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Generalized anxiety disorder is a complex condition, linked to family background, psychological and patient environment.
Stress and anxiety have both physical and mental consequences.
Generalized anxiety disorder is often a chronic disease that the patient must learn to manage every day.
The most effective therapy through the acquisition of psychological strategies to reduce the effects of anxiety and anxiety control (without the use of sedative).
Specific advice for the patient and his family
Regular physical activity, respect a sleep hygiene and food are usually very beneficial.
Encourage the patient to do daily relaxation exercises to relieve nervous tension and symptoms.
Advise him to organize soothing activities, entertaining and enjoyable. Take the activities that have been positive in the past.
Use the principles of behavioral and cognitive therapies for anxiety management:
general situations: Identify excessive worry or pessimistic thoughts and consider strategies to think those negative thoughts. For example: if the daughter of a patient five minutes late returning from school, the patient will think happened to him something. When the patient begins to worry, you have appendre him think: "I begin again to let myself be overwhelmed by concern She only has a few minutes late and should arrive soon.".
problematic situations: Talk with the patient's thoughts and reactions to life's problems. Refute erroneous thoughts (catastrophic thoughts, helplessness and loneliness ...) and reinforce positive strategies for managing anxiety (problem solving technique). Ideally the patient should be able to gain a sense of mastery of his problems which greatly alleviate his anxiety symptoms.
For example: a patient visits because he suffers from chronic anxiety, nausea and insomnia. These symptoms began after the establishment of a diagnosis of asthma in his son and they increase when her son has seizures.
Reassure the patient about his symptoms and pathology of his son and consider certain steps that the patient may begin in the following weeks, such as:
- Learn the methods of asthma management.
- Meet with professionals to learn more about the manifestations and treatment of asthma.
- Meet patient associations, exchange experiences with other parents of children with asthma ...
Treatment
Drugs are secondary treatment in the management of generalized anxiety. They can however be used if significant anxiety symptoms persist despite the implementation of the recommendations listed above.
Anxiolytic treatment can be used in a timely manner during the acute manifestations. Background Treatment is with antidepressants for a period of at least 6 months. specialized consultation
A specialized consultation (especially psychotherapy) may be considered if necessary.
How to proceed ?
Consider using a vocabulary that the patient can understand. Make a list of symptoms and parallel list of diagnostic features of the disease. Tell the patient that you think his symptoms match the diagnostic features of the disease.
Explain to the patient that he has a known medical condition, turn to him the natural history of the disease and the improvements that can be expected by the proposed treatments.
List the treatments available and present the detailed patient therapeutically you advise him. Adopt a confident and optimistic attitude: "This treatment has been effective in many other patients."
Invite them to ask questions and discuss.
Feel free to repeat important information for subsequent visits.
psychoeducation
or a doctor might say to his patient
You will find below proposals on what a general practitioner could tell a patient with a given condition, at the first consultation.
F10: abuse or alcohol dependence
"A reasonable alcohol consumption is limited to a maximum of 14 drinks per week for women / 28 drinks for men. It seems that you drink more than that. At this level, alcohol consumption may damaging your liver, your heart and lead to depression or dementia. Our first objective is to mitigate the danger involved alcohol for your health. The best solution is to reduce the number of glasses you drink and to keep a journal where you will indicate the total number of drinks. Drink light beer. Space frequency of alcohol intake by non-alcoholic beverages. Try to establish two alcohol-free days each week and limit your alcohol intake to two drinks every other day. You come back and see me in two weeks and you show me your newspaper. I am aware that you will go through good and bad times and it can be difficult and scary at first, but it takes you hang back and see me in two weeks. Once this first step accomplished, I could help you through other methods (motivational interviewing). "
F11: Abuse or dependence psychoactive substances (excluding alcohol)
(Psychoactive substances such as codeine, sedatives or marijuana if the patient is taking other types of drugs, direct them to specialized services).
