Generalized anxiety disorder – synonyms, diagnosis, treatment
Synonyms: fear neurosis, anxiety neurosis Definition of generalized anxiety disorder. Anxiety and excitement about everyday things that go on for a long time, accompanied by heavy meditations and anxious anticipation
Epidemiology of generalized anxiety disorder. Prevalence rates vary depending on the diagnostic criteria and trigger mechanisms of the disorder; 5%, the ratio of women: men is 2: 1, the typical patients of the general practitioner!
• Vulnerability-stress model
• Genetic and neurobiological factors (heredity); neurobiological disorders in the system of neurotransmitters and receptor functions (among other things, changes in the sensitivity of receptors to GABA and benzodiazepines)
The main symptoms of generalized anxiety disorder:
• “Pathological Concern” (eg, your own health)
• Permanent groundless fears and worries about ordinary things.
• Physical stress Diagnostic criteria for generalized anxiety disorder:
• Stages of diagnostic search – normal or pathological anxiety?
– Are there signs of other mental disorders or somatic diseases?
• State-Trait-Anxiety-Inventory (STAI): scale for assessing anxiety • Hamilton anxiety scale (NAMA): scale for objective assessment
• First of all – with panic disorder, obsessional disorder, depression – often there is comorbidity
• In addition, anxiety often accompanies other mental and somatic diseases!
• Somatic diseases. Coronary heart disease, hyperthyroidism, hypoglycemia, pheochromocytoma, carcinoid, pulmonary embolism, bronchial asthma, syphilis, epilepsy, migraine, multiple sclerosis
• Neurological and mental illness. Organic psycho-syndrome, alcoholism, drug addiction; schizophrenia, depression, adjustment disorders / stress / personality disorders
• Effect of caffeine intake, pharmacological agents. Sympathomimetics, theophylline, bronchial drugs
Depression, substance abuse Treatment of generalized anxiety disorder
– drugs of choice
– antidepressants (citalopram, escitalo-pram, paroxetine, venlafaxine), the response rate is 60% (respectively, 40% placebo, confidence level A)
– new drug pregabalin (150-600 mg / day.)
– second-line drugs
– opipramol and buspirone
– for emergency treatment (for relief of acute attacks), benzodiazepines can be used in a short course (once)
• Cognitive behavioral therapy or a single psychotherapy session. Current and prognosis. Often takes a chronic course of varying intensity; clinical recovery of 50% within 5 years.