Generalized anxiety disorder: A 40-year follow-up study
Department of Psychiatry, Complutense University of Madrid, Madrid, Madrid, Spain Acta Psychiatrica Scandinavica
(Impact Factor: 5.61).
06/2007; 115(5):372-9. DOI: 10.1111/j.1600-0447.2006.00896.x
There is insufficient knowledge of the long-term course of generalized anxiety disorder (GAD). We studied the course of this disorder in patients who were followed up for 40 years.
Patients admitted with the diagnosis of anxiety states ('anxious thymopathy' ) to the Lopez Ibor Neuropsychiatric Research Institute between 1950 and 1961 were examined between 1984 and 1988 (n = 65). The retrospective diagnosis of GAD was made according to DSM-III-R criteria during 1984-1988 (first examination). A re-examination was performed by the same psychiatrist in the period 1997-2001 (n = 59; second examination).
At first and second examinations 20% and 17% of subjects were diagnosed as GAD. Improvement was observed in 83%. GAD tended to disappear around age 50, but was replaced by somatization disorders. Lack of regular treatment compliance, female sex, and onset of GAD before age 25 were variables associated with a worse outcome. Undifferentiated somatization disorder was the most prevalent clinical status at follow-up.
After several decades, participants improve with regard to GAD, although most continue to present somatizations.
Available from: Jozien M Bensing
- "Although clinical severity and treatment adequacy play a role in symptomatic improvement and full recovery from a depressive episode, recovery also seems to be influenced by social support, education level, age, (un)employment and non-depressive psychopathology [25-29]. For anxiety disorders, a good outcome was predicted by mild symptoms, high education level and being employed, as well as male gender and later onset [25,30,31], while comorbidity with major depression worsened clinical outcomes in a 12-year study . "
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ABSTRACT: There is little evidence as to whether or not guideline concordant care in general practice results in better clinical outcomes for people with anxiety and depression. This study aims to determine possible associations between guideline concordant care and clinical outcomes in general practice patients with depression and anxiety, and identify patient and treatment characteristics associated with clinical improvement.
This study forms part of the Netherlands Study of Depression and Anxiety (NESDA).Adult patients, recruited in general practice (67 GPs), were interviewed to assess DSM-IV diagnoses during baseline assessment of NESDA, and also completed questionnaires measuring symptom severity, received care, socio-demographic variables and social support both at baseline and 12 months later. The definition of guideline adherence was based on an algorithm on care received. Information on guideline adherence was obtained from GP medical records.
721 patients with a current (6-month recency) anxiety or depressive disorder participated. While patients who received guideline concordant care (N=281) suffered from more severe symptoms than patients who received non-guideline concordant care (N=440), both groups showed equal improvement in their depressive or anxiety symptoms after 12 months. Patients who (still) had moderate or severe symptoms at follow-up, were more often unemployed, had smaller personal networks and more severe depressive symptoms at baseline than patients with mild symptoms at follow-up. The particular type of treatment followed made no difference to clinical outcomes.
The added value of guideline concordant care could not be demonstrated in this study. Symptom severity, employment status, social support and comorbidity of anxiety and depression all play a role in poor clinical outcomes.
Available from: Kamila White
- "We measured symptomatic improvement and remission during the augmentation phase, and maintenance of improvement and relapse rate during the maintenance phase, using the Ham-A and the Penn State Worry Questionnaire (PSWQ (Meyer et al., 1990)). We examined two definitions of remission: Ham-A score of 8 or less, and PSWQ score of 40 or less, based on data from studies in geriatric GAD patients and normal older controls (Hamilton, 1959; Association, 2000; Diefenbach et al., 2001; Schoevers et al., 2003; Sinoff and Werner, 2003; Hollon et al., 2005; Schuurmans et al., 2006; Rubio and Lopez- Ibor, 2007). "
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ABSTRACT: Generalized anxiety disorder (GAD) is a prevalent psychiatric condition in older adults with deleterious effects on health and cognition. Although selective serotonin reuptake inhibitor (SSRI) medications have some efficacy as acute treatments for geriatric GAD, incomplete response is the most common outcome of monotherapy. We therefore developed a novel sequential treatment strategy, using personalized, modular cognitive-behavioral therapy (mCBT) to augment SSRI medication.
In an open label pilot study (N = 10), subjects received a sequenced trial of 12 weeks of escitalopram followed by 16 weeks of escitalopram augmented with mCBT. We also examined the maintenance effects of mCBT over a 28-week follow-up period following drug discontinuation and termination of psychotherapy.
Results suggest that (1) adding mCBT to escitalopram significantly reduced anxiety symptoms and pathological worry, resulting in full remission for most patients and (2) some patients maintained response after all treatments were withdrawn.
Findings suggest that mCBT may be an effective augmentation strategy when added to SSRI medication and provide limited support for the long-term benefit of mCBT after discontinuation of pharmacotherapy.
Available from: Vladan Starcevic
- "The anxiety disorders tend to disappear in the fifth decade ( Bandelow 2003 ; Kessler et al . 2005a ; Rubio and Lopez - Ibor 2007a , b ) . Patients with anxiety disorders are frequent users of emergency medical services ( Klerman et al . "
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ABSTRACT: In this report, which is an update of a guideline published in 2002 (Bandelow et al. 2002, World J Biol Psychiatry 3:171), recommendations for the pharmacological treatment of anxiety disorder, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) are presented. Since the publication of the first version of this guideline, a substantial number of new randomized controlled studies of anxiolytics have been published. In particular, more relapse prevention studies are now available that show sustained efficacy of anxiolytic drugs. The recommendations, developed by the World Federation of Societies of Biological Psychiatry (WFSBP) Task Force for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-traumatic Stress Disorders, a consensus panel of 30 international experts, are now based on 510 published randomized, placebo- or comparator-controlled clinical studies (RCTs) and 130 open studies and case reports. First-line treatments for these disorders are selective serotonin reuptake inhibitors (SSRIs), serotonin-noradrenaline reuptake inhibitors (SNRIs) and the calcium channel modulator pregabalin. Tricyclic antidepressants (TCAs) are equally effective for some disorders, but many are less well tolerated than the SSRIs/SNRIs. In treatment-resistant cases, benzodiazepines may be used when the patient does not have a history of substance abuse disorders. Potential treatment options for patients unresponsive to standard treatments are described in this overview. Although these guidelines focus on medications, non-pharmacological were also considered. Cognitive behavioural therapy (CBT) and other variants of behaviour therapy have been sufficiently investigated in controlled studies in patients with anxiety disorders, OCD, and PTSD to support them being recommended either alone or in combination with the above medicines.
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