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Generalized Anxiety Disorder

The DSM-IV identifies the principle characteristic of generalized anxiety disorder as excessive anxiety and worry, usually, over a period of greater than 6 months. The concerns are considered to be far out of proportion to reality. The anxiety is accompanied by at least three of the following symptoms: restlessness, easy fatiguability, difficulty concentrating, muscle tension, irritability, and sleep disturbance. The symptoms are sufficiently severe to interfere with the person's life style, and are not attributable to another mental disorder.

In primary care, patients with GAD often present to their physicians with a cluster of autonomic symptoms, such as:

Cardiac (chest pains, palpitations, tachycardia, tachypnea)
Pulmonary (hyperventilation, smothering sensations, dyspnea)
Gastrointestinal (globus hystericus, indigestion, abdominal pains,


No reliable figures are available of the actual incidence of GAD, probably because of the changing diagnostic criteria used in various studies (DSM-III, DSM-IIIR, ICD-10). It is evident, however, that

GAD is recognized as a chronic disease, most frequently seen comorbidly with depression, other anxiety disorders, or a host of physical disorders. It has recently received additional attention because


As in most other forms of anxiety disease, the treatment of GAD requires pharmacotherapy, psychotherapy and patient education. In GAD more than any other, however, therapeutic success


There are three groups of medications that have proven effective in the management of GAD: BZDs, azipirones, and antidepressants. On a short term basis, the BZDs, especially short-acting BZDs (alprazalom, loreazepam, and clonazepam) may be the drugs of choice. They work promptly and


CBT may also be effective for patients with GAD, and there is some evidence to indicate that positive results may be more enduring than with medication. The relatively high costs, the