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General anxiety disorder or generalized anxiety disorder (GAD) is an anxiety disorder that is characterized by excessive and uncontrollable worry about everyday things. The frequency, intensity, and duration of the worry are disproportionate to the actual source of worry, and such worry often interferes with daily functioning. Image File history File links Broom_icon. ... Image File history File links Information_icon. ... Shortcut: WP:-( Vandalism is indisputable bad-faith addition, deletion, or change to content, made in a deliberate attempt to compromise the integrity of the encyclopedia. ... The International Statistical Classification of Diseases and Related Health Problems (commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following codes are used with International Statistical Classification of Diseases and Related Health Problems. ... The International Statistical Classification of Diseases and Related Health Problems (commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... Anxiety disorder is a blanket term covering several different forms of abnormal, pathological anxiety, fears, phobias and nervous conditions that may come on suddenly or gradually over a period of several years, and may impair or prevent the pursuing of normal daily routines. ...

Introduction

GAD affects approximately 5% of the total population, yet is more prevalent in women and much more prevalent in youth, where 12% to 20% are affected (Achenbach, Howell, McConaughy & Stranger, 1995). People with GAD often have a variety of symptoms such as tension, skittishness, restlessness, hyperactivity, worrying, fear, and rumination. These symptoms must be consistent, persisting at least every other day and persist for at least 6 months (DSM-IV; American Psychiatric Association, 1994, as cited in Heimberg, 2004).

GAD sufferers often worry excessively over things such as their job, their finances, and the health of themselves and their family. However, GAD sufferers can also worry over more minor matters such as deadlines for appointments, keeping the house clean, and whether or not their workspace is properly organized.

Only about 30% of the causes of GAD are inherited, yet certain traits cause people to become more prone to obtaining it. People with general nervousness, depression, inability to tolerate frustration, and feelings of being inhibited are more likely to be shown in GAD patients. People with GAD tend to have more conflicts with others and are very hard on themselves, they also tend to avoid common situations for fear of worry and anxiety (Leahy, 2000 as cited in Hemiberg, 2004, pg 270). In youth GAD often leads to lower levels of social supports, academic underachievement, underemployment, substance use and high probability of obtaining other psychiatric disorders (Velting, Setzer, & Albano, 2004 as cited in Gosch, 2006, pg 247). GAD differs from other anxiety disorders in the sense that there is no clear stimulus that elicits anxiety or was associated with how it began. It also lacks the clear avoidance and escape behaviors of phobias and unlike panic attacks associated with most disorders, GAD stays fairly moderate in its anxiety levels (Deffenbacher and Suinn, 1987, pg 332).

Diagnosis

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 Generalized Anxiety Disorder. The Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, is the handbook used most often in diagnosing mental disorders in the United States and other countries. ...

1. 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).
2. The person finds it difficult to control the worry.
3. 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.
   1. restlessness or feeling keyed up or on edge
   2. being easily fatigued
   3. irritability
   4. muscle tension
   5. sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)
   6. difficulty concentrating or the mind going blank
4. 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 posttraumatic stress disorder.
5. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
6. 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.

This article does not cite its references or sources. ... Social anxiety, sometimes known as social phobia or social anxiety disorder (SAD), is a common form of anxiety disorder that causes sufferers to experience intense anxiety in some or all of the social interactions and public events of everyday life. ... Separation anxiety disorder (or simply separation anxiety) is a psychological condition in which an individual has excessive anxiety regarding separation from home or from people to whom the individual has a strong emotional attachment (like a mother). ... For the symphonic black metal band, see Anorexia Nervosa (band) Anorexia nervosa is a psychiatric diagnosis that describes an eating disorder characterised by low body weight and body image distortion with an obsessive fear of gaining weight. ... Hypochondria (sometimes hypochondriasis) is the unfounded belief that one is suffering from a serious illness. ... Posttraumatic stress disorder (PTSD), is a term for the psychological consequences of exposure to or confrontation with stressful experiences, which involve actual or threatened death, serious physical injury or a threat to physical integrity and which the person found highly traumatic. ...

Prevalence

The World Health Organization's Global Burden of Disease project did not include generalized anxiety disorders.^[1] In lieu of global statistics, here are some prevalence rates from around the world: The World Health Organization (WHO) is a specialized agency of the United Nations that acts as a coordinating authority on international public health, headquartered in Geneva, Switzerland. ...

• Australia: 3 percent of adults^[1]
• Canada: Between 3-5 percent of adults^[2]
• Italy: 2.9 percent^[3]
• Taiwan: 0.4 percent^[4]
• United States: Approximately 6.8 million American adults, or about 3.1 percent of people age 18 and over, in a given year^[5]

Potential Causes of GAD

Some research suggests that GAD may run in families, and it may also grow worse during stress. GAD usually begins at an earlier age and symptoms may manifest themselves more slowly than in most other anxiety disorders. Some people with GAD report onset in early adulthood, usually in response to a life stressor. Once GAD develops, it is chronic.

