Review Question - QID 105778

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Generalized Anxiety Disorder Introduction Overview QID: 105778 (M2.PY.15.108)

QID 105778 (Type "105778" in App Search)

A 43-year-old woman presents to a new primary care physician complaining of anxiety. She has been worrying non-stop recently about the possibility that her husband will lose his job as a teacher. Her husband, who is present, assures the physician that his job is entirely secure and states that she has "fretted" for their entire marriage, though the exact topic causing her anxiety varies over time. She also worries excessively about everyday tasks, such as whether she will catch the train on time and whether their house in Southern California is sufficiently earthquake-proof. She has no way to overcome these worries. She endorses other symptoms including poor sleep (associated with racing thoughts about her various worries), fatigue, and impaired concentration at work, all of which have been present for at least the past year. Her vital signs are within normal limits and there are no abnormalities on physical exam. What is the most likely diagnosis?

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Acute stress disorder

0/27

Social phobia

0/27

Agoraphobia

0/27

Posttraumatic stress disorder

0/27

Generalized anxiety disorder

96%

26/27

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This clinical presentation is consistent with generalized anxiety disorder (GAD). Patients with GAD experience excessive anxiety about multiple topics and other associated symptoms (e.g. impaired concentration and insomnia) for at least 6 months.

GAD is characterized by the presence of generalized, persistent, and excessive anxiety as well as a combination of various psychological and somatic complaints. DSM-5 diagnostic criteria for GAD require excessive and uncontrollable anxiety about a number of events or activities as well as at least 3 (or more) of the following: restlessness, easy fatigability, difficulty concentrating, irritability, muscle tension, or sleep disturbance. These symptoms occur more days than not for at least 6 months, and the disturbance is not attributable to the physiological effects of a substance (e.g. alcohol, drug abuse, medications).

Kavan et al. state that GAD is a common presenting diagnosis in the primary care setting. Treatment options include cognitive behavioral therapy (CBT) and treatment with selective serotonin reuptake inhibitors (SSRIs), the first-line pharmacologic agent in this condition. Complementary and alternative medicine therapies have not been shown to be effective in GAD.

Zhang et al. find that the lifetime prevalence of GAD was 11% in a sample of 1,974 community-dwelling individuals over the age of 65. Interestingly, 24.6% reported a late onset of GAD, with a first diagnosis after the age of 50. This cross-sectional study suggests that GAD in the elderly may not just be a continuation of early-onset illness.

Illustration A provides an overview of the clinical features of DSM-5 anxiety disorders.

Incorrect Answers:
Answer 1: Acute stress disorder occurs within 1 month of exposure to a worrisome event and lasts between 2 days to 4 weeks.
Answer 2: Social phobia is an anxiety disorder involving exposure to social and/or performance situations.
Answer 3: Agoraphobia involves fearfulness and avoidance of situations that may be difficult to escape from (e.g. being in a crowd).
Answer 4: Post-traumatic stress disorder involves re-experiencing an extremely traumatic event and is associated with hyper-sympathetic symptoms.

ILLUSTRATIONS: