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How long does it take to treat generalized anxiety disorder? Generalized anxiety disorder: description and treatment


Description:

Generalized anxiety disorder is a mental disorder characterized by general, persistent anxiety that is not associated with specific objects or situations.


Symptoms:

Generalized anxiety disorder (GAD) is characterized by:
      * persistent (period of at least six months);
      * generalized (severe tension, anxiety and a feeling of impending troubles in everyday events and problems; various fears, worries, forebodings);
      * non-fixed (not limited to any specific circumstances).
There are 3 characteristic groups of symptoms of generalized anxiety disorder:
   1. Anxiety and fears that are difficult for the patient to control and that last longer than usual. This worry is generalized and does not focus on specific problems, such as the possibility of having a panic attack (as in panic disorder), being stranded (as in), or being dirty (as in obsessive-compulsive disorder).
   2. Motor tension, which can be expressed in muscle tension, tremors, inability to relax, (usually bilateral and often in the frontal and occipital areas).
   3. Hyperactivity of the autonomic nervous system, which is expressed by increased sweating, tachycardia, dry mouth, epigastric discomfort and dizziness.
Other psychiatric symptoms of generalized anxiety disorder include irritability, poor concentration, and sensitivity to noise. Some patients, when tested for their ability to concentrate, complain of poor memory. If memory impairment is indeed detected, then it is necessary to conduct a thorough psychological examination to exclude a primary organic mental disorder.
Other motor symptoms include aching muscle pain and muscle stiffness, especially in the back and shoulder area.
Autonomic symptoms can be grouped according to functional systems as follows:
      * gastrointestinal: dry mouth, difficulty swallowing, epigastric discomfort, excessive gas formation, rumbling in the stomach;
      * respiratory: a feeling of constriction in the chest, difficulty in inhaling (as opposed to difficulty exhaling with asthma) and the consequences of hyperventilation;
      * cardiovascular: a feeling of discomfort in the heart area, palpitations, a feeling of absence of a heartbeat, pulsation of the cervical vessels;
      * urogenital: frequent urination, loss of erection, decreased libido, menstrual irregularities, temporary amenorrhea;
      * nervous system: feeling of staggering, feeling of blurred vision, etc.
Patients may seek help for any of these symptoms without addressing anxiety symptoms.
GAD is also typical. Patients may experience difficulty falling asleep and a feeling of anxiety when waking up. Sleep is often interrupted with unpleasant dreams. At times, nightmares occur, and patients wake up in horror. Sometimes they remember nightmares, and other times they don't know why they woke up anxious. Patients with this condition may wake up unrested. Early morning awakening is not a characteristic feature of this disorder, and if it is present, it must be assumed that it is part of a depressive disorder. A person with this disorder often has a characteristic appearance. His face looks tense with furrowed brows, his posture is tense, he is restless, and he often trembles. The skin is pale. Frequently sweats, especially in the palms, soles and armpits. He is whiny, which at first may suggest and reflects a general depressed mood. Other symptoms of generalized anxiety disorder include fatigue, depressive symptoms, obsessive symptoms,... However, these symptoms are not leading. If they are leading, then a different diagnosis must be made. Some patients experience hyperventilation at times, with corresponding symptoms added to the clinical picture, especially paresthesia in the extremities and dizziness.


Causes:

The cognitive theory of the origin of generalized anxiety disorder, developed by A. Beck, interprets anxiety as a reaction to perceived danger. Individuals prone to developing anxious reactions have a persistent distortion in the process of perceiving and processing information, as a result of which they consider themselves unable to cope with the threat or control the environment. The attention of anxious patients is selectively directed precisely to possible danger. Patients with this disease, on the one hand, are firmly convinced that anxiety is a kind of effective mechanism that allows them to adapt to the situation, and on the other hand, they regard their anxiety as uncontrollable and dangerous. This combination seems to close a “vicious circle” of constant anxiety.


Treatment:

For treatment the following is prescribed:


The goal of treatment for generalized anxiety disorder is to eliminate the core symptoms of chronic restlessness, muscle tension, autonomic hyperactivation, and sleep disturbances. Therapy must begin with explaining to the patient the fact that his somatic and mental symptoms are a manifestation of increased anxiety and that anxiety itself is not a “natural reaction to stress,” but a painful condition that can be successfully treated. The main methods of treating generalized anxiety disorder are psychotherapy (primarily cognitive-behavioral and relaxation techniques) and drug therapy. For treatment, antidepressants from the SSRI group are usually prescribed; if unresponsive to this therapy, adding an atypical antipsychotic may help.


Send specific messages to the heart, lungs, muscles and other organs through nerves throughout the body. Hormonal alarm signals come through the blood - for example, adrenaline is released. Taken together, these “messages” lead to the body speeding up and intensifying its work. The heart beats faster than usual. Nausea occurs. The body is covered with trembling (tremor). Sweat increases. It is impossible to avoid dry mouth, even if a person drinks a lot of liquid. Chest and headache hurt. Sucks in the pit of the stomach. Shortness of breath appears.

The excitement of a healthy body must be distinguished from painful, pathological anxiety. Normal anxiety is useful and necessary when experiencing stress. It warns of danger or a situation of possible confrontation. The individual then decides whether he should "take the fight" (for example, take a difficult exam). If too high, the subject understands that he needs to get away from such an event as quickly as possible (for example, when attacked by a wild animal).

But there is a special type of anxiety in which a person’s condition becomes painful, and manifestations of anxiety prevent him from carrying out normal life activities.

With GAD, a person is afraid for a long time. Often extreme confusion is unmotivated, i.e. the reason for it cannot be understood.

