Anxiety

Generalized Anxiety Disorder

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Generalized Anxiety Disorder

  • 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
  • Pathophysiology
  1. Dysregulation of 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
  • Symptoms
  • Physical
  1. See Anxiety Symptoms
  2. Excessive, overwhelming and uncontrolled worry
  • Symptoms
  • Avoidance behaviors
  1. Avoidance of activities may be subtle
  2. Limited interpersonal relationships
  3. Procrastination
  4. Non-assertive in new situations
  • Diagnosis
  • Diagnostic Criteria (DSM V)
  1. Excessive anxiety and worry for at least 6 months on most days
  2. Involves two or more life circumstances (e.g. home, work)
  3. Anxiety or worry is difficult to control
  4. Associated symptoms (3 present in adult, 1 in child)
    1. Restlessness or on edge
    2. Fatigue
    3. Difficult concentration
    4. Irritable
    5. Muscle tension
    6. Sleep disturbance
  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
      1. See Anxiety Secondary Causes
    3. Not primarily due to Substance Abuse
  • 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
  • Prognosis
  • Predictors of better outcomes
  1. Lower anxiety level
  2. Lower demoralization level
  3. Higher level of Major Depression at presentation