Generalised Anxiety Disorder

A 38-year-old woman from Delhi presents to the psychiatry outpatient clinic with a 14-month history of persistent worry about her job performance, finances, and her children's future. She reports difficulty concentrating at work, muscle tension, and sleep disturbance (early morning awakening). She denies panic attacks, agoraphobia, or specific phobias. Physical examination is unremarkable. Thyroid function tests and complete blood count are normal. She has tried relaxation techniques without sustained benefit. What is the most appropriate first-line pharmacological intervention?

A 32-year-old woman presents to the psychiatry clinic with a 14-month history of persistent worry about her job performance, finances, and family relationships. She reports difficulty concentrating at work, muscle tension, and sleep disturbance (early morning awakening). She denies panic attacks, agoraphobia, or specific phobias. Physical examination reveals no focal neurological signs. Thyroid function tests and complete blood count are normal. She has no past psychiatric history and denies substance use. What is the most likely diagnosis?

A 28-year-old man with a 10-month history of GAD is started on sertraline 50 mg daily. After 2 weeks, he reports increased anxiety, restlessness, and insomnia. He is concerned about the worsening symptoms and asks whether the medication is appropriate. What is the most appropriate next step?

Which neurotransmitter system dysfunction is considered the primary neurobiological basis for Generalised Anxiety Disorder?

A 42-year-old man from Mumbai attends the psychiatry clinic with a 10-month history of constant worry about his health, work stability, and family relationships. He reports muscle tension, fatigue, irritability, and difficulty sleeping (sleep maintenance insomnia). He denies panic attacks, specific triggers, or avoidance behaviours. He has no prior psychiatric history. Physical examination and routine investigations (CBC, thyroid function, ECG) are normal. He has attended 4 sessions of cognitive–behavioural therapy (CBT) over 2 months with minimal improvement. What is the most appropriate next step in management?