"Your drug use is a serious danger and we have already discussed the problems that led to your workplace and your family. If you decide to stop, I suggest you start by keeping a journal of your drug and try to gradually reduce. Why do not'd come back in a week with this newspaper? We can then identify times when you consume the drug and seek to understand why. Subsequently, I can help you through other methods (motivational interviewing). "
F20-F29: Chronic Psychotic Disorders / Schizophrenia: relapse (outpatient)
"We talked about the difficulties you endure to focus or motivation. We also talked about the fact that you start to hear voices and have different ideas of those around you. The resumption of regular treatment can help control these symptoms. I want you to accept to start treatment and I warn your family and your psychiatrist to your situation. We could meet again next week. On this occasion, I would like you to come with your family or people who live with you so we can consider new strategies to control your symptoms (problem solving strategies and social skills training). "
F23: acute psychotic disorder (outpatient)
"You told me that your thoughts were confused and strange and it frightened you very much. This change may have several origins and we must study it. I will refer you to a specialist who will make a diagnosis and recommend a treatment. We could hospitalize you but it is better that you stay at home during treatment. Until you meet the specialist, I would like you to take drugs that will appease the strange ideas and fear they cause. Until your appointment, I would like to see you regularly to make sure you are well. "
P.S: It is better that you make an appointment yourself with a psychiatrist with the patient and his relatives.
F31: Bipolar disorder (outpatient)
"You have me so said you were all very energetic turn, very active and euphoric and irritable. You feel more yourself. I think you have a disease called bipolar disorder. If we do not take care, you could spend all your money, disrupt the balance of your family and in general, to harm you. (In chronic episode) I think you should take your treatment and, if all goes well, a new hospital should not be necessary. I would like to arrange a new appointment with the specialist, who took care of you the last time.
(If the first episode) I would like to have the opinion of a specialist. Meanwhile, should you take medication that will calm your mood and energy. I want to talk about the disease with family members. Later, I'll teach you some techniques called problem-solving strategies that solve the challenges you face. "
P.S: It is better that you make an appointment yourself with a psychiatrist with the patient and his relatives.
Depression F32 (outpatient)
"You told me that you feel sad that nothing interested you and that your life was disrupted in. These symptoms last for some time now and can not be explained entirely by the events in your life as you might think. I think you have depression. If we do not take care, it can last for months and spoil your career plans and your friendships.
(If the depression is moderate or severe) I think you need antidepressant treatment. Once you start this treatment, I will teach you some psychological strategies (organization of activities, problem-solving strategies, cognitive therapy) to accelerate the improvement of your condition and help you feel great. I would like to see you in a few days. It would be better that you come back with a loved one and let us find a solution to help you feel better.
I can also refer you to a specialist. What do you prefer ? "
P.S: Depending on the severity of the patient's depression, it may be best to make an appointment yourself with a psychiatrist with the patient and his relatives.
F40 Social Phobia
"In recent years you have become anxious in social situations. You are afraid that others notice that you are particularly anxious or you dread being judged or rejected. You are afraid that they think (and maybe you think you) that you are weak or incompetent and therefore you avoid such situations. We call this social phobia disease and if we do not take care, it will tend to persist. Indeed, every time you avoid a situation, the relief that you experience strengthens vis-à-vis afraid of this and similar situations.
Treatment with antidepressants soothe your anxiety and it will be easier for you to resume social activities.
I can also teach you how to control your anxiety by breathing control techniques, to better understand your response to these frightening situations (cognitive therapy) and master gradually facing their (technical gradual exposure).
I can also refer you to a specialist for advice treatment. What do you prefer ? "
F41 Panic Disorder / Agoraphobia
"You suffer from sudden panic attacks. Your heart is racing, you have trouble breathing or you have other disturbing symptoms. So you can be afraid of a heart attack, fall or die during one of these attacks. You now avoid situations that do not offer you can help or escape. We call this illness panic disorder with agoraphobia. If not treated, it may persist because every time you avoid a situation, the relief that you experience strengthens vis-à-vis afraid of this and similar situations.
I can teach you to master the manifestations of anxiety through breathing control techniques, better think your fear through cognitive therapy and control scary situations facing them gradually (technical gradual exposure).
Antidepressants will soothe your fears and it will be easier to resume social activities.
I can also refer you to a specialist for advice treatment. What do you prefer ? "
F40.2 Specific Phobia
"Many people have an excessive fear of snakes, poisonous insects, altitude, closed places, dogs, calm waters ... Most of the time, they support these fears from childhood and learned to avoid situations that frighten them. Avoid fear strengthens the phobia. If your phobia often disrupts your life and your daily activities, I can teach you to confront it and to control it with the gradual exposure technique. "
F41.1 Generalized anxiety
"You worry about a symptom which in my opinion does not reveal serious illness. You explained to me that for months you were concerned about persistent and uncontrollable for the events of everyday life. You feel tense mentally and physically and it exhausts you. You told me that you live like this, with ups and downs, very long time. We call this disorder or generalized anxiety disorder.
