General anxiety disorder (GAD) presentation

Subtopics are introduction, etiology, clinical feature, DSM 5, Differential diagnosis, treatment.
presented in american university of Barbados by Yogesh Vishwakarma.

1. General anxiety disorder (gad)

2. Table of content Introduction Definition About GAD Physician anxiety disorders Etiology Clinical features Diagnostic criteria: DSM V Differential diagnosis Treatment Physiotherapy Medications

3. Definition of GAD It is a persistent anxiety brought about by continual day-to-day concern and worry [1] Can be likened to overthinking! [1] Anxiety, Generalized Anxiety Disorder (GAD), Sadaf Munir; Veronica Takov https://www.psychologytoday.com/us/blog/what-mentally-strong-people-dont-do/201602/6-tips-stop-overthinking

4. Introduction [1,6]

5. GAD is part of a spectrum of disorders known as anxiety disorders. [1,6] It may be referred to as Anxiety disorder. [1,6] Can be mistaken with other anxiety disorders such as. [1,6] Differs from other types of Anxiety disorders in that it is persistent, invasive and uncontrollable anxiety or worry towards any issue or situation. [1,6] [1] Anxiety, Generalized Anxiety Disorder (GAD), Sadaf Munir; Veronica Takov [6] https://ada.com/conditions/generalized-anxiety-disorder/ https://www.mindful.org/high-anxiety-2/

6. Those who suffer from GAD are at high risk of Suicidal ideation/commit suicide. [4] Drug use disorders [5] Substance abuse [ 5] Sociopathy [4,5] Psychopathy [4,5] 4 ht tps://www.cnbc.com/2019/05/21/stress-and-rigorous-work-push-a-doctor-to-co mmit-suicide-every-day-in-us.html 5 https://www.transformationstreatment.center/co-occurring/anxiety-disorder/

7. 20% of adults suffer from GAD annually, in the general population. [1] Doctors make up a majority of GAD cases. [4] About 80% of doctors have some sort of mental disorder including GAD. [10] http://mandegar.info/?l=Cornishway+Group+Practice++Information+about+the+doctors 1 Anxiety, Generalized Anxiety Disorder (GAD), Sadaf Munir; Veronica Takov 4 ht tps://www.cnbc.com/2019/05/21/stress-and-rigorous-work-push-a-doctor-to-co mmit-suicide-every-day-in-us.html 10 https://www.bmj.com/content/365/bmj.l1861 Introduction: Physician Anxiety disorders [4,12]

8. https://www.eventbrite.com.au/e/townsville-qld-educating-the-nurse-of-the-future-consultation-workshop-tickets-58822296071 GAD leading to physician suicide is common. [4] According to the American Medical Student Association, medical students are 3 times more likely to commit suicide compared to their peers. [12] 4 ht tps://www.cnbc.com/2019/05/21/stress-and-rigorous-work-push-a-doctor-to-co mmit-suicide-every-day-in-us.html 12 https://www.amsa.org/2017/06/21/suicide-is-more-common-in-medical-school-than-in-any-other-school-setting/

9. ETIOLOGY [6,9,16]

10. No single cause exists [6,9] However, GAD has been associated with: Gender [6] Females are twice as likely to be diagnosed with GAD as men. Presence of physical or emotional trauma [9] Bullying is associated with increased risk. https://www.verywellmind.com/gad-causes-risk-factors-1392982

11. Genetic factors [9] A significant number of patients and their first-degree relatives develop GAD, Polymorphisms on chromosome 8. Neurotransmitters [9] Variations in benzodiazepines, serotonin, N-methyl-D-aspartate, cholecystokinin . “Challenging parenting” is found to reduce risk of GAD. [16] 9 https://www.healthguideinfo.com/generalized-anxiety-disorder/p109654/ 6 https://ada.com/conditions/generalized-anxiety-disorder/

