1. generalized anxiety disorder
Shehana al-shammmari

3. DEFINITION
Generalized and persistent anxiety, excessive anxiety or worry (apprehensive expectation) about a number of events (e.g. work, school performance) that the individual finds difficult to control, not restricted to, or predominating in , any particular circumstances (free-floating). lasting for at least six months or longer

4. organic causes such as thyrotoxicosis, parathyroid disease,
AETIOLOGY
. Genetic predisposition
. Current stress
. Life events
organic causes such as thyrotoxicosis, parathyroid disease,
hypoglycaemia

6. ASSOCIATIONS/RISK FACTORS
Childhood experiences characterised . ° subjective apprehension (fears, worries) ° increased vigilance ° feeling restless and on edge ° sleeping difficulties (initial/middle insomnia, fatigue on waking) ° motor tension (tremor, hyperactive deep reflexes) ° autonomic hyperactivity (e.g. tachycardia). • GAD may be comorbid with other anxiety disorders, depression,alcohol and drug abuse.

7. EPIDEMIOLOGY
Lifetime prevalence is 5%. F > M. Onset is in adolescence to early adulthood. ° generalized anxiety disorder (GAD) (2–4%)

8. HISTORY
The symptoms should be present most days for at least several weeks at a time. These symptoms should involve elements of: . apprehension (worries about future misfortunes, feeling on edge, difficulty concentrating) . motor tension (restlessness, fidgeting, tension headaches, trembling) . autonomic overactivity (sweating, tachycardia or tachypnoea, dizziness, dry mouth).

9. Tachycardia and tachypnoea.
EXAMINATION
Tachycardia and tachypnoea.

10. Differential diagnoses
° excessive caffeine consumption
° depression
° psychotic disorders
° withdrawal from drugs or alcohol

11. MANAGEMENT Medication - Cognitive behavioral therapy
• CBT (self-help material or face to face) for GAD seeks to:
Psychoeducation , distraction techniques ,cognitive control , breathing/relaxation techniques
Medication -
. Benzodiazepines may be useful in the short term.
- Other pharmacological treatments include:
-beta blocker to control some physical symptoms
-° serotonin noradrenaline reuptake inhibitors (SNRIs)
-° pregabalin
° buspirone

12. COMPLICATIONS
Half will develop a depressive illness. May misuse alcohol or illicit substances to cope with anxiety.

13. PROGNOSIS
Course may be chronic, worse at times of stress. Poor prognosis is associated with longer duration of illness, co-morbid psychiatric disorder and poor premorbid personality.

14. summary GAD is persistent anxiety, excessive anxiety or worry
Causes of anxiety :-
1-biological
2-environmental
3- integrative perspective
4- brain chemistry
Symptoms of anxiety
motor tension
sleeping difficulties
Shortness of breath
feeling restless

15. cont INVESTIGATIONS: FBC, U þ Es, LFTs, Ca, TFTs. MANAGEMENT: CBT
medication

17. references