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| {{Generalized anxiety disorder}} | | {{Generalized anxiety disorder}} |
| {{CMG}} | | {{CMG}}; {{AE}} {{I.D.}} |
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| ==Diagnosis==
| | {{SK}} GAD; anxiety |
| According to the ''Diagnostic and Statistical Manual'' IV-Text Revision ([[DSM-IV-TR]]), the following criteria must be met for a person to be diagnosed with Generalised Anxiety Disorder.
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| # Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least six months, about a number of events or activities (such as work or school performance).
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| # The person finds it difficult to control the worry.
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| # The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months). Note: Only one item is required in children.
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| ## restlessness or feeling keyed up or on edge
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| ## being easily fatigued
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| ## irritability
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| ## muscle tension
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| ## difficulty falling or staying asleep, or restless unsatisfying sleep
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| ## difficulty concentrating or the mind going blank
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| # The focus of the anxiety and worry is not confined to features of an Axis I disorder, e.g., the anxiety or worry is not about having a [[panic attack]] (as in panic disorder), being embarrassed in public (as in [[social phobia]]), being contaminated (as in [[obsessive-compulsive disorder]]), being away from home or close relatives (as in [[Separation Anxiety Disorder]]), gaining weight (as in [[anorexia nervosa]]), having multiple physical complaints (as in [[somatization disorder]]), or having a serious illness (as in [[hypochondriasis]]), and the anxiety and worry do not occur exclusively during [[post-traumatic stress disorder]].
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| # The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
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| # The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., [[hyperthyroidism]]) and does not occur exclusively during a Mood Disorder, a Psychotic Disorder, or a Pervasive Developmental Disorder.
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| ==Treatment== | | ==[[Generalized anxiety disorder overview|Overview]]== |
| ===SSRIs===
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| {{main|Selective serotonin reuptake inhibitor}}
| | ==[[Generalized anxiety disorder historical perspective|Historical Perspective]]== |
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| Pharmaceutical treatments for GAD, include [[selective serotonin reuptake inhibitor]]s (SSRIs),<ref name="mayo">[http://www.mayoclinic.com/health/generalized-anxiety-disorder/DS00502/DSECTION=8 "Generalized anxiety disorder"], Mayo Clinic. Accessed [[29 May]] [[2007]].</ref> which are antidepressants that influence brain chemistry to block the reabsorption of [[serotonin]] in the [[brain]].<ref>[http://www.mayoclinic.com/health/ssris/MH00066 "SSRIs"], Mayo Clinic. Accessed [[29 May]] [[2007]].</ref> SSRIs are mainly indicated for [[clinical depression]], but are also effective in treating anxiety disorders.<ref name="mayo" /> Common side effects include [[nausea]], [[sexual dysfunction]], [[headache]], [[diarrhea]], [[Selective serotonin reuptake inhibitor#Adverse effects|among others]]. Common SSRIs prescribed for GAD include:
| | ==[[Generalized anxiety disorder classification|Classification]]== |
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| * [[fluoxetine]] (''Prozac'')
| | ==[[Generalized anxiety disorder pathophysiology|Pathophysiology]]== |
| * [[paroxetine]] (''Paxil'')
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| * [[escitalopram]] (''Lexapro;Cipralex'')
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| ===Other Drugs=== | | ==[[Generalized anxiety disorder differential diagnosis|Differentiating Generalized Anxiety Disorder from other Diseases]]== |
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| * [[imipramine]] (''Tofranil'')
| | ==[[Generalized anxiety disorder epidemiology and demographics|Epidemiology and Demographics]]== |
| * [[venlafaxine]] (''Effexor'')
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| * [[Buspirone]] (''BuSpar'')
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| Venlafaxine (Effexor) is a [[serotonin-norepinephrine reuptake inhibitor]] (SNRI). SNRIs, a class of drugs related to the SSRIs, alter the chemistries of both [[norepinephrine]] and serotonin in the brain. Imipramine (Tofranil) is a [[tricyclic antidepressant]] (TCA). TCAs are thought to act on serotonin, norepinephrine, and [[dopamine]] in the brain. Buspirone is a [[serotonin]] [[Receptor (biochemistry)|receptor]] [[agonist]] belonging to the [[azaspirodecanedione]] class of compounds.