12. Clinical features [15]

13. Clinical features of GAD are:- Psychological and cognitive features. Physical Features.

14. Psychological and cognitive features. Worrying or anxiety.

15. Psychological and cognitive features. Worries that are difficult to control. https://www.google.com/ search?biw =1407&bih=613&tbm= isch&sa =1&ei=wSM5XcLIK4785gLhn5-ACw&q= Worrying+or+anxiety .+ gif&oq = Worrying+or+anxiety .+ gif&gs_l =img.3...76232.78893..79334...0.0..0.171.526.0j4......0....1..gws-wiz-img.GSIgRfFBfCw&ved=0ahUKEwiCreqOks_jAhUOvlkKHeHPB7AQ4dUDCAY&uact=5#imgrc=RNmwSiXfpuF2rM:

16. https://giphy.com/gifs/week-finals-summed-mRh4cLIYhrs9G https://www.google.com/ search?biw =1422&bih=678&tbm= isch&sa =1&ei=4nk4XcjvAa2t5wKj5ov4Dw&q= difficulty+concentrating&oq = difficulty+con&gs_l =img.1.0.0l2j0i5i30l3j0i8i30l3j0i24l2.357281.382298..384183...0.0..6.351.8085.42j25j5j1......0....1j2..gws-wiz-img.....0..35i39j0i67j0i10j0i10i24.po2cXCxQfaA#imgdii=zkvHUBDY4sv6CM:& imgrc =oX0F5ZpPJtgZDM: Poor Concentration. Psychological and cognitive features.

17. Feeling keyed up or on edge. Psychological and cognitive features. https://www.google.com/search?q=on+edge+feeling+gif&source=lnms&tbm=isch&sa=X&ved=0ahUKEwih6Z7SlM_jAhXDrFkKHYLpDd0Q_AUIESgB&biw=1407&bih=613#imgrc=spwVj_y9WeYDSM:

18. Physical Features https://www.indiatvnews.com/lifestyle/health-sleeping-less-than-6-hours-or-restlessness-at-night-may-harden-your-arteries-460048 https://www.buzzfeed.com/tahliapritchard/walk-and-talk-please Restlessness.

19. Physical Features https://giphy.com/gifs/will-smith-fresh-prince-of-bel-air-ypW86tTXxGh0s https://giphy.com/gifs/smelling-KtPsCn9wjUx1e Headaches & Nausea.

20. Fatigue. https://www.google.com/ search?biw =1407&bih=613&tbm= isch&sa =1&ei=ESQ5Xa_TOsfc5gKK4aKQBQ&q= Fatigue+gif&oq = Fatigue+gif&gs_l =img.3..0j0i5i30j0i7i30l3j0i7i5i30j0i8i7i30l2j0i30l2.79372.88236..90006...0.0..1.193.1958.7j9......0....1j2..gws-wiz-img.b5dop00MZEA&ved=0ahUKEwjvn4y1ks_jAhVHrlkKHYqwCFIQ4dUDCAY&uact=5#imgrc=wU3YAGGMooTbRM: Physical Features

21. Physical Features Trouble sleeping. https://www.google.com/ search?biw =1407&bih=613&tbm= isch&sa =1&ei=aiY5XcTPNcib5gKB4rCwAQ&q= Trouble+sleeping+gif&oq = Trouble+sleeping+gif&gs_l =img.3...541938.543616..544665...0.0..0.215.1683.5j8j1......0....1j2..gws-wiz-img.......0i67j0.vOCKmAQCT8k&ved=0ahUKEwjErNHTlM_jAhXIjVkKHQExDBYQ4dUDCAY&uact=5#imgrc= YFdCLoNXBl-mcM :