First, I can offer you learn psychological strategies such as breathing control techniques, problem solving or relaxation to help you control your anxiety and your tension.
Secondly, if necessary, we can combine these techniques antidepressant treatment. (The antidepressants are also used to treat anxiety disorders). I can also refer you to a specialist. What do you prefer ? "
F41.2 Anxiety disorder and mixed depression
"You told me that you feel sad that nothing interested and that you feel you worried and anxious all the time. These symptoms last for some time now and can not be explained entirely by the events in your life as you might think. I think you have an anxiety disorder and mixed depression. If we do not take care, it can last for months and spoil your career plans and your friendships.
I think you need to take an antidepressant and gain psychological strategies. Once you start the medication, I'll teach you techniques (organization of activities, problem-solving strategies, cognitive therapy) to speed your recovery and help you feel great.
I would like to see you in a few days. It would be better that you come back with a close and let us find a way to make you feel better.
I can also refer you to a specialist. What do you prefer ? "
F42 Obsessive-Compulsive Disorder
"You told me you were constantly assailed by fears for your family and for yourself and you had difficulty in resisting them. To control your fears, you must compel you to certain rituals, but you realize today that the obsessions and compulsions dominate your life.
Antidepressant treatment reduces the intensity of these obsessions and it will be easier to resist them.
I can also show you how to organize the management of these compulsions (technical and progressive technical exhibition relapse prevention) and mitigate the force of obsessions to feel good.
I can also refer you to a specialist for advice treatment. What do you prefer? "
F43.2 Adjustment disorders
"You go through a difficult period and you feel overwhelmed. You are struggling to cope and you feel sad and anxious. I can prescribe medications that certainly appease your nervousness but unfortunately prevent you learn to control yourself. That's why I prefer to enjoy our meetings to teach you strategies that will speed your recovery and help you cope with future situations. These are strategies called stress management and problem solving. "
F44 Dissociative Disorders (conversion)
"I do not think your symptoms indicate a serious illness. You know, your symptoms are sometimes caused by stress or emotional upset. We must go home to rest and you come back and see me in a few days. So, we refer the point and I will teach you some strategies to deal with the stress that seems to cause these symptoms (problem-solving strategies, progressive muscle relaxation, communication training). "
Stress and anxiety have both physical and mental consequences.
Generalized anxiety disorder is often a chronic disease that the patient must learn to manage every day.
The most effective therapy through the acquisition of psychological strategies to reduce the effects of anxiety and anxiety control (without the use of sedative).
Specific advice for the patient and his family
Regular physical activity, respect a sleep hygiene and food are usually very beneficial.
Encourage the patient to do daily relaxation exercises to relieve nervous tension and symptoms.
Advise him to organize soothing activities, entertaining and enjoyable. Take the activities that have been positive in the past.
Use the principles of behavioral and cognitive therapies for anxiety management:
general situations: Identify excessive worry or pessimistic thoughts and consider strategies to think those negative thoughts. For example: if the daughter of a patient five minutes late returning from school, the patient will think happened to him something. When the patient begins to worry, you have appendre him think: "I begin again to let myself be overwhelmed by concern She only has a few minutes late and should arrive soon.".
problematic situations: Talk with the patient's thoughts and reactions to life's problems. Refute erroneous thoughts (catastrophic thoughts, helplessness and loneliness ...) and reinforce positive strategies for managing anxiety (problem solving technique). Ideally the patient should be able to gain a sense of mastery of his problems which greatly alleviate his anxiety symptoms.
For example: a patient visits because he suffers from chronic anxiety, nausea and insomnia. These symptoms began after the establishment of a diagnosis of asthma in his son and they increase when her son has seizures.
Reassure the patient about his symptoms and pathology of his son and consider certain steps that the patient may begin in the following weeks, such as:
- Learn the methods of asthma management.
- Meet with professionals to learn more about the manifestations and treatment of asthma.
- Meet patient associations, exchange experiences with other parents of children with asthma ...
Treatment
Drugs are secondary treatment in the management of generalized anxiety. They can however be used if significant anxiety symptoms persist despite the implementation of the recommendations listed above.
Anxiolytic treatment can be used in a timely manner during the acute manifestations. Background Treatment is with antidepressants for a period of at least 6 months. specialized consultation
A specialized consultation (especially psychotherapy) may be considered if necessary.
How to proceed ?
