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Dialogues in Clinical Neuroscience Jun 2017Generalized anxiety disorder (GAD) is a prevalent and highly disabling mental health condition; however, there is still much to learn with regard to pertinent... (Review)
Review
Generalized anxiety disorder (GAD) is a prevalent and highly disabling mental health condition; however, there is still much to learn with regard to pertinent biomarkers, as well as diagnosis, made more difficult by the marked and common overlap of GAD with affective and anxiety disorders. Recently, intensive research efforts have focused on GAD, applying neuroimaging, genetic, and blood-based approaches toward discovery of pathogenetic and treatment-related biomarkers. In this paper, we review the large amount of available data, and we focus in particular on evidence from neuroimaging, genetic, and neurochemical measurements in GAD in order to better understand potential biomarkers involved in its etiology and treatment. Overall, the majority of these studies have produced results that are solitary findings, sometimes inconsistent and not clearly replicable. For these reasons, they have not yet been translated into clinical practice. Therefore, further research efforts are needed to distinguish GAD from other mental disorders and to provide new biological insights into its pathogenesis and treatment.
Topics: Anxiety Disorders; Biomarkers; Diagnosis, Differential; Humans; Mental Disorders; Neuroimaging; Prevalence
PubMed: 28867939
DOI: 10.31887/DCNS.2017.19.2/dnutt -
Lancet (London, England) Dec 2006Generalised anxiety disorder is a persistent and common disorder, in which the patient has unfocused worry and anxiety that is not connected to recent stressful events,... (Review)
Review
Generalised anxiety disorder is a persistent and common disorder, in which the patient has unfocused worry and anxiety that is not connected to recent stressful events, although it can be aggravated by certain situations. This disorder is twice as common in women than it is in men. Generalised anxiety disorder is characterised by feelings of threat, restlessness, irritability, sleep disturbance, and tension, and symptoms such as palpitations, dry mouth, and sweating. These symptoms are recognised as part of the anxiety syndrome rather than independent complaints. The symptoms overlap greatly with those of other common mental disorders and we could regard the disorder as part of a spectrum of mood and related disorders rather than an independent disorder. Generalised anxiety disorder has a relapsing course, and intervention rarely results in complete resolution of symptoms, but in the short term and medium term, effective treatments include psychological therapies, such as cognitive behavioural therapy; self-help approaches based on cognitive behavioural therapy principles; and pharmacological treatments, mainly selective serotonin reuptake inhibitors.
Topics: Anti-Anxiety Agents; Anxiety Disorders; Chronic Disease; Cognitive Behavioral Therapy; Comorbidity; Female; Humans; Male; Prevalence
PubMed: 17174708
DOI: 10.1016/S0140-6736(06)69865-6 -
American Family Physician May 2015Generalized anxiety disorder (GAD) and panic disorder (PD) are among the most common mental disorders in the United States, and they can negatively impact a patient's... (Review)
Review
Generalized anxiety disorder (GAD) and panic disorder (PD) are among the most common mental disorders in the United States, and they can negatively impact a patient's quality of life and disrupt important activities of daily living. Evidence suggests that the rates of missed diagnoses and misdiagnosis of GAD and PD are high, with symptoms often ascribed to physical causes. Diagnosing GAD and PD requires a broad differential and caution to identify confounding variables and comorbid conditions. Screening and monitoring tools can be used to help make the diagnosis and monitor response to therapy. The GAD-7 and the Severity Measure for Panic Disorder are free diagnostic tools. Successful outcomes may require a combination of treatment modalities tailored to the individual patient. Treatment often includes medications such as selective serotonin reuptake inhibitors and/or psychotherapy, both of which are highly effective. Among psychotherapeutic treatments, cognitive behavior therapy has been studied widely and has an extensive evidence base. Benzodiazepines are effective in reducing anxiety symptoms, but their use is limited by risk of abuse and adverse effect profiles. Physical activity can reduce symptoms of GAD and PD. A number of complementary and alternative treatments are often used; however, evidence is limited for most. Several common botanicals and supplements can potentiate serotonin syndrome when used in combination with antidepressants. Medication should be continued for 12 months before tapering to prevent relapse.
Topics: Adult; Anti-Anxiety Agents; Antidepressive Agents; Anxiety Disorders; Comorbidity; Diagnosis, Differential; Dietary Supplements; Humans; Life Style; Panic Disorder; Patient Education as Topic; Phytotherapy; Prevalence; Psychiatric Status Rating Scales; Psychotherapy; Referral and Consultation; Relaxation Therapy; Selective Serotonin Reuptake Inhibitors; Severity of Illness Index
PubMed: 25955736
DOI: No ID Found -
The Psychiatric Quarterly Sep 2020Generalized Anxiety Disorder (GAD) from an official recognition as a residual category in DSM-III has come a long way to be appreciated as a common underlying anxiety...
