Generalized Anxiety Disorder vs Panic Disorder

Why Uncontrollable worry about school, money, and health daily is correct

• The GAD-7 is a severity measure, not a diagnostic instrument; a score of 16 indicates severe anxiety symptoms and obligates the clinician to take a history that assigns those symptoms to a specific disorder.
• Generalized anxiety disorder requires excessive, difficult-to-control worry about multiple domains occurring more days than not for at least 6 months, plus at least three of six associated symptoms including restlessness, fatigue, irritability, muscle tension, concentration difficulty, and sleep disturbance.
• Uncontrollable worry about school, money, and health daily — the multi-domain, persistent, hard-to-control worry that defines GAD and separates it from every episodic anxiety disorder; correct.

Why the others are wrong

• Abrupt surges of fear that peak within several minutes — the defining feature of a panic attack, and when attacks are recurrent, unexpected, and followed by a month of worry about further attacks, they define panic disorder instead.
• Persistent fear of being scrutinized while speaking in class — social anxiety disorder, in which the fear is bounded by performance and social evaluation rather than diffuse.
• Avoidance of buses and crowds unless a friend goes along — agoraphobia, defined by fear of situations where escape or help would be difficult.

Both her chronic course and the multi-domain content of the worry, obtained purely by history, make the distinction; the somatic symptoms themselves overlap across all four conditions and cannot discriminate.

Why Sertraline is correct

• Panic disorder with situational avoidance is treated long-term with an SSRI plus cognitive behavioral therapy.
• Sertraline lowers attack frequency and anticipatory anxiety without dependence, making it the preferred maintenance agent.
• It addresses the underlying disorder rather than only aborting acute attacks.

Why the others are wrong

• Alprazolam — fast relief but tolerance, dependence, and rebound anxiety make benzodiazepines poor long-term monotherapy (rapid-relief trap).
• Propranolol — blunts peripheral autonomic symptoms such as tremor and palpitations but does not prevent panic attacks or reduce the anticipatory avoidance described here.
• Hydroxyzine — a nonaddictive as-needed anxiolytic without evidence for maintenance control of panic disorder (PRN-versus-maintenance trap).