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1
Kendler, Kenneth S. "Major Depression and Generalised Anxiety Disorder." British Journal of Psychiatry 168, S30 (June 1996): 68–75. http://dx.doi.org/10.1192/s0007125000298437.
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In both clinical and epidemiological samples, major depression (MD) and generalised anxiety disorder (GAD) display substantial comorbidity. In a prior analysis of lifetime MD and GAD in female twins, the same genetic factors were shown to influence the liability to MD and to GAD. A follow-up interview in the same twin cohort examined one-year prevalence for MD and GAD (diagnosed using a one-month minimum duration of illness). Bivariate twin models were fitted using the program Mx. High levels of comorbidity were observed between MD and GAD. The best-fitting twin models, when GAD was diagnosed with or without a diagnostic hierarchy, found a genetic correlation of unity between the two disorders. The correlation in environmental risk factors was +0.70 when GAD was diagnosed non-hierarchically, but zero when hierarchical diagnoses were used. Our findings provide further support for the hypothesis that in women, MD and GAD are the result of the same genetic factors. Environmental risk factors that predispose to ‘pure’ GAD episodes may be relatively distinct from those that increase risk for MD.
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Stein, D. J. "Generalised anxiety disorder." South African Journal of Psychiatry 19, no. 3 (August 30, 2013): 5. http://dx.doi.org/10.4102/sajpsychiatry.v19i3.950.
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<div style="left: 70.8662px; top: 324.72px; font-size: 15.45px; font-family: serif; transform: scaleX(1.06067);" data-canvas-width="421.662">Generalised anxiety disorder (GAD) is a common disorder with</div><div style="left: 70.8662px; top: 344.72px; font-size: 15.45px; font-family: serif; transform: scaleX(1.03815);" data-canvas-width="421.12199999999996">a lifetime prevalence of 6.1% and a 1-year prevalence of 2.9% in</div><div style="left: 70.8662px; top: 364.72px; font-size: 15.45px; font-family: serif; transform: scaleX(1.04618);" data-canvas-width="101.39249999999998">one large study.</div><div style="left: 172.475px; top: 365.947px; font-size: 9.00733px; font-family: serif;">[</div><div style="left: 175.624px; top: 365.947px; font-size: 9.00733px; font-family: serif; transform: scaleX(0.97944);" data-canvas-width="7.3458000000000006">1]</div><div style="left: 183.1px; top: 364.72px; font-size: 15.45px; font-family: serif; transform: scaleX(1.09377);" data-canvas-width="309.60599999999994">It occurs most commonly in the 45 - 55-year</div><div style="left: 70.8662px; top: 384.72px; font-size: 15.45px; font-family: serif; transform: scaleX(1.08819);" data-canvas-width="405.0329999999999">age group with women twice as likely as men to have GAD.</div><div style="left: 476.121px; top: 385.947px; font-size: 9.00733px; font-family: serif;">[</div><div style="left: 479.269px; top: 385.947px; font-size: 9.00733px; font-family: serif; transform: scaleX(0.97944);" data-canvas-width="7.3458000000000006">1]</div>
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Yonkers, Kimberly A., Meredith G. Warshaw, Ann O. Massion, and Martin B. Keller. "Phenomenology and Course of Generalised Anxiety Disorder." British Journal of Psychiatry 168, no. 3 (March 1996): 308–13. http://dx.doi.org/10.1192/bjp.168.3.308.
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BackgroundThe diagnostic category of generalised anxiety disorder (GAD) was originally intended to describe residual anxiety states. Over the years clinical criteria have been refined in an attempt to describe a unique diagnostic entity. Given these changes, little is known about the clinical course of this newly defined disorder. This study investigates the longitudinal course, including remission and relapse rates, for patients with DSM–III–R defined GAD.MethodAnalysis of the 164 patients with GAD participating in the Harvard Anxiety Research Program. Patients were assessed with a structured clinical interview at intake and re-examined at six month intervals for two years and then annually for one to two years. Psychiatric Status Ratings were assigned at each interview point. Kaplan–Meier curves were constructed to assess likelihood of remission.ResultsComorbidity was high, with panic disorder and social phobia as the most frequently found comorbid disorders. The likelihood of remission was 0.15 after one year and 0.25 after two years. The probability of becoming asymptomatic from all psychiatric symptoms was only 0.08.ConclusionsThis prospective study confirms the chronicity associated with GAD and extends this finding to define the one and two year remission rates for the disorder. Likelihood of remission for GAD and any other comorbid condition after one year was half the annual remission rate for GAD alone.
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Butler, G., A. Cullington, G. Hibbert, I. Klimes, and M. Gelder. "Anxiety Management for Persistent Generalised Anxiety." British Journal of Psychiatry 151, no. 4 (October 1987): 535–42. http://dx.doi.org/10.1192/bjp.151.4.535.
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A preliminary controlled investigation of the effectiveness of Anxiety Management as a treatment for generalised anxiety disorder (GAD) is described. Patients with a primary diagnosis of GAD, in which the current episode had lasted for at least 6 months but not more than 2 years, were included. Anxiety Management, a self-help treatment including procedures for managing somatic and cognitive symptoms, and for dealing with avoidance and low self-confidence, was given either immediately or after a 12-week waiting period. The average length of treatment was 8.7 sessions. Highly significant changes in anxiety, depression, and problem ratings were shown after treatment. These changes were replicated when the waiting list group had also received treatment, and gains were maintained by both groups for 6 months. Similar degrees of improvement and maintenance of change were shown in subgroups with and without minor depressive disorder or recurrent panic attacks.
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K B, Shiddnagouda, Roy K. B., and Prasannakumar Patil. "MANAGEMENT OF CHITTODWEGA - A CASE REPORT." April 2021 9, no. 4 (April 15, 2021): 928–31. http://dx.doi.org/10.46607/iamj4209042021.
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Anxiety is arguably an emotion that predates the evolution of man. Its ubiquity in humans, and its presence in a range of anxiety disorders, makes it an important clinical focus. GAD (Generalised anxiety disorder) is the most common psychiatric disorder characterised by Repeated, Persistent and unrealistic worry about life-events but it is different from normal feelings of anxiousness. The prevalence rate of Anxiety disorder varies according to the different age groupas per the current DSM-5 criteria, only phobia and GAD are included under anxiety disorders, with weighted prevalence values of 4.2% and 5.8% respectively. For these available Psychiatric drugs are having various adverse effect and produces the dependency of the drugs, for this integrated approach is very essential, Ayurveda medicines are safe, cost effective hence here a case of chittodwega is successfully treated with Shamana medicine. Keywords: Generalized anxiety disorder, Chittodwega, Ayurveda, Shamana
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Rickels, K., and E. Schweizer. "The spectrum of generalised anxiety in clinical practice: the role of short-term, intermittent treatment∗." British Journal of Psychiatry 173, S34 (July 1998): 49–54. http://dx.doi.org/10.1192/s0007125000293525.
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Background DSM–IV generalised anxiety disorder (GAD) has a high lifetime prevalence, but subthreshold anxiety states are even more common, particularly in family practice.Method Generalised anxiety is conceptualised as a spectrum of disorders, with transient anxiety at one end and GAD at the other.Results Based on longterm experience with family practice patients, the authors suggest that most anxious patients, wherever on this continuum they are placed, could be treated with short-term, possibly intermittent, rather than chronic anxiolytic therapy. Data are presented which show that 50% of chronic GAD patients are only in need of such short-term intermittent therapy.Conclusions Further clinical research is needed to refine short-term, intermittent treatments for anxiety spectrum disorders, to make effective treatments available to those suffering from anxiety but falling short of diagnostic criteria for GAD, and to target more effectively the different treatment strategies.
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Ross, Stephanie Maxine. "Generalized Anxiety Disorder (GAD)." Holistic Nursing Practice 27, no. 6 (2013): 366–68. http://dx.doi.org/10.1097/hnp.0b013e3182a8eb62.
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Thobaben, Marshelle. "Generalized Anxiety Disorder (GAD)." Home Health Care Management & Practice 17, no. 2 (February 2005): 140–42. http://dx.doi.org/10.1177/1084822304270221.
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&NA;. "Tiagabine reduces symptoms of generalised anxiety disorder (GAD),." Inpharma Weekly &NA;, no. 1518 (December 2005): 16. http://dx.doi.org/10.2165/00128413-200515180-00040.