Symptoms of pathological anxiety may, at first glance, be similar to manifestations of a normal, healthy anxiety state, especially when we are talking about the so-called “anxious individuals.” For them, anxiety is an everyday norm of well-being, and not a disease. To distinguish generalized anxiety disorder from the norm, you need to find at least three of the following symptoms in a person:

  • anxiety, nervous excitement, impatience appear much more often than in usual living conditions;
  • fatigue sets in faster than usual;
  • it is difficult to gather attention, it often fails - as if it is turned off;
  • the patient is more irritable than usual;
  • muscles are tense and cannot be relaxed;
  • sleep disturbances appeared that were not there before.

Anxiety that occurs for only one of these reasons is not a sign of GAD. Most likely, obsessive anxiety for any single reason means a phobia - a completely different disease.

Generalized anxiety disorder occurs between the ages of 20 and 30. Women get sick more often than men. The causes of this disorder are unknown, so it often seems that they do not exist at all. However, a number of indirect factors can influence the development of such a condition. This

  • heredity: there are many anxious individuals in the family; had relatives who suffered from GAD;
  • during childhood, the patient suffered psychological trauma: he was poorly communicated with in the family, one of the parents or both died, a syndrome was identified, etc.;
  • after suffering major stress (for example, a family crisis), generalized anxiety disorder developed. The crisis is over, the provoking factors have been exhausted, but the signs of GAD remain. From now on, any minor stress, which has always been easy to cope with, maintains the symptoms of the disease.

GAD in some cases develops as a secondary, concomitant disease in those suffering from depression and schizophrenia.

The diagnosis of GAD is made if its symptoms have developed and persisted for 6 months.

Is it possible to overcome generalized anxiety disorder? The treatment of this disease has been studied quite well. The manifestation of the disease may not be severe, but in the worst cases it can make the patient unable to work. In the sudden mode, difficult and lighter periods change; under stress (for example, the patient has lost his job or separated from a loved one), spontaneous exacerbations are possible.

Patients with GAD tend to smoke incredibly heavily, drink alcohol, and use drugs. This way they distract themselves from the disturbing symptoms, and for a while it really helps. But it is quite obvious that by “supporting” themselves in this way, they can completely lose their health.

Treatment for GAD cannot be quick and, unfortunately, does not provide complete recovery. At the same time, the treatment process, if carried out in courses over many years, will provide significant relief of symptoms and a qualitative improvement in life.

Its task at the first stage is to show the patient what changes need to be made in the ideas and thoughts that provoke anxiety. Then the patient is taught to build his thinking without harmful, useless and false premises - so that it works realistically and productively.

Individual consultations are conducted, during which the person practices problem-solving techniques.

Where technical and financial conditions allow, there are group courses to combat anxiety symptoms. They teach relaxation and attach great importance to strategies for overcoming difficulties.

For self-help, psychological support centers (if they exist) can provide literature and videos teaching relaxation and how to overcome stress. Special techniques for relieving anxiety are described.

Drug therapy is based on the use of two types of drugs: buspirone and antidepressants.

Buspirone is considered the best medicine for its action. Its effect has not been fully studied. It is only known that it affects the production of a special substance in the brain - serotonin, which is presumably responsible for the biochemistry of anxiety symptoms.

Antidepressants, although they do not directly target anxiety, can be effective in treating it.

Currently, benzodiazepine drugs (for example, diazepam) are increasingly prescribed for the treatment of GAD. Despite their apparent ability to relieve anxiety, benzodiazepines are addictive, causing them to stop working. Moreover, additional treatment has to be carried out against addiction. In severe cases of GAD, diazepam is prescribed for a period of no more than 3 weeks.

Antidepressants and buspirone are not addictive.

To achieve the greatest effect, cognitive therapy and buspirone treatment are combined.

Advances in modern pharmacology allow us to expect new medications in the coming years that will help completely cure generalized anxiety disorder.

Generalized anxiety disorder or generalized anxiety disorder is a disorder characterized by diffuse and chronic worry. Unlike people with phobias or PTSD, people with generalized anxiety disorder do not have anxiety caused by specific triggers; they may be disturbed by something related to ordinary life. Patients diagnosed with generalized anxiety disorder often shift the focus of their anxiety from one problem to another as their daily circumstances change.

What is a generalized disorder characterized by?

Generalized anxiety disorder is characterized by constant worry and fear that is excessive and difficult to control. Common problems associated with generalized anxiety disorder include work, money, health, safety, and household chores. The anxiety typical of this condition often depends on a large number of problems and is related to the person's environment.

A patient diagnosed with generalized anxiety disorder usually recognizes that his anxiety is disproportionate in duration or intensity to the actual likelihood or impact of a dangerous situation or event. Anxiety levels in people with this condition may rise and fall over a period of weeks or months, but tend to become a chronic problem. The disorder usually worsens during stressful periods.

What are the symptoms of generalized anxiety disorder

Work, family life, social activities, or other areas of a person's functioning are the main criteria for the manifestation of symptoms of generalized anxiety disorder. Diagnostic manuals for psychiatrists mention physical symptoms such as insomnia, muscle pain, headaches, indigestion, etc. Common symptoms in adults include anxiety, fatigue, difficulty concentrating, irritability, high muscle tension and sleep disturbances.

Patients diagnosed with generalized anxiety disorder have a high incidence of concurrent (accompanying) psychiatric symptoms, especially those associated with depression, other anxiety disorders, or substance abuse. They also often have or develop stress-related physical illnesses and conditions such as headaches, irritable bowel syndrome, temporomandibular joint dysfunction, bruxism, and hypertension. In addition, the discomfort or complications associated with arthritis, diabetes, and other chronic diseases are often exacerbated by the generalized disorder. Such people are more likely to seek help from their physician than from a psychiatrist, and are also more likely than patients with other disorders to visit health care facilities, undergo extensive or repeated diagnostic testing, describe their health as very poor, and smoke or drink alcohol heavily. Additionally, patients with anxiety disorders have higher mortality rates.

Why is generalized disorder so difficult to recognize?

