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Journal of Anxiety Disorders Oct 2016Although cognitive and behavioral therapies are effective in the treatment of anxiety disorders, it is not clear what the relative effects of these treatments are. We... (Meta-Analysis)
Meta-Analysis Review
Although cognitive and behavioral therapies are effective in the treatment of anxiety disorders, it is not clear what the relative effects of these treatments are. We conducted a meta-analysis of trials comparing cognitive and behavioral therapies with a control condition, in patients with social anxiety disorder (SAD), generalized anxiety disorder (GAD) and panic disorder. We included 42 studies in which generic measures of anxiety were used (BAI, HAMA, STAI-State and Trait). Only the effects of treatment for panic disorder as measured on the BAI (13.33 points; 95% CI: 10.58-16.07) were significantly (p=0.001) larger than the effect sizes on GAD (6.06 points; 95% CI: 3.96-8.16) and SAD (5.92 points; 95% CI: 4.64-7.20). The effects remained significant after adjusting for baseline severity and other major characteristics of the trials. The results should be considered with caution because of the small number of studies in many subgroups and the high risk of bias in most studies.
Topics: Anxiety Disorders; Cognitive Behavioral Therapy; Humans; Panic Disorder; Phobia, Social; Treatment Outcome
PubMed: 27637075
DOI: 10.1016/j.janxdis.2016.09.003 -
The Journal of Clinical Psychiatry 2001Generalized, persistent, and free-floating anxiety was first described by Freud in 1894, although the diagnostic term generalized anxiety disorder (GAD) was not included... (Review)
Review
Generalized, persistent, and free-floating anxiety was first described by Freud in 1894, although the diagnostic term generalized anxiety disorder (GAD) was not included in classification systems until 1980 (Diagnostic and Statistical Manual for Mental Disorders, Third Edition [DSM-III]). Initially considered a residual category to be used when no other diagnosis could be made, it is now widely accepted that GAD represents a distinct diagnostic category. Since 1980, revisions to the diagnostic criteria for GAD in the DSM-III-R and DSM-IV classifications have markedly redefined this disorder, increasing the duration criterion to 6 months and increasing the emphasis on worry and psychic symptoms. This article reviews the development of the diagnostic criteria for defining GAD from Freud to DSM-IV and compares the DSM-IV criteria with the criteria set forth in the tenth revision of the International Classification of Diseases. The impact of the changes in diagnostic criteria on research into GAD, and on diagnosis, differential diagnosis, and treatment of GAD, will be discussed.
Topics: Anxiety Disorders; Austria; Comorbidity; Diagnosis, Differential; History, 20th Century; Humans; Panic Disorder; Psychiatric Status Rating Scales; Psychoanalysis; Psychometrics; Psychotherapy; Severity of Illness Index; Terminology as Topic
PubMed: 11414550
DOI: No ID Found -
The Psychiatric Clinics of North America Mar 2001Children and adolescents with GAD suffer from excessive, pervasive worries that interfere with social, academic, and family functioning. The comorbidity rate with other... (Review)
Review
Children and adolescents with GAD suffer from excessive, pervasive worries that interfere with social, academic, and family functioning. The comorbidity rate with other anxiety disorders and major depression is high. The course tends to be chronic, and evidence shows continuity between anxiety disorders in youth and adulthood. Individual and group CBT and the incorporation of family anxiety management training have demonstrated efficacy in the treatment of childhood GAD. No double-blind, placebo-controlled, pharmacotherapy trials with adequate sample sizes for children and adolescents with GAD have been published. Preliminary data support the potential efficacy of selective serotonin reuptake inhibitors, buspirone, and high-potency benzodiazepines. Adequately powered, controlled, pharmacologic treatment trials are necessary. Future research should be directed toward comparing the relative efficacy of psychotherapy, pharmacotherapy, and both in the treatment of GAD in youth.
Topics: Adolescent; Anxiety Disorders; Child; Child, Preschool; Comorbidity; Humans; Panic Disorder; Psychiatric Status Rating Scales
PubMed: 11225504
DOI: 10.1016/s0193-953x(05)70210-0 -
Clinical Psychology Review Mar 2018Obsessive-compulsive disorder (OCD) and generalized anxiety disorder (GAD) are early-onset disorders with significant overlapping phenomenology, especially in young... (Review)
Review
Intolerance of uncertainty in youth with obsessive-compulsive disorder and generalized anxiety disorder: A transdiagnostic construct with implications for phenomenology and treatment.
