Diagnostic Criteria & Screening Tools for GAD PDF

DIAGNOSTIC CRITERIA & SCREENING TOOLS FOR GAD Dr Dylan Birk Introduction Generalised anxiety disorder (GAD) is a common condition defined as chronic, excessive worry for at least 6 months that causes distress or impairment and is hard to control. The worry is not confined to features of another men...

DIAGNOSTIC CRITERIA & SCREENING TOOLS FOR GAD Dr Dylan Birk Introduction Generalised anxiety disorder (GAD) is a common condition defined as chronic, excessive worry for at least 6 months that causes distress or impairment and is hard to control. The worry is not confined to features of another mental health disorder, a result of substance misuse, or relating only to a physical health condition. Treatment is primarily with psychotherapy (usually cognitive behavioural therapy), serotonergic antidepressants, or a combination of these approaches. Diagnostic Criteria DSM-5 CRITERIA Must meet all the criteria below: 1. Excessive anxiety and worry occurring more days than not for at least 6 months, about a number of events or activities. 2. The individual finds it difficult to control the worry. 3. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months). Note: only one item is required in children Restlessness or feeling keyed up or on edge Being easily fatigued Difficulty concentrating or mind going blank Irritability Muscle tension Sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep). 4. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. 5. The disturbance is not attributable to the physiological effects of a substance (e.g., drug of misuse, a medication) or another medical condition (e.g., hyperthyroidism). 6. The disturbance is not better explained by another mental disorder ICD-11 CRITERIA Marked symptoms of anxiety that persist for at least several months, for more days than not, manifested by either general apprehension (i.e., 'free-floating anxiety') or excessive worry focused on multiple everyday events, most often concerning family, health, finances, and school or work. Has additional symptoms such as muscular tension or motor restlessness, sympathetic autonomic overactivity, subjective experience of nervousness, difficulty maintaining concentration, irritability, or sleep disturbance. The symptoms result in significant distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning. The symptoms are not a manifestation of another health condition and are not because of a substance or medication on the central nervous system. Screening Tools GAD-2 The Generalized Anxiety Disorder 2-item (GAD-2) is a very brief and easy to perform initial screening tool for generalized anxiety disorder. It only involves two questions as below: Over the last two weeks, how often have you felt bothered by the following? Feeling nervous, anxious or on-edge Not at all Several Days More than half of days Nearly every day +0 points + 1 point + 2 points + 3 points Not being able to stop or control worrying Not at all Several Days More than half of days Nearly every day +0 points + 1 point + 2 points + 3 points If a patient scores themselves three or more, it is recommended that a further review using DSM-5/ICD- 11 criteria is performed GAD-7 This is another questionnaire that may aid in diagnosis, but also help track the effects of treatment on the patient’s score over time. It is not a diagnostic test – use the results in context of the clinical history and examination. The score is out of 21. The recommendations for each result are summarised below Points Outcome 0-4 No anxiety 5-9 Mild. Consider monitoring 10-14 Moderate, possibly clinically significant 15 and above Severe, consider active treatment As with the GAD-2, you ask the question “over the last two weeks, how often have you been bothered by any of the following problems?” Patients choose between Not at all + 0 points Several days + 1 point More than half the days + 2 points Nearly every day +3 points The questions we ask are: 1. Feeling nervous, anxious or on edge 2. Not being able to stop or control worrying 3. Worrying too much about different things 4. Trouble relaxing 5. Being so restless that it’s hard to sit still 6. Becoming easily annoyed or irritable 7. Feeling afraid as if something awful might happen