| ID | 127 |
|---|---|
| Name | GENERALIZED ANXIETY DISORDER (GAD) (ANXIETY NEUROSIS) |
| Cause | |
| Signs Symptoms | |
| Diagnosis | |
| Investigations | |
| Management | |
| Introduction | This is the commonest form of anxiety disorder characterised by lack of concentration, loss of interest and unforeseen fears due to adaptation to environmental stress. This anxiety may be free, floating or specific to any situation or events. Anxiety is a defense mechanism of mind or ego, protecting us from lot of ill happening out of inner conflict or stress from outer world. In GAD excessive anxiety and worry occur most of the days for at least 6 months related with a number of events or activities (work or school performance). The person cannot control or find it difficult to control the worry. In DSMIV criteria patient needs to have 3 symptoms out of the following 6 symptoms for diagnosis of GAD i. Restlessness or feeling keyed up or on edge ii. Being easily fatigued iii. Difficulties in concentrating or mind going blank iv. Irritability v. Muscle tension vi. Sleep disturbance (difficulties in falling asleep, total sleep disturbance). |
| History | |
| Etiology | Etiology: 1. Many patients appear to have personality traits of high anxiety and poor tolerance of stress. 2. Unexpected life events which the patient cannot handle. 3. Unexpected disasters such as floods, accidents and terrorist activities. 4. Sexual background |
| Clinical Features | Clinical features: These are devided into 2 groups- psychological and somatic. If somatic symptoms predominate the patient is lilkely to regard himself as physically ill. Symptoms of anxiety disorder: Psychological Somatic Apprehension Tremor, Sweating Fears of impending disaster Palpitations, Chest pain Irritability Breathlessness Depersonalisation Headache, Dizziness Diarrhoea Frequency of micturition Initial insomnia Poor concentration |
| Preventions | |
| Treatment | Treatment: 1. Counseling 2. Supportive psychotherapy- explanation and reassurance. 3. Cognitive behavioral therapy 4. Specific relaxation techniques should be tought. 5. Change of place may be effective. 6. Drug treatment: i. SSRI’s for 204 weekes. ii. Benzodiazepines also may be used. iii. Beta-adrenoceptor blocking drug i.e propranolol 20-80mg daily. iv. Tricyclic antidepressants (in low dose): e.g- Amitriptyline 50-150mg at night, v. MAO inhibitor: e.g- Phenelzine 15mg 4 times daily. |
| Complications | |
| Prognosis | Prognosis: Good. |
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