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NCBI Bookshelf. Sadaf Munir ; Veronica Takov. Authors Sadaf Munir ; Veronica Takov 1. Generalized anxiety disorder is one of the most common mental disorders.
Generalized anxiety disorder is characterized by persistent, excessive, and unrealistic worry about everyday things. This worry could be multifocal such as finance, family, health, and the future. It is excessive, difficult to control, and is often accompanied by many non-specific psychological and physical symptoms. Excessive worry is the central feature of generalized anxiety disorder. The median age at onset is 11 years. General prevalence in children younger than 18 years is between 5.
The prevalence is approximately twice as high among women as among men. Early clinical studies evaluating DSM-III according to this definition found that the disorder seldom occurred in the absence of another comorbid anxiety or mood disorder.
Additional changes in the definition of excessive worry and the required number of associated psychophysiological symptoms were made in the DSM-IV. Nonetheless, such data became available over the past decade. The new data also challenged the validity of the threshold decisions embodied in the DSM-V. Anxiety can be a normal phenomenon in children. Stranger anxiety begins at seven to nine months of life. Noradrenergic, serotonergic, and other neurotransmitter systems are believed to play a role in the body's response to stress.
The serotonin system and the noradrenergic systems are common pathways involved in anxiety. It is, therefore, selective serotonin reuptake inhibitors SSRI and serotonin-norepinephrine reuptake inhibitors SNRI that are the first-line agent for its treatment.
Patients with anxiety can pose a diagnostic challenge, as somatic symptoms are more common than psychologic symptoms. Many scales have been developed to assess the severity and diagnosis. The GAD-7 has been validated as a diagnostic tool and severity assessment scale. Initial assessment begins by addressing behavior or somatic symptoms. Evaluate for psychosocial stress, psychosocial difficulties, and developmental issues. The two main treatments for generalized anxiety disorder are cognitive behavior therapy and medications.
Patients may benefit most from a combination of the two. This includes psychoeducation, changing maladaptive thought patterns, and gradual exposure to anxiety-provoking situations. Antipsychotics may also help some patients, especially those with associated behavior problems. Examples are diazepam and clonazepam are long-acting agents. These agents are used when an immediate reduction of symptoms is desired, or a short-term treatment is needed.
Generally, cooperative and compliant patients who are aware that their symptoms have a psychological basis are more likely to respond to benzodiazepines. Since there is a concern for misuse and dependence, patients with a history of alcoholism or drug abuse are not appropriate candidates for this treatment.
Buspirone is a non-benzodiazepine which does not cause dependency. It is also less sedating than benzodiazepines, and tolerance does not occur at therapeutic doses. All medications should be titrated slowly and continued for at least 4 weeks to determine if they work. Once symptoms are under control, the medications need to be used for at least 12 months before gradually tapering them. Every single medication has adverse effects like weight gain, hyperlipidemia, and diabetes; thus the patients need to be monitored.
The education of the patient is vital as it can help ease anxiety. The triggers for anxiety should be managed like avoiding caffeine, alcohol, nicotine, stress and improving sleep.
Many complementary and alternative remedies are available but the evidence to support their efficacy is lacking. Further, some agents like Kava may injure the liver. The prognosis for patients with generalized anxiety disorder is guarded. Many patients are not compliant with medications because of cost and adverse effects. Relapses are common and patients often search physicians who comply with their needs.
Because of the lack of conventional medicine to cure the disorder, many opt for alternative therapies without much success. Overall, the quality of life of these patients is poor. Consider further evaluation for anxiety disorder if an adult is excessively anxious or an infant or child is excessively clingy and difficult to console during the pediatric visit. Many medical conditions may mimic anxiety disorders. One should distinguish between the anxiety and the illness and should evaluate for organic diseases before making this diagnosis.
The condition has very high morbidity and mortality and thus is best managed by an interprofessional team that includes a mental health nurse, pharmacist, psychologist, a psychiatrist, and the primary care provider. Many patients have moderate to severe symptoms and lead to poor quality of life.
Most have no idea that the condition can be treated. Thus, the key to improving outcomes is patient education. The nurse practitioner, pharmacist, and primary care provider should urge the patient to stop tobacco, alcohol and caffeinated beverages.
