GAD: Symptoms, pathophysiology, risk factors, diagnostic criteria, treatment options.
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Generalized anxiety disorder, GAD, is a very common mental disorder characterized by excessive, difficult to control, and often irrational, worry about everyday activities. The worry is persistent and typically encompasses different areas of life including work, health, finance, family and relationships. Patients have hard time with daily tasks, and often present with psychological as well as physical symptoms, such as restlessness, muscle tension, digestive problems, headaches and sleep disturbance.
The mechanism of GAD is not well understood. Some evidence suggests that GAD patients may experience persistent activation in areas of the brain that process stimuli associated with fear, anxiety, and emotions. Dysfunction of brain pathways involved in anxiety, such as serotonin and noradrenergic systems, is thought to be responsible.
Development of GAD is likely due to a combination of genetic and environmental factors such as significant life changes or traumatic events. Women are somewhat more affected than men. Other risk factors include lower level of education, chronic illnesses and other mental disorders.
Diagnosis of GAD is challenging. Patients must be tested to rule out other medical conditions, psychiatric disorders, or use of substances that may produce similar symptoms.
Diagnostic criteria published by the American Psychiatric Association include:
- excessive anxiety occurring for more than half of the time, and ongoing for at least six months.
- the anxiety is difficult to control; and is associated with at least 3 of the following symptoms: restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbance.
- the anxiety results in significant distress or impairment in social and occupational areas.
- symptoms are not due to other conditions or substance use.
The GAD-7, a questionnaire of 7 items, is usually used as a screening tool and for severity assessment. Greater GAD-7 scores indicate greater severity.
Treatments are most effective when combining life style changes, psychotherapy and medications.
Lifestyle recommendations include identifying and removing possible triggers, eating healthy, practicing relaxation techniques, improving sleep and doing physical exercise.
Medications include antidepressants, anti-anxiety agents, and benzodiazepines.
Selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are considered first-line therapy. All antidepressants should be tested for optimal dosage and taken for at least 4 weeks to determine efficacy. Patients must be monitored for adverse effects. On the other hand, benzodiazepines are generally prescribed only for relieving acute anxiety on a short-term basis because of potential risk for misuse and dependence.
