Generalised Anxiety Disorders (GAD)
Generalised Anxiety Disorders (GAD)
General and supportive measures
ICD-10 code: F41.1
DESCRIPTION
Excessive anxiety or worry about a number of factors or events, occurring on most days for at least 6 months. The intensity, frequency or duration of the anxiety is out of proportion to the actual likelihood or impact of the anticipated event. The individual finds it hard to control the worry and to keep worrisome thoughts from interfering with attention to tasks. During the course of the disorder, the focus of the worry may shift from one concern to another. The worries interfere with psychosocial functioning, are pervasive and distressing and often have no precipitants.
DIAGNOSTIC CRITERIA (DSM 5)
Excessive anxiety or worry that is both difficult to control and associated with 1 of the following 6 symptoms for 6 months:
- restlessness or a feeling 'keyed-up' or 'on edge',
- difficulty concentrating or 'mind going blank',
- irritability,
- muscle tension,
- sleep disturbance, and
- being easily fatigued.
GAD causes significant distress or impairment in functioning.
Exclude other psychiatric disorders, general medical conditions or effects of substances.
GENERAL AND SUPPORTIVE MEASURES
A suitably qualified clinician should perform these interventions.
- Cognitive behavioural therapy (CBT): aimed at changing pessimistic, anxiety-based cognitions and developing strategies to reduce anxieties and avoidant behaviour patterns.
- Behaviour therapy: relaxation, desensitisation by imagining or exposure to anxiety-provoking situations.
- Psychodynamic/supportive psychotherapy: aimed at promoting self-esteem, assertiveness and autonomy.
MEDICATION TREATMENT
- Fluoxetine, oral, 0.5 mg/kg/day.
- Dose range: 20 - 40 mg daily.
- Recommended average dose: 20 mg/day.
Fluoxetine may only be available in 20 mg capsules, in which case citalopram tablets can be used initially, titrated to 20 mg and then changed to fluoxetine 20 mg.
If there is a poor response to fluoxetine after an adequate trial of treatment, i.e. 4 - 6 weeks, consider an alternative SSRI.
- Citalopram, oral, 0.4 mg/kg/day.
- Dose range: 5 - 40 mg daily.
- Recommended average dose: 10 - 20 mg/day.
REFERRAL
- 12 years and under.
- Failure to respond after 6 - 8 weeks to an adequate trial of therapy and medication.
- Adverse events to fluoxetine/citalopram.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter 14: Child & Adolescent Psychiatry, 14.5 Anxiety Disorders, 14.5.1 Generalised Anxiety Disorder (GAD)