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Yonkers, Kimberly A., Ingrid R. Dyck, Meredith Warshaw, and Martin B. Keller. "Factors predicting the clinical course of generalised anxiety disorder." British Journal of Psychiatry 176, no. 6 (June 2000): 544–49. http://dx.doi.org/10.1192/bjp.176.6.544.
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BackgroundCross-sectional data show that generalised anxiety disorder (GAD) is a chronic condition with episodes lasting much longer than the six-month minimum required by DSM–III–R and DSM–IV. Although GAD is chronic, little is known about factors influencing illness duration.AimsTo investigate variables that influence the clinical course of GAD.MethodA total of 167 patients with GAD participated in the Harvard–Brown Anxiety Research Program. Patients were assessed at intake and re-examined at six- to twelve-month intervals for five years. Kaplan–Meier curves were constructed to assess the likelihood of remission. Regression analysis was used to investigate factors predicting full or partial remission.ResultsThe rate of remission was 0.38 after five years. Diminished likelihood of remission was associated with low overall life satisfaction, poor spousal or family relationships, a concurrent cluster B or C personality disorder and a low global assessment score.ConclusionsFull or partial remissions were less likely to occur in patients with poor relationships and personality disorders. These patients should be given more intensive and possibly multi-modal therapy.
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Remes, Olivia, Nicholas Wainwright, Paul Surtees, Louise Lafortune, Kay-Tee Khaw, and Carol Brayne. "Generalised anxiety disorder and hospital admissions: findings from a large, population cohort study." BMJ Open 8, no. 10 (October 2018): e018539. http://dx.doi.org/10.1136/bmjopen-2017-018539.
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ObjectiveGeneralised anxiety disorder (GAD) is the most common anxiety disorder in the general population and has been associated with high economic and human burden. However, it has been neglected in the health services literature. The objective of this study is to assess whether GAD leads to hospital admissions using data from the European Prospective Investigation of Cancer-Norfolk. Other aims include determining whether early-onset or late-onset forms of the disorder, episode chronicity and frequency, and comorbidity with major depressive disorder (MDD) contribute to hospital admissions.DesignLarge, population study.SettingUK population-based cohort.Participants30 445 British participants were recruited through general practice registers in England. Of these, 20 919 completed a structured psychosocial questionnaire used to identify presence of GAD. Anxiety was assessed in 1996–2000, and health service use was captured between 1999/2000 and 2009 through record linkage with large, administrative health databases. 17 939 participants had complete data on covariates.Main outcome measurePast-year GAD defined according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition.ResultsIn this study, there were 2.2% (393/17 939) of respondents with GAD. Anxiety was not independently associated with hospital admissions (incidence rate ratio (IRR)=1.04, 95% CI 0.90 to 1.20) over 9 years. However, those whose anxiety was comorbid with depression showed a statistically significantly increased risk for hospital admissions (IRR=1.23, 95% CI 1.02 to 1.49).ConclusionPeople with GAD and MDD comorbidity were at an increased risk for hospital admissions. Clinicians should consider that meeting criteria for a pure or individual disorder at one point in time, such as past-year GAD, does not necessarily predict deleterious health outcomes; rather different forms of the disorder, such as comorbid cases, might be of greater importance.
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Curtiss, Joshua, and David H. Klemanski. "Identifying Individuals With Generalised Anxiety Disorder: A Receiver Operator Characteristic Analysis of Theoretically Relevant Measures." Behaviour Change 32, no. 4 (September 16, 2015): 255–72. http://dx.doi.org/10.1017/bec.2015.15.
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This article appraises the ability of several measures, assessing symptomatology theoretically relevant to generalised anxiety disorder (GAD), to accomplish successful classification of individuals with DSM-IV GAD and individuals with mood or other anxiety disorders. Participants were 197 individuals (average age = 36.43; 67.5% female) receiving treatment at a clinic, who completed pretreatment self-report measures. Receiver operator characteristic analyses and logistic regression analyses were employed to determine the classificatory abilities, including sensitivity and specificity, of several GAD relevant measures. The Penn State Worry Questionnaire (PSWQ) accomplished significant classification in both comparison group dyads: GAD-Anxiety and GAD-Mood. Whereas the general distress of depression subscale of the Mood and Anxiety Symptoms Questionnaire (MASQ) accomplished significant classification in the GAD-Anxiety group dyad, both the general distress of anxiety and anxious arousal subscales of the MASQ did so in the GAD-Mood group dyad. Only the PSWQ significantly predicted the presence of GAD, while controlling for other symptom variables. Though evidence supports the uniqueness of some symptoms of GAD, including worry, often considered pathognomonic to GAD, the modest areas under the curve, sensitivity, and specificity of the measures afford tenuous support for the utility of these measures. The lack of highly sensitive and specific symptomatology comport with critiques of GAD as a diagnostically delimited category.
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Nath, Selina, Elizabeth G. Ryan, Kylee Trevillion, Debra Bick, Jill Demilew, Jeannette Milgrom, Andrew Pickles, and Louise M. Howard. "Prevalence and identification of anxiety disorders in pregnancy: the diagnostic accuracy of the two-item Generalised Anxiety Disorder scale (GAD-2)." BMJ Open 8, no. 9 (September 2018): e023766. http://dx.doi.org/10.1136/bmjopen-2018-023766.
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ObjectiveTo estimate the population prevalence of anxiety disorders during pregnancy and investigate the diagnostic accuracy of the two-item Generalised Anxiety Disorder scale (GAD-2) for a) GAD and b) any anxiety disorder.DesignCross-sectional survey using a stratified sampling design. Sampling weights were used in the analysis to adjust for the bias introduced by the stratified sampling.SettingInner-city maternity service, South London.Participants545 pregnant women were interviewed after their first antenatal appointment; 528 provided answers on the GAD-2 questions.Main outcome measuresDiagnosis generated by the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th edition (SCID).ResultsPopulation prevalence of anxiety disorders was 17% (95% CI 12% to 21%): 5% (95% CI 3% to 6%) for GAD, 4% (95% CI 2% to 6%) for social phobia, 8% (95% CI 5% to 11%) for specific phobia and 2% (95% CI 1% to 4%) for obsessive-compulsive disorder. Post-traumatic stress disorder (PTSD) prevalence was unclear due to higher levels of reluctance to respond to PTSD interview questions but sensitivity analyses suggest population prevalence maybe up to 4% (95% CI 2% to 6%). Weighted sensitivity of GAD-2 for GAD (cut-off ≥3) was 69%, specificity 91%, positive predictive value 26%, negative predictive value 98% and likelihood ratio 7.35. For any anxiety disorder the weighted sensitivity was 26%, specificity 91%, positive predictive value 36%, negative predictive value 87% and likelihood ratio 2.92.ConclusionsAnxiety disorders are common but GAD-2 generates many false positives and may therefore be unhelpful in maternity services.
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Tyrer, Peter. "Against the Stream: Generalised anxiety disorder (GAD) – a redundant diagnosis." BJPsych Bulletin 42, no. 2 (March 1, 2018): 69–71. http://dx.doi.org/10.1192/bjb.2017.12.
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SummaryThe diagnosis of generalised anxiety disorder is a distraction of no value. It is highly unreliable, co-occurring with many other disorders of firmer diagnostic status, and has intrinsic connections to personality dysfunction. It is argued that classification would be heartily relieved to rid itself of this unnecessary appendage and for the symptom of anxiety to remain as a descriptive term only.Declaration of interestNone.
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Hayes, J. F. "Generalized Anxiety Disorder." InnovAiT: Education and inspiration for general practice 4, no. 12 (July 17, 2011): 685–90. http://dx.doi.org/10.1093/innovait/inr074.
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This article describes the key features of generalized anxiety disorder (GAD) to help GPs recognize patients with the disorder and provide a management strategy that can be used in the primary care setting to support them. Management strategies are linked to recently updated National Institute for Health and Clinical Excellence (NICE) guidelines and include both drug treatments and psychological interventions. As a GP, the ability to screen at-risk patients, diagnose those with symptoms, assess the severity of GAD, provide education and self-help strategies and referral appropriately to specialist mental health services is important. Although the course of GAD tends to be relapsing and remitting, effective control of symptoms can help to allow patients to live a more normal life.
