5-Minute Clinical Consult

Anxiety (Generalized Anxiety Disorder)

Anxiety (Generalized Anxiety Disorder) is a topic covered in the 5-Minute Clinical Consult.

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5-Minute Clinical Consult

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Basics

Description

  • Persistent, excessive, and difficult-to-control worry associated with significant symptoms of motor tension, autonomic hyperactivity, and/or disturbances of sleep or concentration.
  • System(s) affected: nervous (resulting in increased sympathetic tone and increased catecholamine release); may have secondary effects on other symptoms such as cardiac (tachycardia) and GI (nausea, irregular bowels)

Epidemiology

Prevalence
  • 12-month prevalence rate: 2–3%
  • Lifetime prevalence rate: 5%
  • Onset can occur any time in life but is typically during adulthood; median age of onset in the United States is 31 years.
  • Predominant sex: female > male (2:1) (1)

Etiology and Pathophysiology

  • May be mediated by abnormalities of neurotransmitter systems (i.e., serotonin, norepinephrine, and γ-aminobutyric acid [GABA])
  • Associated with altered regional brain function (increased activity in the amygdala and prefrontal cortex) (2)

Genetics
  • Strongly linked to depression in heritability studies
  • A variant of the serotonin transporter gene (5HT1A) may contribute to both conditions; other genes (such as that for glutamic acid decarboxylase) also may play a role.

Risk Factors

  • Caucasian race
  • Adverse life events: stress, medical illness, disability, unemployment, and childhood physical and mental abuse
  • Family history
  • Lack of social support
  • Obesity
  • Comorbid psychiatric disorders (3)

General Prevention

  • Regular exercise is associated with decreased anxiety and depression.
  • CBT and parental intervention in children with social withdrawal or early anxiety may protect against the development of GAD (3).

Commonly Associated Conditions

  • Major depressive disorder (>60%), dysthymia, bipolar disorder
  • Alcohol/drug abuse
  • Cigarette smoking in adolescence
  • Panic disorder, agoraphobia, simple phobia, social anxiety disorder, anorexia nervosa

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