In many cases it is difficult for the physician to determine whether anxiety precedes or follows the physical condition of his patient; Sometimes a person develops generalized anxiety disorder after being diagnosed with a physical chronic illness. In other cases, stress caused by constant and repeated worry leads to physical illnesses and disorders. There is a general concept of a “vicious circle” in the relationship between generalized anxiety disorder and other disorders.

Generalized anxiety disorder in children

Children diagnosed with generalized anxiety disorder have the same symptoms as adults. They worry about issues that are not typical for children, such as whether the family has enough money for emergency needs, how safe it is to play on the playground, whether there is enough gas in the tank of the family car before a trip, and similar problems. Concerns also arise among children from stable and happy families who do not have serious financial or other problems.

Generalized anxiety disorder often has an insidious onset that begins relatively early, although it can be precipitated by a sudden crisis at any age. Doctors say the disease most often begins in childhood, although symptoms may not appear until adolescence or early adulthood. About half of all patients diagnosed with this disorder report that their anxiety began in childhood or adolescence. This type of constant anxiety can be considered as part of a person's temperament, or as an innate predisposition, and sometimes as an anxious feeling. However, it is not unusual for people to become anxious during their adult years in response to chronically stressful or anxiety-producing situations.

The specific experiences of a person with generalized anxiety disorder may depend on their ethnic background or culture. Some people experience dissociative symptoms when their perception of reality is temporarily altered - they may feel as if they are in a trance, or as if they are observing the activities around them but not participating in them.

What are the causes of generalized disorder

The causes of generalized anxiety disorder are a mixture of genetic and environmental factors. It is known that the disease is familial. Recent studies of the human genome point to a genetic factor in the development of generalized anxiety disorder. This has identified a gene associated with panic disorder, raising the possibility that there is a gene or genes that determine susceptibility to generalized anxiety. The role of the family environment (social modeling) in a person's susceptibility to this mental disorder is uncertain. Social modeling, the process of learning patterns of behavior and emotional response from observing parents or other adults, appears to be a more important factor for women than for men.

Social and gender factors of anxiety disorders

Another factor in the development of generalized anxiety disorder is social expectations associated with gender roles. Previous findings that women have higher levels of emotional stress and lower quality of life than men have recently been confirmed. The higher prevalence of the disease in women is associated with diffuse but pervasive expectations. Many women take on responsibility for the well-being and safety of other family members in addition to work or vocational school. The global nature of these responsibilities, as well as their inexorable nature, is described as a mirror image of the persistent but nonspecific anxiety associated with anxiety.

Socioeconomic status may also contribute to generalized anxiety. One study found that this mental disorder is more closely associated with the accumulation of minor stressors than with any demographic factors. However, people with lower socioeconomic status have fewer resources to cope with minor stressors and appear to be at greater risk for generalized anxiety.

Physiological causes of generalized anxiety disorder

Another factor in generalized anxiety disorder may be the level of muscle tension. It has been found that patients diagnosed with this disease tend to respond to physiological stress in a rigid, stereotypical manner. Their autonomic responses are similar to those of healthy individuals, but muscle tension shows a significant increase. However, it is not yet known whether the level of muscle tension is a cause or an effect of generalized anxiety disorder.

What are the symptoms of generalized disorder

The symptoms of generalized anxiety disorder have changed somewhat over time. Previously, psychiatrists did not clearly distinguish between generalized anxiety disorder and panic disorder. After specific treatments for panic disorder were developed, generalized anxiety disorder came to be considered anxiety disorder without panic attacks or major depressive symptoms. This definition turned out to be unreliable. As a result, the disease is defined in terms of psychological symptoms (excessive worry) rather than physical (muscle tension) or autonomic symptoms of anxiety.

According to the above, the symptoms of generalized anxiety are:

  • excessive worry and worry about a series of events or activities occurring over at least six months,
  • anxiety that cannot be controlled
  • anxiety associated with several symptoms such as anxiety, fatigue, irritability or muscle tension,
  • anxiety that causes problems or deterioration in relationships at work or school,
  • the anxiety is not caused by another anxiety disorder, such as panic disorder, social phobia or obsessive-compulsive disorder,
  • the anxiety is not caused by a substance (such as a drug).
  • symptoms associated with high levels of physiological arousal: muscle tension, irritability, fatigue, anxiety, insomnia,
  • symptoms associated with distorted thinking processes: poor concentration, unrealistic assessment of problems, periodic restlessness,
  • symptoms related to coping strategies: procrastination, avoidance, inadequate problem-solving skills.

Generalized disorders - demographics and statistics

It is difficult to compare current statistics of generalized anxiety disorder with those of the last century due to changes in diagnostic criteria for the disease. Mental health professionals say that as of 2000, approximately three percent of the total population in developed countries experience symptoms for some time. The figure for children is five percent. Women suffer from generalized anxiety disorder approximately twice as often as men. The prevalence of the disease among different ethnic groups is more difficult to determine due to cultural influences.

Diagnosis of generalized anxiety disorder

Diagnosis of generalized anxiety disorder, especially in primary care settings, is complicated by several factors. One of them is the high level of comorbidity (overlap) between this disease and other mental or physical disorders. The second is the significant overlap between anxiety disorders in general and depression. Some practitioners believe that depression and generalized anxiety cannot be separate disorders because research has repeatedly documented the existence and frequency of “mixed” anxiety/depression syndrome.

Evaluating a patient for a diagnosis of generalized anxiety disorder involves the following steps.

Conversation with the patient

The doctor asks the patient to describe the anxiety and note whether it is acute (hours to weeks) or persistent (months to years). If a patient describes a recent stressful event, the doctor will also assess for “dual anxiety,” which refers to acute anxiety that is added to persistent worry. The doctor may also have the patient fill out a diagnostic questionnaire to evaluate the presence of anxiety disorders. The Hamilton Scale is a widely used tool for assessing anxiety disorders in general. The Generalized Anxiety Disorder Questionnaire is a more recent diagnostic tool and is specific to this disorder.

