Mental Health Book


Generalized Anxiety Disorder

Aka: Generalized Anxiety Disorder
  1. See Also
    1. Anxiety Disorder
    2. Anxiety Secondary Cause
    3. Anxiety Symptoms
    4. Obsessive Compulsive Disorder
    5. Body Dysmorphic Disorder
    6. Panic Disorder
    7. Social Anxiety Disorder (Social Phobia)
    8. Acute Stress Disorder
    9. Post-Traumatic Stress Disorder
    10. Excessive Worry
    11. Anxiety Non-pharmacologic Management
    12. Anxiety Pharmacologic Management
  2. 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
  3. Pathophysiology
    1. Dysregulation of worry
  4. 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
  5. Symptoms: Physical
    1. See Anxiety Symptoms
    2. Excessive, overwhelming and uncontrolled worry
  6. Symptoms: Avoidance behaviors
    1. Avoidance of activities may be subtle
    2. Limited interpersonal relationships
    3. Procrastination
    4. Non-assertive in new situations
  7. Diagnosis: Diagnostic Criteria (DSM 5, 300.02, F41.1)
    1. Excessive anxiety and worry for at least 6 months on most days
    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
  8. 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
  9. Differential Diagnosis
    1. See Anxiety Secondary Causes
    2. Major Depression
    3. Personality Disorder (Anxiety Cluster)
    4. Other Anxiety Disorder
      1. Excessive Worry due to Panic Attacks
      2. Anxiety Adjustment Disorder
      3. Social Anxiety Disorder
      4. Obsessive Compulsive Disorder
      5. Posttraumatic Stress Disorder
    5. Other psychiatric conditions
      1. Eating Disorder (anxiety)
      2. Body Dysmorphic Disorder
      3. Delusional disorder (e.g. Schizophrenia)
  10. Management
    1. See Anxiety Non-pharmacologic Management
    2. See Anxiety Medications
  11. Prognosis: Predictors of better outcomes
    1. Lower anxiety level
    2. Lower demoralization level
    3. Higher level of Major Depression at presentation
  12. References
    1. APA (1994) DSM IV, APA, p. 432-6
    2. Derogatis (1989) Anxiety and Depressive Disorders, p.42
    3. Kroenke (2007) Ann Intern Med 146(5): 317-25 [PubMed]
    4. Locke (2015) Am Fam Physician 91(9): 617-24 [PubMed]
    5. Wittchen (2002) J Clin Psychiatry 63:24-34 [PubMed]
    6. Zal (1995) Fam Prac Recert 17(10): 17-32 [PubMed]

Anxiety Disorders (C0003469)

Definition (NCI) A category of psychiatric disorders which are characterized by anxious feelings or fear often accompanied by physical symptoms associated with anxiety.
Definition (NCI_CTCAE) A disorder characterized by apprehension of danger and dread accompanied by restlessness, tension, tachycardia, and dyspnea unattached to a clearly identifiable stimulus.
Definition (CSP) general term for the group of specific, anxiety-related, avoidance- prone disorders listed as NTs.
Definition (PSY) Disorders characterized by anxiety or dread without apparent object or cause. Symptoms include irritability, anxious expectations, pangs of conscience, anxiety attacks, or phobias.
Definition (MSH) Persistent and disabling ANXIETY.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D001008
ICD10 F41.9
SnomedCT 191703000, 192405006, 65673007, 197480006
DSM4 300.00
LNC MTHU020812
English Disorder, Anxiety, Disorders, Anxiety, Anxiety Disorder NOS, Anxiety disord unspecified, Anxiety disorder, unspecified, [X]Anxiety disord unspecified, [X]Anxiety disorder, unspecified, Anxiety disorders, ANXIETY DIS, anxiety disorder (diagnosis), anxiety disorder, Anxiety Disorders, Anxiety NOS, Anxiety Disorders [Disease/Finding], anxiety disorder nos, anxiety disorders, [X]Anxiety disorder, unspecified (disorder), Anxiety, Anxiety disorder, Anxiety disorder (disorder), Anxiety disorder, NOS, Anxiety disorder [Ambiguous], Anxiety Disorder, Disorder;anxiety
Italian Disturbo ansioso, Disturbi d'ansia
Swedish Ångeststörningar
Japanese フアンショウガイ, 不安神経症, 神経症性不安状態, 不安状態-神経症性, 不安ノイローゼ, 神経症-不安, 不安障害
Czech úzkostné poruchy, anxiózní poruchy, Úzkostná porucha
Finnish Ahdistuneisuushäiriöt
Spanish Trastorno de ansiedad, [X]trastorno de ansiedad, no especificado, [X]trastorno de ansiedad, no especificado (trastorno), trastorno de ansiedad (concepto no activo), Trastornos de Angustia, trastorno de ansiedad (trastorno), trastorno de ansiedad, Trastornos de Ansiedad
German Angststoerung, nicht naeher bezeichnet, Angststoerung, Angststörungen
Korean 상세불명의 불안 장애
Portuguese Transtornos de Ansiedade, Distúrbios de Ansiedade, Transtornos de Angústia, Transtornos Ansiosos, Pertubação de ansiedade
Polish Zaburzenia lękowe
Hungarian Szorongásos zavar
Norwegian Angstforstyrrelser, Angstlidelser
Dutch Angststoornis, niet gespecificeerd, angststoornis, Angststoornis, Angststoornissen
French Trouble anxieux, Troubles anxieux, Troubles de l'anxiété
Derived from the NIH UMLS (Unified Medical Language System)

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