Generalized anxiety disorder: between neglect and an epidemic.
ABSTRACT This article reviews the main issues associated with the concept and the diagnosis of generalized anxiety disorder (GAD) and examines the proposed DSM-5 diagnostic criteria for GAD. The lack of specific features, which is the primary issue for GAD, will not be addressed in DSM-5. The hallmark of the condition will remain pathological worry, although it also characterizes other disorders. Likewise, the proposed behavioral diagnostic criteria lack specificity for GAD, and it is not clear how these will be assessed. The proposed changes will lower the diagnostic threshold for GAD in DSM-5. Although this will not necessarily lead to a better recognition of GAD and an improvement in the perception of its relevance and clinical utility, many currently subthreshold cases will qualify for this diagnosis. The likely inclusion of many such "false-positives" will result in an artificial increase in the prevalence of GAD and will have further negative consequences.
SourceAvailable from: Vladan StarcevicAustralian and New Zealand Journal of Psychiatry 09/2013; 47(11). DOI:10.1177/0004867413503719 · 3.77 Impact Factor
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ABSTRACT: Background Research on the neurobiological basis of Generalized Anxiety Disorder (GAD) has considerably expanded in recent years. However, many studies investigated different domains and used different methods and paradigms. Therefore, this review aims to integrate the findings to date and to identify the core correlates of neurobiological underpinnings of GAD discovered so far. Methods We conducted a systematic review of original papers investigating neural correlates, connectivity, or structural changes as well as reporting changes in the serotonergic system, noradrenergic system and cortisol levels in DSM-IV-defined GAD samples until December 2013. Results Studies have identified abnormal amygdala and prefrontal cortex activation in patients and decreased functional connectivity between these areas. Furthermore, studies showed increased gray matter volume and decreased structural connectivity between these structures. Neuroendocrine findings are less consistent, but increased reactivity of the noradrenergic system and perpetuations in the cortisol secretion have been reported. Limitations Only studies on DSM-IV defined Generalized Anxiety Disorder which employed a group comparison were included. Conclusions Current research suggests a distinct set of neurobiological alterations in Generalized Anxiety Disorder. However, future research on the interaction between these structures and systems and on the specificity of these findings in relation to other mental disorders is urgently needed.Journal of Affective Disorders 02/2014; 158:114-126. DOI:10.1016/j.jad.2014.01.022 · 3.71 Impact Factor
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ABSTRACT: Background To review the prevalence and impact of generalized anxiety disorder (GAD) below the diagnostic threshold and explore its treatment needs in times of scarce healthcare resources. Methods A systematic literature search was conducted until January 2013 using PUBMED/MEDLINE, PSYCINFO, EMBASE and reference lists to identify epidemiological studies of subthreshold GAD, i.e. GAD symptoms that do not reach the current thresholds of DSM-III-R, DSM-IV or ICD-10. Quality of all included studies was assessed and median prevalences of subthreshold GAD were calculated for different subpopulations. Results Inclusion criteria led to 15 high-quality and 3 low-quality epidemiological studies with a total of 48,214 participants being reviewed. Whilst GAD proved to be a common mental health disorder, the prevalence for subthreshold GAD was twice that for the full syndrome. Subthreshold GAD is typically persistent, causing considerably more suffering and impairment in psychosocial and work functioning, benzodiazepine and primary health care use, than in non-anxious individuals. Subthreshold GAD can also increase the risk of onset and worsen the course of a range of comorbid mental health, pain and somatic disorders; further increasing costs. Results are robust against bias due to low study quality. Conclusions Subthreshold GAD is a common, recurrent and impairing disease with verifiable morbidity that claims significant healthcare resources. As such, it should receive additional research and clinical attention.BMC Psychiatry 05/2014; 14(1):128. DOI:10.1186/1471-244X-14-128 · 2.24 Impact Factor