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Fonzo, Gregory A., Holly J. Ramsawh, Taru M. Flagan, Sarah G. Sullivan, Andrea Letamendi, Alan N. Simmons, Martin P. Paulus, and Murray B. Stein. "Common and disorder-specific neural responses to emotional faces in generalised anxiety, social anxiety and panic disorders." British Journal of Psychiatry 206, no. 3 (March 2015): 206–15. http://dx.doi.org/10.1192/bjp.bp.114.149880.
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BackgroundAlthough evidence exists for abnormal brain function across various anxiety disorders, direct comparison of neural function across diagnoses is needed to elicit abnormalities common across disorders and those distinct to a particular diagnosis.AimsTo delineate common and distinct abnormalities within generalised anxiety (GAD), panic and social anxiety disorder (SAD) during affective processing.MethodFifty-nine adults (15 with GAD, 15 with panic disorder, 14 with SAD, and 15 healthy controls) underwent functional magnetic resonance imaging while completing a facial emotion matching task with fearful, angry and happy faces.ResultsGreater differential right amygdala activation to matching fearful v. happy facial expressions related to greater negative affectivity (i.e. trait anxiety) and was heightened across all anxiety disorder groups compared with controls. Collapsing across emotional face types, participants with panic disorder uniquely displayed greater posterior insula activation.ConclusionsThese preliminary results highlight a common neural basis for clinical anxiety in these diagnoses and also suggest the presence of disorder-specific dysfunction.
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Via, E., M. A. Fullana, X. Goldberg, D. Tinoco-González, I. Martínez-Zalacaín, C. Soriano-Mas, C. G. Davey, et al. "Ventromedial prefrontal cortex activity and pathological worry in generalised anxiety disorder." British Journal of Psychiatry 213, no. 1 (May 9, 2018): 437–43. http://dx.doi.org/10.1192/bjp.2018.65.
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BackgroundPathological worry is a hallmark feature of generalised anxiety disorder (GAD), associated with dysfunctional emotional processing. The ventromedial prefrontal cortex (vmPFC) is involved in the regulation of such processes, but the link between vmPFC emotional responses and pathological v. adaptive worry has not yet been examined.AimsTo study the association between worry and vmPFC activity evoked by the processing of learned safety and threat signals.MethodIn total, 27 unmedicated patients with GAD and 56 healthy controls (HC) underwent a differential fear conditioning paradigm during functional magnetic resonance imaging.ResultsCompared to HC, the GAD group demonstrated reduced vmPFC activation to safety signals and no safety–threat processing differentiation. This response was positively correlated with worry severity in GAD, whereas the same variables showed a negative and weak correlation in HC.ConclusionsPoor vmPFC safety–threat differentiation might characterise GAD, and its distinctive association with GAD worries suggests a neural-based qualitative difference between healthy and pathological worries.Declaration of interestNone.
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Butters, Meryl A., Rishi K. Bhalla, Carmen Andreescu, Julie Loebach Wetherell, Rose Mantella, Amy E. Begley, and Eric J. Lenze. "Changes in neuropsychological functioning following treatment for late-life generalised anxiety disorder." British Journal of Psychiatry 199, no. 3 (September 2011): 211–18. http://dx.doi.org/10.1192/bjp.bp.110.090217.
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BackgroundGeneralised anxiety disorder (GAD) in older adults is associated with neuropsychological impairment.AimsWe examined neuropsychological functioning in older adults with GAD in comparison with psychiatrically healthy older adults at baseline, and we examined changes following a 12-week placebo-controlled trial of escitalopram.MethodA total of 160 participants without dementia aged ⩾60 with current GAD and 37 individuals in a comparison group without psychiatric history underwent neuropsychological assessment. Of these, 129 participants with GAD were reassessed post-treatment (trial registration: NCT00105586).ResultsThe participants with GAD performed worse than the comparison group in information processing speed, working memory, inhibition, problem-solving (including concept formation and mental flexibility) and immediate and delayed memory. Neuropsychological functioning was correlated with everyday functioning. After treatment, those with low cognitive scores experienced working memory, delayed memory and visuospatial ability improvement and those who reported clinical improvement in anxiety exhibited improvement in the ability to engage inhibition and episodic recall. These improvements were modest and of similar magnitude in both treatment conditions.ConclusionsGeneralised anxiety disorder in older adults is associated with neuropsychological impairments, which are associated with functional impairment. Those with GAD who either have a low cognitive performance or report clinical improvement in anxiety post-treatment, show improvement in multiple cognitive domains. These findings underscore the importance of treatments that aid cognition as well as anxiety symptoms.
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Draper, Mark, Clare S. Rees, and Paula R. Nathan. "Internet-Based Self-Management of Generalised Anxiety Disorder: A Preliminary Study." Behaviour Change 25, no. 4 (December 1, 2008): 229–44. http://dx.doi.org/10.1375/bech.25.4.229.
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AbstractDespite the continuing development of effective cognitive and behavioural interventions for Generalised Anxiety Disorder (GAD) less attention has been paid to the important issue of improving treatment accessibility and affordability. Self-management approaches that utilise the convenience of the Internet may provide a means by which more people can avail themselves of effective treatments. To date, studies examining the effectiveness of such approaches for GAD lag behind the work conducted with other clinical problems. This study describes the response of three individuals with a primary diagnosis of GAD to an Internet-based treatment completed at their own pace. The intervention (‘What? Me Worry!?!; Saulsman, Nathan, Lim, and Correia, 2005) combines several cognitive and behavioural components with the inclusion of a significant metacognitive component. All participants achieved clinically significant improvement on measures of worry, GAD symptomatology, and metacognitions. Moreover, none of the participants met the diagnostic criteria for GAD at the completion of the study. A larger randomised controlled trial of this intervention is indicated.
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Stocchi, F., G. Nordera, R. Jokinen, and U. Lepola. "Paroxetine treatment of generalised anxiety disorder (GAD): Remission status." European Neuropsychopharmacology 11 (January 2001): S307. http://dx.doi.org/10.1016/s0924-977x(01)80421-1.
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Argyropoulos, S. "Sensitivity of the Generalised Anxiety Disorder Inventory (GADI) to Detect Changes in Two Experimental Models of Human Anxiety." European Psychiatry 24, S1 (January 2009): 1. http://dx.doi.org/10.1016/s0924-9338(09)70749-7.
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We developed and validated a new questionnaire for the assessment of the symptom profile and severity of generalised anxiety, the Generalised Anxiety Disorder Inventory (GADI). The 18-item scale (Argyropoulos et al, 2007, J Psychopharmacology, 21: 145-152) showed good reliability, convergent and divergent validity. The scale comprises three factors, relating to cognitive, somatic and sleep symptoms. It distinguishes accurately GAD patients from non-patient controls. The cognitive factor also distinguishes GAD from other anxiety disorders and depression. The sensitivity of the GADI to detect changes in symptom levels was tested in two experimental models of anxiety induction; the inhalation of 7.5% CO2 over a period of 20 minutes, which models generalised anxiety, and a single vital capacity inhalation of 35% CO2, which models panic anxiety (Bailey et al, 2005, Depression & Anxiety, 21: 18-25; Bailey et al, 2007, J Psychopharmacology, 21: 42-49). We found that the GADI was able to detect the differential drug effect of a benzodiazepine (alprazolam) and placebo in the anxiety induced by these tests in healthy volunteers.
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Kindt, Merel, Susan Bögels, and Mattijn Morren. "Processing Bias in Children with Separation Anxiety Disorder, Social Phobia and Generalised Anxiety Disorder." Behaviour Change 20, no. 3 (September 1, 2003): 143–50. http://dx.doi.org/10.1375/bech.20.3.143.24832.
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AbstractThe present study examined processing bias in children suffering from anxiety disorders. Processing bias was assessed using of the emotional Stroop task in clinically referred children with separation anxiety disorder (SAD), social phobia (SP), and/or generalised anxiety disorder (GAD) and normal controls. The aims of the present study were twofold: (a) to test whether clinically anxious children show a bias towards threat stimuli, and (b) to examine whether this bias is domain-specific. No evidence was obtained for either an anxiety-related bias towards threat, or a domain-specificity effect. Clearly, these findings diverge markedly from adult studies and stress the importance of further research on anxiety-related information processing in children.