| | ==[[Generalized anxiety disorder risk factors|Risk Factors]]== |
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| ===Benzodiazepines=== | | ==[[Generalized anxiety disorder natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| {{main|Benzodiazepine}}
| | ==Diagnosis== |
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| [[Benzodiazepines]] (or "benzos") are fast-acting [[sedatives]] that are also used to treat GAD and other [[anxiety disorders]].<ref name="mayo" /> These are often given in the short-term due to their nature to become [[addiction|habit-forming]]. Side effects include [[drowsiness]], reduced [[motor coordination]] and problems with [[equilibrioception]]. Common benzodiazepines used to treat GAD include<ref name="mayo" />: | | [[Generalized anxiety disorder diagnostic criteria|Diagnostic Criteria]] | [[Generalized anxiety disorder history and symptoms|History and Symptoms]] | [[Generalized anxiety disorder laboratory findings|Laboratory Findings]] | [[Generalized anxiety disorder other imaging findings|Other Imaging Findings]] | [[Generalized anxiety disorder other diagnostic studies|Other Diagnostic Studies]] |
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| * [[alprazolam]] (''Xanax'')
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| * [[chlordiazepoxide]] (''Librium'')
| | ==Treatment== |
| * [[clonazepam]] (''Klonopin'')
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| * [[diazepam]] (''Valium'')
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| * [[lorazepam]] (''Ativan'')
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| ===Herbal=== | |
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| {{main|Kava}}
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| [[Kava]], a relaxant made from a root only of a relative of the [[black pepper]] plant, is effective at controlling anxiety - particularly when used as a short term fast acting drug in combination with CBT (see below). The recommended use is for a support person such as the GAD sufferer's partner or housemate to encourage a dose when anxiety strikes as the patient is often unwilling/unable to dose themselves. Kava is absorbed through most mucous membranes and takes effect in roughly the same time as alcohol. It is a symptomatic relief for anxiety and does not address the fundamental problem, but it does give the patient a reliable mental crutch to work through the core problems. It appears that the required dosage actually decreases with regular use, perhaps as a form of [[Operant conditioning|conditioning]]. Two major advantages of Kava supported therapy are the rapid response of the active ingredients (removing the need for [[titration]]) and the lack of withdrawal symptoms. There are no specific contraindications with other chemical treatments, but caution must be observed when the patient is already taking psychoactive drugs.
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| ===Cognitive behavioral therapy===
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| {{main|Cognitive behavioral therapy}}
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| A [[psychological]] method of treatment for GAD is [[cognitive behavioral therapy]] (CBT), which involves a [[therapist]] working with the patient to understand how [[thought]]s and [[feeling]]s influence [[behavior]].<ref name="cbt">[http://www.babcp.com/babcp/what_is_CBT.htm "A Guide to Understanding Cognitive and Behavioural Psychotherapies"], British Association of Behavioural and Cognitive Psychotherapies. Accessed [[29 May]] [[2007]].</ref> The goal of the therapy is to change negative thought patterns that lead to the patient's anxiety, replacing them with positive, more realistic ones. Elements of the therapy include [[Exposure Therapy|exposure strategies]] to allow the patient to gradually confront their anxieties and feel more comfortable in anxiety-provoking situations, as well as to practice the skills they have learned. CBT can be used alone or in conjunction with [[medication]].<ref name="mayo" />
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| ==GAD and Comorbid Depression==
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| In the National Comorbidity Survey (2005), 58% of patients diagnosed with [[Clinical depression|major depression]] were found to have an anxiety disorder; among these patients, the rate of comorbidity with GAD was 17.2%, and with [[panic disorder]], 9.9%. Patients with a diagnosed anxiety disorder also had high rates of comorbid depression, including 22.4% of patients with [[social phobia]], 9.4% with [[agoraphobia]], and 2.3% with panic disorder. For many, the symptoms of both depression and anxiety are not severe enough (i.e. are subsyndromal) to justify a primary diagnosis of either major depressive disorder (MDD) or an anxiety disorder.
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| Patients can also be categorized as having mixed anxiety-depressive disorder, and they are at significantly increased risk of developing full-blown depression or anxiety. Appropriate treatment is necessary to alleviate symptoms and prevent the emergence of more serious disease.
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| Accumulating evidence indicates that patients with comorbid depression and anxiety tend to have greater illness severity and a lower treatment response than those with either disorder alone. In addition, social function and quality of life are more greatly impaired.
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| In addition to coexisting with depression, research shows that GAD often coexists with [[substance abuse]] or other conditions associated with [[Stress (medicine)|stress]], such as [[irritable bowel syndrome]]. Patients with physical symptoms such as [[insomnia]] or [[headache]]s should also tell their doctors about their feelings of worry and tension. This will help the patient's health care provider to recognize whether the person is suffering from GAD.
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| ==See also==
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| * [[Anxiety disorder]]
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| * [[Social anxiety disorder]]
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| * [[Clinical depression]]
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| * [[Cognitive behavioral therapy]]
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| * [[Anxiety Disorders Association of America]]
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| ==References==
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| {{reflist|2}}
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| [[de:Generalisierte Angststörung]]
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| [[es:Trastorno de ansiedad generalizada]]
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| [[fr:Anxiété généralisée]]
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| [[he:הפרעת חרדה מוכללת]]
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| [[nl:Gegeneraliseerde angststoornis]]
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| [[no:Generalisert angstlidelse]]
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| [[pl:Zespół lęku uogólnionego]]
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| [[fi:Yleistynyt ahdistuneisuushäiriö]]
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| [[sv:Generaliserat ångestsyndrom]]
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| | [[Generalized anxiety disorder medical therapy|Medical Therapy]] | [[Generalized anxiety disorder psychotherapy|Psychotherapy]]| [[Generalized anxiety disorder brain stimulation therapy|Brain Stimulation Therapy]] |
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| | ==Case Studies== |
| | [[Generalized anxiety disorder case study one|Case #1]] |
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| {{WH}} | | {{WH}} |