22. Physical Features Muscle aches. https://giphy.com/gifs/woman-toenails-GnHt6DuQiUtMc

23. Physical Features Sweating. https://giphy.com/gifs/gif-this-vwjAf1EsSG7k1Jbtkx

24. Physical Features Irritability. https://www.google.com/imgres?imgurl=https://thumbs.gfycat.com/HairyAdvancedHowlermonkey-size_restricted.gif&imgrefurl=https://gfycat.com/hairyadvancedhowlermonkey&tbnid=wJDzaxXxKccOzM&vet=1&docid=0yC0V5rem49nJM&w=534&h=251&itg=1&hl=en&source=sh/x/im

25. GAD patients often suffer from other anxiety disorders such as social anxiety disorder and substance abuse such as excessive alcohol consumption, among other symptoms. https://www.google.com/ search?biw =1407&bih=613&tbm= isch&sa =1&ei=oSk5XcenJaKw5wLeiangCg&q= alcohol+consumption+gif&oq = alcohol+consumption+gif&gs_l =img.3...698724.712706..713230...0.0..3.272.4129.3j21j4......0....1..gws-wiz-img.....0..35i39j0i67j0j0i10j0i8i30j0i24.Uwu8IdLSKoU&ved=0ahUKEwiH_Pjbl8_jAhUi2FkKHd5ECqwQ4dUDCAY&uact=5#imgrc=PtRLJRC0d2ETJM:

26. DSM -5 CRITERIA

27. Diagnostic criteria: According to the DSM-5 [13,14] A. Excessive anxiety and worry (apprehensive expectation),  occurring more days than not for at least 6 months, about a number of events or activities. B. The individual finds it difficult to control the worry. http://seniorcarepsychological.com/anxiety-disorders-and-related-dsm-5-diagnostic-codes/ 13 https://dsm.psychiatryonline.org/doi/10.1176/appi.books.9780890425596.dsm05 14 https://www.ihs.gov/california/tasks/sites/default/assets/File/GPRA/C5_%20Anxiety%20Disorders%20(Liu)_508.pdf

28. Diagnostic criteria: According to the DSM-5 [13,14] C. The anxiety and worry: – 1. Restlessness or feeling keyed up or on edge. – 2. Being easily fatigued. – 3. Difficulty concentrating or mind going blank. – 4. Irritability. – 5. Muscle tension. – 6. Sleep disturbance. https://www.123rf.com/photo_53896742_gad-generalized-anxiety-disorder-disease-abbreviation-.html 13 https://dsm.psychiatryonline.org/doi/10.1176/appi.books.9780890425596.dsm05 14 https://www.ihs.gov/california/tasks/sites/default/assets/File/GPRA/C5_%20Anxiety%20Disorders%20(Liu)_508.pdf

29. Diagnostic criteria: According to the DSM-5 [13,14] D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social occupational. E. The disturbance is not attributable to the physiological effects of a substance. F. The disturbance is not better explained by another mental disorder. https://www.123rf.com/photo_16629177_abstract-word-cloud-for-generalized-anxiety-disorder-with-related-tags-and-terms.html 13 https://dsm.psychiatryonline.org/doi/10.1176/appi.books.9780890425596.dsm05 14 https://www.ihs.gov/california/tasks/sites/default/assets/File/GPRA/C5_%20Anxiety%20Disorders%20(Liu)_508.pdf

30. Differential diagnosis [15]

31. Differential diagnosis of GAD is rather complicated for a number of reasons: Many conditions have similar presentations such as Other psychiatric disorders e.g. major depressive disorder. Endocrine conditions like hyperthyroidism. Cardiopulmonary conditions such as obstructive pulmonary disease. Use of substances, for example, caffeine, or Substance withdrawal. 15 https://www.aafp.org/afp/2015/0501/p617.html#sec-3 https://fr.123rf.com/photo_17957672_illustration-de-la-d%C3%A9coupe-des-lettres-imprim%C3%A9es-dispos%C3%A9es-pour-former-les-mots-c-est-compliqu%C3%A9-.html

