Generalized Anxiety Disorder

Help For GAD Problems

What is Gad?  Symptoms Treatment

People with generalized anxiety disorder experience worry or anxiety and a number of physical and psychologic symptoms. Gad is frequently difficult to diagnose and get rid of because of the variety of presentations and the common occurrence of comorbid medical or psychiatric conditions. The lifetime prevalence is approximately 4 to 6 percent in the general population and is more common in women than in men.  

It is often chronic, and patients with this disorder are more likely to be seen by family physicians than by psychiatrists for psychiatric treatment.

Treatment of generalized anxiety disorder consists of pharmacotherapy and various forms of psychotherapy and family therapy. The benzodiazepines are used for short-term treatment, but because of the frequently chronic nature of generalized anxiety disorder, they may need to be continued for months to years.

Buspirone and antidepressants remain the best current treatment of generalized anxiety disorder and are used for the pharmacologic medication of patients with GAD. Patients must receive an appropriate pharmacologic trial with dosage titrated to optimal levels as judged by the control of generalized anxiety symptoms and the tolerance of side effects. Psychiatric consultation should be considered for patients who do not respond to an appropriate trial of pharmacotherapy.

Severe anxiety disorders, such as generalized anxiety disorder (GAD), panic disorder and social phobia, are the most prevalent psychiatric disorders in the United States, and patients with these disorders are more likely to seek treatment from a family care physician than from a psychiatrist.

Patients coping with generalized anxiety disorders are more likely than other patients to make frequent medical appointments, to undergo extensive diagnostic testing, to report their health as poor and to smoke cigarettes and abuse other substances.

Anxiety disorders, particularly panic disorder, occur more frequently in patients with chronic medical illnesses (e.g., hypertension, chronic obstructive pulmonary disease, irritable bowel syndrome, diabetes) than in the general population.

Conversely, patients dealing with generalized anxiety disorders are more likely than others to develop a medical illness, and the presence of an anxiety disorder may prolong the course of a medical illness. Patients with anxiety disorders have higher rates of mortality from all causes.

Characteristics of Generalized Anxiety Disorder

The definition of generalized anxiety disorder has changed over time. Originally, little distinction was made between panic disorder and generalized anxiety disorder. As panic disorder became better understood and specific treatments were developed, generalized anxiety disorder was defined in the Diagnostic and Statistical Manual of Mental Disorders, 3d ed. (DSM-III) as a disorder without panic attacks or symptoms of major depression.

This definition had little reliability, and current diagnostic criteria for generalized anxiety disorder in the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV)10 emphasize the psychic component (e.g., the worry) rather than the somatic (e.g., muscle tension) or autonomic symptoms (e.g., diaphoresis, increased arousal).

In addition to the DSM-IV framework, the symptoms of generalized anxiety disorder can be conceptualized as being contained in three categories: excessive physiologic arousal, distorted cognitive processes and poor coping strategies.

To make the diagnosis of generalized anxiety disorder by DSM-IV criteria, the worry and other associated GAD symptoms must be present for at least six months and must adversely affect the patient's life (e.g., the patient misses work days or cannot maintain daily responsibilities).

The diagnosis can be challenging because the difference between normal anxiety and generalized anxiety disorder is not always distinct and because generalized anxiety disorder often coexists with other psychiatric disorders (e.g., major depression, dysthymia, panic disorder, substance abuse).

The lifetime prevalence of generalized anxiety disorder is 4.1 to 6.6 percent,14 which is higher than that of the other anxiety disorders. The prevalence of generalized anxiety disorder in patients visiting physicians' offices is twice that found in the community.

It is more prevalent in women than in men, with the median age of onset occurring during the early 20s. The onset of symptoms is usually gradual, although generalized anxiety disorder can be precipitated by stressful life events. The condition tends to be chronic with periods of exacerbation and remission.

After obtaining a patient history, the physician should try to categorize the anxiety as acute (or brief or intermittent) or persistent (or chronic). Acute anxiety lasts from hours to weeks (in contrast, panic attacks last for minutes) and is usually preceded by a stressor.

Often, comorbid conditions (e.g., major depression) are not present. Persistent anxiety lasts for months to years and can include what is called "trait anxiety." Trait anxiety can be viewed as part of a patient's temperament; for instance, a patient may say, "I've always been nervous, but I don't know about what."

Although there is usually not a precipitating stressor in most cases of persistent anxiety, a stressor can exacerbate the patient's baseline level of anxiety. This situation is called "double anxiety" (i.e., acute anxiety superimposed on persistent anxiety). Generalized anxiety disorder is a form of persistent anxiety and can occur in patients with or without trait anxiety.

Physical Symptoms of GAD Symptoms of generalized anxiety disorder can occur before, during or after the onset of the symptoms of major depression or panic disorder.....

The Causes of Generalized Anxiety Disorder How do I know if I have generalized anxiety disorder? Most people worry and these occasional worries are normal. This doesn't mean that you have generalized anxiety disorder...

Treating Generalized Anxiety with Medication Although few controlled studies support the long-term use of benzodiazepines, GAD is a chronic disorder, and some patients will require benzodiazepine therapy for months to years.....

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