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Generalized anxiety disorder

Generalized anxiety disorder
Other namesGeneralised anxiety disorder
SpecialtyPsychiatry, psychology Edit this on Wikidata
SymptomsExcessive worry, restlessness, trouble sleeping, feeling tired, irritability, difficulty concentrating, muscle tension,[1] sweating, trembling[2]
ComplicationsDepression, heart disease, suicide[3]
Differential diagnosisPanic disorder, post-traumatic stress disorder, social anxiety disorder, borderline personality disorder, antisocial personality disorder, obsessive–compulsive disorder, specific phobia
TreatmentBehavioral therapy, metacognitive therapy, medications
MedicationAnxiolytics
Frequency3–5% (lifetime prevalence)[4]

Generalized anxiety disorder (GAD) is a mental and behavioral disorder,[5] specifically an anxiety disorder characterized by excessive, uncontrollable and often irrational worry about events or activities.[6] Worry often interferes with daily functioning, and individuals with GAD are often overly concerned about everyday matters such as health, finances, death, family, relationship concerns, or work difficulties.[7][8] Symptoms may include excessive worry, restlessness, trouble sleeping, exhaustion, irritability, sweating, and trembling.[2]

Symptoms must be consistent and ongoing, persisting at least six months, for a formal diagnosis of GAD.[6][7] Individuals with GAD often have other disorders including other psychiatric disorders (e.g., major depressive disorder), substance use disorder, obesity, and may have a history of trauma or family with GAD.[9] Clinicians use screening tools such as the GAD-7 and GAD-2 questionnaires to determine if individuals may have GAD and warrant formal evaluation for the disorder. Additionally, sometimes screening tools may enable clinicians to evaluate the severity of GAD symptoms.[10][11]

GAD is believed to have a hereditary or genetic basis (e.g., first-degree relatives of an individual who has GAD are themselves more likely to have GAD),[12] but the exact nature of this relationship is not fully appreciated.[9][13][14] Genetic studies of individuals who have anxiety disorders (including GAD) suggest that the hereditary contribution to developing anxiety disorders is only approximately 30–40%, which suggests that environmental factors may be more important to determining whether an individual develops GAD.[9][12] There is a strong overlapping relationship between GAD and major depressive disorder (MDD), with 72% of those with a lifelong diagnosis of GAD also being diagnosed with MDD at some point in their lives.[15]

The pathophysiology of GAD implicates several regions of the brain that mediate the processing of stimuli associated with fear, anxiety, memory, and emotion (i.e., the amygdala, insula, and the frontal cortex).[16][9] The amygdala is part of the brain that is associated with experiencing emotions. In the amygdala, the basolateral amygdala complex recognizes sensory information and activates GABAergic neurons which can cause somatic symptoms of anxiety. GABAergic neurons control the nervous system by reducing feelings of stress, anxiety, and fear. When there is an inadequate number of GABAergic neurons, those negative feelings become apparent and can release somatic responses of stress.[17] It has been suggested that individuals with GAD have greater amygdala and medial prefrontal cortex (mPFC) activity in response to stimuli than individuals who do not have GAD.[9] However, the relationship between GAD and activity levels in other parts of the frontal cortex is the subject of ongoing research with some literature suggesting greater activation in specific regions for individuals who have GAD but where other research suggests decreased activation levels in individuals who have GAD as compared to individuals who do not have GAD.[9][16]

Treatment includes psychotherapy (e.g., cognitive behavioral therapy [CBT] or metacognitive therapy) and pharmacological intervention.[18][9] CBT and selective serotonin reuptake inhibitors (SSRI) antidepressants (e.g., escitalopram, sertraline, and fluoxetine) are first-line psychological and pharmacological treatments; other options include serotonin–norepinephrine reuptake inhibitors (SNRI) antidepressants (e.g., duloxetine and venlafaxine). In more severe, last resort cases, potent anxiolytics such as diazepam, clonazepam, and alprazolam are used, though not as first-line drugs as benzodiazepines are frequently abused and habit forming. In Europe, pregabalin is also used.[19] The positive effects (if any) of complementary and alternative medications (CAMs), exercise, therapeutic massage and other interventions have been studied.[20]

Estimates regarding prevalence of GAD or lifetime risk (i.e., lifetime morbid risk [LMR])[21] for GAD vary depending upon which criteria are used for diagnosing GAD (e.g., DSM-5 versus ICD-10) although estimates do not vary widely between diagnostic criteria.[9] In general, ICD-10 is more inclusive than DSM-5, so estimates regarding prevalence and lifetime risk tend to be greater using ICD-10.[9] In regard to prevalence, in a given year, about two (2%) percent of adults in the United States[21] and Europe have been suggested to have GAD.[22][23] However, the risk of developing GAD at any point in life has been estimated at 9.0%.[21] Although it is possible to experience a single episode of GAD during one's life, most people who experience GAD experience it repeatedly over the course of their lives as a chronic or ongoing condition.[9] GAD is diagnosed twice as frequently in women as in men.[24][9]

