Navigating a Case of Generalised Anxiety Disorder in Clinical Practice

Posted on: August 3, 2022
Last Updated: August 3, 2022

In this video, Dr Sanil Rege, Consultant Psychiatrist explores how to navigate the clinical presentation of anxiety, with a focus on Chelsea, a 20-year-old telesales operator with no significant history of mental health concerns, who feels like “she is going mad with anxiety.”

 The case presentation reviews the DSM-5 criteria for Generalised Anxiety Disorder (GAD) and how to assess the patient’s anxiety levels using the GAD-7 assessment.

We also consider other contributors to rule out anxiety disorder, including substance-induced and medical conditions, and how to differentiate GAD from obsessive compulsive disorder or major depressive disorder.

The video concludes with an algorithm for the stepwise assessment of anxiety disorder.

OTHER CONTRIBUTORS TO RULE OUT IN ANXIETY DISORDER:

Substance-induced

  • Intoxication (e.g., stimulants)
  • Withdrawal (e.g., alcohol, benzodiazepines)
  • Adverse effects of OTC medicines

Medical

More common medical disorders to exclude:

  • Hyper/hypothyroidism
  • Cardiac arrhythmias
  • Vestibular dysfunction
  • Seizure disorders
  • Hypoglycaemia

Plus, a range of less common disorders including hyper/hypo parathyroidism and electrolyte disturbances.

SUMMARY OF ASSESSMENT APPROACH

  • Is it anxiety? Yes/No (Differential diagnoses)
  • Is anxiety severe? Yes/No If Yes, manage severe symptoms and reassure the patient. Educate that anxiety is normal and will not cause harm. If required start de-arousal (breathing)
  • Is it an anxiety disorder? Yes/No i.e., does it meet diagnostic criteria for panic disorder, social anxiety disorder or GAD? If not consider other diagnoses
  • Use Clinical Practice Guidelines to plan treatment
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