Treatment

Treatments for GAD include medications and cognitive behavioral therapy. A combination of the two has proved the most effective in alleviating symptoms; medication alone may reduce some anxiety but will not eliminate it entirely. A Cognitive Behavioral Therapy (CBT) is a psychotherapy based on modifying everyday thoughts and behaviors, with the aim of positively influencing emotions. ...

SSRIs and SNRIs are commonly used to treat GAD. Examples include SSRIs such as fluvoxamine (Luvox, Faverin), sertraline (Zoloft), paroxetine (Paxil, Seroxat), citalopram (Celexa), escitalopram (Lexapro, Cipralex) and the SNRI venlafaxine (Efexor). The antiepileptic pregabalin (Lyrica) is also used. Benzodiazepenes such as diazepam and alprazolam are sometimes used in the short-term in order to alleviate extreme cases of anxiety, but they are not safe for continuous use because of the high risk of dependency^{[citation needed]}. The anti-anxiety drug buspirone (BuSpar) is sometimes used in addition to or instead of SSRIs in the treatment of GAD. SSRI is an acronym that stands for several things: It is a class of antidepressants called selective serotonin reuptake inhibitor SSRI also is used as the stock symbol for Silver Standard Resources Inc. ... Serotonin norepinephrine reuptake inhibitors (SNRIs) are a class of antidepressant used in the treatment of clinical depression and other affective disorders. ... Fluvoxamine (brand name as Luvox®, Faverin®, Fevarin® and Dumyrox®) is an antidepressant which functions pharmacologically as a selective serotonin reuptake inhibitor. ... Sertraline hydrochloride (also labeled under numerous brand names: Zoloft, Sertralin, Lustral, Apo-Sertral, Asentra, Gladem, Serlift, Stimuloton, Xydep, Serlain, Concorz) is a popular orally administered antidepressant of the selective serotonin reuptake inhibitor (SSRI) type. ... Paroxetine or paroxetine hydrochloride is a selective serotonin reuptake inhibitor (SSRI) antidepressant. ... Citalopram is an antidepressant drug used to treat depression associated with mood disorders. ... This article or section does not cite its references or sources. ... Venlafaxine hydrochloride is a prescription antidepressant first introduced by Wyeth in 1993. ... Pregabalin (brand name: Lyrica®) is a new anticonvulsant drug indicated as an add on therapy for partial onset seizures and for certain types of neuropathic pain. ... alprazolam 2mg tablets The benzodiazepines are a class of drugs with sedative, hypnotic, anxiolytic, anticonvulsant, amnestic and muscle relaxant properties. ... Diazepam (IPA: ), marketed under brand names Valium®, Stesolid, Diazemuls, Seduxen, Bosaurin, Diapam, Antenex and Apozepam)[1] is a drug which is a benzodiazepine derivative. ... Alprazolam is a short-acting drug in the benzodiazepine class used to treat anxiety disorders and as an adjunctive treatment for depression. ... Buspirone (brand-names Ansial®, Ansiced®, Anxiron®, Axoren®, Bespar®, BuSpar®, Buspimen®, Buspinol®, Buspisal®, Narol®) is an anxiolytic agent and a serotonin receptor agonist belonging to the azaspirodecanedione class of compounds. ...

SSRIs and SNRIs are generally considered the most effective treatment because both anxiety and depression are thought to be associated with the neurotransmitter serotonin; thus a great deal of people who experience depression also experience anxiety symptoms (there is, however, no scientific proof of this). When both disorders are diagnosed, this is called comorbidity. Other antidepressant drugs such as tricyclics and MAO inhibitors are not used in the treatment of GAD. Chemical structure of D-Aspartic Acid, a common Amino Acid neurotransmitter. ... Serotonin (5-hydroxytryptamine, or 5-HT) is a monoamine neurotransmitter synthesized in serotonergic neurons in the central nervous system (CNS) and enterochromaffin cells in the gastrointestinal tract. ... In medicine and in psychiatry, comorbidity is either The presence of one or more disorders (or diseases) in addition to a primary disease or disorder; or The effect of such additional disorders or diseases. ... Chemical structure of the tricyclic antidepressant amitriptyline Tricyclic antidepressants are a class of antidepressant drugs first used in the 1950s. ... Monoamine oxidase inhibitors (MAOIs) are a class of antidepressant drugs prescribed for the treatment of depression. ...

GAD and Comorbid Depression

In the National Comorbidity Survey (2005), 58% of patients diagnosed with 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. Clinical depression (also called major depressive disorder, or sometimes unipolar when compared with bipolar disorder) is a state of intense sadness, melancholia or despair that has advanced to the point of being disruptive to an individuals social functioning and/or activities of daily living. ... Panic disorder (also known as cardiac neurosis or neurosis cordis) is a mental condition that causes the sufferer to experience sporadic panic attacks. ... Social anxiety, sometimes known as social phobia or social anxiety disorder (SAD), is a common form of anxiety disorder that causes sufferers to experience intense anxiety in some or all of the social interactions and public events of everyday life. ... Agoraphobia is an anxiety disorder which primarily consists of the fear of experiencing a difficult or embarrassing situation from which the sufferer cannot escape. ...

