Article2012

Generalized anxiety disorder: diagnosis and treatment

Elizabeth A. Hoge · Ana Ivkovic · Gregory L. Fricchione

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Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes Mental Health Treatment and Access Psychological Treatments and Disorders

Abstract

#### Summary points Generalized anxiety disorder (GAD) is relatively common, with lifetime prevalence rates of 4-7%. It is a disorder of chronic uncontrollable worry, compounded by physiological symptoms such as disturbed sleep, muscle tension, and difficulty concentrating. The disorder is associated with seriously impaired social and occupational functioning, comorbidity with other disorders, and increased risk for suicide.1 GAD can go undiagnosed because of a focus on physical symptoms and because of the stigma of mental illness. However, the disorder can be treated. This article reviews current knowledge about the diagnosis and treatment of GAD, including pharmacotherapy and psychosocial therapies. #### Sources and selection criteria We based this review on articles found by searching PubMed and the Cochrane Database of Systematic Reviews using the terms “generalized anxiety disorder” and “generalised anxiety disorder”. Our search was limited to English language articles published between 2005 and 2012. Meta-analyses, reviews, and randomised controlled trials were prioritized. GAD is characterized by excessive worry and symptoms of physiological arousal such as restlessness, insomnia, and muscle tension (box). To meet Diagnostic and Statistical Manual of Mental Disorders , fourth edition (DSM-IV) criteria for the disorder, the patient must have excessive and difficult to control anxiety about several different events or activities.2 For example, anxiety confined to concern about personal safety would not qualify (but should elicit inquiries about symptoms of post-traumatic stress disorder or agoraphobia, for example). In addition to worry, patients must have at least three of the six physiological arousal symptoms listed in the box. …

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References

2005Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication 2009The Neurocircuitry of Fear, Stress, and Anxiety Disorders 2001A Review and Meta-Analysis of the Genetic Epidemiology of Anxiety Disorders 2008Cognitive-Behavioral Therapy for Adult Anxiety Disorders 1994DSM-III-R Generalized Anxiety Disorder in the National Comorbidity Survey 1995Common mental disorders and disability across cultures. Results from the WHO Collaborative Study on Psychological Problems in General Health Care 2002Generalized anxiety and depression in primary care: prevalence, recognition, and management.1997Mental Disorders and Disability Among Patients in a Primary Care Group Practice

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