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Generalized Anxiety Disorder (GAD)

Anxiety is a subjective feeling of apprehension caused by a threat to a person or his values. Some describe it as an exaggerated feeling of impending doom, dread, or uneasiness. Unlike fear - a reaction to danger from a specific external source - anxiety is a reaction to an internal threat, such as an unacceptable impulse or a repressed thought that is straining to reach a conscious level or a real, threatened, or imagined threat to the patient's self-esteem.

Occasional anxiety is a rational response to a real threat and is a normal part of life. Overwhelming anxiety, however, can result in a generalized anxiety disorder (GAD) - uncontrollable, unrealistic worry that is persistent. More than 80% of patients with GAD suffer from major depression, arrhythmias, or social phobia. Onset is usually before age 20, and the patient usually has a history of childhood fears. It's equally common in men and women.

Causes

Anxiety can indicate a primary psychiatric condition, be related to a primary medicaL disease, or be related to a medication adverse effect. In GAD, an aberration in benzodiazepine receptor regulation is thought to occur. Serotonin changes also appear to playa part in anxiety.

Signs and symptoms

The signs and symptoms of generalized anxiety disorder can vary in combination or severity. They may include:

  • Change in appetite
  • Frequent need to use bathroom
  • Startled easily
  • Lump in throat, difficulty swallowing
  • Sleeplessness
  • Restlessness
  • Feeling of being keyed up or on edge
  • Difficulty concentrating
  • Stomachache
  • Diarrhea
  • Headache

Signs and tests

A physical examination and a psychological evaluation should be completed in order to rule out other causes of anxiety. Physical disorders that may mimic an anxiety state should be ruled out, as well as drug-induced symptoms. Various diagnostic tests may be done in this process.

Treatment

Drug treatment and psychotherapy is most effective in treating a patient with this disorder. Complete symptomatic relief is rare, however. The benzodiazepine anti-anxiety drugs relieve anxiety but should only be prescribed for 4 to 6 weeks because the patient may develop tolerance to the drugs and because of a potential for abuse. Buspirone an anti-anxiety drug, causes less sedation and less risk of physical and psychological dependence than the benzodiazepines. However it takes several weeks to take effect.

Psychotherapy can help the patient identify and deal with the cause of anxiety. anticipate his reactions and plan effective response strategies to deal with the anxiety. The patient may also learn relaxation techniques, such as deep breathing, progressive muscle relaxation, focused relaxation, and visualization.


 

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