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Turki, M., J. Ben Thabet, N. Charfi, M. Mezghanni, M. Maalej Bouali, N. Zouari, L. Zouari, and M. Maalej. "Generalized anxiety disorder comorbidities: Panic and depressive disorder." European Psychiatry 41, S1 (April 2017): S486. http://dx.doi.org/10.1016/j.eurpsy.2017.01.580.
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IntroductionIt has been well documented that generalized anxiety disorder (GAD) can co-occur with mood disorders and other anxious disorders, particularly panic disorder (PD). These comorbidities can complicate therapeutic management and burden the prognosis.AimTo highlight the relationship between GAD and panic and depressive disorders.MethodsWe conducted a cross-sectional study, among 250 subjects consulting in 6 primary care units in Sfax, Tunisia. These participants, randomly chosen, were asked to answer a questionnaire after their consent. The diagnosis of GAD and PD were assessed by the “Mini International Neuropsychiatric Interview” of the DSM-IV. Depressive symptoms were evaluated using the “Beck Depression Inventory” (BDI).ResultsThe average age was 39 years. The sex ratio M/F was 1/2.The GAD was diagnosed in 10.8% of participants. The mean IDB score was 3.8. According to this scale, a mild depression was noted in 23.6%, moderate 12% and severe in 2.8% of cases. The GAD was statistically associated with psychiatric histories (P = 0.009), particularly depression disorder (P = 0.004) and the history of suicide attempt (P < 0.001).The IDB score was significantly higher in participants with GAD (P < 0.001). Among them, 74% presented moderate to severe depression.GAD co-occurs with PD in 22.2% of cases. This association was statistically significant (P < 0.001). Participants presenting GAD- PD comorbidity are at higher risk of developing depression (P = 0.003).ConclusionOne must always think to screen comorbidities in the presence of either diagnosis, in order to ensure a better management.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Wang, Na. "Association between Arsenic and Generalized Anxiety Disorder: A Cross-Sectional Study." Women Health Care and Issues 4, no. 4 (May 27, 2021): 01–05. http://dx.doi.org/10.31579/2642-9756/054.
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Aim: In some regions of Bayannaoer arsenic concentration in well drinking water is higher than the international standard of 10 μg/L. The purpose of this study is to evaluate the impact of exposures to arsenic in drinking water on generalized anxiety disorder (GAD). Materials and Methods: A survey was conducted in 2016 among villagers in Hangjinhou County, Bayannaoer City, Inner Mongolia. A questionnaire was used to inquire about GAD, arsenic related neurological symptoms. Arsenic concentration in the water was measured and arsenicosis prevalence was assessed. Multinomial logistic regression and ordinal logistic regression were performed to evaluate the association of abnormal arsenic levels on increased GAD symptoms. Results: 446 participants were enrolled. Subjects with exposure to water arsenic levels>10 μg/L were significantly more likely to have mild GAD than controls (adjusted odds ratio [AOR] =2.3, 95% confidence interval [CI], 1.1-4.8). Participants who were diagnosed with arsenicosis were more likely to report mild anxiety than minimal anxiety compared to those who did not (AOR=2.3, 95% CI, 1.3-4.1). Survey respondents with palpitations, forgetfulness, headaches, dizziness, decreased taste, decreased hearing, loss of touch, abnormal warm and cold sensation, blurred vision, numbness and tingling were more likely to report mild, moderate and severe anxiety. Conclusions: Arsenic exposure was associated with a higher risk of GAD. Screening for arsenic exposure should be incorporated into the evaluation of GAD, in areas where arsenic in drinking water is known to be abnormal.
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Allgulander, Christer, David Hackett, and Eliseo Salinas. "Venlafaxine Extended Release (ER) in the Treatment of Generalised Anxiety Disorder." British Journal of Psychiatry 179, no. 1 (July 2001): 15–22. http://dx.doi.org/10.1192/bjp.179.1.15.
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BackgroundGeneralised anxiety disorder (GAD) has received less study than other anxiety disorders, particularly its long-term treatment.AimsTo assess the efficacy and safety of venlafaxine extended release (ER) in patients with GAD.MethodA total of 541 out-patients, 18–86 years old, were recruited to this 24-week, placebo-controlled, double-blind study of three fixed doses (37.5, 75 and 150 mg/day) of venlafaxine ER.ResultsAll doses of venlafaxine ER showed efficacy superior to placebo, apparent from week 2, that was sustained throughout the 24-week study for the two higher doses. The discontinuation rate did not differ significantly among the treatment groups.ConclusionsVenlafaxine ER is an effective and safe treatment for GAD for up to 6 months.
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Mahoney, Alison E. J., Megan J. Hobbs, Alishia D. Williams, Gavin Andrews, and Jill M. Newby. "The Mediating Relationship Between Maladaptive Behaviours, Cognitive Factors, and Generalised Anxiety Disorder Symptoms." Behaviour Change 35, no. 2 (May 24, 2018): 123–38. http://dx.doi.org/10.1017/bec.2018.13.
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Cognitive theories of generalised anxiety disorder (GAD) posit that cognitive and behavioural factors maintain the disorder. This study examined whether avoidance and safety behaviours mediated the relationship between cognitive factors and GAD symptoms. We also examined the reverse mediation model; that is, whether cognitive factors mediated the relationship between maladaptive behaviours and GAD symptoms. Undergraduate psychology students (N = 125 and N = 292) completed the Worry Behaviours Inventory (a recently developed measure of maladaptive behaviours associated with GAD), in addition to measures of intolerance of uncertainty, cognitive avoidance, metacognitive beliefs, and symptoms of GAD and depression. Analyses supported the reliability and validity of the WBI. We consistently found that engagement in maladaptive behaviours significantly mediated the relationship between cognitive factors and symptoms of GAD. The reverse mediation model was also supported. Our results are consistent with the contention that cognitive and behavioural factors contribute to GAD symptom severity.
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Bögels, Susan M., Nienke Snieder, and Merel Kindt. "Specificity of Dysfunctional Thinking in Children with Symptoms of Social Anxiety, Separation Anxiety and Generalised Anxiety." Behaviour Change 20, no. 3 (September 1, 2003): 160–69. http://dx.doi.org/10.1375/bech.20.3.160.24836.
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AbstractThe present study investigated whether children with high symptom levels of either social phobia (SP), separation anxiety disorder (SAD), or generalised anxiety disorder (GAD) are characterised by a specific set of dysfunctional interpretations that are consistent with the cognitive model of their specific fear (“content-specificity of interpretations”). It was also examined whether such cognitive bias is predominantly activated in those ambiguous situations that are relevant for the pertinent fear (“content-specificity of situations”). Children high on symptoms of SP, SAD, and GAD and low-anxious control children were exposed to stories describing ambiguous situations and asked to give their interpretations and action plans. Results showed that high-anxious children displayed a negative cognitive bias compared to control children, but did not differ from controls with respect to the action plans given. Some evidence was found for the content-specificity of this cognitive bias. That is, consistent with the hypothesis of content-specificity of interpretations, children high on SAD reported more interpretations consistent with the content of their fear than children high on SP and GAD. Further, children high on SP and SAD predominantly displayed a negative cognitive bias in response to respectively social and separation situations. Children high on GAD did not show content-specificity for interpretations or situations. The theoretical implications of these findings are briefly discussed.
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Mendelsohn, Augustus Kram, Carolina Daffre, Katelyn Oliver, Jeehye Seo, Natasha Lasko, and Edward Pace-Schott. "765 Anxiety and sleep in Generalized Anxiety Disorder with and without Insomnia Disorder." Sleep 44, Supplement_2 (May 1, 2021): A298. http://dx.doi.org/10.1093/sleep/zsab072.762.