Generalized Anxiety Disorder (GAD) from an official recognition as a residual category in DSM-III has come a long way to be appreciated as a common underlying anxiety pathway in the literature. Despite still being defined as extreme anxiety and worry upon performance and about one's health, GAD seems to be a general umbrella of anxiety, covering even social anxiety and panic disorder (PD) and even when not treated and chronic, leading to major depressive disorder (MDD). Along the line of some other similar studies and contentions, in the present study we sought to validate the hypothesis of GAD encompassing social anxiety as well as performance anxiety and its extension to PD and MDD. We also examined the onset of each diagnostic category of GAD, PD and MDD and their developmental course in our clinical sample. 113 patients with Generalized Anxiety Disorder (GAD) out of 295 referrals to our mood and anxiety clinic during the three months of May-July 2019, were identified and included in this research. We expanded the definition of GAD as per our clinical observation to include any situations triggering the anxiety including any performance and social situations and did not exclude if the anxiety led to panic attacks. The results of our study showed that an encompassing GAD (including performance and social anxiety) has an early onset, recognized partially in childhood, but mostly during adolescence. An untreated GAD was complicated with panic disorder and episodes of major depression, each with an onset later in life. GAD in our study was also found to be familial and genetic, while its post-morbid depression seemed to be more a reaction to a long-standing untreated anxiety. The findings of our study if replicated has research implication of better understanding the developmental course of mood disorders and hold the promise of more targeted treatments of anxiety, panic and depression in clinical practice.
Topics: Adult; Age of Onset; Anxiety Disorders; Comorbidity; Depressive Disorder, Major; Humans; Panic Disorder; Phobia, Social
PubMed: 32383134
DOI: 10.1007/s11126-020-09747-0 -
Der Nervenarzt May 2021In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) separation anxiety disorder has been included in the chapter on anxiety... (Review)
Review
In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) separation anxiety disorder has been included in the chapter on anxiety disorders, thereby removing the age of onset restriction that previously required first onset during childhood or adolescence. Separation anxiety disorder has a lifetime prevalence of 4.8% and onset often occurs after the age of 18 years. Despite the high prevalence, separation anxiety disorder is often underdiagnosed and subsequently remains untreated. This narrative review summarizes the etiology, clinical features, diagnostic criteria as well as important differential diagnostic aspects, common comorbidity profiles and treatment implications of separation anxiety disorder. Furthermore, relevant implications for everyday practice and future perspectives for treatment and research are discussed.
Topics: Adolescent; Anxiety Disorders; Anxiety, Separation; Child; Comorbidity; Diagnostic and Statistical Manual of Mental Disorders; Humans; Prevalence
PubMed: 33319254
DOI: 10.1007/s00115-020-01037-1 -
Advances in Therapy Sep 2021
Topics: Anxiety Disorders; Depression; Depressive Disorder, Major; Humans
PubMed: 34417991
DOI: 10.1007/s12325-021-01859-8 -
Lancet (London, England) Mar 2008Our understanding of social anxiety disorder (also known as social phobia) has moved from rudimentary awareness that it is not merely shyness to a much more... (Review)
Review
Our understanding of social anxiety disorder (also known as social phobia) has moved from rudimentary awareness that it is not merely shyness to a much more sophisticated appreciation of its prevalence, its chronic and pernicious nature, and its neurobiological underpinnings. Social anxiety disorder is the most common anxiety disorder; it has an early age of onset--by age 11 years in about 50% and by age 20 years in about 80% of individuals--and it is a risk factor for subsequent depressive illness and substance abuse. Functional neuroimaging studies point to increased activity in amygdala and insula in patients with social anxiety disorder, and genetic studies are increasingly focusing on this and other (eg, personality trait neuroticism) core phenotypes to identify risk loci. A range of effective cognitive behavioural and pharmacological treatments for children and adults now exists; the challenges lie in optimum integration and dissemination of these treatments, and learning how to help the 30-40% of patients for whom treatment does not work.
Topics: Anti-Anxiety Agents; Anxiety Disorders; Diagnosis, Differential; Diagnostic Imaging; Humans; Phobic Disorders; Prevalence; Psychiatric Status Rating Scales; Psychotherapy; Selective Serotonin Reuptake Inhibitors
PubMed: 18374843
DOI: 10.1016/S0140-6736(08)60488-2 -
American Family Physician Aug 2022Generalized anxiety disorder (GAD) and panic disorder (PD) are common mental health conditions in adults that are often seen in primary care. Although there is...
Generalized anxiety disorder (GAD) and panic disorder (PD) are common mental health conditions in adults that are often seen in primary care. Although there is insufficient evidence to support universal screening for PD and GAD, evaluation should be considered in patients who express recurrent, pervasive worry or present with somatic symptoms not attributed to underlying medical conditions. The GAD-7 and Patient Health Questionnaire for PD are validated screening tools that can aid in diagnosis and assessment. Anxiety disorders often present with substance use disorders, which should be treated concurrently. Effective therapies for PD and GAD include cognitive behavior therapy and anti-depressants, including selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors. Benzodiazepines are not recommended for first-line therapy or long-term use because of adverse reactions, risk of dependence, and higher mortality. No consistent evidence currently supports a specific prevention strategy for PD or GAD, but exercise may be beneficial.
