IN THIS ISSUE
GENERALIZED ANXIETY DISORDER
Generalized anxiety disorder is characterized by persistent, excessive, and uncontrollable worry and anxiety about daily life and routine activities. The anxiety and worry are associated with at least 3 of the following 6 symptoms, with at least some symptoms present for more days than not during the past 6 months: feeling restless, keyed up, or on edge; being easily fatigued; having difficulty concentrating or mind going blank; irritability; muscle tension; and sleep disturbance. Patients suffering from generalized anxiety disorder may consistently expect the worst and experience physical symptoms of anxiety, including myalgias, trembling, jumpiness, headache, dysphagia, gastrointestinal discomfort, diarrhea, sweating, hot flashes, and feeling lightheaded and breathless (27,28). Patients with anxiety disorders are more likely to seek treatment from a primary care physician than from a psychiatrist, so it is important to be alert to possible manifestations of anxiety (27).
Screening includes assessing symptoms of generalized anxiety disorder, level of functional impairment, and presence of comorbid psychiatric conditions. If you suspect generalized anxiety disorder, use the GAD-7 assessment tool (29) to help confirm the diagnosis (Resources—City Health Information: World Trade Center).
Differential Diagnosis (27)
Rule out other possible causes for the symptoms before beginning any form of treatment. Anxiety may be caused by hyperthyroidism, Cushing's disease, and arrhythmias, among other disorders. Medications such as steroids, over-the-counter sympathomimetics, SSRIs, digoxin, thyroxine, and theophylline, as well as alcohol, caffeine, nicotine, and cocaine and other illicit drugs (whether during intoxication or withdrawal), can also cause or exacerbate anxiety symptoms.
Treatment involves psychotherapy, pharmacotherapy (Box 5), or both (27). The short-term treatment goal is to rapidly reduce symptoms and overwhelming anxiety; long-term goals include full recovery, relapse prevention, and management of any comorbid disorders. Consider pharmacotherapy for patients whose anxiety affects their daily functioning (27).
Psychotherapy (28,30). Psychotherapy is most effective when used in combination with pharmacotherapy, but psychotherapy alone can be used as the initial treatment for patients with mild generalized anxiety disorder.
Treatment approaches include