Anxiety that is generalised and persistent but not restricted to, or even strongly predominating in, any particular environmental circumstances (i.e. it is "free-floating")

Aetiology

• Typical age of onset between 20-40
• 2:1 female:male ratio
• 90% are co-morbid with other psychiatric disorders, e.g. depression, substance abuse, other anxiety disorders

Clinical features

• Persistent nervousness, trembling, muscular tensions, sweating, lightheadedness, palpitations, dizziness, and epigastric discomfort
• Fears that the patient or a relative will shortly become ill or have an accident are often expressed
• Needs to be severe enough to be:
  • Long-lasting (most days for at least 6 months)
  • Not controllable
  • Causing significant distress/impairment in function
• Typically associated with:
  • 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, restless unsatisfying sleep)

Investigations

ICD-11 criteria

• Apprehension: worries about future misfortunes, feeling on edge, difficulty concentrating
• Motor tension: restlessness, fidgeting, tension headaches, trembling, inability to relax
• Autonomic overactivity: lightheadedness, sweating, tachycardia, epigastric discomfort, dizziness

Management

1. Psychoeducation
2. Self-help/psychoeducation groups
3. High intensity psychological intervention (CBT) OR drug treatment (SSRI e.g. sertraline)
   1. Consider short term use of benzodiazepines <2 weeks
4. SNRI e.g. duloxetine