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Abstract Introduction Insomnia Disorder (ID) elevates risk of incident anxiety disorders and vice versa. We examined whether ID and poor sleep are associated with greater self-reported anxiety in persons with Generalized Anxiety Disorder (GAD). Methods Twenty-one participants with GAD and ID (GAD+/ID+) having Insomnia Severity Index (ISI) scores ≥ 13 (mean 17.8, SD 3.6) and 14 with GAD but not ID (GAD+/ID-) having ISI scores ≤ 12 (mean 6.4, SD 3.4) completed 14 days of actigraphy and sleep diaries as well as a night of ambulatory polysomnography (PSG) following an acclimation night. Participants completed the Pittsburgh Sleep Quality Index (PSQI), the State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA-T/C, -T/S), the Ford Insomnia Response to Stress Test (FIRST), the Penn State Worry Questionnaire (PSWQ), and the Anxiety Sensitivity Index (ASI). Differences in self-reported anxiety (STICSA, ASI, PSWQ) between GAD+/ID+ and GAD+/ID- were analyzed using t-tests. Relationships of anxiety with retrospective (PSQI, FIRST, ISI), longitudinal (actigraphy, diaries) and physiological (PSG) sleep variables were analyzed using simple regression. Results GAD+/ID+ versus GAD+/ID- participants showed trends toward higher anxiety on the PSWQ (p=0.075), ASI (p=0.072) and STICSA-T/S (p=0.078). PSQI scores were positively associated with STICSA-T/S, (R=0.417, p=0.018, N=32). Greater insomnia reactivity (FIRST) was associated with increased worry on the PSWQ (R=0.352, p=0.044, N=33). STICSA-T/C was negatively associated with mean diary (R= -0.440, p=0.015, N=30) and actigraph (R= -0.517, p=0.01, N=24) total sleep time (TST). Actigraph mean TST trended toward lower PSWQ (R= -0.376, p=0.058, N=26) while actigraph mean sleep efficiency (SE) trended toward lesser STICSA-T/C (R= -0.397, p=0.058). Greater REM% was associated with greater STICSA-T/C (R=0.613, p=0.0005, N=28) and STICSA-T/S (R=0.516, p=0.005), a relationship also seen in GAD+/ID+ alone (p=0.03 and 0.015 respectively, N=16). Slow Wave Sleep% (SWS%) was not associated with lesser STICSA-T/S across both groups (p=0.14) but was so in GAD+/ID+ (R= -0.539, p=0.031, N=16). Conclusion GAD+/ID+ versus GAD+/ID-, show greater worry, anxiety sensitivity and somatic anxiety. In GAD, shorter and poorer quality sleep measured retrospectively or averaged longitudinally, as well as greater REM%, are associated with greater somatic and cognitive anxiety. Among those with ID, greater SWS% is associated with less somatic anxiety. Support (if any) R21MH115279, R01MH109638
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Alhoshan, Eman. "A Determination of the Construct Validity of Both an Adapted Self-Confidence Questionnaire, the Personal Evaluation Inventory [PEI], (Shrauger & Schohn, 1995) and a Generalised Anxiety Disorder [GAD] Questionnaire (Taylor, 1953)." Journal of Education and Learning 8, no. 2 (February 25, 2019): 69. http://dx.doi.org/10.5539/jel.v8n2p69.
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The objectives in this research were to determine the construct validity of both an adapted self-confidence questionnaire, the Personal Evaluation Inventory (PEI), developed by Shrauger and Schohn, and a Generalised Anxiety Disorder (GAD) questionnaire, which was adapted from the Taylor Manifest Anxiety Scale.
The research was conducted in two girls’ primary schools in Saudi Arabia to collect relevant data on the convergent and discriminant validity of the GAD and PEI questionnaires using the Multi-Trait Multi-Method (MTMM) matrix to prove construct validity. Sixty students and two teachers filled in questionnaires, with each student evaluating themselves and, then, their peers. The teachers evaluated themselves, their self-confidence and generalised degree of their anxiety disorder.
The results were that the MTMM analysis supported, to a large extent, both convergent and discriminant validity of the analysed data from students and teachers on two traits (self-confidence and generalised anxiety disorder) and across three methods of measurement (self-reporting, peer-rating and teacher-rating).
The results were that the Mono-Trait Mono-Method coefficients were relatively high, and there was relative strength in the Hetero-Trait Mono-Method coefficients. The Hetero-Trait Mono-Method coefficients were reasonable for self-confidence and for the generalised anxiety disorder questionnaires, but teacher-ratings for both traits were unexpected. Furthermore, the Hetero-Trait Hetero-Method coefficients were not constant and showed an unstable variance.
In conclusion, the PEI and GAD questionnaires possess acceptable construct validity, but that the teacher-ratings for both the PEI and the GAD questionnaires needed modification in order to attain the desirable construct validity.
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Khawaja, Nigar G., and Janette McMahon. "The Relationship of Meta-Worry and Intolerance of Uncertainty With Pathological Worry, Anxiety, and Depression." Behaviour Change 28, no. 4 (December 1, 2011): 165–80. http://dx.doi.org/10.1375/bech.28.4.165.
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AbstractThis study explored how meta-worry and intolerance of uncertainty relate to pathological worry, generalised anxiety, obsessive–compulsive disorder, social phobia, and depression. University students (n = 253)completed a questionnaire battery. A series of regression analyses were conducted. The results indicated that meta-worry was associated with GAD, social phobia, obsessive–compulsive, and depressive symptoms. Intolerance of uncertainty was related to GAD, social phobia, and obsessive–compulsive symptoms, but not depressive symptoms. The importance of meta-worry and intolerance of uncertainty as predictors of pathological worry, GAD, social phobia, obsessive–compulsive and depressive symptoms was also examined. Even though both factors significantly predicted the aforementioned symptoms, meta-worry emerged as a stronger predictor of GAD and obsessive compulsive symptoms than did intolerance of uncertainty. Intolerance of uncertainty, compared with meta-worry, appeared as a stronger predictor of social phobia symptoms. Findings emphasise the importance of addressing meta-worry and/or intolerance of uncertainty not only for the assessment and treatment of generalised anxiety disorder (GAD), but also obsessive–compulsive disorder, social phobia, and depression.
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Li, Hui, Bin Zhang, Qiang Hu, Lanlan Zhang, Yi Jin, Jijun Wang, Huiru Cui, Jiaoyan Pang, and Chunbo Li. "Altered heartbeat perception sensitivity associated with brain structural alterations in generalised anxiety disorder." General Psychiatry 33, no. 1 (February 2020): e100057. http://dx.doi.org/10.1136/gpsych-2019-100057.
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BackgroundPalpitation is a common complaint in generalised anxiety disorder (GAD). Brain imaging studies have investigated the neural mechanism of heartbeat perception in healthy volunteers. This study explored the neuroanatomical differences of altered heartbeat perception in patients with GAD using structural MRI.AimsBased on the strong somatic-interoceptive symptoms in GAD, we explored the regional structural brain abnormalities involved in heartbeat perception in patients with GAD.MethodsThis study was applied to the a priori regions using neuroanatomical theories of heartbeat perception, including the insula, anterior cingulate cortex, supplementary motor area and prefrontal cortex. A total of 19 patients with GAD and 19 healthy control subjects were enrolled. We used the FMRIB Software Library voxel-based morphometry software for estimating the grey matter volume of these regions of interest and analysed the correlation between heartbeat perception sensitivity and the volume of abnormal grey matter.ResultsPatients with GAD showed a significantly decreased volume of grey matter in their left medial prefrontal cortex, right orbital frontal cortex and anterior cingulate cortex. The grey matter volume of the left medial prefrontal cortex negatively correlated with heartbeat perception sensitivity in patients with GAD.ConclusionsIt should be the first study that shows heartbeat perception is associated with brain structure in GAD. Our findings suggest that the frontal region may play an important role in aberrant heartbeat perception processing in patients with GAD, and this may be an underlying mechanism resulting in the abnormal cardiovascular complaints in GAD. This is hypothesised as a ‘top-down’ deficiency, especially in the medial prefrontal cortex. This will provide the foundation for a more targeted region for neuromodulation intervention in the future.
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&NA;. "PRX 00023* may reduce symptoms of generalised anxiety disorder (GAD),." Inpharma Weekly &NA;, no. 1501 (August 2005): 6. http://dx.doi.org/10.2165/00128413-200515010-00015.
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Davidson, JR, W. Zhang, KM Connor, J. Ji, K. Jobson, Y. Lecrubier, AC McFarlane, et al. "Review: A psychopharmacological treatment algorithm for generalised anxiety disorder (GAD)." Journal of Psychopharmacology 24, no. 1 (October 2, 2008): 3–26. http://dx.doi.org/10.1177/0269881108096505.