Medical assessment

Non-psychiatric disorders known to cause concern should be ruled out (hyperthyroidism, Cushing's disease, mitral valve prolapse, carcinoid syndrome, and pheochromocytoma), as well as certain medications (steroids, digoxin, thyroxine, theophylline, and selective serotonin reuptake inhibitors) that may also cause anxiety as a side effect. The patient is also asked about the use of herbal medications.

Substance Abuse Assessment

Because anxiety is a common symptom of substance abuse and withdrawal symptoms, the doctor may ask about the patient's use of caffeine, nicotine, alcohol, and other substances (including medications).

Assessment of other mental disorders

This step is necessary because of the frequent overlap between generalized anxiety disorder and depression or other anxiety disorders.

In some cases, the doctor will interview the patient's family members to obtain more information about the onset of anxiety symptoms, dietary habits, etc.

Treatment for Generalized Anxiety Disorder

There are several types of therapy that have been found effective in treating generalized anxiety disorder. Most patients with this disease are treated with a combination of medications and psychotherapy.

Medicines

Pharmacological therapy is usually prescribed for patients whose anxiety is severe enough to interfere with daily activities. Several different groups of medications are used to treat generalized anxiety disorder, which include the following.


Benzodiazepines

This group of tranquilizers does not reduce anxiety, but it reduces restlessness by reducing muscle tension and hypervigilance. They are often prescribed to patients with dual anxiety because they act very quickly. However, benzodiazepines have several disadvantages: they are not suitable for long-term therapy because they can cause dependence, they cannot be prescribed to patients who abuse alcohol, and they cause short-term memory loss and difficulty concentrating.

Tricyclic antidepressants

Imipramine, nortriptyline and desipramine are indicated in patients with generalized anxiety disorder. However, they have some problematic side effects; Imipramine has been associated with heart rhythm disturbances, and other tricyclics often cause drowsiness, dry mouth, constipation and mental confusion. They also increase the risk of falls and other accidents.

Buspirone

Buspirone is as effective as benzodiazepines and antidepressants in controlling anxiety symptoms. It is slower acting but has fewer side effects.

Selective serotonin reuptake inhibitors

Paroxetine, an SSRI, has been approved as a drug for the treatment of generalized anxiety disorder. Venlafaxine is useful for patients with mixed anxiety-depression syndrome; it is the first drug to be labeled as both an antidepressant and an anxiolytic. Venlafaxine is also effective in treating patients whose symptoms are primarily somatic.

Psychotherapy

Research shows that cognitive therapy is superior to medications and psychodynamic psychotherapy in treating this disease, but a certain number of doctors fundamentally disagree with this. Typically, people with generalized anxiety, who have a personality disorder, live with chronic social stress, or who are distrustful of psychotherapeutic approaches require medication treatment. The greatest benefit of cognitive therapy is its effectiveness in helping patients evaluate their problems in more realistic ways and use better problem-solving techniques.

Alternative and complementary therapies

Several alternative and complementary methods may be useful in treating people with generalized anxiety disorder. These include hypnotherapy; music therapy; Ayurvedic medicine; yoga; meditation. Biofeedback and relaxation techniques are also recommended for patients with generalized anxiety to reduce physiological arousal. Additionally, massage therapy, hydrotherapy, shiatsu, and acupuncture relieve muscle spasms or soreness associated with this condition.

Forecast and prevention of anxiety disorders

Generalized anxiety disorder is usually viewed as a long-term condition that can become a lifelong problem. Patients often find that their symptoms flare up or worsen during stressful periods in their lives. Less commonly, people with generalized anxiety disorder recover spontaneously.

Genetic factors contributing to generalized anxiety disorder have not been fully identified. In addition, many of the stressors of modern life that raise people's anxiety levels are difficult to avoid. The best preventive strategy, given the early onset of the disease, is to model realistic parental appraisals of stressful events and teach effective steps to cope with them.

Disclaimer: The information presented in this article about generalized anxiety disorder is intended to inform the reader only. It is not intended to be a substitute for advice from a healthcare professional.

Generalized anxiety disorder is a disease characterized by constant excessive worry, apprehension of danger, as well as anxiety caused by various events or activities (study, work, etc.). The duration of this condition is usually six months or more.

Generalized anxiety disorder in adults is a fairly common condition, occurring in approximately 3-5% of the population. It should be noted that women are more susceptible to it than men. An anxiety disorder usually begins to develop at an early age, but the risk of developing the disorder exists at any age. In some cases, the severity of the disorder varies periodically, and sometimes manifestations of the disease can appear over many years.

Symptoms

Among the main symptoms of anxiety disorder in adults are an irrational vision of problems, excessive and prolonged tension and anxiety, and increased irritability. Other symptoms: feeling nervous, muscle tension, increased sweating, headaches and nausea. In addition, difficulty concentrating, frequent urge to go to the toilet, tremors, fatigue, mild excitability, and problems falling asleep.

Often, depression, phobias, alcoholism and drug addiction, as well as obsessive-compulsive and panic disorder occur as a result of the disease.

Reasons

To date, there is no reliable data on the causes of the disease. However, there is information that certain environmental factors, genetics, and brain chemistry may contribute to the development of this disorder.

According to some statistical studies, heredity plays a significant role in the development of anxiety disorder. Thus, there is a concept of genetic predisposition to the development of this disorder.

Abnormal levels of certain neurotransmitters in a person's brain can have a direct impact on the onset and progression of the disorder. Neurotransmitters (mediators) are specific conductors of chemicals that facilitate the transfer of information from one nerve cell to another. Messages may not get through properly if the neurotransmitters are imbalanced, which can cause changes in the brain's response to normal circumstances, causing the patient to suffer from unreasonable worries.