Obsessive-compulsive disorder (OCD) and generalized anxiety disorder (GAD) are early-onset disorders with significant overlapping phenomenology, especially in young patients who, due to developmental stage, may have difficulty recognizing obsessions and worries as unrealistic or excessive. Shared phenomenology and high rates of comorbidity between OCD and GAD raise the possibility of common underlying processes, and recent work has focused on intolerance of uncertainty (IU) as a reasonable candidate. With an emphasis on the youth literature, we review the phenomenological overlap between OCD and GAD, how symptoms may relate to IU, and how IU may be measured. We review existing psychotherapeutic treatments and discuss how understanding the role of IU may assist in the development of novel psychotherapeutic strategies to improve treatment outcomes. Neuroimaging studies of IU in OCD and GAD are also discussed and suggestions for further research are offered. We conclude that, consistent with Research Domain Criteria (RDoC), IU represents a transdiagnostic construct with a demonstrable neural basis that could be targeted to improve existing treatments for these disorders.
Topics: Adolescent; Anxiety Disorders; Humans; Obsessive-Compulsive Disorder; Psychotherapy; Uncertainty
PubMed: 29426573
DOI: 10.1016/j.cpr.2018.01.007 -
Clinical Therapeutics 2000This article reviews the prevalence, diagnosis, and treatment of generalized anxiety disorder (GAD). (Review)
Review
OBJECTIVE
This article reviews the prevalence, diagnosis, and treatment of generalized anxiety disorder (GAD).
BACKGROUND
Patients with GAD often present to primary care physicians; frequently the disorder manifests with somatic symptoms that have no identifiable physiologic foundation. Accurate diagnosis and treatment often prove elusive, and health care resources are inappropriately consumed in the management of a wide array of complaints, including headache, noncardiac angina, fatigue, insomnia, or abdominal discomfort. Early diagnosis and intervention are critical; GAD is frequently associated with other anxiety and mood disorders, major depressive disorder among them. The differential diagnosis of GAD is complex, including medication side effects and substance-related dependence or withdrawal phenomena, as well as endocrine, neurologic, cardiorespiratory, and autoimmune disorders.
CONCLUSIONS
GAD is differentiated from adjustment disorder with anxiety because only GAD can manifest without identifiable emotional stressors; it is differentiated from panic disorder largely on the basis of the chronicity of GAD and the episodic, abrupt nature of panic attacks, with the involvement of at least 4 autonomic, cardiopulmonary, neurologic, or other symptoms. In addition to psychotherapy, education, lifestyle modifications, and social support, several pharmacologic agents may be appropriate therapy for GAD. Given the chronic, nonremitting, relapsing character of GAD, use of benzodiazepines, which confer short-term relief, is usually ill-advised in long-term treatment because these agents can impair cognitive and psychomotor function, interact with various central nervous system depressants (eg, alcohol), and exhibit substantial potential for abuse, tolerance, dependence, and withdrawal effects. Buspirone and certain antidepressants, including the dual noradrenergic-serotonergic reuptake inhibitor venlafaxine, represent first-line therapy for GAD.
Topics: Adolescent; Adult; Antidepressive Agents; Anxiety Disorders; Benzodiazepines; Diagnosis, Differential; Female; Humans; Male; Mental Disorders; Middle Aged; Panic Disorder
PubMed: 10815647
DOI: 10.1016/s0149-2918(00)89070-0 -
Current Psychiatry Reports Jun 2012Since the introduction of generalized anxiety disorder into the diagnostic system for psychiatric conditions, scientists have worked to develop effective treatments for... (Review)
Review
Since the introduction of generalized anxiety disorder into the diagnostic system for psychiatric conditions, scientists have worked to develop effective treatments for the amelioration of chronic, excessive worry. In addition to traditional cognitive-behavioral therapy, more recent advances have focused on treatments targeting intolerance of uncertainty, meta-cognitions, emotion dysregulation, lack of acceptance of internal experiences, and emotional contrasts. This article reviews these therapeutic approaches and summarizes recent publications relevant to the psychological treatment of worry and generalized anxiety disorder.
