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- Excessive worry, feelings of apprehension, panic or
dread regarding general life events
accompanied by physiologic arousal
- Symptoms persist for at least 6 months, occurring
most days
- Person reports little control of symptoms
- Impairs social, occupational, & interpersonal areas
Presentation:
- Excessive worry, irritability,
- Insomnia, Panic
Generalized Anxiety
Disorder (GAD):
Physical symptoms:
Presentation:
- Palpitations
- Muscle tension
- Restlessness
- Fatigue
- Sweating
- Difficulty concentrating
- Nausea
- Diarrhea
- Urinary Frequency
- Chest pain
, Diagnosis:
- R/O physical cause (hyperthyroidism, stimulant abuse,
caffeine, drug/alcohol withdrawal/abuse, cardiac
arrhythmias)
- At least 3 of the following:
- Restlessness
- Hypervigilance
- Easy fatigability
- Irritability
- Sleep disturbance
- Muscle tension
- Difficulty concentrating
Treatment:
- Mild Cases tx in primary care
- More significant cases refer to psychiatry
- Medications:
- Benzodiazepines → Short term (2-4
weeks)
- SSRI → 1st line
- SNRI
Generalized Anxiety
- Buspirone (Buspar): 7.5 mg po BID
Disorder (GAD):
(up to total 30 daily)
Diagnosis and Treatment -
- TCAs
- Clonidine
- Therapy:
- Cognitive-behavioral
- Psychotherapy
Alternative Tx:
- Herbs
- St. John's Wort, Kava, Phenibut,
- Educate about the risks
- Meditation; include aromatherapy
- Rose, orange oil, sage, lavender, rosemary
-Yoga, massage
http://www.yogajournal.com/article/practicesection/fre
e-from-worry/
- Exercise DAILY
- Diet
- Whole food, high in greens
- Eliminate ETOH, caffeine
- Reduce/eliminate sugar
- Try trial of no gluten
, - Characterized by recurrent, unexpected panic attacks
- Panic Attack= period of extreme anxiety usually
peaking within 10 minutes and rarely lasts more than 1
hour
- May have a trigger
- Physical symptoms of impending doom
Presentation:
- Can present at any age, although most commonly
starts in 20's
- Affects female: males 3:1
- Intense fear with physical symptoms
- Often think they are having a heart attack
- Panic = SEVERE ANXIETY!!!
Symptoms:
- Intense fear plus 4 or more of the following:
- Palpitations, tachycardia
- Sweating
- Trembling/shaking
- SOB
- Sensation of choking
- Nausea/abdominal distress
- Dizziness/faintness
- Depersonalization
- Fear of losing control
- Fear of dying
- Paresthesia
- Chills/hot flushes
Panic Disorder:
Treatment:
- Medications:
- Benzodiazepines
- Short term and helpful acutely → Use
ONLY for 4 weeks
- SSRIs
- Paroxetine (Paxil) 20mg daily works well
Or sertraline (Zoloft) 50 po daily
- Treat 9-12 months
- Psychotherapy
- Stress reduction techniques
Alternative Tx: