• A 38-year-old female comes to your office complaining of poor work performance.  She is concerned about her performance despite reassurance from her boss. Upon further questioning, she reveals that she is also very concerned about paying bills, if the bus will be on time, if her children are happy in addition to a myriad of other things.  She has been anxious "as long as she can remember."
  • Clinical definition
    • excessive, poorly controlled anxiety that tends to occur daily for > 6 months
    • anxiety is not related to a specific focus, but rather is generalized to most issues 
  • Symptoms 
    • sleep disturbance/fatigue
    • difficulty concentrating
    • autonomic hyperactivity
      • similar to other anxiety/panic disorders
    • motor excitation
      • jumpy, fidgety
    • constant surveillance/vigilance
  • Psychotherapy
  • Pharmacologic
    • SSRIs 
      • take several weeks to work
    • buspirone
      • can be used as an adjunct to SSRIs
    • venlafaxine
    • benzodiazepines
      • used in the interim until SSRI response is seen
      • not used for long term management as a result of abuse potential
  • Herbal 
    • kava plant has been shown in verified studies to have mild beneficial effect for patients with generalized anxiety disorder
      • kava toxicity manifests as liver failure, hepatitis, or cirrhosis 

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