Generalized anxiety disorder (GAD)

Generalized anxiety disorder (GAD) is an anxiety disorder that is characterized by excessive, uncontrollable and often irrational worry about everyday things, which is disproportionate to the actual source of worry. This excessive worry often interferes with daily functioning, as individuals suffering GAD typically catastrophize, anticipate disaster, and are overly concerned about everyday matters such as health issues, money, family problems, or work difficulties. They often exhibit a variety of physical symptoms, including fatigue, headaches, muscle tension, muscle aches, difficulty swallowing, trembling, twitching, irritability, sweating, and hot flashes. These symptoms must be consistent and on-going, persisting at least 6 months, for a formal diagnosis of GAD to be introduced. Approximately 6.8 million American adults experience GAD, affecting about twice as many women as men.

Diagnosis

According to the Diagnostic and Statistical Manual IV-Text Revision (DSM-IV-TR), the following criteria must be met for a person to be diagnosed with Generalised Anxiety Disorder.

1. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least six months, about a number of events or activities (such as work or school performance).
2. The person finds it difficult to control the worry.
3. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months). Note: Only one item is required in children.
   1. restlessness or feeling keyed up or on edge
   2. being easily fatigued
   3. irritability
   4. muscle tension (difficulty falling or staying asleep, or restless unsatisfying sleep)
   5. difficulty concentrating or the mind going blank
4. The focus of the anxiety and worry is not confined to features of an Axis I disorder, e.g., the anxiety or worry is not about having a panic attack (as in panic disorder), being embarrassed in public (as in social phobia), being contaminated (as in obsessive-compulsive disorder), being away from home or close relatives (as in Separation Anxiety Disorder), gaining weight (as in anorexia nervosa), having multiple physical complaints (as in somatisation disorder), or having a serious illness (as in hypochondriasis), and the anxiety and worry do not occur exclusively during post-traumatic stress disorder.
5. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
6. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism) and does not occur exclusively during a Mood Disorder, a Psychotic Disorder, or a Pervasive Developmental Disorder.

GAD-7 screening test

A new test has recently been introduced called the GAD-7 Screening Test which has a high rate of accuracy in screening for Generalised Anxiety Disorder. It is a self-administered test that screens for Generalised Anxiety Disorder. These figures suggest that the 5% prevalence for GAD may be too low and that up to 20% of people may have GAD.

Prevalence

The World Health Organization's Global Burden of Disease project did not include generalised anxiety disorders. In lieu of global statistics, here are some prevalence rates from around the world:

• Australia: 3 percent of adults
• Canada: Between 3-5 percent of adults
• Italy: 2.9 percent
• Taiwan: 0.4 percent
• United States: Approximately 6.8 million American adults, or about 3.1 percent of people age 18 and over, in a given year

Potential Causes of GAD

Some research suggests that GAD may run in families^{[citation needed]}, and it may also grow worse during stress. GAD usually begins at an earlier age and symptoms may manifest themselves more slowly than in most other anxiety disorders^{[citation needed]}. Some people with GAD report onset in early adulthood, usually in response to a life stressor. Once GAD develops, it is chronic.^[8]

Treatment

SSRIs

Pharmaceutical treatments for GAD, include selective serotonin reuptake inhibitors (SSRIs),^[9] which are antidepressants that influence brain chemistry to block the reabsorption of serotonin in the brain.^[10] SSRIs are mainly indicated for clinical depression, but are also effective in treating anxiety disorders.^[9] Common side effects include nausea, sexual dysfunction, headache, diarrhea, among others. Common SSRIs perscribed for GAD include:

• fluoxetine (Prozac)
• paroxetine (Paxil)
• escitalopram (Lexapro)

Other Drugs

• imipramine (Tofranil)
• venlafaxine (Effexor)

Venlafaxine (Effexor) is a serotonin-norepinephrine reuptake inhibitor (SNRI). SNRIs, a class of drugs related to the SSRIs, alter the chemistries of both norepinephrine and serotonin in the brain. Imipramine (Tofranil) is a tricyclic antidepressant (TCA). TCAs are thought to act on serotonin, norepinephrine, and dopamine in the brain.

Benzodiazepines

Benzodiazepines (or "benzos") are fast-acting sedatives that are also used to treat GAD and other anxiety disorders.^[9] These are often given in the short-term due to their nature to become habit-forming. Side effects include drowsiness, reduced motor coordination and problems with equilibrioception. Common benzodiazepines used to treat GAD include^[9]:

• alprazolam (Xanax)
• chlordiazepoxide (Librium)
• clonazepam (Klonopin)
• diazepam (Valium)
• lorazepam (Ativan)

Cognitive behavioural therapy

A psychological method of treatment for GAD is cognitive behavioural therapy (CBT), which involves a therapist working with the patient to understand how thoughts and feelings influence behavior.^[11] The goal of the therapy is to change negative thought patterns that lead to the patient's anxiety, replacing them with positive, more realistic ones. Elements of the therapy include exposure strategies to allow the patient to gradually confront their anxieties and feel more comfortable in anxiety-provoking situations, as well as to practice the skills they have learned. CBT can be used alone or in conjunction with medication.^[9]

GAD and Comorbid Depression

In the National Comorbidity Survey (2005), 58% of patients diagnosed with major depression were found to have an anxiety disorder; among these patients, the rate of comorbidity with GAD was 17.2%, and with panic disorder, 9.9%. Patients with a diagnosed anxiety disorder also had high rates of comorbid depression, including 22.4% of patients with social phobia, 9.4% with agoraphobia, and 2.3% with panic disorder. For many, the symptoms of both depression and anxiety are not severe enough (i.e. are subsyndromal) to justify a primary diagnosis of either major depressive disorder (MDD) or an anxiety disorder.

Patients can also be categorized as having mixed anxiety-depressive disorder, and they are at significantly increased risk of developing full-blown depression or anxiety. Appropriate treatment is necessary to alleviate symptoms and prevent the emergence of more serious disease.^{[citation needed]}

Accumulating evidence indicates that patients with comorbid depression and anxiety tend to have greater illness severity and a lower treatment response than those with either disorder alone.^{[citation needed]} In addition, social function and quality of life are more greatly impaired.

In addition to coexisting with depression, research shows that GAD often coexists with substance abuse or other conditions associated with stress, such as irritable bowel syndrome.^{[citation needed]} Patients with physical symptoms such as insomnia or headaches should also tell their doctors about their feelings of worry and tension. This will help the patient's health care provider to recognize whether the person is suffering from GAD.

Controversy

The loose diagnostic criteria advanced by the DSM-IV makes it very easy for practitioners diagnose a patient with GAD. Assessment of the incidence and prevalence of GAD is difficult, because a large proportion of people with GAD have a comorbid diagnosis, either physical or mental. The diagnosis of GAD can be challenging because the difference between normal anxiety and GAD is not always distinct.^[12]Furthermore, the diagnostic criteria — restlessness, fatigue, difficulty concentrating, irritability, muscle tension or sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep) — are common factors of human life, otherwise known as normal anxiety. Without the evidence of the patient showing increased motor tension, autonomic hyperactivity (shortness of breath, rapid heart rate, dry mouth, cold hands, and dizziness) but not panic attacks; and increased vigilance and scanning (feeling keyed up, increased startling, impaired concentration), anxiety is not necessarily indicative of an anxiety disorder.

With a combined CBT/NlP/Hypnotic approach we have a proven track record of bringing a resolution to GAD sufferers.Please feel free to contact us for further information

Keep it Hypnotic

David