Topics: Anxiety Disorders; Humans; Psychotherapy
PubMed: 22403039
DOI: 10.1007/s11920-012-0263-1 -
Journal of Psychiatric Practice Sep 2019We examined the accuracy of the anxiety not otherwise specified (anxiety NOS) diagnosis in 61 patients, using data from older Veterans screened for a large trial of... (Randomized Controlled Trial)
Randomized Controlled Trial
We examined the accuracy of the anxiety not otherwise specified (anxiety NOS) diagnosis in 61 patients, using data from older Veterans screened for a large trial of cognitive behavioral therapy for late-life generalized anxiety disorder. We compared the anxiety NOS diagnoses based on the electronic medical record to diagnoses obtained via a gold standard structured diagnostic interview conducted for this trial. We found concordance of the anxiety NOS diagnosis in only 2 participants (3%). Most patients (77%) met diagnostic criteria for a specific Diagnostic & Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) anxiety disorder, including generalized anxiety disorder, posttraumatic stress disorder, panic disorder, and/or social anxiety disorder, on the basis of a structured diagnostic interview. The erroneous diagnosis of anxiety NOS is a barrier to patients receiving appropriate evidence-based care for specific anxiety-related and trauma-related disorders. Undertreated anxiety can result in poorer health outcomes, overutilization of medical services, and increased health care costs. Accurate diagnosis of anxiety disorders is foundational to evidence-based treatment; thus, it is imperative that patients presenting with anxiety symptoms receive proper diagnostic assessment to facilitate access to the appropriate evidence-based mental health services.
Topics: Aged; Anxiety Disorders; Cognitive Behavioral Therapy; Diagnosis, Differential; Diagnostic Errors; Diagnostic and Statistical Manual of Mental Disorders; Evidence-Based Practice; Female; Humans; Interview, Psychological; Male; Mental Health Services; Patient Selection; Psychiatric Status Rating Scales; Psychotropic Drugs; Veterans
PubMed: 31505520
DOI: 10.1097/PRA.0000000000000408 -
Seishin Shinkeigaku Zasshi =... 2012Generalized, persistent, and free-floating anxiety was first described by Freud in 1894. The diagnostic term generalized anxiety disorder (GAD) was not in classification... (Review)
Review
Generalized, persistent, and free-floating anxiety was first described by Freud in 1894. The diagnostic term generalized anxiety disorder (GAD) was not in classification systems until the publication of the diagnostic and statistical manual for mental disorders, third edition (DSM-III) in 1980. Initially considered as a residual category to be used when no other diagnosis could be made, it is not accepted that GAD represents a distinct diagnostic category yet. Since 1980, revisions to the diagnostic criteria for GAD in the DSM-III-R, DSM-IV and DSM-5 classifications have slightly redefined this disorder. The classification is fluid. The duration criterion has increased to 6 months in DSM-IV, but decreased to 3 months in DSM-5. This article reviews the development of diagnostic criteria for defining GAD from Freud to DSM-5 and compares the DSM-5 criterion with DSM-IV and the tenth revision of the International Classification of Disease. The impact of the changes in diagnostic criteria on research into GAD, and on diagnosis, differential diagnosis, will be discussed.
Topics: Anxiety Disorders; Comorbidity; Depressive Disorder; Diagnosis, Differential; Diagnostic and Statistical Manual of Mental Disorders; Humans; Psychoanalysis
PubMed: 23198594
DOI: No ID Found -
Acta Psychiatrica Scandinavica.... 1998This theoretical paper reviews the status of generalized anxiety disorder (GAD) and the Axis I and Axis II disorders with which it is often comorbid. Differences in... (Review)
Review
This theoretical paper reviews the status of generalized anxiety disorder (GAD) and the Axis I and Axis II disorders with which it is often comorbid. Differences in comorbidity between the epidemiological and clinical literatures are discussed. Special attention is given to panic disorder, the symptoms of which are similar to those of GAD. The boundaries of GAD and its relationship to other Axis I disorders and to Axis II disorders raise important implications for its classification.
Topics: Anxiety Disorders; Comorbidity; Humans; Mental Disorders; Mood Disorders; Panic Disorder; Psychiatric Status Rating Scales
PubMed: 9777042
DOI: 10.1111/j.1600-0447.1998.tb05961.x -
Polski Merkuriusz Lekarski : Organ... Feb 2016Risk of generalized anxiety disorder (GAD) within life is estimated at 2.6-5.1%. Amongst etiological factors that affect the development of the disorder are: biological... (Review)
Review
Risk of generalized anxiety disorder (GAD) within life is estimated at 2.6-5.1%. Amongst etiological factors that affect the development of the disorder are: biological and psychological problems, including cognitive models. There are known several cognitive models: metacognitive, Borkovec'c model and the model developed in Quebec. Key cognitive contents that occur with generalized anxiety disorder are focused on two aspects: metacognitive beliefs and intolerance of uncertainty. A primary purpose of cognitive-behavioural therapy (CBT) is the modification of dysfunctional beliefs about worry. Cognitive behavioural therapy is effective in reducing anxiety, makes it easier to operate in the professional sphere and improves the quality of life.
Topics: Anxiety; Anxiety Disorders; Cognitive Behavioral Therapy; Humans; Quality of Life
PubMed: 27000822
DOI: No ID Found