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Generalized Anxiety Disorder

Generalized anxiety disorder  (GAD) is a relatively common anxiety problem, affecting 3-4% of the population, Generalized anxiety disorder is much more than the normal anxiety people experience day to day. It's chronic and exaggerated worry and tension, even though nothing seems to provoke it. Having this disorder means always anticipating disaster, often worrying excessively about health, money, family, or work. Sometimes, though, the source of the worry is hard to pinpoint. Simply the thought of getting through the day provokes anxiety. The diagnostic criteria for GAD is as follows:

For more than half the days in at least 6 months, the patient experiences excessive anxiety
      and worry about several events or activities.

The patient has trouble controlling these feelings.

Associated with this anxiety and worry, the patient has 3 or more of the following symptoms,
      some of which are present for over half the days in the past 6 months:*

* Feels restless, edgy, keyed up
* Tires easily
* Trouble concentrating
* Irritability
* Increased muscle tension
* Trouble sleeping (initial insomnia or restless, unrefreshing sleep)

Aspects of another Axis I disorder do not provide the focus of the anxiety and worry.

The symptoms cause clinically important distress or impair work, social or personal functioning.

The disorder is not directly caused by a general medical condition or by substance use, including
      medications and drugs of abuse.

It does not occur only during a Mood Disorder, Psychotic Disorder, Posttraumatic Stress Disorder
     or Pervasive Developmental Disorder.


Associated Features 

* Depressed Mood
* Somatic or Sexual Dysfunction
* Anxious or Fearful or Dependent Personality


Differential Diagnosis 

Some disorders have similar or even the same symptoms. The clinician, therefore, in his diagnostic attempt has to differentiate against the following disorders which he needs to rule out to establish a precise diagnosis.

Anxiety Disorder Due to a General Medical Condition;
Substance-Induced Anxiety Disorder;
Panic Disorder;
Social Phobia;
Obsessive-Compulsive Disorder;
Anorexia Nervosa;
Somatization Disorder;
Separation Anxiety Disorder;
Obsessional thoughts;
Posttraumatic Stress Disorder;
Adjustment Disorder;
Mood Disorders;
Psychotic Disorders;
Nonpathological anxiety.



GAD may be caused by both biological and psychological factors. The presence of GAD has previously been linked to abnormalities in a number of different brain chemicals, particularly those known to be associated with fear and emotional responses. Moreover, the symptoms of GAD appear to worsen during periods of stress. Although some studies have reported that GAD runs in families, others have not found this connection.

GAD usually does not cause people to avoid situations, and there isn’t an element of a "panic attack" involved in the prognosis, either. It’s the  thinking, dwelling, ruminating, and inability to shut the mind off that so incapacitates the person. At other times, thoughts seem almost non-existent because the anxious feelings are so dominant. Feelings of worry, dread, lack of energy, and a loss of interest in life are common. Many times there is no "trigger" or "cause" for these feelings and the person realizes these feelings are irrational. Nevertheless, the feelings are very real. At this point, there is no "energy" or "zest" in life and no desire to want to do much.

Normal life stresses aggravate generalized anxiety. The person who typically performs well at work and receives a sense of accomplishment from it, all of a sudden finds that work has become drudgery. If work is perceived as a negative environment, and the person no longer feels fulfilled, then considerable worry takes place over these situations. As a result, the anticipatory anxiety about going to work can become quite strong.



GAD can be treated with drug therapy, counseling, or both. Many patients have demonstrated improvement with counseling techniques such as behavioral and cognitive-behavioral therapy. A combination of medication and counseling can also be used.

GAD has been shown to respond best to cognitive-behavioral therapy, an active therapy that involves more than just talking to a therapist. In CBT, the person gradually learns to see situations and problems in a different perspective and learns the methods and techniques to use to alleviate and reduce anxiety. Sometimes medication is a helpful adjunct to therapy, but for many people it is not necessary. Research indicates that generalized anxiety is fully treatable and can be successfully overcome over the course of about three to four months if the person is motivated and works toward recovery.

Counseling and Psychotherapy [ See Therapy Section ]:

Psychotherapy: Most patients with mild symptoms can be treated with supportive counseling and education without need for medication.  Other therapies: Relaxation training and cognitive therapy have been found to be of benefit.  General measures: Regular exercise and avoidance of caffeine and alcohol.

Pharmacotherapy [ See Psychopharmacology Section ] :

There are several medications that have been used successfully to relieve the symptoms of anxiety, including benzodiazepines and azapirones. Some antidepressants are also currently under investigation for the treatment of GAD.

Tricyclic Antidepressants (TCAs). Imipramine 
Antihistamines. Hydroxyzine (Atarax, Vistaril)
Benzodiazepines.Alprazolam (Xanax)  Lorazepam (Ativan) 
Buspirone. Selective Serotonin Reuptake Inhibitors (SSRIs). (Prozac, Paxil, Luvox, Zoloft).
Beta-blockers. Propranolol (Inderal) 

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