Generalised Anxiety Disorder Copyright This content has been conceptualized and prepared by Hansa MedCell. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the permission of Hansa MedCell. Disclaimer The content has been compiled from various medical sources by Hansa Medcell in association with a leading key opinion leader (Sr. Practicing Doctor) as a faculty of the course. Medical knowledge is constantly changing, so standard safety precautions must be followed, but as new research and clinical experience broaden our knowledge, changes in treatment and drug therapy may become necessary or appropriate. While every reasonable effort has been made to ensure accuracy of content, it is the responsibility of the practitioner, relying on experience and knowledge of the patient, to determine dosages and the best treatment for each individual patient. Hansa MedCell does not assume any liability for any injury and/or damage to persons or property arising from relying on the information contained in the publication.
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Generalised Anxiety Disorder
Copyright This content has been conceptualized and prepared by Hansa MedCell. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the permission of Hansa MedCell.
Disclaimer The content has been compiled from various medical sources by Hansa Medcell in association with a leading key opinion leader (Sr. Practicing Doctor) as a faculty of the course. Medical knowledge is constantly changing, so standard safety precautions must be followed, but as new research and clinical experience broaden our knowledge, changes in treatment and drug therapy may become necessary or appropriate.While every reasonable effort has been made to ensure accuracy of content, it is the responsibility of the practitioner, relying on experience and knowledge of the patient, to determine dosages and the best treatment for each individual patient. Hansa MedCell does not assume any liability for any injury and/or damage to persons or property arising from relying on the information contained in the publication.
CASE: THE ANXIOUS SALESMAN
Mr. R, 31-years-old successful salesman presents to the physicians clinic. He complains of
muscle tension, headaches and difficulty sleeping. The symptoms have gone worse since the last
15 days and he is unable to concentrate on his job.
On enquiry, Mr. R was apparently alright till his marriage 2 years ago. His symptoms started
after the birth of his child a year back. Initially the symptoms were off and on, about once a
week. But recently they come every other day. He worries about not having enough money for
his family in the event he dies suddenly or is fired from his job. He worries about job stability
and feels he would be unable to get another job that would pay him as well. Mr. R is the eldest of
4 children, his father was a electrician.
Mr. R is an introvert; he had perfectionist traits and used to excel in his studies. He wanted to
become an engineer but could not do so because he had to support his family.
1. Based on the above history, your diagnosis would be; a. Anxiety disorder
b. Major depression
c. Psychosis
The correct answer is a. Anxiety disorder
Anxiety is a diffuse, unpleasant, vague sense of apprehension with or without associated
autonomic symptoms. Normal anxiety alerts an individual of impending danger and
enables him to take precautionary or corrective measures. Pathological anxiety is
characterised by an exaggerated response to stressor anxiety in the absence of stress.
In major depression, depressed mood/melancholia is prominent. The patient also may
have psychomotor retardation/agitation, perceptual and thinking disturbances, loss of
pleasure and interest in daily activities, fatigue, inability to concentrate, lack of
appetitive, insomnia and suicidal ideation.
Psychosis is characterised by lack of touch with reality which causes problems in daily
functioning. Symptoms include delusions, hallucinations, disorganised speech,
disorganized behavior and negative symptoms.
2. The type of anxiety disorder the patient has is; a. Panic disorder
b. Obsessive-compulsive disorder
c. Generalised anxiety disorder
The correct answer is c. Generalised anxiety disorder
GAD is characterised by persistent anxiety, unrelated to a specific event. People suffering
from GAD cannot help worrying about anything and everything, even in calm situations.
They have difficulty relaxing, falling asleep, and/or concentrating, and tend to be
impatient and irritable. Physical symptoms accompanying GAD include sweating; an
upset stomach; diarrhoea; frequent urination; cold, clammy hands; a lump in the throat; a
dry mouth; shortness of breath; headaches; and dizziness
Panic attacks are sudden, unexplainable waves of panic that seem to come out of the
blue. A person who has experienced one or more panic attacks often develops a fear of
having one again. The individual may even try to stay away from anything that reminds
him or her of the last attack to avoid having another one. People can have panic attacks
with or without agoraphobia. These attacks include symptoms such as heart palpitations,
shortness of breath, chest pain, feelings of choking or smothering, nausea, dizziness,
sweating and trembling. An afflicted person might also be overwhelmed by a fear of
dying, going crazy or losing control.
Obsessive-Compulsive Disorder is a disorder in which the mind is flooded with
involuntary thoughts, or in which an individual feels compelled to repeat certain acts over
and over again (for example, hand washing). This disorder can interfere significantly with
everyday living, and usually leads to concern and/or resentment among friends, family,
and co-workers.
3. What are the various types of anxiety disorders? The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision
(DSM-IV-TR) classifies the anxiety disorders into the following categories:
Diagnostic criteria for generalised anxiety disorder
Excessive anxiety and worry (apprehensive expectation), occurring more days than not
for at least six months, about a number of events or activities (such as work or school
performance).
The person finds it difficult to control the worry.
The anxiety and worry are associated with three (or more) of the following six symptoms
(with at least some symptoms present for more days than not for the past six months).
NOTE: Only one item is required in children.
o Restlessness or feeling keyed up or on the edge
o Being easily fatigued
o Difficulty concentrating or mind going blank
o Irritability
o Muscle tension
o Sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying
sleep)
The focus of the anxiety and worry is not confined to features of an Axis I disorder, e.g.,
the anxiety or worry is not about having a panic attack (as in Panic Disorder), being
embarrassed in public (as in Social Phobia), being contaminated (as in Obsessive-
Compulsive Disorder), being away from home or close relatives (as in Separation
Anxiety Disorder), gaining weight (as in Anorexia Nervosa), having multiple physical
complaints (as in Somatization Disorder), or having a serious illness (as in
Hypochondriasis), and the anxiety and worry do not occur exclusively during Post-
traumatic Stress Disorder.
The anxiety, worry or physical symptoms cause clinically significant distress or
impairment in social, occupational or other important areas of functioning.
The disturbance is not due to the direct physiological effects of a substance (e.g., a drug
of abuse, a medication) or a general medical condition (e.g., hyperthyroidism) and does
not occur exclusively during a mood disorder, a psychotic disorder, or a pervasive
developmental disorder.
4. The symptoms associated with generalised anxiety disorder include; a. Restlessness
b. Insomnia
c. Worries
d. All of the above
The correct answer is d. All of the above
5. What are the differentiating features between generalized anxiety disorder, panic