Topics: Adult; Anxiety Disorders; Benzodiazepines; Cognitive Behavioral Therapy; Humans; Panic Disorder; Selective Serotonin Reuptake Inhibitors
PubMed: 35977134
DOI: No ID Found -
Journal of Anxiety Disorders Dec 2009Theoretical conceptualizations of generalized anxiety disorder (GAD) continue to undergo scrutiny and refinement. The current paper critiques five contemporary models of... (Review)
Review
Theoretical conceptualizations of generalized anxiety disorder (GAD) continue to undergo scrutiny and refinement. The current paper critiques five contemporary models of GAD: the Avoidance Model of Worry and GAD [Borkovec, T. D. (1994). The nature, functions, and origins of worry. In: G. Davey & F. Tallis (Eds.), Worrying: perspectives on theory assessment and treatment (pp. 5-33). Sussex, England: Wiley & Sons; Borkovec, T. D., Alcaine, O. M., & Behar, E. (2004). Avoidance theory of worry and generalized anxiety disorder. In: R. Heimberg, C. Turk, & D. Mennin (Eds.), Generalized anxiety disorder: advances in research and practice (pp. 77-108). New York, NY, US: Guilford Press]; the Intolerance of Uncertainty Model [Dugas, M. J., Letarte, H., Rheaume, J., Freeston, M. H., & Ladouceur, R. (1995). Worry and problem solving: evidence of a specific relationship. Cognitive Therapy and Research, 19, 109-120; Freeston, M. H., Rheaume, J., Letarte, H., Dugas, M. J., & Ladouceur, R. (1994). Why do people worry? Personality and Individual Differences, 17, 791-802]; the Metacognitive Model [Wells, A. (1995). Meta-cognition and worry: a cognitive model of generalized anxiety disorder. Behavioural and Cognitive Psychotherapy, 23, 301-320]; the Emotion Dysregulation Model [Mennin, D. S., Heimberg, R. G., Turk, C. L., & Fresco, D. M. (2002). Applying an emotion regulation framework to integrative approaches to generalized anxiety disorder. Clinical Psychology: Science and Practice, 9, 85-90]; and the Acceptance-based Model of GAD [Roemer, L., & Orsillo, S. M. (2002). Expanding our conceptualization of and treatment for generalized anxiety disorder: integrating mindfulness/acceptance-based approaches with existing cognitive behavioral models. Clinical Psychology: Science and Practice, 9, 54-68]. Evidence in support of each model is critically reviewed, and each model's corresponding evidence-based therapeutic interventions are discussed. Generally speaking, the models share an emphasis on avoidance of internal affective experiences (i.e., thoughts, beliefs, and emotions). The models cluster into three types: cognitive models (i.e., IUM, MCM), emotional/experiential (i.e., EDM, ABM), and an integrated model (AMW). This clustering offers directions for future research and new treatment strategies.
Topics: Adaptation, Psychological; Anxiety Disorders; Avoidance Learning; Cognitive Behavioral Therapy; Emotions; Humans; Models, Psychological; Problem Solving; Psychological Theory; Uncertainty
PubMed: 19700258
DOI: 10.1016/j.janxdis.2009.07.006 -
Psychiatria Polska Aug 2019Due to the co-occurrence of symptoms of anxiety disorders and obsessive-compulsive disorders, and the hypothesis about common etiopathological factors, we performed a... (Comparative Study)
Comparative Study
OBJECTIVES
Due to the co-occurrence of symptoms of anxiety disorders and obsessive-compulsive disorders, and the hypothesis about common etiopathological factors, we performed a research addressing the occurrence and severity of anxiety symptoms, the severity of groups of neurotic symptoms, and conducted factor analyses in two groups of patients: diagnosed with obsessive compulsive disorder (OCD) and with generalized anxiety disorder (GAD).
MATERIAL AND METHODS
A retrospective study was conducted on two groups of patients: 76 - diagnosed with OCD, and 186 - diagnosed with GAD. The source of information about the presence and severity of symptoms was the Symptom Checklist "O" (KO"O"). The impact of sex and the presence or absence of cognitive impairments (Bender's and Benton's tests) on the investigated associations were accounted for.
RESULTS
No significant differences in the severity of most anxiety symptoms were found between the groups of patients diagnosed with OCD or GAD. Patients with GAD were characterized by a significantly higher intensity of phobic disorders, conversion disorders, cardiac autonomic dysfunctions, and hypochondria, when compared to patients with OCD. Factor analyses identified the existence of three similar factors in the OCD and the GAD groups: 'anxiety/depressiveness', 'obsessions' and 'compulsions'. Additional factors were, among others, 'depressiveness' in OCD and separation anxiety in GAD.
CONCLUSIONS
The research indicates that anxiety plays a significant role in the clinical picture of OCD and may reach a severity similar to that observed in GAD. The presence and severity of anxiety and somatization symptoms can be associated with the presence of cognitive impairments, which requires further investigation.
Topics: Adult; Anxiety; Anxiety Disorders; Female; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Psychiatric Status Rating Scales; Retrospective Studies; Severity of Illness Index
PubMed: 31760413
DOI: 10.12740/PP/105378