It should also be noted that psychological trauma and stress such as divorce, death of a loved one, job change, alcohol or drug abuse can cause the development of the disorder. Systematic use of psychoactive substances (caffeine, nicotine or alcohol), as well as constant stress, can provoke an increase in a person’s anxiety level.

Diagnostics

Diagnosis consists of analyzing the medical history, as well as conducting a complete medical examination of the patient. To date, there are no specialized tests for diagnosing anxiety disorders. Therefore, the doctor uses various tests in order to promptly diagnose the physical disease that is causing the symptoms of the disorder.

The final diagnosis is based on the patient's history, the duration and intensity of the disease, as well as the identified problems associated with dysfunction of various organs that affect the symptoms. The presence of symptoms for six months may be the basis for a diagnosis. In addition, the symptoms must be severe enough to interfere with the patient's normal lifestyle, forcing him to miss work or school.

Treatment

Drug treatment of anxiety disorder consists primarily of providing emergency care for manifestations of fear and anxiety. In this case, the patient is asked to take benzodiazepine tranquilizers such as Phenazepam, Lorazepam, Alprazolam (Xanax), Clonazepam or Relanium (Diazepam). The duration of the course of treatment is, as a rule, no more than two months, as there is a risk of developing addiction. Treatment for sleep disorders is based on the use of Ivadal or Imovan. In order to reduce the severity of somatovegetative symptoms of anxiety, beta-blockers such as Trazicor, Propranolol or Obzidan, Atenolol are used. For a combination of anxiety and depression, Ipramil, Zoloft, Prozac, Anafranil (Clomipramine), Lerivon, Amitriptyline or Paxil are used. As a rule, these drugs are used in combination with tranquilizers. Treatment for severe anxiety involves the use of antipsychotics, in particular Eglonil, Chlorprothixene, Teralen or Tizercin.

Treatment of anxiety disorder also includes such methods of psychotherapy as short-term psychodynamic method, cognitive-behavioural, relaxation (autogenic training), as well as self-regulation methods with biofeedback.

Prevention

It is almost impossible to prevent the development of an anxiety disorder, but there are some fairly simple tips that, if followed, will help reduce the risk of developing the disease. First of all, it is recommended to minimize the consumption of foods rich in caffeine, including cola, tea, coffee and chocolate. Before taking a medicine, be sure to read the leaflet on it. The fact is that some drugs contain substances that increase anxiety levels. It is also recommended to exercise regularly and eat a balanced, healthy diet. After severe stress, you should not neglect the help of specialized psychotherapeutic consultations. Relaxation methods such as meditation or yoga are quite effective means of combating anxiety disorders.

Generalized anxiety disorder (GAD) is an anxiety disorder characterized by excessive, uncontrollable and often irrational worry and anxious anticipation of certain events or actions. Excessive worry interferes with daily activities because people with GAD tend to live in anticipation of unhappiness and are overly preoccupied with daily concerns about health, money, death, family problems, problems with friends, interpersonal problems, and difficulties at work. GAD often involves a variety of physical symptoms, such as fatigue, inability to concentrate, headaches, nausea, numbness in the arms and legs, muscle tension, muscle pain, difficulty swallowing, wheezing, difficulty concentrating, trembling, muscle twitching, irritability, anxious agitation, sweating, restlessness, insomnia, hot flashes, rash, inability to control anxiety (ICD-10). To be diagnosed with GAD, these symptoms must be persistent and continuous for at least six months. Each year, GAD is diagnosed in approximately 6.8 million Americans and 2 percent of adults in Europe. GAD is 2 times more common in women than in men. The occurrence of this disorder is more likely in people who have experienced violence, as well as those with a family history of GAD. Once GAD occurs, it can become chronic, but it can be brought under control or completely eliminated with proper treatment. A standardized rating scale, such as the GAD-7, is used to assess the severity of generalized anxiety disorder. GAD is the most common cause of disability in the United States.

Reasons

Genetics

About a third of the abnormalities associated with generalized anxiety disorder are determined by genes. People with a genetic predisposition to GAD are more likely to develop GAD when exposed to stressors.

Psychoactive substances

Long-term use of benzodiazepines can increase anxiety, and reducing the dosage leads to a decrease in anxiety symptoms. Long-term alcohol use is also associated with anxiety disorders. Long-term abstinence from drinking alcohol can lead to the disappearance of anxiety symptoms. A quarter of people receiving treatment for alcohol addiction took about two years for their anxiety levels to return to normal. In a study conducted in 1988-90, dependence on alcohol and benzodiazepines was associated with about half of the cases of anxiety disorders (such as panic disorder and social phobia) in people receiving mental health care in a British mental health clinic. After stopping alcohol or benzodiazepine use, they experienced a worsening of their anxiety disorders, but their anxiety symptoms resolved with abstinence. Sometimes anxiety precedes the use of alcohol or benzodiazepines, but dependence on them only worsens the chronic course of anxiety disorders, contributing to their progression. Recovery from benzodiazepine use takes longer than recovery from alcohol use, but it is possible. Tobacco smoking is a proven risk factor for the development of anxiety disorders. Use has also been linked to anxiety.

Mechanisms

Generalized anxiety disorder is associated with impaired functional connectivity of the amygdala and the processing of fear and anxiety. Sensory input enters the amygdala through the basal-lateral complex (includes the lateral, basal, and accessory basal ganglia). The basal-lateral complex processes sensory memories associated with fear and transmits information about the importance of the threat to other parts of the brain (prefrontal cortex and postcentral gyrus) associated with memory and sensory information. Another part, namely the nearby central nucleus of the amygdala, is responsible for the response to species-specific fear, which is associated with the brain stem region, the hypothalamus and the cerebellum. In people with generalized anxiety disorder, these connections are functionally less pronounced, and there is more gray matter in the central nucleus. There are other differences - the amygdala region has poorer connectivity with the insula and cingulate region, which is responsible for general salience, and better connectivity with the parietal cortex and the prefrontal cortex circuit, which is responsible for executive actions. The latter is likely a strategy needed to compensate for dysfunction of the amygdala, which is responsible for anxiety. This strategy confirms cognitive theories, according to which, by reducing emotions, the level of anxiety is reduced, which, in essence, is a compensatory cognitive strategy.

