
 Anxiety is less likely to occur, as well as quicker to remit,
among those who are religious.
 It is not always clear which factors are causes and which are
effects of anxiety;

14. CAUSES – Psychological Cont...
 Anxiety is less likely to occur, as well as quicker to
remit, among those who are religious.
 It is not always clear which factors are causes and which are
effects of anxiety;

15. CAUSES: Social
 Poverty and social isolation are associated with
increased risk of mental health problems in general.
 Child abuse (physical, emotional, sexual, or neglect)
is also associated with increased risk of developing
depressive disorders later in life.

16. CAUSES: Social cont...
 Lack of social support can also increase the
likelihood for one to experience anxiety
 Neighborhood social disorder
 Adverse work condition
 Prejudice

17. DIAGONOSIS
 Clinical assessment
 DSM-V
 Differential diagnoses

18. Diagnosis: Clinical Assessment
 Clinical assessment: (A diagnostic assessment may
be conducted) by a suitably trained general
practitioner, or by a psychiatrist or psychologist,
who records the person's current circumstances,
biographical history, current symptoms and family
history.
 The main purpose of assessment is to identify the
main stressors

19. Diagnosis: DSM V CRITERIA
 Excessive anxiety and worry, occurring more days
than not for at least 6 months, about a number of
events or activities (such as school or work
performance)
 Individual finds it difficult to control worrying

20. Diagnosis: DSM V CRITERIA
 Anxiety and worry are associated with three (3) or
more of the following six symptoms (with some
symptoms having been present for more days than
not for the past 6 months)
Restlessness or feeling keyed up or on edge
Being easily fatigued, difficulty concentrating
Irritability
Muscle tension
Sleep disturbance

21. Diagnosis: Differential Diagnosis
Acute Respiratory Distress Syndrome
•Adrenal Crisis
•Alcoholism, Delirum Tremens
•Amphetamine-Related Psychiatric Disorders
•Anaphylaxis
•Anorexia Nervosa, bulimia
•Apnea, Sleep disorders
•Asthma
•Body Dysmorphic Disorder
•Caffeine-Related Psychiatric Disorders
•Cannabis Compound Abuse
•Depression
•Diabetes Mellitus, Type 1, •Diabetic Ketoacidosis
•Factitious Disorder, Malingering
•Gastritis,
•Hyperaldosteronism, Primary
•Hypercalcemia
•Hyperparathyroidism
•Irritable Bowel Syndrome
•Phobic Disorders
•Somatoform Disorders

22. MANAGEMENT
 Cognitive Behavioral
therapy
 Motivational
interviewing
 Medication

23. MANAGEMENT: CBT
 The goal of the therapy is to change
negative thought patterns that lead to the
patient's anxiety, replacing them with
positive, more realistic ones.
 Elements of the therapy include exposure
strategies to allow the patient to confront
their anxieties gradually and feel more
comfortable in anxiety-provoking
situations, as well as to practice the skills
they have learned. CBT can be used alone
or in conjunction with medication.

24. MANAGEMENT: CTB
 Therapy also includes psychoeducation, self-monitoring,
stimulus control techniques, relaxation, self-control
desensitization, cognitive restructuring, worry exposure, worry
behavior modification, and problem-solving.
 The first step in the treatment of GAD is psychoeducation which
involves giving information to the patient about the disorder and
the treatment.
 The purpose of psychoeducation is to provide some relief,
destigmatization of the disorder, enhance motivation for
treatment based on a rationale of the components of the
treatment, and increasing compliance by developing realistic
expectations about treatment.

25. MANAGEMENT:
MOTIVATIONAL INTERVIEWING
 A promising innovative approach to improving
recovery rates for the treatment of GAD by
combining CBT with Motivational Interviewing
(MI).

26. MANAGEMENT:
MOTIVATIONAL INTERVIEWING
 Motivational Interviewing is a strategy centered on the patient
that aims to increase intrinsic motivation and decrease
ambivalence about change due to the treatment. MI contains four
key elements;
 (1) express empathy,
 (2) heighten dissonance between behaviors that are not desired
and values that are not consistent with those behaviors,
 (3) move with resistance rather than direct confrontation, and
 (4) encourage self-efficacy

27. MANAGEMENT: Medication
 Antidepressants: are mainly used
for depression but is also used for
GAD:
 Selective serotonin re-uptake
inhibitors (SSRIs), including
fluoxetine (Prozac), sertraline
(Zoloft), paroxetine (Paxil),
fluvoxamine (Luvox), citalopram
(Celexa), and escitalopram
(Lexapro).

28. MANAGEMENT:Benzodiazepines
 Are most often prescribed to patients with
Generalized Anxiety Disorder.
 Research suggests that these drugs give some relief,
at least in the short term.
 However, they carry some risks, mainly impairment
of both cognitive and motor functioning, and
psychological and physical dependence that makes it
difficult for patients to stop taking them.

29. MANAGEMENT: Benzos cont...
 alprazolam (Xanax, Xanax XR, Niravam, Alprax)
 chlordiazepoxide (Librium)
 clonazepam (Klonopin)
 clorazepate (Tranxene)
 diazepam (Valium)
 lorazepam (Ativan

30. MANAGEMENT: Other
 Psychotropic drugs:
 Buspirone (BuSpar) is a serotonin receptor partial
agonist,
 Duloxetine (Cymbalta)- SNRI - type antidepressant
 Imipramine (Tofranil) is a (TCA).
Other tricyclic antidepressants - as
clomipramine,etc. TCAs are thought to act on
serotonin, norepinephrine, and dopamine in the
brain.

31. Other cont...
 Venlafaxine (Effexor XR) is a serotonin-
norepinephrine reuptake inhibitor (SNRI). SNRIs
alter the chemistries of both norepinephrine and
serotonin in the brain.
 Non-psychotropic drugs
 Propranolol (Inderal, avlocardyl) -BB
 Clonidine - Sympatholytic
 Prazosin - Sympatholytic, alpha-adrenoblocker

32. PREVENTION
 Abstain from alcohol or use illegal drugs. These
substances can make depression worse and might
lead to thoughts of suicide.
 Be compliant with medication and also be aware of
what side effects to expect. Learn to recognize the
early signs that your depression is getting worse.

33. PREVENTION CONT...
 Talk to someone you trust about how you are feeling
 Try to be around people who are caring and positive
 CTB for persons who are at risk
 Meditation
 Trust

34. References
 http://frugivoremag.com/2010/11/3-ways-food-is-contributing-to-the-rise-in-
anxiety-related-illness/
 http://www.ncbi.nlm.nih.gov/pubmed/19371500
 http://www.neurodiagnosticdevices.com/tag/generalized-anxiety-disorder
 http://www.adaa.org/understanding-anxiety/generalized-anxiety-disorder-
gad