Consider using a vocabulary that the patient can understand. Make a list of symptoms and parallel list of diagnostic features of the disease. Tell the patient that you think his symptoms match the diagnostic features of the disease.
Explain to the patient that he has a known medical condition, turn to him the natural history of the disease and the improvements that can be expected by the proposed treatments.
List the treatments available and present the detailed patient therapeutically you advise him. Adopt a confident and optimistic attitude: "This treatment has been effective in many other patients."
Invite them to ask questions and discuss.
Feel free to repeat important information for subsequent visits.
psychoeducation
or a doctor might say to his patient
You will find below proposals on what a general practitioner could tell a patient with a given condition, at the first consultation.
F10: abuse or alcohol dependence
"A reasonable alcohol consumption is limited to a maximum of 14 drinks per week for women / 28 drinks for men. It seems that you drink more than that. At this level, alcohol consumption may damaging your liver, your heart and lead to depression or dementia. Our first objective is to mitigate the danger involved alcohol for your health. The best solution is to reduce the number of glasses you drink and to keep a journal where you will indicate the total number of drinks. Drink light beer. Space frequency of alcohol intake by non-alcoholic beverages. Try to establish two alcohol-free days each week and limit your alcohol intake to two drinks every other day. You come back and see me in two weeks and you show me your newspaper. I am aware that you will go through good and bad times and it can be difficult and scary at first, but it takes you hang back and see me in two weeks. Once this first step accomplished, I could help you through other methods (motivational interviewing). "
F11: Abuse or dependence psychoactive substances (excluding alcohol)
(Psychoactive substances such as codeine, sedatives or marijuana if the patient is taking other types of drugs, direct them to specialized services).
"Your drug use is a serious danger and we have already discussed the problems that led to your workplace and your family. If you decide to stop, I suggest you start by keeping a journal of your drug and try to gradually reduce. Why do not'd come back in a week with this newspaper? We can then identify times when you consume the drug and seek to understand why. Subsequently, I can help you through other methods (motivational interviewing). "
F20-F29: Chronic Psychotic Disorders / Schizophrenia: relapse (outpatient)
"We talked about the difficulties you endure to focus or motivation. We also talked about the fact that you start to hear voices and have different ideas of those around you. The resumption of regular treatment can help control these symptoms. I want you to accept to start treatment and I warn your family and your psychiatrist to your situation. We could meet again next week. On this occasion, I would like you to come with your family or people who live with you so we can consider new strategies to control your symptoms (problem solving strategies and social skills training). "
F23: acute psychotic disorder (outpatient)
"You told me that your thoughts were confused and strange and it frightened you very much. This change may have several origins and we must study it. I will refer you to a specialist who will make a diagnosis and recommend a treatment. We could hospitalize you but it is better that you stay at home during treatment. Until you meet the specialist, I would like you to take drugs that will appease the strange ideas and fear they cause. Until your appointment, I would like to see you regularly to make sure you are well. "
P.S: It is better that you make an appointment yourself with a psychiatrist with the patient and his relatives.
F31: Bipolar disorder (outpatient)
"You have me so said you were all very energetic turn, very active and euphoric and irritable. You feel more yourself. I think you have a disease called bipolar disorder. If we do not take care, you could spend all your money, disrupt the balance of your family and in general, to harm you. (In chronic episode) I think you should take your treatment and, if all goes well, a new hospital should not be necessary. I would like to arrange a new appointment with the specialist, who took care of you the last time.
(If the first episode) I would like to have the opinion of a specialist. Meanwhile, should you take medication that will calm your mood and energy. I want to talk about the disease with family members. Later, I'll teach you some techniques called problem-solving strategies that solve the challenges you face. "
P.S: It is better that you make an appointment yourself with a psychiatrist with the patient and his relatives.
Depression F32 (outpatient)
"You told me that you feel sad that nothing interested you and that your life was disrupted in. These symptoms last for some time now and can not be explained entirely by the events in your life as you might think. I think you have depression. If we do not take care, it can last for months and spoil your career plans and your friendships.
(If the depression is moderate or severe) I think you need antidepressant treatment. Once you start this treatment, I will teach you some psychological strategies (organization of activities, problem-solving strategies, cognitive therapy) to accelerate the improvement of your condition and help you feel great. I would like to see you in a few days. It would be better that you come back with a loved one and let us find a solution to help you feel better.
I can also refer you to a specialist. What do you prefer ? "
P.S: Depending on the severity of the patient's depression, it may be best to make an appointment yourself with a psychiatrist with the patient and his relatives.
