Generalized anxiety disorder is excessive, hard-to-control worry about many everyday things on most days for at least 6 months, with physical symptoms such as tension and poor sleep. It is very common, and therapy and antidepressant medicines work well.
Key symptoms
- Constant worry about work, health, family or money
- Restlessness or feeling on edge
- Fatigue and trouble concentrating
- Irritability and muscle tension
- Trouble falling or staying asleep
What you find on exam
- Mental status exam: anxious affect, worry content
- Heart rate, blood pressure, tremor
- Look for thyroid enlargement or other medical clues
- Ask about caffeine, alcohol and drug use
Tests
- GAD-7 to screen and track severity
- Thyroid tests to rule out hyperthyroidism
- PHQ-9 to look for depression
- Other tests only when history suggests a medical cause, such as ECG for palpitations
Treatment basics
- Cognitive behavioral therapy
- First-line medicine: an SSRI such as escitalopram or sertraline, or an SNRI such as venlafaxine
- Buspirone as an alternative or add-on
- Avoid long-term benzodiazepines
- Sleep, exercise and less caffeine and alcohol
Red flags
- Suicidal thoughts
- Chest pain, weight loss or other signs of a medical cause
- Heavy alcohol or sedative use to cope
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Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.