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Gústavsson, Sævar M., Paul M. Salkovskis, and Jón F. Sigurðsson. "Cognitive analysis of specific threat beliefs and safety-seeking behaviours in generalised anxiety disorder: revisiting the cognitive theory of anxiety disorders." Behavioural and Cognitive Psychotherapy 49, no. 5 (March 12, 2021): 526–39. http://dx.doi.org/10.1017/s135246582100014x.
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AbstractBackground:Generalised anxiety disorder (GAD) has been an uneasy member of the anxiety disorders group since its inclusion in the third edition of the DSM. Multiple theories and treatment protocols for GAD and its defining symptom, excessive worry, have comparable efficacy in treating GAD symptoms. Crucially, these theories of GAD and excessive worry fail to explain when and why worry is excessive and when it is adaptive.Aims:In this paper we propose a cognitive behavioural account of the difference between excessive and adaptive states of worry and explore the theme of threat and the function of safety-seeking behaviours as seen in GAD. Specifically, we incorporate the concept of inflated responsibility in a cognitive behavioural analysis of threat appraisal and safety-seeking behaviours in excessive worry and GAD.Conclusion:It is proposed that when worry is used as a strategy intended to increase safety from perceived social or physical threat then it should be conceptualised as a safety-seeking behaviour. However, when worry is used as a strategy to solve a problem which the person realistically can resolve or to deal explicitly with the feeling of anxiety then it functions as an adaptive coping behaviour. We also propose that the theme of threat in GAD centres on an inflated sense of responsibility for external everyday situations, and the function of safety-seeking behaviours is to attain certainty that responsibility has been fulfilled. The clinical implications of this cognitive behavioural analysis of excessive worry are discussed, as well as future research directions.
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Gould, Rebecca L., Julie Loebach Wetherell, Kate Kimona, Marc A. Serfaty, Rebecca Jones, Christopher D. Graham, Vanessa Lawrence, et al. "Acceptance and commitment therapy for late-life treatment-resistant generalised anxiety disorder: a feasibility study." Age and Ageing 50, no. 5 (April 13, 2021): 1751–61. http://dx.doi.org/10.1093/ageing/afab059.
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Abstract Background Generalised anxiety disorder (GAD) is the most common anxiety disorder in older people. First-line management includes pharmacological and psychological therapies, but many do not find these effective or acceptable. Little is known about how to manage treatment-resistant generalised anxiety disorder (TR-GAD) in older people. Objectives To examine the acceptability, feasibility and preliminary estimates of the effectiveness of acceptance and commitment therapy (ACT) for older people with TR-GAD. Participants People aged ≥65 years with TR-GAD (defined as not responding to GAD treatment, tolerate it or refused treatment) recruited from primary and secondary care services and the community. Intervention Participants received up to 16 one-to-one sessions of ACT, developed specifically for older people with TR-GAD, in addition to usual care. Measurements Co-primary outcomes were feasibility (defined as recruitment of ≥32 participants and retention of ≥60% at follow-up) and acceptability (defined as participants attending ≥10 sessions and scoring ≥21/30 on the satisfaction with therapy subscale). Secondary outcomes included measures of anxiety, worry, depression and psychological flexibility (assessed at 0 and 20 weeks). Results Thirty-seven participants were recruited, 30 (81%) were retained and 26 (70%) attended ≥10 sessions. A total of 18/30 (60%) participants scored ≥21/30 on the satisfaction with therapy subscale. There was preliminary evidence suggesting that ACT may improve anxiety, depression and psychological flexibility. Conclusions There was evidence of good feasibility and acceptability, although satisfaction with therapy scores suggested that further refinement of the intervention may be necessary. Results indicate that a larger-scale randomised controlled trial of ACT for TR-GAD is feasible and warranted.
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Soen, Cindy Claudia, Irena Monica Hardjasasmita, and Aretha Ever Ulitua. "Generalized Anxiety Disorder: Diagnosis and Treatment." Jurnal Muara Medika dan Psikologi Klinis 1, no. 2 (March 24, 2022): 133. http://dx.doi.org/10.24912/jmmpk.v1i2.14865.
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Generalized Anxiety Disorder or GAD is the most common psychological disorder that is characterized by excessive anxiety and worry (expectations of restlessness) where the symptoms last for six months. The ultimate aims of this research are to explain GAD with its three approaches such as humanistic, psychoanalytic and cognitive based on literature review and research evidence and identify the assessment and treatment for GAD. Treatment for GAD consists of various forms of psychotherapy for instance Cognitive Behavior Therapy (CBT) and Acceptance Based Group Behavioral Therapy (ABBT). We believe that the result of this study can be used as reference to find more about generalized anxiety disorder and come up with specific treatment that is more effective.
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Latas, Milan, Tihomir Stojkovic, Mina Cvjetkovic-Bosnjak, Milica Zaric, and Srdjan Milovanovic. "How do we treat generalized anxiety disorder?" Srpski arhiv za celokupno lekarstvo 142, no. 3-4 (2014): 204–12. http://dx.doi.org/10.2298/sarh1404204l.
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Introduction. In addition to significant prevalence of generalized anxiety disorder (GAD) and related consequences, it seems that this disorder has not been studied sufficiently in Serbia. Objective. The aim of this study was to investigate the understanding of psychopathology and the adequate treatment of patients with GAD by psychiatrists in Serbia. Methods. The study comprised 84 doctors - psychiatrists and neuropsychiatrists who were engaged in treatment of patients with GAD. Anonymous survey was used as the basic instrument, which collected information about the socio-demographic and professional data, experience in treating GAD and understanding psychopathology of GAD, as well as the first and the second choice therapy for patients with GAD. Results. The majority of psychiatrists (62.2%) indicated the symptoms of distress/tension and slightly lower percent (36.6%) designated the symptoms of worry/anxiety as the key symptoms of GAD when it was diagnosed. The results showed that almost all patients (96.5%) had been treated with benzodiazepines before coming to psychiatrists. Most psychiatrists preferred the use of SSRI/SNRI antidepressants (76.2%), usually in combination with benzodiazepines (71.4%) for the treatment of patients with GAD; however, if these doctors got GAD, the preference of benzodiazepine use would be significantly lesser (45.2%) than for the treatment of their patients. Preference for the use of SSRI/SNRI antidepressants was significantly more frequent in physicians with completed residency. Conclusion. The understanding of psychopathology and treatment practice for patients with GAD in this sample of psychiatrists in Serbia is mostly consistent with the current trends for GAD treatment.
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Kummer, Arthur, Francisco Cardoso, and Antonio Lucio Teixeira. "Generalized anxiety disorder and the Hamilton Anxiety Rating Scale in Parkinson's disease." Arquivos de Neuro-Psiquiatria 68, no. 4 (August 2010): 495–501. http://dx.doi.org/10.1590/s0004-282x2010000400005.
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Anxiety is common in Parkinson's disease (PD), but studies concerning specific anxiety disorders are scarce. Essential psychometric properties of anxiety rating scales are also lacking. OBJECTIVE: To investigate general anxiety disorder (GAD) in PD and psychometric properties of the Hamilton Anxiety Rating Scale (Ham-A). METHOD: Ninety-one PD patients underwent neurological and psychiatric examination, which included the MINI-Plus, the Ham-A and the Hamilton Depression Rating Scale (Ham-D). RESULTS: GAD was present in 30.8% of PD patients. Patients with GAD had longer disease duration (p=0.044) and were in use of higher doses of levodopa (p=0.034). They also tended to have more motor fluctuations and dyskinesias. The group with GAD scored higher in Ham-A (p<0.001), in the somatic (p=0.004) and psychic (p<0.001) subscales of Ham-A, and in Ham-D (p=0.004). The Ham-A showed good internal consistency (Cronbach's alpha=0.893) and a cutoff score of 10/11 is suggested to screen for GAD. CONCLUSION: GAD is frequent in PD and the Ham-A may be a useful instrument to screen for this disorder.
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Rynn, Moira A., and Olga Brawman-Mintzer. "Generalized Anxiety Disorder: Acute and Chronic Treatment." CNS Spectrums 9, no. 10 (October 2004): 716–23. http://dx.doi.org/10.1017/s1092852900022367.