F40 Social Phobia
"In recent years you have become anxious in social situations. You are afraid that others notice that you are particularly anxious or you dread being judged or rejected. You are afraid that they think (and maybe you think you) that you are weak or incompetent and therefore you avoid such situations. We call this social phobia disease and if we do not take care, it will tend to persist. Indeed, every time you avoid a situation, the relief that you experience strengthens vis-à-vis afraid of this and similar situations.
Treatment with antidepressants soothe your anxiety and it will be easier for you to resume social activities.
I can also teach you how to control your anxiety by breathing control techniques, to better understand your response to these frightening situations (cognitive therapy) and master gradually facing their (technical gradual exposure).
I can also refer you to a specialist for advice treatment. What do you prefer ? "
F41 Panic Disorder / Agoraphobia
"You suffer from sudden panic attacks. Your heart is racing, you have trouble breathing or you have other disturbing symptoms. So you can be afraid of a heart attack, fall or die during one of these attacks. You now avoid situations that do not offer you can help or escape. We call this illness panic disorder with agoraphobia. If not treated, it may persist because every time you avoid a situation, the relief that you experience strengthens vis-à-vis afraid of this and similar situations.
I can teach you to master the manifestations of anxiety through breathing control techniques, better think your fear through cognitive therapy and control scary situations facing them gradually (technical gradual exposure).
Antidepressants will soothe your fears and it will be easier to resume social activities.
I can also refer you to a specialist for advice treatment. What do you prefer ? "
F40.2 Specific Phobia
"Many people have an excessive fear of snakes, poisonous insects, altitude, closed places, dogs, calm waters ... Most of the time, they support these fears from childhood and learned to avoid situations that frighten them. Avoid fear strengthens the phobia. If your phobia often disrupts your life and your daily activities, I can teach you to confront it and to control it with the gradual exposure technique. "
F41.1 Generalized anxiety
"You worry about a symptom which in my opinion does not reveal serious illness. You explained to me that for months you were concerned about persistent and uncontrollable for the events of everyday life. You feel tense mentally and physically and it exhausts you. You told me that you live like this, with ups and downs, very long time. We call this disorder or generalized anxiety disorder.
First, I can offer you learn psychological strategies such as breathing control techniques, problem solving or relaxation to help you control your anxiety and your tension.
Secondly, if necessary, we can combine these techniques antidepressant treatment. (The antidepressants are also used to treat anxiety disorders). I can also refer you to a specialist. What do you prefer ? "
F41.2 Anxiety disorder and mixed depression
"You told me that you feel sad that nothing interested and that you feel you worried and anxious all the time. These symptoms last for some time now and can not be explained entirely by the events in your life as you might think. I think you have an anxiety disorder and mixed depression. If we do not take care, it can last for months and spoil your career plans and your friendships.
I think you need to take an antidepressant and gain psychological strategies. Once you start the medication, I'll teach you techniques (organization of activities, problem-solving strategies, cognitive therapy) to speed your recovery and help you feel great.
I would like to see you in a few days. It would be better that you come back with a close and let us find a way to make you feel better.
I can also refer you to a specialist. What do you prefer ? "
F42 Obsessive-Compulsive Disorder
"You told me you were constantly assailed by fears for your family and for yourself and you had difficulty in resisting them. To control your fears, you must compel you to certain rituals, but you realize today that the obsessions and compulsions dominate your life.
Antidepressant treatment reduces the intensity of these obsessions and it will be easier to resist them.
I can also show you how to organize the management of these compulsions (technical and progressive technical exhibition relapse prevention) and mitigate the force of obsessions to feel good.
I can also refer you to a specialist for advice treatment. What do you prefer? "
F43.2 Adjustment disorders
"You go through a difficult period and you feel overwhelmed. You are struggling to cope and you feel sad and anxious. I can prescribe medications that certainly appease your nervousness but unfortunately prevent you learn to control yourself. That's why I prefer to enjoy our meetings to teach you strategies that will speed your recovery and help you cope with future situations. These are strategies called stress management and problem solving. "
F44 Dissociative Disorders (conversion)
"I do not think your symptoms indicate a serious illness. You know, your symptoms are sometimes caused by stress or emotional upset. We must go home to rest and you come back and see me in a few days. So, we refer the point and I will teach you some strategies to deal with the stress that seems to cause these symptoms (problem-solving strategies, progressive muscle relaxation, communication training). "