Diagnosis

DSM-5 criteria

The diagnostic criteria for a diagnosis of generalized anxiety disorder (GAD), according to the Diagnostic and Statistical Manual of Mental Disorders DSM-5 (2013), published by the American Psychiatric Association, are as follows:

    A. Excessive anxiety and excitement (expectation with fear), prevailing for 6 months; the number of anxious days in most cases coincides with the number of events and active actions (work or school activity).

    B. Anxiety is difficult to control.

    B. Anxiety and agitation caused by three of the following six symptoms (predominant over 6 months):

    Anxiety or a feeling of being on edge and on edge.

    Fatigue.

    Difficulty concentrating or feeling “blacked out.”

    Irritability.

    Muscle tension.

    Sleep disturbance (difficulty falling asleep, poor sleep quality, insomnia).

It should be noted that to determine GAD in children, the presence of one symptom is sufficient.

    D. Anxiety, agitation, and physical symptoms leading to clinically significant distress or impairment in social, occupational, and other important areas of life.

    E. Anxiety is not related to the physiological effects of substances (eg, drugs of abuse) or other disorders of the body (eg, hyperthyroidism).

    E. The anxiety cannot be explained by another mental disorder (for example, anxiety and worry associated with panic attacks, observed in panic disorder, fear of negative evaluative opinions in social anxiety disorder and social phobia, fear of dirt and other obsessions in, fear of separation in anxiety disorder, caused by separation, reminder of traumatic events in, fear of weight gain in, physical complaints in somatic symptom disorder, impaired body image in body dysmorphic disorder, feeling of serious illness in hypochondriacal disorder, delusional ideas in delusional disorder). Since the publication of the Diagnostic and Statistical Manual of Mental Disorders (2004), there have been no significant changes to the concept of generalized anxiety disorder (GAD), although minor changes include revisions to the diagnostic criteria.

ICD-10 criteria

ICD-10 Generalized anxiety disorder “F41.1” Note: Alternative criteria apply for diagnosis in children (see F93.80).

    A. A period of at least six months of marked tension, worry and anxiety, coinciding with the number of events and problems.

    B. At least four of the following symptoms must be present, one of them must be from the first four points.

Symptoms of autonomic arousal:

    (1) Palpitation, rapid heartbeat.

    (2) Sweating.

    (3) Trembling or shaking.

    (4) Dry mouth (not due to medication or thirst)

Symptoms related to the chest and abdomen:

    (5) Difficulty breathing.

    (6) Feeling of suffocation.

    (7) Chest pain or discomfort.

    (8) Nausea or abdominal distress (eg, rumbling stomach).

Symptoms related to the brain and intellect:

    (9) Dizziness, feeling of staggering, fainting or delirium.

    (11) Fear of losing control, going crazy, or losing consciousness.

    (12) Fear of death.

General symptoms:

    (13) Sudden fever or chills.

    (14) Numbness or tingling sensation.

Symptoms of tension:

    (15) Muscle tension and pain.

    (16) Restlessness and inability to relax.

    (17) Feeling trapped, on edge, or mental tension.

    (18) Feeling of a “lump in the throat”, difficulty swallowing.

Other nonspecific symptoms:

    (19) Exaggerated reaction to sudden situations, numbness.

    (20) Difficulty concentrating, feeling “passed out” due to excitement and anxiety.

    (21) Long-term irritability.

    (22) Difficulty falling asleep due to anxiety.

    B. The disorder does not meet the criteria for panic disorder (F41.0), anxiety-phobic disorders (F40.-) or hypochondriacal disorder (F45.2).

    D. Most commonly used exclusion criteria: not caused by a medical condition such as hyperthyroidism, an organic mental disorder (F0), or a substance use disorder (F1) such as excessive use of amphetamine-like substances or benzodiazepine withdrawal.

Prevention

Treatment

Cognitive behavioral therapy is more effective than medications (such as SSRIs), while both reduce anxiety, cognitive behavioral therapy is more effective in combating depression.

Therapy

Generalized anxiety disorder is based on psychological components including cognitive avoidance, belief in positive anxiety, ineffective problem solving and emotional processing, intergroup problems, past trauma, low tolerance to uncertainty, focusing on negative events, ineffective stress coping mechanism, emotional overarousal , poor understanding of emotions, destructive emotion management and regulation, experiential avoidance, behavioral limitations. In order to successfully address the above cognitive and emotional aspects of GAD, psychologists often use techniques aimed at psychological intervention: social self-monitoring, relaxation techniques, self-monitoring of desensitization, gradual stimulus control, cognitive restructuring, tracking the results of anxiety, focusing on the present moment, living without expectations, problem-solving techniques, processing core fears, socialization, discussing and reframing anxiety beliefs, teaching emotional control skills, experiential exposure, psychological self-help training, non-judgmental awareness and acceptance exercises. There are also behavioral therapies, cognitive therapies, and combinations of both to treat GAD that focus on the key components listed above. Within cognitive behavioral therapy, key components include cognitive and behavioral therapy, as well as acceptance and commitment therapy. Uncertainty acceptance therapy and motivational counseling are two new techniques in the treatment of GAD, both as stand-alone treatments and as adjuncts to enhance the effects of cognitive therapy.

