Generalized Anxiety Disorder

Aka: Generalized Anxiety Disorder

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II. Definitions

  1. Generalized Anxiety Disorder
    1. Persistent and Excessive Worry, fear, uneasiness, restlessness, irritability, Muscle tension on >50% of days, lasting at least 6 months

III. Epidemiology

  1. Most common Anxiety Disorder
  2. Adult Prevalence
    1. Annual: 2 to 3% per year
    2. Lifetime: 7-8% in women, 4-5% in men
  3. Onset peaks in ages 20 to 40 years (least common over age 60 years)
  4. Women are more than twice as likely to be diagnosed with anxiety over lifetime

IV. Pathophysiology

  1. Dysregulation of worry

V. Symptoms: Topics of Excessive Worry

  1. Children
    1. School performance
    2. Sports performance
    3. Catastrophic events (e.g. earthquake, nuclear war)
  2. College students
    1. Academic performance
    2. Relationships
  3. Adults
    1. Children's well-being
    2. Illness or injury
    3. Family and other relationships
    4. Occupational and financial concerns
  4. Elderly
    1. Health
    2. Social relationships
    3. Finances

VI. Symptoms: Physical

  1. See Anxiety Symptoms
  2. Excessive, overwhelming and uncontrolled worry

VII. Symptoms: Avoidance behaviors

  1. Avoidance of activities may be subtle
  2. Limited interpersonal relationships
  3. Procrastination
  4. Non-assertive in new situations

VIII. Diagnosis: Diagnostic Criteria (DSM 5, 300.02, F41.1)

  1. Excessive anxiety and worry for at least 6 months on most days (more than 50%)
  2. Involves two or more life circumstances (e.g. home, work, school)
  3. Anxiety or worry is difficult to control
  4. Associated symptoms (3 present in adult, 1 in child), with some symptoms present on more than half of the days
    1. Restlessness or on edge
    2. Fatigue
    3. Difficult concentration
    4. Irritable
    5. Muscle tension
    6. Sleep disturbance (difficulty falling or staying asleep, or restless or unsatisfying sleep)
  5. Impaired social or occupational functioning or distress
  6. No Anxiety Secondary Cause
    1. Not primarily to other psychiatric illness
      1. See Differential Diagnosis below
    2. Not primarily due to underlying medical condition (e.g. Hyperthyroidism)
      1. See Anxiety Secondary Causes
    3. Not primarily due to Substance Abuse

IX. Diagnosis: Scales

  1. Generalized Anxiety Disorder Scale (GAD-7)
  2. PROMIS Emotional Distress-Anxiety Short Form for adults
  3. Severity Measure for Generalized Anxiety Disorder - Adults
  4. Hamilton Anxiety Scale (HAM-A)
  5. Zung Self Rating Scale for Anxiety
  6. Beck Anxiety Scale

X. Differential Diagnosis

  1. See Anxiety Secondary Causes
  2. Other Anxiety Disorders
    1. Excessive Worry due to Panic Attacks
    2. Anxiety Adjustment Disorder
    3. Social Anxiety Disorder
    4. Obsessive Compulsive Disorder
    5. Posttraumatic Stress Disorder
    6. Separation Anxiety Disorder
  3. Other psychiatric conditions
    1. Major Depression
    2. Personality Disorder (Anxiety Cluster)
    3. Eating Disorder (e.g. Anorexia Nervosa)
    4. Body Dysmorphic Disorder
    5. Delusional disorder (e.g. Schizophrenia)
  4. Substances
    1. Stimulants (e.g. Cocaine, Amphetamines, excessive Caffeine)
    2. Depressant Substance Withdrawal (e.g. Alcohol, Benzodiazepines, Opioids)
  5. Medical Conditions
    1. Hyperthyroidism
    2. Cardiopulmonary Disease (e.g. Asthma, Congestive Heart Failure, Atrial Fibrillation)

XI. Management

  1. See Anxiety Non-pharmacologic Management
  2. See Anxiety Medications

XII. Prognosis: Predictors of better outcomes

  1. Lower anxiety level
  2. Lower demoralization level
  3. Higher level of Major Depression at presentation

XIII. References

  1. APA (1994) DSM IV, APA, p. 432-6
  2. Derogatis (1989) Anxiety and Depressive Disorders, p.42
  3. Kowalchuk (2022) Am Fam Physician 106(6): 657-64 [PubMed]
  4. Kroenke (2007) Ann Intern Med 146(5): 317-25 [PubMed]
  5. Locke (2015) Am Fam Physician 91(9): 617-24 [PubMed]
  6. Wittchen (2002) J Clin Psychiatry 63:24-34 [PubMed]
  7. Zal (1995) Fam Prac Recert 17(10): 17-32 [PubMed]

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