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AbstractClinical and epidemiological data suggest that generalized anxiety disorder (GAD) is a chronic illness causing patients to suffer for many years leading to significant distress in daily life functioning. The literature suggests the several conclusions. GAD is a disorder in need of appropriate treatment and often has a chronic course with comorbid conditions, such as major depression and other anxiety disorders. Benzodiazepines, while effective anxiolytic agents acutely, when prescribed for >4 weeks cause rebound anxiety and following prolonged therapy may lead to withdrawal symptoms. Antidepressants cause significant anxiety relief compared with placebo and for psychosocial treatment cognitive-behavioral therapy is an efficacious psychosocial treatment. Many GAD patients are in need of long-term medication management. Furthermore, there is limited data for patients diagnosed with GAD the treatment outcome with the combination of medication and psychotherapy both acutely and long-term; how to best sequence these treatments; for those patients who do not meet remission criteria what is the ideal approach for augmentation; and for patients with treatment-refractory GAD the empirical evidence is lacking on medication switching and augmentation strategies. Research is needed in the area of developing treatment strategies for patients suffering from treatment-refractory GAD. There is still an urgent need to explore treatment combinations and duration strategies in the management of patients suffering with GAD.
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Buff, C., C. Schmidt, L. Brinkmann, B. Gathmann, S. Tupak, and T. Straube. "Directed threat imagery in generalized anxiety disorder." Psychological Medicine 48, no. 4 (July 24, 2017): 617–28. http://dx.doi.org/10.1017/s0033291717001957.
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BackgroundWorrying has been suggested to prevent emotional and elaborative processing of fears. In cognitive-behavioral therapy (CBT), generalized anxiety disorder (GAD) patients are exposed to their fears during the method of directed threat imagery by inducing emotional reactivity. However, studies investigating neural correlates of directed threat imagery and emotional reactivity in GAD patients are lacking. The present functional magnetic resonance imaging (fMRI) study aimed at delineating neural correlates of directed threat imagery in GAD patients.MethodNineteen GAD patients and 19 healthy controls (HC) were exposed to narrative scripts of either disorder-related or neutral content and were encouraged to imagine it as vividly as possible.ResultsRating results showed that GAD patients experienced disorder-related scripts as more anxiety inducing and arousing than HC. These results were also reflected in fMRI data: Disorder-related v. neutral scripts elicited elevated activity in the amygdala, dorsomedial prefrontal cortex, ventrolateral prefrontal cortex and the thalamus as well as reduced activity in the ventromedial prefrontal cortex/subgenual anterior cingulate cortex in GAD patients relative to HC.ConclusionThe present study presents the first behavioral and neural evidence for emotional reactivity during directed threat imagery in GAD. The brain activity pattern suggests an involvement of a fear processing network as a neural correlate of initial exposure during directed imagery in CBT in GAD.
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Ansell, E. B., A. Pinto, M. O. Edelen, J. C. Markowitz, C. A. Sanislow, S. Yen, M. Zanarini, et al. "The association of personality disorders with the prospective 7-year course of anxiety disorders." Psychological Medicine 41, no. 5 (September 14, 2010): 1019–28. http://dx.doi.org/10.1017/s0033291710001777.
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BackgroundThis study prospectively examined the natural clinical course of six anxiety disorders over 7 years of follow-up in individuals with personality disorders (PDs) and/or major depressive disorder. Rates of remission, relapse, new episode onset and chronicity of anxiety disorders were examined for specific associations with PDs.MethodParticipants were 499 patients with anxiety disorders in the Collaborative Longitudinal Personality Disorders Study, who were assessed with structured interviews for psychiatric disorders at yearly intervals throughout 7 years of follow-up. These data were used to determine probabilities of changes in disorder status for social phobia (SP), generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), panic disorder and panic disorder with agoraphobia.ResultsEstimated remission rates for anxiety disorders in this study group ranged from 73% to 94%. For those patients who remitted from an anxiety disorder, relapse rates ranged from 34% to 67%. Rates for new episode onsets of anxiety disorders ranged from 3% to 17%. Specific PDs demonstrated associations with remission, relapse, new episode onsets and chronicity of anxiety disorders. Associations were identified between schizotypal PD with course of SP, PTSD and GAD; avoidant PD with course of SP and OCD; obsessive-compulsive PD with course of GAD, OCD, and agoraphobia; and borderline PD with course of OCD, GAD and panic with agoraphobia.ConclusionsFindings suggest that specific PD diagnoses have negative prognostic significance for the course of anxiety disorders underscoring the importance of assessing and considering PD diagnoses in patients with anxiety disorders.
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Yen, Ju-Yu, Pai-Cheng Lin, Mei-Feng Huang, Wei-Po Chou, Cheng-Yu Long, and Chih-Hung Ko. "Association between Generalized Anxiety Disorder and Premenstrual Dysphoric Disorder in a Diagnostic Interviewing Study." International Journal of Environmental Research and Public Health 17, no. 3 (February 5, 2020): 988. http://dx.doi.org/10.3390/ijerph17030988.
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Background: Premenstrual dysphoric disorder (PMDD) demonstrates predictable, cyclic, affective and somatic symptoms that are aggravated in the late luteal phase and are resolved by menstruation. Generalized anxiety disorder (GAD) is characterized by excessive and persistant worry. The present study aims to evaluate the association between PMDD and GAD. The fluctuations of behavior inhibition, anxiety, depression, and irritability were also evaluated during the menstrual cycle among women with PMDD and healthy women. Methods: There were 100 women diagnosed with PMDD based on a psychiatric interview and on a prospective evaluation in three menstrual cycles. A total of 96 healthy women were recruited as controls. Each individual’s GAD diagnosis, behavior inhibition, behavior activation, depression, anxiety, and irritability were assessed in both luteal and follicular phases. Results: The odds ratio of women with GAD having PMDD was 7.65 (95% CI: 1.69–34.63) in relation to those without it. This association was partially mediated by behavior inhibition and irritability and was completely mediated by depression. Women with PMDD and GAD had higher anxiety during the luteal phase and higher PMDD severity, depression, and irritability than those without GAD in the follicular phase. There is no difference in anxiety, depression, or irritability between the luteal and follicular phases among women with PMDD and GAD. Conclusions: Women with GAD were more likely to have PMDD. Anxiety, depression, and irritability symptoms in women with PMDD and GAD were not relieved in the follicular phase. Thus, GAD should be assessed for women with PMDD. Their anxiety, depression, and irritability should be intervened not only in the luteal phase, but also in the follicular phase. Depression, irritability and behavior inhibition mediated the association between PMDD and GAD. Intervening with these mediators to attenuate GAD and PMDD comorbidity should be researched in the future.
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McIntosh, Cameron, and Rocco Crino. "Towards a Unified Worry Exposure Protocol for Generalised Anxiety Disorder: A Pilot Study." Behaviour Change 30, no. 3 (August 12, 2013): 210–25. http://dx.doi.org/10.1017/bec.2013.19.
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Background: Worry exposure is a cognitive–behaviour therapy (CBT) technique frequently used to treat GAD, yet there are only a few studies on its effectiveness. Aim: To compare two worry exposure protocols developed for GAD to make a preliminary determination about the most effective way in which to present the feared stimuli to participants. Method: Nine university students suffering from GAD were administered four 1-hour treatment sessions. Exposure was conducted by either directly imagining (DI) or via audio-recording/playback (AR) exposure to their feared event. General worry and intolerance of uncertainty (IOU) were the primary dependent variables. Results: All participants in the DI and half of the AR condition reported subclinical GAD at post-treatment, with results being maintained at 3-month follow-up and the treatment responders also reported decreased depression, anxiety and stress. Conclusions: The DI protocol was more effective than the AR methodology in this sample, and may be an appropriate standard for worry exposure research and clinical practice.
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West, Bonnie, and Paul Willner. "Magical Thinking in Obsessive-Compulsive Disorder and Generalized Anxiety Disorder." Behavioural and Cognitive Psychotherapy 39, no. 4 (February 21, 2011): 399–411. http://dx.doi.org/10.1017/s1352465810000883.