Cognitive behavioral therapy

Cognitive behavioral therapy is a psychological treatment for GAD that involves the therapist working with the patient to understand the influence of thoughts and feelings on behavior. The goal of this therapy is to change the negative way of thinking that leads to anxiety, replacing it with a more realistic and positive one. Therapy involves learning and practicing strategies to help the patient gradually learn to cope with anxiety and become increasingly comfortable in anxiety-producing situations. Cognitive behavioral therapy may be accompanied by medication. Components of cognitive behavioral therapy for GAD include: psychoeducation, self-monitoring, stimulus control techniques, relaxation, self-monitoring desensitization, cognitive restructuring, worry disclosure, worry behavior modification, and problem-solving skills. The first step in treating GAD is psychoeducation, which involves providing information to the patient about the disorder and treatment. The purpose of psychoeducation is to provide comfort, destigmatize the disorder, improve motivation to seek treatment by talking about the treatment process, and increase trust in the doctor due to realistic expectations from the course of treatment. Self-monitoring involves daily monitoring of the timing and level of anxiety, as well as events that trigger anxiety. The point of self-control is to identify factors that provoke anxiety. Stimulus control technique refers to reducing the conditions under which anxiety occurs. Patients are asked to postpone anxiety to a certain time and place specifically chosen for anxiety, in which everything will be aimed at anxiety and solving problems. Relaxation techniques are designed to reduce patients' stress and provide them with alternatives to fearful situations (other than feeling anxious). Deep breathing exercises, progressive muscle relaxation, and relaxation falls are among the relaxation techniques. Self-desensitization is the practice of viewing situations that cause anxiety and worry in a state of deep relaxation until the underlying causes of anxiety are addressed. Patients imagine in reality how they cope with situations and reduce their level of anxiety in their responses. When the anxiety disappears, they enter a state of deep relaxation and “turn off” the situations they imagine. The point of cognitive reconstruction is to replace an anxious perspective with a more functional and adaptive one, focusing on the future and oneself. This practice involves Socratic questioning, which forces patients to look past their worries and problems to understand that there are more powerful feelings and ways of processing what happened. Behavioral experiments are also used to test the effectiveness of negative and positive thoughts in life situations. In cognitive behavioral therapy used to treat GAD, patients engage in anxiety-identification exercises in which they are asked to imagine the worst possible outcome of situations that frighten them. And, according to the instructions, instead of running away from the presented situations, patients look for alternative outcomes of the presented situation. The goal in this anxiety therapy is to habituate and reinterpret the meaning of frightening situations. Prevention of anxious behavior requires the patient to monitor their behavior in order to identify the causes of anxiety and subsequent independent non-involvement in these disturbances. Instead of engaging, patients are encouraged to use other coping mechanisms learned in the treatment program. Problem solving focuses on actual problems and is broken down into several stages: (1) defining the problem, (2) formulating goals, (3) thinking through various solutions to the problem, (4) making a decision, and (5) executing and revising the solution. The feasibility of using cognitive behavioral therapy for GAD is almost undeniable. Despite this, this therapy can be improved, as only 50% of people treated with cognitive behavioral therapy returned to a highly functional life and full recovery. Therefore, there is a need to improve the components of cognitive behavioral therapy. Cognitive behavioral therapy significantly helps one third of patients, while having no effect on the other third.

Acceptance and Commitment Therapy

Acceptance and Commitment Therapy (ACT) is a part of cognitive behavioral therapy that is based on the acceptance model. TPE is designed with three therapeutic goals in mind: (1) reducing avoidance strategies for feelings, thoughts, memories, and sensations; (2) reducing one's literal response to one's thoughts (i.e., understanding that the thought “I am worthless” does not mean that one's life is actually meaningless) and (3) strengthening the ability to stick to a promise to change one's behavior. These goals are achieved by switching from trying to control events to working on changing one's behavior and focusing on areas and goals that are meaningful to a particular person, as well as creating habits of adherence to behavior that will help the person achieve his goals. This psychological therapy teaches skills of self-awareness (focusing on meaning in the present moment without judgment) and acceptance (openness and willingness to connect) that apply to events that are beyond your control. This helps a person, during such events, to adhere to behavior that contributes to the formation and affirmation of his personal values. Like many other psychotherapies, TPE is most effective when combined with medications.

Therapy for intolerance to uncertainty

Therapy for intolerance of uncertainty is aimed at changing the constant negative reaction manifested in relation to uncertain events and events, regardless of the likelihood of their occurrence. This therapy is used as an independent therapy for GAD. It builds patients' tolerance, ability to cope and accept uncertainty in order to reduce anxiety. The basis of intolerance of uncertainty therapy is the psychological components of psychoeducation, knowledge about anxiety, problem-solving skills, revaluation of the benefits of anxiety, virtual openness, awareness of uncertainty, and behavioral openness. Studies have proven the effectiveness of this therapy in the treatment of GAD; during follow-up of patients who underwent this therapy, improvement in well-being progressed over time.

Motivational counseling

A promising innovative approach that can increase the percentage of people cured after GAD. It consists of a combination of cognitive behavioral therapy with motivational counseling. Motivational counseling is a strategy aimed at increasing motivation and reducing ambivalence towards changes resulting from treatment. Motivational counseling has four key elements; (1) expressing empathy, (2) identifying inconsistencies between unwanted behavior and values ​​that are inconsistent with the behavior, (3) developing resilience rather than direct confrontation, and (4) promoting self-reliance. This therapy is based on asking open-ended questions, listening carefully and thoughtfully to the patient's responses, “talking to change,” and talking about the advantages and disadvantages of change. Combining cognitive behavioral therapy with motivational counseling has been shown to be more effective than cognitive behavioral therapy alone.

Drug therapy

SSRIs

Drug therapy prescribed for GAD includes selective serotonin reuptake inhibitors (SSRIs). They are first line therapy. The most common side effects of SSRIs are disorders such as nausea, sexual dysfunction, headaches, diarrhea, constipation, anxiety, increased risk of suicide, serotonin syndrome and others.