32. It is further complicated in that conditions that are a part of GAD differential diagnosis are also common comorbidities. Patient history, physical examination, laboratory findings and more are helpful in diagnosing GAD. https://www.tumblr.com/search/its%20complicated%20lyrics

33. Treatment [7]

34. Treatment [7] Treatments focus on managing symptoms Classified into: Psychotherapy Medications https://en.ra6.org/finding-the-right-depression-treatment.htm

35. Psychotherapy [7] Psychotherapy [7 ] Also known as talk therapy conducted in therapy sessions Does psychotherapy work? 75% of patients to receive psychotherapy benefit from it Shown to improve Emotional health. Behavior. Brain and body function. In the fall of 2016, the song-writer admitted on his social media account that he had checked himself into rehab to help manage his anxiety disorder. https://www.billboard.com/articles/columns/hip-hop/8466037/kid-cudi-interview-billboard-cover-story-2018

36. psychotherapy [7] Types of psychotherapy Cognitive behavioral therapy (CBT). Interpersonal therapy (IPT). Dialectical behavior disorder therapy. Support therapy.

37. Medications [8] Based on the belief that mental illness come from chemical imbalances in the brain Types of medications Antipsychotic Commonly prescribed antipsychotics : Typical:- haloperidol, loxapine , chlorpromazine, etc. Atypical:- clozapine, risperidone, aripiprazole, etc. Side effects: Drowsiness, upset stomach, increased appetite, weight gain, and seizures (rare). In January of 2015 the actress took to social media to disclose being on medication for general anxiety disorder https://www.indiatimes.com/entertainment/celebs/8-celebrities-who-spoke-about-coping-up-with-depression-and-gave-us-an-important-message-275032.html

38. Antidepressants Atypical antidepressants: Bupropion, Nefazodone, Trazodone, etc. Side effects: Insomnia, constipation, tremors, dry mouth. Mood stabilizers Commonly prescribed Mood stabilizers: Lithium, valproic acid, Carbamazepine, etc . Side effects: Weight gain, dizziness, blurred vision, confusion, stomach problems

39. Medications [8] Types continued Tranquilizers and sleeping pills Common tranquilizers and sleeping pills are : Benzodiazepines, lorazepam, flurazepam, etc Side effects: Headaches, slurred speech, confusion Stimulants and related medicines Example of stimulants are: methylphenidate, amphetamines, etc. Side effects: Decreased appetite, weight loss, rapid pulse, trouble sleeping

40. references Health guide. (20014). Health guide info.com. Retrieved from URL https://www.healthguideinfo.com/generalized-anxiety-disorder/p109654/ M. Mirjana . (2018). The Structure of Challenging Parenting Behavior and Associations With Anxiety in Dutch and Australian Children. Journal of Clinical Child & Adolescent Psychology ( 282-295). Retrieved from URL https://www.tandfonline.com/doi/full/10.1080/15374416.2017.1381915 Generalized anxiety disorder. (2017, October 13). Retrieved from https://www.mayoclinic.org/diseases-conditions/generalized-anxiety-disorder/symptoms-causes/syc-20360803 American psychiatry association.(2019). Psychiatry online. Retrieved from URL https://dsm.psychiatryonline.org/doi/10.1176/appi.books.9780890425596.dsm05 Mental health America.(2019). Mental health treatments. Retrieved from URL https://www.mentalhealthamerica.net/medication B. Locke, K. Nell & G. Shultz(May,2015). Diagnosis and Management of Generalized Anxiety Disorder and Panic Disorder in Adults. American Family Physician. Retrieved from URL https://www.aafp.org/afp/2015/0501/p617.html#sec-3

41. Melemis , S. (n.d.). Benzodiazepines, Tranquilizers, Sleeping Pills: Information. Retrieved from https://www.addictionsandrecovery.org/benzodiazepine.htm 20158 Mood Stabilizing Medications. (n.d.). Retrieved from https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/mood-stabilizing-medication

42. Thank you!!