  1. ^ American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Washington: American Psychiatric Association. doi:10.1176/appi.books.9780890425596. ISBN 978-0-89042-555-8.
  2. ^ a b "Generalized Anxiety Disorder: When Worry Gets Out of Control". NIMH. Retrieved 30 May 2019.
  3. ^ DeMartini J, Patel G, Fancher TL (2 April 2019). "Generalized Anxiety Disorder". Annals of Internal Medicine. 170 (7): ITC49–ITC64. doi:10.7326/AITC201904020. PMID 30934083. S2CID 91187957.
  4. ^ Craske MG, Stein MB (24 June 2016). "Anxiety". The Lancet. 388 (10063): 3048–3059. doi:10.1016/S0140-6736(16)30381-6. PMID 27349358. S2CID 208789585.
  5. ^ Drs; Sartorius N, Henderson A, Strotzka H, Lipowski Z, Yu-cun S, You-xin X, et al. "The ICD-10 Classification of Mental and Behavioural Disorders Clinical descriptions and diagnostic guidelines" (PDF). www.who.int World Health Organization. Microsoft Word. bluebook.doc. pp. 115–6. Retrieved 23 June 2021 – via Microsoft Bing.
  6. ^ a b Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Washington, D.C.: American Psychiatric Association. 2013. p. 222. ISBN 978-0-89042-554-1.
  7. ^ a b "What Is Generalized Anxiety Disorder?", National Institute of Mental Health. Accessed 28 May 2008.
  8. ^ Torpy JM, Burke AE, Golub RM (2011). "Generalized Anxiety Disorder". JAMA. 305 (5): 522. doi:10.1001/jama.305.5.522. PMID 21285432.
  9. ^ a b c d e f g h i j k Stern TA (13 February 2015). "Anxiety Disorders (chapter 32)". Massachusetts General Hospital comprehensive clinical psychiatry. Massachusetts General Hospital (Second ed.). London: Elsevier. ISBN 978-0-323-32899-9. OCLC 905232521.
  10. ^ Spitzer RL, Kroenke K, Williams JB, Löwe B (2006). "A Brief Measure for Assessing Generalized Anxiety Disorder". Archives of Internal Medicine. 166 (10): 1092–7. doi:10.1001/archinte.166.10.1092. PMID 16717171.
  11. ^ Schalet BD, Cook KF, Choi SW, Cella D (January 2014). "Establishing a common metric for self-reported anxiety: linking the MASQ, PANAS, and GAD-7 to PROMIS Anxiety". Journal of Anxiety Disorders. 28 (1): 88–96. doi:10.1016/j.janxdis.2013.11.006. ISSN 1873-7897. PMC 4046852. PMID 24508596.
  12. ^ a b Cite error: The named reference :8 was invoked but never defined (see the help page).
  13. ^ Cite error: The named reference Strawn 1057–1070 was invoked but never defined (see the help page).
  14. ^ Cite error: The named reference :6 was invoked but never defined (see the help page).
  15. ^ Moffitt TE, Harrington H, Caspi A, Kim-Cohen J, Goldberg D, Gregory AM, et al. (2007). "Depression and Generalized Anxiety Disorder". Archives of General Psychiatry. 64 (6): 651–660. doi:10.1001/archpsyc.64.6.651. PMID 17548747.
  16. ^ a b Cite error: The named reference Etkin was invoked but never defined (see the help page).
  17. ^ Saha S, Batten TF, Henderson Z (2000-08-23). "A GABAergic projection from the central nucleus of the amygdala to the nucleus of the solitary tract: a combined anterograde tracing and electron microscopic immunohistochemical study". Neuroscience. 99 (4): 613–626. doi:10.1016/S0306-4522(00)00240-2. ISSN 0306-4522. PMID 10974425. S2CID 1926839.
  18. ^ Patel G, Fancher TL (2013-12-03). "In the clinic. Generalized anxiety disorder". Annals of Internal Medicine. 159 (11): ITC6–1, ITC6–2, ITC6-3, ITC6-4, ITC6-5, ITC6-6, ITC6-7, ITC6-8, ITC6-9, ITC6-10, ITC6-11, quiz ITC6-12. doi:10.7326/0003-4819-159-11-201312030-01006. ISSN 1539-3704. PMID 24297210. S2CID 42889106.
  19. ^ European Medicines Agency. EPAR summary for the public (Lyrica/pregabalin) EMA/229012/2010.
  20. ^ Barić H, Đorđević V, Cerovečki I, Trkulja V (March 2018). "Complementary and Alternative Medicine Treatments for Generalized Anxiety Disorder: Systematic Review and Meta-analysis of Randomized Controlled Trials". Advances in Therapy. 35 (3): 261–288. doi:10.1007/s12325-018-0680-6. ISSN 0741-238X. PMID 29508154. S2CID 3939726.
  21. ^ a b c Kessler RC, Petukhova M, Sampson NA, Zaslavsky AM, Wittchen HU (September 2012). "Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States". International Journal of Methods in Psychiatric Research. 21 (3): 169–184. doi:10.1002/mpr.1359. ISSN 1557-0657. PMC 4005415. PMID 22865617.
  22. ^ "The Numbers Count" Archived 2014-07-28 at the Wayback Machine, National Institute of Mental Health. Accessed 28 May 2007.
  23. ^ Lieb R, Becker E, Altamura C (2005). "The epidemiology of generalized anxiety disorder in Europe". European Neuropsychopharmacology. 15 (4): 445–52. doi:10.1016/j.euroneuro.2005.04.010. hdl:2066/54596. PMID 15951160. S2CID 19888900.
  24. ^ Geddes J, Price J, Gelder RM, Mayou R (2012). Psychiatry (4th ed.). Oxford: Oxford University Press. p. 287. ISBN 978-0-19-923396-0.

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