A family study of generalized anxiety disorder
The frequency of generalized anxiety disorder was higher among first-degree relatives of probands with generalized anxiety (N = 20) than among the relatives of control subjects (N = 20), but it was not higher among relatives of probands with panic disorder (N = 40) or agoraphobia (N = 40). Also, the frequency of panic disorder was higher among relatives of probands with panic disorder than among control relatives but was not higher among relatives of generalized anxiety probands. Relatives of probands with generalized anxiety who had the same disorder had a mild, stress-related illness. The results confirm the separation between generalized anxiety disorder and panic disorder but challenge the distinction between generalized anxiety and adjustment disorders.
Available from: Simon Davies
- "However, once it became clear that there were several different anxiety disorders related to this construct , GAD was recognized as being a separate disorder from panic disorder and phobic conditions in DSM-III in which it appeared as a residual category or diagnosis of exclusion used for anxiety presentations that lacked the discrete attacks or situational fear and avoidance typical of these other disorders (Noyes et al., 1987). Diagnostic criteria were refined in DSM-III-R moving away from the notion of a residual category to provide more specific diagnostic criteria, with notably the addition of a requirement of a six month duration, while in DSM- IV core symptom of 'excessive or unrealistic worry' was outlined, underlining a complete departure from the residual category approach of DSM-III. "
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ABSTRACT: Anxiety disorders are common, very disabling and have high personal and social costs. We aim to describe and discuss in this chapter the main phenomenological features of the five main anxiety syndromes/disorders: panic disorder, obsessive-compulsive disorder, social anxiety disorder, post-traumatic stress disorder and generalized anxiety disorder, taking the position that some of these features are shared between them – both phenomenological and aetiological. We specifically aim to focus on diagnostic criteria, prevalence and phenomenology of anxiety disorders.
Available from: Frank H. Wilhelm
- "The classification of anxiety disorders that began with DSM-III (American Psychiatric Association, 1980) postulates a number of distinct diseases presumed to have distinct biological underpinnings. For example, family studies confirm that generalized anxiety disorder (GAD) and panic disorder (PD) are separate disorders (Noyes et al., 1987; Weissman, 1990), probably with different genetic backgrounds. "
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ABSTRACT: Although DSM-IV criteria for anxiety disorders include physiological symptoms, these symptoms are evaluated exclusively by verbal report. The current review explores the background for this paradox and tries to demonstrate on theoretical and empirical grounds how it could be resolved, providing new insights about the role of psychophysiological measures in the clinic. The three-systems approach to evaluating anxiety argues that somatic measures as well as verbal and behavioral ones are indispensable. However, the low concordance between these domains of measurement impugns their reliability and validity. We argue that concordance can be improved by examining the relationship of variables less global than anxiety and by restriction to specific anxiety disorders. For example, recent evidence from our and other laboratories indicate a prominent role of self-reported and physiologically measured breathing irregularities in panic disorder. Nonetheless, even within a diagnosis, anxiety patients vary radically in which somatic variables are deviant. Thus, in clinical practice, individual profiles of psychological and physiological anxiety responses may be essential to indicate distinct therapeutic approaches and ways of tracking improvement. Laboratory provocations specific to certain anxiety disorders and advances in ambulatory monitoring vastly expand the scope of self-report and physiological measurement and will likely contribute to a refined assessment of anxiety disorders.
Available from: psychiatryonline.org
- "Later-onset panic disorder e (>20 years old) Mannuzza et al., 1994/1995 (18) DSM-III-R Panic disorder without major depressive disorder Panic disorder with major depressive disorder Fyer et al., 1995 (19) DSM-III-R Panic disorder with agoraphobia Fyer et al., 1996 (20) DSM-III-R Panic disorder with or without agoraphobia Panic disorder with social phobia Social phobia Fyer et al., 1993 (23) DSM-III-R Social phobia Stein et al., 1998 (24) DSM-IV Generalized social phobia Fyer et al., 1995 (19) DSM-III-R Social phobia Simple phobia Fyer et al., 1990 (22) DSM-III-R Simple phobia Noyes et al., 1987 (29) DSM-III and III-R Generalized anxiety disorder Mendlewicz et al., 1993 (15) DSM-III Generalized anxiety disorder a 95% confidence intervals, when available, are given in parentheses. "
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ABSTRACT: With recent advances in molecular genetics, the rate-limiting step in identifying susceptibility genes for psychiatric disorders has become phenotype definition. The success of psychiatric genetics may require the development of a "genetic nosology" that can classify individuals in terms of the heritable aspects of psychopathology. The authors' aim is to begin to apply this analysis to the anxiety disorders, focusing on panic and phobic disorders.
Two parallel traditions of defining anxiety phenotypes are reviewed: the first, more closely identified with clinical psychiatry, has identified categorical diagnoses (e.g., panic disorder and social phobia). The other, more closely identified with psychological studies of personality development, has examined dimensional traits (e.g., neuroticism) and anxious temperament (e.g., behavioral inhibition).
The authors suggest that a genetic nosology of panic and phobic disorders may incorporate features of both traditions and discuss strategies for optimizing genetic approaches to anxiety including 1) studying phenotypic extremes, 2) identifying biological trait markers, and 3) using animal models to identify candidate loci.
An important dividend from the effort to define the boundaries of heritable phenotypes for genetic studies of anxiety may be a refinement of the nosology of anxiety disorders.
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