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Management of Generalised Anxiety Disorder in Primary Care

Management of Generalised Anxiety Disorder in Primary Care. Shumona Rahman GP VTS ST2. GAD: worry, anxiety & tension. frequent distressing worry that’s difficult to control about many things that might go wrong in the future. restlessness, irritability, muscle tension, fatigue,

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Management of Generalised Anxiety Disorder in Primary Care

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  1. Management of Generalised Anxiety Disorder in Primary Care Shumona Rahman GP VTS ST2

  2. GAD: worry, anxiety & tension frequent distressing worry that’s difficult to control about many things that might go wrong in the future restlessness, irritability, muscle tension, fatigue, difficulty concentrating, and sleep disturbance more ‘freeze’ than ‘fight or flight’: thoughts more than images, unhappy but not strongly in touch with emotions, or with the present moment

  3. GAD is a syndrome of ongoing anxiety and worry about many events or thoughts that the patient generally recognises as excessive and inappropriate • More common in women • Risk factors are: • Being aged between 35 and 54 • Being divorced or separated • Living alone or as a lone parent

  4. Immediate management: • Educate and actively monitor • Low-intensity psychological interventions - www.anxietyuk.org.uk - www.nopanic.org.uk -www.ntw.nhs.uk/pic/selfhelp - www.moodjuice.scot.nhs.uk/anxiety.asp 3. Benzodiazepines should not usually be used as a short term measure during crises

  5. No initial response: CBT “Utilises cognitive techniques (e.g. to challenge “automatic negative thoughts” and maladaptive beliefs) and structure approaches to modify dysfunctional patterns of behaviour.” • Online • NHS (New Thoughts) • Private

  6. Successful CBT approach for GAD • self-monitoring for early signs of anxiety and tension • training in calming skills, application during daily life, and coming into the present • using imaging to encourage use of calming skills and cognitive coping strategies • cognitive coping strategies include worry tree, worry outcome diary, worry problem solving times, worry-free zones, beliefs about worry, etc

  7. Pharmacotherapy (SSRIs) • Sertraline : most cost effective, but does not have UK marketing authorisation • Paroxetine and venlafaxine in extended release formulation have marketing authorisation The efficacy and side-effects should be reviewed within 2 weeks of starting treatment and again at 4, 6 and 12 weeks. If the patient is showing improvement on treatment the drug should be continued for at least 6 months after the optimal dose is reached (monitor every 8-12 wks), after which the dose can be tapered

  8. Who to Refer? • Those at risk of self-harm • Hx of substance misuse • Combination therapy may be warranted • If there is no improvement after a 12-week course, another SSRI or another form of therapy should be offered

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