Unit 3- Generalized Anxiety Disorder

Diagnosis criteria for GAD

excessive anxiety and worry for at least 6 months with a least 3 of the following symptoms: on edge, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance

Prevalence of GAD

25% will experience anxiety in their lifetime

Etiology/Risk factors of GAD

biological, genetic, and environmental influences, Socioeconomic factors, ethnic factors, stressful life events

Drug-disease issues for GAD

co-morbid depression, substance abuse risk, elderly more susceptible to falls, pregnancy issues, withdrawal syndromes

Physical symptoms associated with GAD

Fast heart rate, Rapid breathing, Sweating, Fatigue, Muscle tension, Sleep disturbance (usually insomnia)

Emotional symptoms associated with GAD

Persistent worry and fear about everyday situations, Feeling keyed up or on edge / restlessness, Easily fatigued, Mind going blank / difficulty concentrating, Irritability

Pathophysiology of GAD

Dysregulation of stimulus processing, amygdala hyperactivity, imbalances of 5HT, NE, and DA

receptor desensitization

Rapid signal attenuation in response to continuous agonist stimulation, leading to a decreased drug response with frequent administration.

First Line therapy for GAD and response time/remission

SSRIs, SNRIs; 4-16 weeks, most patients don’t achieve full remission

Second-line therapy for GAD

Buspirone, Benzodiazepines, Hyrdoxyzine

Which second-line therapy is used for rapid symptom relief, and should it be used long term?

Benzodiazepines, and no

Benzos ADME

All readily absorbed across the BBB, most undergo CYP450 metabolism followed by glucuronidation, and are excreted in urine

Ultra-short acting benzos and half life

Midazolam, traizolam, less than 2 hrs

Short acting benzos and half-life

Temazepam, oxazepam; less than or equal to 10 hrs

Intermediate Benzos and half-life

alprazolam, lorazepam, estazolam; 10-24 hrs

long acting benzos and half-life

diazepam, klonopin; more than 24 hrs

ADRs of Benzos

sedation, rebound insomnia, memory impairment, depression, dependence, withdrawal, pregnancy risks

MOA of benzos

GABA receptor agonist

HAM-A scale 0-17 in GAD means?

mild anxiety

HAM-A scale 18-24 in GAD means?

mild to moderate anxiety

HAM-A scale 25-30 in GAD means?

moderate to Severe anxiety

HAM-A scale 31-56 in GAD means?

severe anxiety

GAD treatment timeline

Response in 4-16 weeks, see improvement in sx with benzos in about 2 weeks

Monitoring timeline for GAD

Biweekly for first 8 weeks, use rating scales