In addition, relief of stress is vital and thus a referral for cognitive behavior therapy may help. There are many drugs that can be used to treat anxiety but they all have side effects, which is a common reason for non-compliance. The pharmacist should emphasize the benefits of these medications and urge compliance to improve the symptoms. At the same time, the primary care provider should monitor for hyperlipidemia, diabetes and weight gain as a result of the medications.
Overall, anxiety disorders are underdiagnosed and undertreated. When left untreated, anxiety disorders often lead to severe depression and abuse of drugs and alcohol. In addition, there is a high rate of suicide among these patients. Many patients with chronic anxiety have a poor quality of life. The education of both the patient and family by the pharmacist, nurse, and provider as a team is important to reduce the high morbidity and addiction problems with treatment medications.
Family members should help ensure medication compliance and provide a supportive environment. Unfortunately, despite optimal treatment, relapse rates are high.
To access free multiple choice questions on this topic, click here. This book is distributed under the terms of the Creative Commons Attribution 4. Turn recording back on. National Center for Biotechnology Information , U. StatPearls [Internet]. Search term. Introduction Generalized anxiety disorder is one of the most common mental disorders. Etiology The etiology may include: Stress. History and Physical Patients with anxiety can pose a diagnostic challenge, as somatic symptoms are more common than psychologic symptoms.
Factors commonly associated with generalized anxiety include: Female gender. Evaluation Initial assessment begins by addressing behavior or somatic symptoms.
Pharmacotherapy Several types of medications are used to treat generalized anxiety disorder. Benzodiazepines Examples are diazepam and clonazepam are long-acting agents. Buspirone BuSpar Buspirone is a non-benzodiazepine which does not cause dependency.
Psychotherapy is used in addition to medications; this combination has proven to be effective. Differential Diagnosis Hyperthyroidism. Prognosis The prognosis for patients with generalized anxiety disorder is guarded. Pearls and Other Issues Consider further evaluation for anxiety disorder if an adult is excessively anxious or an infant or child is excessively clingy and difficult to console during the pediatric visit.
Questions To access free multiple choice questions on this topic, click here. References 1. Leonard K, Abramovitch A. Cognitive functions in young adults with generalized anxiety disorder. Curr Top Med Chem. Int J Geriatr Psychiatry. Generalized anxiety disorder and associated factors in adults in the Amazon, Brazil: A population-based study. J Affect Disord. Case Rep Psychiatry. The Diagnosis and Treatment of Anxiety Disorders. Dtsch Arztebl Int. Anxious distress in depressed outpatients: Prevalence, comorbidity, and incremental validity.
J Psychiatr Res. Psychiatrists' treatment preferences for generalized anxiety disorder. Hum Psychopharmacol.
"Anxietas Tibiarum". Depression and Anxiety Disorders in Patients With Restless Legs Syndrome
Background: Symptoms of anxiety and depression in patients with restless legs syndrome RLS have been observed. However, it is unclear whether rates of threshold depression and anxiety disorders according to DSM-IV criteria in such patients are also elevated. Rates of anxiety and depressive disorders were compared between RLS patients within this age range and community respondents from a nationally representative sample with somatic morbidity of other types. In addition, lifetime rates of panic disorder and most depressive disorders as well as comorbid depression and anxiety disorders were considerably increased among RLS patients compared with controls. Conclusions: The results suggest that RLS patients are at increased risk of having specific anxiety and depressive disorders. Causal attributions of patients suggest that a considerable proportion of the excess morbidity for depression and panic disorder might be due to RLS symptomatology.
What Are Anxiety Disorders?
Contemporary Psychiatry pp Cite as. Anxiety from the Latin anxietas , in turn derived from angere , to choke, throttle, trouble, distress is an emotional state induced by the perception of danger or threat arising from the environment or from within the individual him- or herself. In humans, as in animals, anxiety is necessary for survival, as it protects the individual from repeated contact with threatening situations. It can also be understood as a preparatory reaction for fight or flight. The behavioral inhibition accompanying anxiety also has an important protective function: in both animal and human social conflicts, it brings about the retreat of the aggressor.