Benzodiazepines

Benzodiazepines are the most commonly prescribed medications for GAD. Studies have suggested that benzodiazepines provide short-term relief. Despite this, there are certain risks when taking them, mainly the deterioration of cognitive and motor function, as well as the development of psychological and physical dependence, which make it difficult to stop taking them. People taking benzodiazepines have been shown to have decreased concentration at work and in school. In addition, non-diazepine drugs affect driving and increase the number of falls in older people, which leads to hip fractures. Given these disadvantages, benzodiazepines are only justified for short-term relief of anxiety. Cognitive behavioral therapy and medication are about equally effective in the short term, but cognitive behavioral therapy is more effective than medication over the long term. Benzodiazepines (benzos) are fast-acting narcotic sedatives used to treat GAD and other anxiety disorders. Benzodiazepines are prescribed for the treatment of GAD and have a positive effect in the short term. The World Anxiety Council does not recommend long-term use of benzodiazepines, as this contributes to the development of resistance, psychomotor impairment, memory and cognitive impairment, physical dependence and withdrawal symptoms. Side effects include: drowsiness, limited motor coordination, balance problems.

Pregabalin and gabapentin

Psychiatric medications

    Selective serotonin-norepinephrine reuptake inhibitors (SNRIs) - (Effexor) and duloxetine (Cymbalta).

    New, atypical serotonergic antidepressants – vilazodone (Viibrid), vortioxetine (Brintellix), (Valdoxan).

    Tricyclic antidepressants - imipramine (Tofranil) and clomipramine (Anafranil).

    Certain monoamine oxidase inhibitors (MAOIs) include moclobemide (Marplan) and, rarely, phenelzine (Nardil).

Other medicines

    Hydroxyzine (Atarax) is an antihistamine, a 5-HT2A receptor agonist.

    Propranolol (Inderal) is a sympatholytic, beta-inhibitor.

    Clonidine is a sympatholytic, α2-adrenergic receptor agonist.

    Guanfacine is a sympatholytic, α2-adrenergic receptor agonist.

    Prazosin is a sympatholytic, alpha inhibitor.

Concomitant diseases

GAD and depression

The National Comorbidity Survey (2005) found that 58% of patients diagnosed with major depression also had an anxiety disorder. In these patients, the comorbidity rate was 17.2 percent for GAD and 9.9 percent for panic disorder. Patients diagnosed with anxiety disorder had high rates of comorbid depression, including 22.4 percent with social phobia, 9.4 percent with agoraphobia, and 2.3 percent with panic disorder. According to a longitudinal cohort study, about 12% of subjects had GAD comorbid with MDD. These data suggest that patients with comorbid depression and anxiety are more severely ill and less likely to respond to treatment than patients with only one disorder. In addition, they have a lower standard of living and more problems in the social sphere. In many patients, the symptoms observed are not severe enough (ie, subsyndromal) to warrant a primary diagnosis of major depressive disorder (MDD) or anxiety disorder. Despite this, dysthymia is the most common comorbid diagnosis in patients with GAD. They may also have mixed anxiety-depressive disorder, with an increased risk of severe depression or anxiety disorder.

GAD and substance abuse disorders

People with GAD also have long-term comorbid alcohol abuse (30%-35%) and alcohol dependence, as well as drug abuse and dependence (25%-30%). Those with both disorders (GAD and substance abuse disorder) are at increased risk for other comorbid disorders. It found that among people suffering from a substance abuse disorder, just over half of the 18 people studied had GAD as their primary disorder.

Other co-occurring disorders

In addition to comorbid depression, GAD has been shown to often correlate with stress-related conditions such as irritable bowel syndrome. Patients with GAD may experience symptoms such as insomnia, headaches, pain and cardiac events, and interpersonal problems. Another study suggests that 20 to 40 percent of people with attention deficit hyperactivity disorder also have a comorbid anxiety disorder, of which GAD is the most common. GAD was not included in the World Health Organization's Global Burden of Disease Project. Statistics on disease rates around the world are as follows:

    Australia: 3 percent of adults.

    Canada: About 3-5 percent of adults.

    Italy: 2.9 percent.

    Taiwan: 0.4 percent.

    US: About 3.1 percent of people over 18 in a given year (9.5 million).

GAD typically manifests from early childhood to late adulthood, with the average age of presentation being 31 years (Kessler, Berguland, et al., 2005) and the average patient age being 32.7 years. According to most studies, GAD appears earlier than other anxiety disorders. The prevalence of GAD in children is about 3%, in adults – 10.8%. In children and adults diagnosed with GAD, the disorder begins at age 8-9. Risk factors for developing GAD include low to moderate socioeconomic status, living apart from a spouse, divorce, and widowhood. Women are twice as likely to be diagnosed with GAD than men. This is because women are more likely than men to live in poverty, experience discrimination, and experience sexual and physical violence. GAD is most common among older people. Compared with the general population, patients with internalizing disorders such as depression, generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD) have higher mortality rates but die from the same causes (cardiovascular disease, cerebrovascular disease, and cancer) as people their age.

Comorbidity and treatment

A study that examined the comorbidity of GAD and other depressive disorders confirmed that the effectiveness of treatment does not depend on the comorbidity of the other disorder. The severity of symptoms does not affect the effectiveness of treatment in these cases.

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List of used literature:

Association, American Psychiatric (2013). Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). Washington, D.C.: American Psychiatric Association. p. 222. ISBN 978-0-89042-554-1.

Lieb, Roselind; Becker, Eni; Altamura, Carlo (2005). "The epidemiology of generalized anxiety disorder in Europe". European Neuropsychopharmacology 15(4):445–52. doi:10.1016/j.euroneuro.2005.04.010. PMID 15951160.

Ballenger, J.C.; Davidson, JR; Lecrubier, Y; Nutt, D.J.; Borkovec, T.D.; Rickels, K; Stein, D.J.; Wittchen, H. U. (2001). "Consensus statement on generalized anxiety disorder from the International Consensus Group on Depression and Anxiety." The Journal of clinical psychiatry. 62 Suppl 11:53–8. PMID 11414552.