Generalized Anxiety Disorder

University of Sydney, Sydney Medical School-Nepean, Discipline of Psychiatry, Sydney, NSW, Australia.
The Journal of nervous and mental disease (Impact Factor: 1.69). 08/2012; 200(8):664-7. DOI: 10.1097/NMD.0b013e318263f947
Source: PubMed


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.

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Available from: Vladan Starcevic
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    • "Evidence is needed to show whether the pharmacological and counseling strategies used to treat threshold mental health conditions also benefit subthreshold ones, if they are to be prescribed [72-74]. To save healthcare resources, studies propose stepwise treatment algorithms of increasingly intensive interventions for subthreshold conditions; starting with ‘watchful waiting’ and self-help strategies (life-style changes, appropriate self-medication); working through to primary care and specialist care when symptoms persist or increase [73]. "
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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.
    Full-text · Article · May 2014 · BMC Psychiatry
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    • "This approach to some disorders has been adopted by the architects of DSM-5, most notably generalized anxiety disorder (Starcevic et al., 2012). Within this framework, the diagnostic concept is not questioned and there is little or no consideration as to how it can be improved. "

    Full-text · Article · Feb 2013 · Australian and New Zealand Journal of Psychiatry
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    Full-text · Dataset · Feb 2013
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