Anxiety (Generalized Anxiety Disorder)

Anxiety (Generalized Anxiety Disorder) is a topic covered in the 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 (increased sympathetic tone and catecholamine release), cardiac (tachycardia), pulmonary (dyspnea), and GI (nausea, irregular bowels)

Epidemiology

Prevalence

  • Lifetime prevalence in United States 5.1–11.9%
  • Onset at any age but typically during adulthood; median age of onset in the United States is 31 years.
  • Female > male (2:1)
  • Generally recurrent and chronic in nature; fluctuates in severity
  • COVID-19 survivors have increased incidence of anxiety, depression, and posttraumatic stress disorder (PTSD) (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
A serotonin transporter gene (5HT1A) may contribute to GAD.

Risk Factors

  • Adverse life events (illness, poverty, etc.)
  • Family history
  • 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 GAD (2).

Commonly Associated Conditions

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

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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 (increased sympathetic tone and catecholamine release), cardiac (tachycardia), pulmonary (dyspnea), and GI (nausea, irregular bowels)

Epidemiology

Prevalence

  • Lifetime prevalence in United States 5.1–11.9%
  • Onset at any age but typically during adulthood; median age of onset in the United States is 31 years.
  • Female > male (2:1)
  • Generally recurrent and chronic in nature; fluctuates in severity
  • COVID-19 survivors have increased incidence of anxiety, depression, and posttraumatic stress disorder (PTSD) (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
A serotonin transporter gene (5HT1A) may contribute to GAD.

Risk Factors

  • Adverse life events (illness, poverty, etc.)
  • Family history
  • 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 GAD (2).

Commonly Associated Conditions

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

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