Anxiety (Generalized Anxiety Disorder)

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

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Basics

Description

  • A condition characterized by 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 (increased sympathetic tone and catecholamine release); secondary effects on other symptoms such as cardiac (tachycardia), pulmonary (dyspnea), and GI (nausea, irregular bowels)

Epidemiology

Prevalence
  • 12-month prevalence rate: 1.8%
  • Lifetime prevalence rate in United States 5.1–11.9%
  • Elderly prevalence as high as 7–10%
  • 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)
  • Generally recurrent and chronic in nature; gradual in onset; fluctuates in severity; complete remission less likely (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)

Genetics
  • Strongly linked to depression in heritability studies
  • A variant of the serotonin transporter gene (5HT1A) or other genes may contribute to both conditions.

Risk Factors

  • Adverse life events
  • Family history
  • Chronic physical illness
  • Lack of social support
  • Poverty
  • Comorbid psychiatric disorders (2)

General Prevention

  • Physical activity and cardiorespiratory fitness are associated with decreased generalized anxiety and depression.
  • Cognitive-behavioral therapy (CBT) and parental intervention in children with early anxiety may protect against the development of GAD (2).

Commonly Associated Conditions

  • Major depressive disorder (>60%), dysthymia, bipolar disorder, schizophrenia
  • Alcohol/drug abuse
  • Cigarette smoking in adolescence
  • Panic disorder, agoraphobia, simple phobia, social anxiety disorder, anorexia nervosa, posttraumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), ADHD
  • Somatoform and pain disorders

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