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.^{[citation needed]}

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.^{[citation needed]} In addition, social function and quality of life are more greatly impaired.

In addition to coexisting with depression, research shows that GAD often coexists with substance abuse or other conditions associated with stress, such as irritable bowel syndrome. Patients with physical symptoms such as insomnia or headaches 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. Substance abuse refers to the overindulgence in and dependence on a psychoactive leading to effects that are detrimental to the individuals physical health or mental health, or the welfare of others. ... In medical terms, stress is a physical or psychological stimulus that can produce mental or physiological reactions that may lead to illness. ... Insomnia is characterized by an inability to sleep and/or inability to remain asleep for a reasonable period. ... A headache is a condition of pain in the head; sometimes neck or upper back pain may also be interpreted as a headache. ...

Controversy

The loose diagnostic criteria advanced by the DSM-IV makes it very easy for practitioners diagnose a patient with GAD. Assessment of the incidence and prevalence of GAD is difficult, because a large proportion of people with GAD have a comorbid diagnosis, either physical or mental. The diagnosis of GAD can be challenging because the difference between normal anxiety and GAD is not always distinct.^[6]Furthermore the diagnostic criteria - restlessness, fatigue, difficulty concentrating, irritability, muscle tension or sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep) - are common factors of human life, otherwise known as normal anxiety. Without the evidence of the patient showing increased motor tension, autonomic hyperactivity (shortness of breath, rapid heart rate, dry mouth, cold hands, and dizziness) but not panic attacks; and increased vigilance and scanning (feeling keyed up, increased startling, impaired concentration), anxiety is not necessarily indicative of an anxiety disorder. Anatomy and Physiology of the A.N.S. In contrast to the voluntary nervous system, the involuntary or autonomic nervous system is responsible for homeostasis, maintaining a relatively constant internal environment by controlling such involuntary functions as digestion, respiration, and metabolism, and by modulating energy needed to cope with stressful...

The implementation of drugs over cognitive behavioral therapy (CBT) for GAD is a source of consternation in the medical community as well. While pharmacological treatments have been successfully used to treat GAD, cognitive behavioral therapy has been shown in many clinical trials to be just as efficient and effective without the side effects or risks involved in taking pharmacological enhancers. While CBT has been proven to be effective in treating GAD, pyschostimulants are still prescribed on the hypothesis that there is a neurotransmitter pathophysiology deficiency in the patient, which has yet to be unequivocally proven. A Cognitive Behavioral Therapy (CBT) is a psychotherapy based on modifying everyday thoughts and behaviors, with the aim of positively influencing emotions. ... Pathophysiology is the study of the disturbance of normal mechanical, physical, and biochemical functions that a disease causes. ...

See also

• Social anxiety disorder
• Clinical depression

Social anxiety, sometimes known as social phobia or social anxiety disorder (SAD), is a common form of anxiety disorder that causes sufferers to experience intense anxiety in some or all of the social interactions and public events of everyday life. ... Clinical depression (also called major depressive disorder, or sometimes unipolar when compared with bipolar disorder) is a state of intense sadness, melancholia or despair that has advanced to the point of being disruptive to an individuals social functioning and/or activities of daily living. ...

References

1. ^ ^{a b} http://www.who.int/bulletin/pdf/2000/issue4/bu00-0485.pdf WHO
2. ^ http://www.canmat.org/resources/depression/gad.html
3. ^ http://www.emedicine.com/med/byname/anxiety-disorders.htm
4. ^ http://www.emedicine.com/med/byname/anxiety-disorders.htm
5. ^ [1] NIMH: The Numbers Count
6. ^ Hoehn-Saire R, McLeod DR. Clinical management of generalized anxiety disorder. In: the clinical management of anxiety disorders. Coryell W, Winokur G, eds. New York: Oxford University Press, 1991: 79-100.

External links

• (US) National Institute of Mental Health - Information on generalized anxiety disorder
• Stress and Anxiety Clinical Research Unit at the University of Ottawa Institute of Mental Health Research http://www.rohcg.on.ca/roh-internet/webpage.cfm?site_id=1&org_id=1&morg_id=0&gsec_id=197&parent_item_id=237&item_id=1331

National Institute of Mental Health

• http://www.nimh.nih.gov/publicat/anxiety.cfm#anx7
• UCLA Anxiety Disorders Program Research

Note

(1) Barlow, D. H., & Durand, V. M. (2005). Abnormal psychology: An integrative approach. Australia; Belmont, CA: Wadsworth.