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23.6 Generalized Anxiety Disorder

Table of Contents

Generalised anxiety disorder is characterized by excessive, exaggerated anxiety and worry about everyday life events with no obvious reasons for worry.

Diagnostic Criteria

Symptoms include

  • Persistent worry
  • Disturbances in sleep
  • Poor concentration
  • Mood disturbances
  • Muscle tension
  • Tremors

Non-Pharmacological Treatment

  • Psychotherapy
  • Most patients can be treated as outpatients

Pharmacological Treatment

Indicated where symptoms are interfering with normal functions of daily living. Where there is concomitant drug/alcohol dependence or co-morbid major depressive episode, an antidepressant may be more appropriate.

Acute management

For an acute episode or intense prolonged anxiety:

C: Diazepam 2–5 mg (PO) as a single dose.

  • Repeat if required up to 12 hourly
  • Duration of therapy: up to 2 weeks, taper off to zero within 6 weeks

Maintenance Therapy

S: Fluoxetine (PO) 10–40mg (PO) daily

OR

D: Citalopram (PO) 10–40mg (PO) daily

OR

A: Amitriptyline (PO) 25–75mg daily at night

  • Duration of therapy: variable, although the condition tends to be chronic.
  • Extended medicine treatment should be monitored by a specialist.
Note:
Prolonged treatment with benzodiazepines often leads to tolerance and withdrawal symptoms if the medicine is discontinued abruptly
Avoid combining more than one benzodiazepine.

Referral

Refer to the next level if there is lack of improvement with treatment.

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