Generalized Anxiety Disorder (GAD)

GAD is characterized by intense pervasive worry over virtually every aspect of life associated with physical manifestations of anxiety.

Epidemiology

The lifetime prevalence of GAD is approximately 5%. The typical age of onset is in the early 20s, but the disorder may begin at any age.

Etiology

Twin studies suggest that GAD has both inherited and environmental etiologies. Serotonergic, noradrenergic, and GABA-ergic neurotransmitter systems have been studied in relation to GAD, but the biologic etiology remains obscure. Cognitive-behavioral theorists posit that GAD is due to cognitive distortions in which patients misperceive situations as dangerous when they are not.

Clinical Manifestations

History and Mental Status Examination Patients with generalized anxiety disorder worry excessively about virtually every aspect of their lives (job performance, health, marital relations, and social life). They do not have panic attacks, phobias, obsessions, or compulsions; rather, they experience pervasive anxiety and worry (apprehensive expectation) about a number of events or activities that occur most days for at least 6 months. They must also have difficulty controlling the worry, and it must be associated with at least three of the following symptoms: restlessness, easily fatigued, difficulty concentrating or mind going blank, irritability, muscle tension, and sleep disturbance.

Differential Diagnosis

The focus of the anxiety and worry in GAD must not be symptomatic of another axis I disorder. For example, the anxiety and worry cannot be about having a panic attack (as in panic disorder) or being embarrassed in public (as in social phobia).

Management

The pharmacologic treatment of GAD is with benzodiazepincs, buspirone (a non-benzodiazepine anxiolytic) , gabapentin, or beta-blockers. Although benzodiazepines are very effective, the duration of treatment is limited by the risk of tolerance and dependence. Relaxation techniques are also used in treatment with some success. KEY POINTS 1. GAD is intense worry over every aspect of life. 2. GAD is characterized by difficulty controlling the worry. 3. It is associated with physical manifestations of anxiety. 4. GAD is treated with benzodiazepine, buspirone, beta-blockers, gabapentin, and relaxation techniques.