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Background: Magical thinking (MT), which has historically been associated with psychotic disorders, has more recently been found to be a central cognitive construct in Obsessive-Compulsive Disorder (OCD) that is associated with a poor prognosis (Einstein and Menzies, 2008). Although MT has been found to distinguish OCD from Panic Disorder (PD) (Einstein and Menzies, 2006), little is known about its role in other anxiety disorders. Aims: This study aimed to compare whether elevated levels of magical thinking could distinguish individuals with OCD from non-anxious controls and individuals with Generalized Anxiety Disorder (GAD). Method: The Magical Ideation Scale (MIS, Eckblad and Chapman, 1983) was used to compare levels of magical thinking in groups of individuals with OCD (n = 40), GAD (n = 15), and a normal control group (n = 19). Results: As expected, the mean MIS score of the OCD group was significantly higher than that of the non-clinical group. Interestingly, there was no significant difference between the mean MIS scores of the OCD and GAD group. However, the results of correlational analyses suggest that it may have differing roles in these disorders. Conclusions: Although elevated MT is evident in individuals with OCD, it may not be specific to OCD and may also be prominent in GAD. Further research is recommended to elucidate the exact role of this construct in these disorders.
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NEWMAN, STEPHEN C., and ROGER C. BLAND. "A population-based family study of DSM-III generalized anxiety disorder." Psychological Medicine 36, no. 9 (May 15, 2006): 1275–81. http://dx.doi.org/10.1017/s0033291706007732.
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Background. A recent meta-analysis provides evidence that generalized anxiety disorder (GAD) is familial. However, two of the key studies relied on subjects who were self-selected or recruited from the clinic setting, thereby limiting generalizability.Method. We conducted a family study of GAD in which probands and controls came from a community sample originally enrolled in a prevalence study in Edmonton, Canada. One hundred and sixty probands, 764 controls and 2386 first-degree relatives (FDRs) were interviewed using the Diagnostic Interview Schedule (DIS); lifetime diagnoses were made according to DSM-III criteria without exclusions. Logistic regression analysis was performed with GAD (in a proband) as the ‘exposure’, and GAD in an FDR as the ‘outcome’. Several analytic strategies were used to control for potential confounding by major depressive disorder (MDD) and several anxiety disorders (panic disorder, phobic disorders, obsessive–compulsive disorder, and post-traumatic stress disorder).Results. The odds ratios for the association between GAD in a proband and GAD in an FDR were in the range 1·4–1·8 when the entire FDR sample was analysed, and in the range 2·1–2·8 when we restricted to FDRs who were children of probands and controls.Conclusion. In the community setting, GAD exhibits mild to moderate familial aggregation.
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Tiller, John W. G., and Nola Biddle. "Obtaining Outpatient Referrals for Clinical Research." Australian & New Zealand Journal of Psychiatry 25, no. 1 (March 1991): 132–33. http://dx.doi.org/10.3109/00048679109077728.
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Two methods of recruiting patients with generalised anxiety disorder (GAD) were compared. One hundred general practitioners in the immediate neighbourhood of a major urban hospital were approached for referrals, and an article on generalised anxiety asking for volunteers was placed in the evening newspaper. The former resulted in ten doctor-initiated referrals, two of whom fulfilled DSM-Ill criteria for GAD. The latter resulted in over 500 volunteers. In a random selection of 136 volunteers who secured their doctors' approval, 56 fulfilled GAD criteria. The majority of the remainder had a depressive illness. The newspaper article was more economical of researchers' time and more successful in finding suitable subjects than directly approaching general practitioners.
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Martynikhin, I., N. Neznanov, and S. Mosolov. "Diagnosis of generalized anxiety disorder in Russia: The results of a web-based survey of psychiatrists." European Psychiatry 41, S1 (April 2017): S413. http://dx.doi.org/10.1016/j.eurpsy.2017.01.356.
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IntroductionThere is a lack of attention on generalized anxiety disorder (GAD) in the psychiatrists’ education programs in Russia. The consequence of this is difficult to estimate because of insufficiency of the GAD epidemiology in Russia.ObjectivesAre estimation of the comparative prevalence of diagnosis of GAD among other anxiety and stress related disorders; psychiatrists’ knowledge about GAD and theirs therapeutic approaches.MethodsThe invitations to survey were sent by e-mail to members of the Russian Society of Psychiatrists; 888 psychiatrists took part in the survey. Twenty-six percent of them worked in inpatient departments, 43% – in outpatient departments, 15% – in somatic services, 17% – researchers and university professors.ResultsA total of 83% of respondents have diagnosed GAD at least once during last year. Most often GAD was diagnosed by psychiatrists of somatic services. Mixed anxiety and depressive disorder was diagnosed in 2.5 times more often than GAD; adjustment disorders – in 2.1 times. Doctors have noted that among their patients with other mental disorders 26% have chronic anxiety, but most of doctors do not establish the comorbid diagnosis of GAD for these patients. Only a quarter of doctors consider that detachment of GAD from other anxiety disorders is based on the features of etiology and pathogenesis. In the treatment of GAD together with SSRIs, SNRIs, and pregabalin prescribing, doctors often prescribe benzodiazepines, atypical anxiolytics (hydroxyzine, buspirone) and low-potency antipsychotics (alimemazine, chlorprothixene).ConclusionsIncreasing attention to GAD in the psychiatrists’ education programs may improve diagnosis and treatment of this disorder in Russia.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Markota, Matej, and Robert J. Morgan. "Treatment of Generalized Anxiety Disorder with Gabapentin." Case Reports in Psychiatry 2017 (2017): 1–4. http://dx.doi.org/10.1155/2017/6045017.
Full textAbstract:
Gabapentin is frequently used in the treatment of anxiety disorders. However, there are no randomized controlled trials on the effectiveness of this medication in generalized anxiety disorder (GAD), and there are only a few case reports. We present a case of a 59-year-old female with a psychiatric history of GAD. The patient discontinued benzodiazepines after more than 7 years of daily treatment which led to rebound anxiety, benzodiazepine withdrawal symptoms, and suicidal ideation. She was psychiatrically hospitalized and started on gabapentin. Over the next 10 months of outpatient follow-up, she attempted to taper off gabapentin due to personal preference to limit medications. During this time, we observed a clear dose-response pattern of gabapentin on GAD symptoms. In the absence of controlled studies, these findings may offer important information about the effectiveness of gabapentin in GAD.
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Ansara, Elayne D. "Management of treatment-resistant generalized anxiety disorder." Mental Health Clinician 10, no. 6 (November 1, 2020): 326–34. http://dx.doi.org/10.9740/mhc.2020.11.326.
Full textAbstract:
Abstract Generalized anxiety disorder (GAD) is characterized by persistent and excessive worry. Around half of the patients treated for GAD will fail to respond to initial treatment. Treatment-resistant (or refractory) GAD is defined as failure to respond to at least 1 trial of antidepressant therapy at adequate dose and duration. Review of the literature indicates several potential medication classes and individual agents that can be used as augmentation strategies to treat residual symptoms when recommended therapy per clinical practice guidelines fails. A thorough literature search revealed 2 medication classes with the largest amount of data to support their use in treatment-resistant GAD treatment: gamma-aminobutyric acid–related agents and atypical antipsychotics. This article focuses on evidence-based recommendations for the use of these agents as adjunctive therapies for patients with treatment-resistant GAD. Different pharmacologic approaches to use these agents are demonstrated through 2 patient cases in which patients have failed first-line treatment options.
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Gorwood, P. "Generalized anxiety disorder and major depressive disorder comorbidity: an example of genetic pleiotropy?" European Psychiatry 19, no. 1 (January 2004): 27–33. http://dx.doi.org/10.1016/j.eurpsy.2003.10.002.
Full textAbstract:
AbstractGeneralized anxiety disorder (GAD) and major depressive disorder (MDD) are the most common type of anxiety-mood comorbidity. Up to 80% of subjects with lifetime GAD also have a comorbid mood disorder during their lifetime. Many hypotheses have been raised to explain such high comorbidity. Pleiotropy, i.e. a single genetic mutation explains (apparently) different disorders, is one of them and is hereby reviewed. Importance and reliability of GAD and MDD comorbidity (1); Evidence in favour of co-aggregation of GAD and MDD within families (the risk of one disorder in a proband increasing the risk for the other in relatives) (2); substantial heredity for both disorders according to twin studies with evidence for genetic correlation of unity between the two disorders (3); existence of numerous mechanisms (4) potentially linking the two disorders to common vulnerability genes, are all in accordance with such a hypothesis. Some examples of potentially shared mechanisms (such as CRF dysregulation or abnormal transcription factors) and possible common vulnerability genes (for example, the serotonin transporter gene) are given to highlight the pleiotropy hypothesis.