Chapter 41: Generalized Anxiety Disorder (GAD) with
Verified Answers
GAD epidemiology - CORRECT ANSWER Affects 34% of population during their
lifetime
12% of people seen in anxiety clinic have GAD
Twice as common in women as men
Frequently seen in people with social issues, family history of depression/anxiety,
and people that struggle with substance abuse
Usually begin in early adulthood - chronic disease state in nature
Characterized by waxing and waning of clinical symptoms with periods of
remission and relapse
Many people diagnosed with GAD report feeling anxious their entire life
GAD symptoms - CORRECT ANSWER mind racing
dizzy, disorients, lightheaded
vision strange, blurry
possible sleep disturbance
difficulty swallowing
feeling breathless, breathing fast & shallow
heart racing, palpitation
nausea/lack of appetite
restless legs
trembling arms
sweating or shivering
jelly-like legs
wanting to run
When does normal worry/anxiety turn into GAD? - CORRECT ANSWER Persistent
=Worry about everyday things (money, family, health)
Excessive =Worry for majority of days (3-10 hours/day) for at least 6 months , but
worry for an extended for a extended period of time whereas we all worry about
something for 1-2 hours a day
, Uncontrollable =Often have physical symptoms and worry impairs ability to
function, Leads to fatigue, irritability, and sleep disturbances ;Causes significant
distress
Worry that is unrealistic in nature
GAD treatment agents - CORRECT ANSWER SSRI/SNRI
Buspirone or BZD
Adjunct
CAMS
Multimodal approach focusing on pharmacotherapy and psychotherapy with CBT
GAD treatment goals - CORRECT ANSWER Short term: reduce severity and
duration of symptoms
Long term: improve quality of life while decreasing remission
GAD First line SSRI, SNRI agents *** - CORRECT ANSWER Venlafaxine (Effexor)
Duloxetine (Cymbalta) - most likely to produce beneficial response
Paroxetine (Paxil)
Escitalopram (Lexapro) - most likely to establish remission
Off label use: sertraline (best tolerated), fluoxetine (most likely to achieve
remission of symptoms)
Approved for acute and longterm therapy
GAD first line SSRI, SNRI more notes - CORRECT ANSWER Agents
Response rates of up to 68% and remission rates of 30% with acute therapy
Lack of dependency and usually well tolerated
*drug of choice if patient has a comorbidity of depression
Better than benzos at treating autonomic symptoms (apprehension, worry)
Escitalopram most likely to establish achieve remission
Duloxetine most likely to produced a beneficial response
SSRI MOA - CORRECT ANSWER block the reuptake of serotonin back into
serotogenic neuron, increasing serotonin in post-synaptic cleft
The pathological anxiety state is associated with the dysregulation of multiple
neurotransmitters, including serotonin and NE
Verified Answers
GAD epidemiology - CORRECT ANSWER Affects 34% of population during their
lifetime
12% of people seen in anxiety clinic have GAD
Twice as common in women as men
Frequently seen in people with social issues, family history of depression/anxiety,
and people that struggle with substance abuse
Usually begin in early adulthood - chronic disease state in nature
Characterized by waxing and waning of clinical symptoms with periods of
remission and relapse
Many people diagnosed with GAD report feeling anxious their entire life
GAD symptoms - CORRECT ANSWER mind racing
dizzy, disorients, lightheaded
vision strange, blurry
possible sleep disturbance
difficulty swallowing
feeling breathless, breathing fast & shallow
heart racing, palpitation
nausea/lack of appetite
restless legs
trembling arms
sweating or shivering
jelly-like legs
wanting to run
When does normal worry/anxiety turn into GAD? - CORRECT ANSWER Persistent
=Worry about everyday things (money, family, health)
Excessive =Worry for majority of days (3-10 hours/day) for at least 6 months , but
worry for an extended for a extended period of time whereas we all worry about
something for 1-2 hours a day
, Uncontrollable =Often have physical symptoms and worry impairs ability to
function, Leads to fatigue, irritability, and sleep disturbances ;Causes significant
distress
Worry that is unrealistic in nature
GAD treatment agents - CORRECT ANSWER SSRI/SNRI
Buspirone or BZD
Adjunct
CAMS
Multimodal approach focusing on pharmacotherapy and psychotherapy with CBT
GAD treatment goals - CORRECT ANSWER Short term: reduce severity and
duration of symptoms
Long term: improve quality of life while decreasing remission
GAD First line SSRI, SNRI agents *** - CORRECT ANSWER Venlafaxine (Effexor)
Duloxetine (Cymbalta) - most likely to produce beneficial response
Paroxetine (Paxil)
Escitalopram (Lexapro) - most likely to establish remission
Off label use: sertraline (best tolerated), fluoxetine (most likely to achieve
remission of symptoms)
Approved for acute and longterm therapy
GAD first line SSRI, SNRI more notes - CORRECT ANSWER Agents
Response rates of up to 68% and remission rates of 30% with acute therapy
Lack of dependency and usually well tolerated
*drug of choice if patient has a comorbidity of depression
Better than benzos at treating autonomic symptoms (apprehension, worry)
Escitalopram most likely to establish achieve remission
Duloxetine most likely to produced a beneficial response
SSRI MOA - CORRECT ANSWER block the reuptake of serotonin back into
serotogenic neuron, increasing serotonin in post-synaptic cleft
The pathological anxiety state is associated with the dysregulation of multiple
neurotransmitters, including serotonin and NE
