Overview of generalized anxiety disorder: Epidemiology, presentation, and course

Brown University, Box G-BH, Duncan Building, Providence, RI 02912, USA.
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 02/2009; 70 Suppl 2(Suppl 2):4-9. DOI: 10.4088/JCP.s.7002.01
Source: PubMed


Generalized anxiety disorder (GAD) was defined relatively recently, and the diagnostic criteria are still being refined. The essential feature of the disorder has changed from persistent anxiety to excessive worry, and the required symptom duration has changed from 1 month to 6 months. Additionally, exclusion criteria involving permissibility of the diagnosis in children and wording regarding the relationship of GAD with mood disorders have changed. Nosologic controversies still surround the criteria for excessive worry, symptom duration, the relationship between GAD and major depressive disorder, and the required number of associated symptoms. Alterations in the criteria have been suggested, but more research is needed on the validity of these proposed changes. Generalized anxiety disorder appears to be highly prevalent. In the United States, the lifetime prevalence of DSM-IV GAD is estimated to be about 5% and the current prevalence to be about 2% to 3%. The disorder is differentially prevalent across gender and ethnic and social groups. The course of GAD is chronic and can be exacerbated by poor family relationships, comorbid cluster C personality disorders, and comorbid Axis I disorders. Impairment and suicidal ideation are associated with GAD.

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    • "2005). GAD is a chronic and highly recurrent disease that is associated with significant impairments in quality of life and an increased risk of suicidality (Weisberg, 2009). GAD is frequently comorbid with other psychiatric disorders (Wittchen et al., 1994; Alonso et al., 2004), particularly major depressive disorder (MDD), which is present in two-thirds of patients with GAD at any time in their lives (Judd et al., 1998). "
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    ABSTRACT: To evaluate the effectiveness of pregabalin in patients with resistant generalized anxiety disorder (GAD) and severe depressive symptoms, we carried out a post-hoc analysis of a multicenter, prospective, and observational 6-month study. We included patients who were at least 18 years old, fulfilled the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) criteria for GAD, showed inadequate responses to previous courses of antidepressant treatment, had Montgomery-Asberg Rating Scale scores of at least 35, had not received pregabalin previously, and were prescribed pregabalin upon entry into this study. We included 1815 patients fulfilling the DSM-IV criteria for GAD, and 133 (7.3%) fulfilled the selection criteria for these analyses. Ninety-seven percent of the patients received pregabalin (mean dose: 222 mg/day) in combination with other psychotropics. The Hamilton Anxiety Scale total score was reduced by a mean of 20.3 points (95% confidence interval, 22.1-18.4) (57.2% reduction) at month 6. Pregabalin also ameliorated comorbid depressive symptoms, with a reduction in the mean score of the Montgomery-Asberg Rating Scale of 22.3 points (95% confidence interval, 24.2-20.4) (56.6% reduction). Our results suggest that pregabalin, as part of a combination regimen with antidepressants and/or benzodiazepines, might be effective for the treatment of patients with GAD who have shown inadequate response to previous antidepressants and have severe depressive symptoms.
    International clinical psychopharmacology 06/2015; 30(5). DOI:10.1097/YIC.0000000000000087 · 2.46 Impact Factor
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    • "A person with mild GAD can manage to keep a career and a social life, however, severe GAD can lead to failure at work and an avoidance of social situations. Women are at a greater risk for GAD than are men and a diagnosis of GAD is made when an individual three or more of the above symptoms almost daily for six consecutive months [10,11]. Panic disorder is sudden attacks of fear and a sense of impending doom. "
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    ABSTRACT: Drugs used to treat anxiety have many negative side effects including addiction, depression, suicide, seizures, sexual dysfunction, headaches and more. Anxiolytic medications do not restore normal levels of neurotransmitters but instead manipulate the brain chemistry. For example, selective serotonin reuptake inhibitors (SSRIs) prevent the reuptake of serotonin from the synapse allowing serotonin to remain in the area of activity for a longer period of time but does not correct the lack of serotonin production. Benzodiazepines, such as Valium and Xanax®, stimulate GABA receptors, thus mimicking the calming effects of GABA but again do not fix the lack of GABA production. Often, the brain becomes accustomed to these medications and they often lose their effectiveness, requiring higher doses or different drugs. In contrast to anxiolytic drugs, there are herbs and nutrients which can stimulates neurotransmitter synthesis and more naturally effect and even adjust brain chemistry in the absence of many of the side effects experienced with drugs. Therefore this paper explores several herbal and nutritional approaches to the treatment of anxiety.
    Medical science monitor: international medical journal of experimental and clinical research 04/2012; 18(4):RA40-8. DOI:10.12659/MSM.882608 · 1.43 Impact Factor
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    • "Anxiety in the 21 st century human society represents a large unmet medical need (Weisberg, 2009). Despite concerted efforts and numerous pharmaceutical and other therapeutic applications, a large number of patients still suffer from anxiety related problems. "
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    ABSTRACT: Zebrafish has been gaining popularity in behavioral genetics and behavioral neuroscience as this species offers an excellent compromise between system complexity and practical simplicity for mechanistic analyses of brain and behavior function. Recently, a number of studies started to investigate methods with which fear responses may be induced reliably in zebrafish. The ultimate goal of these studies has been to develop zebrafish models of pathological processes and to investigate the mechanisms of fear and to eventually translate the findings to the human clinic. Previously, animated image of a sympatric predator of zebrafish was shown to induce fear responses. Here we expand on this recently gained knowledge and investigate whether other moving images may induce more robust fear responses. The images investigated include the original sympatric predator, the Indian leaf fish, another sympatric predator, the needle fish, a bird silhouette moved on the side or above the tank, an expanding dot mimicking rapid approach of an object shown on the side and from above the tank, as well as non-fear inducing images including a single and a group of zebrafish. Our results indicate that although the sympatric predators do induce some fear responses, the other images, particularly the expanding dot but also the bird silhouette shown from above are more effective. The results also reveal a stimulus dependent motor pattern response repertoire of zebrafish demonstrating that perhaps univariate quantification methods may not be appropriate for uncovering the complexity of fear or anxiety related phenotypical changes in this species.
    Behavioural brain research 09/2011; 226(1):66-76. DOI:10.1016/j.bbr.2011.09.001 · 3.03 Impact Factor
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