General anxiety disorder

Generalized and persistent excessive anxiety associated with psychological and somatic complaints.

Anxiety disorder comprises a group of related conditions characterized by excessive fear or worry that present as emotional and physical symptoms.

Anxiety disorders are associated with the increased health care utilization and reduce quality of life and functioning.

Anxiety disorders are characterized by anxious mood and, often, phobic avoidance, which results in extreme distress, functional impairment, or the combination.

Anxiety disorders are characterized by fear, nervousness, and worry, as well as by physical symptoms, such as palpitations, shortness of breath, dizziness, and muscle tension.

These symptoms are also common during stressful situations, and may not indicate the presence of an anxiety disorder and intervention may not be needed if symptoms are transient.

Anxiety disorders are the second most common psychiatric disease after depression.

Anxiety disorders: generalized anxiety disorder, social anxiety, disorder, panic disorder, agoraphobia, specific phobias, substance/medication induced, anxiety disorder, and anxiety disorder due to another medical condition.

Anxiety disorders may occur with or contribute to worsening of medical conditions, such as cardiovascular, gastrointestinal, pulmonary diseases, cancer, chronic pain, and migraine headaches.

GAD has a median onset of age of 11 years and typically has a chronic course.

Anxiety disorders typically have early in life onset.

The prevalence of anxiety increase during the COVID-19 pandemic.

Anxiety disorders may contribute to worsening of medical conditions including: cardiovascular, gastrointestinal, and pulmonary diseases, cancer, chronic pain, and migraine headaches.

Anxiety disorders affect approximately 34% of adults during a lifetime in the US.

Up to 71 to 97.8%  of patients with anxiety disorders are incorrectly diagnosed and approximately 41% or not treated.

Associated with an unpleasant mood characterized by worry, and is an adaptive response to perceived threats that can develop into a maladaptive anxiety disorder if it becomes severe and chronic.

GAD is a common disorder of which the central feature is excessive worry about a number of different events.

Generalized anxiety disorder is characterized by excessive worry about multiple topics, including work, school, future, interpersonal relationships, combined with least three of six worry associated symptoms;  sleep, disturbance, muscle tension, concentration problems, irritability, restlessness, fatigue, that are present more days than not for at least six months.

Common anxiety disorders include social anxiety disorder with a 13% lifetime prevalence, generalized anxiety disorder with a 6.2% lifetime prevalence, panic disorder with a 5.2% lifetime prevalence and agoraphobia with a 2.6% lifetime prevalence.

The lifetime prevalence of anxiety disorders is higher in women than men: 40% versus 26%.

GAD is characterized by presence of anxiety and worry related to several events/activities that is difficult to control along with 3 or more of the following 6 symptoms: restlessness or feeling keyed up or on edge; being easily fatigued; difficulty concentrating or mind going blank; irritability; muscle tension; and sleep disturbances.

Anxiety disorders are diagnosed based on severity, frequency, and persistence of a specific set of symptoms that ocher together and associated with psychological distress or impairment in social, occupational areas of functioning.

GAD is a common disorder with excessive worry about a number of different events, excessive anxiety and difficulty controlling worrisome thoughts that persists for at least 6 months.

Antidepressants provide a modest-to-moderate reduction in anxiety in GAD.

Anxiety disorders of the most common mental illnesses in the US.

Effects 40 million adults aged 18 or older.

Affects 18 % of the population.

Median age of onset is 11 years.

Anxiety disorders typically have a chronic course.


Generalized anxiety disorder (GAD) is estimated to affect 7.8% of adults in the United States during their lifetime.

Only one third of affected people receive treatment.

Estimates are 7.8% of children age 3 to 17 have current anxiety disorder;  0.7% have severe anxiety.

Approximately 20% of patients in primary care the criteria for anxiety disorder.

Patients for 3-5 times more likely to go to the doctor and six times more likely to be hospitalized for psychiatric disorders than those without anxiety disorders.

Key symptoms include excessive anxiety about multiple events and issues, and difficulty controlling worrisome thoughts that persists for at least 6 months.

At least the presence of one symptom of autonomic arousal such as palpitation, sweating, trembling or dry mouth necessary for diagnosis.

Anxiety and stress elevate the body’s level of cortisol and adrenaline, which in turn can interfere with the normal functioning of the parasympathetic nervous system resulting in overstimulation of the vagus nerve.

Common in late life with a prevalence up to 7.3% in the community and 11.2% in primary care (Tolin).

Childhood anxiety often interferes with social, emotional, and academic development and can result in substance abuse, dependence, or both; suicide; education underachievement; and functional impairment.

Includes symptoms of restlessness with easy fatigue, difficulty in concentration, sleep disturbance and muscle tension.

Worry over minor matters.

Exclusion of other disorders associated with anxiety is necessary and that includes panic disorder, hypochondriasis, obsessive-compulsive disorder, eating disorders and substance misuse disorders.

Duration of symptoms 6 months or longer.

Prevalence in women almost double that of men.

Common in individuals with chronic illness.

Late life problems predict for increased physical disabilities, memory problems, decreased quality of life, and increased mortality.

It is recommended screening women and adolescent girls aged 13 years or older, including pregnant and postpartum women, for anxiety.

USPSTF recommends% screening for anxiety in children and adolescents age 8 to 18, but the current evidence is insufficient to assess the balance of benefits and harms of screening for anxiety in children seven years or younger.

USPSTF recommends% screening for anxiety in adults, age 18 to 64 years.

May be a risk factor for the development of depression and is commonly associated with depressive disorders.

More than 50% of patients with depression report clinically significant anxiety and have greater refractoriness to standard treatments than patients who have depression without anxiety.

The presence of an Exide, he disorder and depression is associated with increased risk for hospitalization and suicide.

Depression and the prevalence of alcohol use disorder or substance use disorder is approximately 16.5% in patients who have at least one anxiety disorder.


With anxiety disorders there may be difficulty accessing calming feedback from the frontal cortex.



For the initial management of GAD, evidence-based psychotherapies such as cognitive behavioral therapy are considered as first-line treatments.

Usually treated with benzodiazepines and antidepressants.

Can have negative impact on treatment outcomes since individuals with this problem are less likely to adhere to medical treatments.

Exercise training is useful, especially in those preferred nonpharmacologic treatments, as he can reduce symptoms among sedentary patients who have a chronic illness (Herring MP).

Intervention is recommended when persistent symptoms cause distress and impair social, occupational, and other areas of functioning.

Panic attacks are characterized by episodes of fear, and at least four physical symptoms: such as palpitations, shortness of breath, and/or cognitive symptoms of fear of dying, or losing control that peak within minutes.

Treatment: first line treatments include pharmacotherapy, and psychotherapy.

No single systemic approach for treatment guideline exists.

Selective serotonin, reuptake inhibitors and serotonin norepinephrine reuptake inhibitors are the first line therapies for generalized anxiety disorder, social anxiety disorder, and panic disorder.

Patients with anxiety disorders tend to be sensitive to adverse effects of medications, and some of these effects can replicate, anxiety itself.

For anti-depressive medications,  anxiolytic effects typically begin approximately 2 to 4 weeks after treatment initiation, and improvement may continue over weeks to months.

Patients should avoid situations that cause repeat episodes of anxiety.

For patients who respond to medication, the drug should be continued for at least one year to reduce the incidence of relapse.

SSRIs, benzodiazepines and tricyclic antidepressants have the highest symptom improvement scores.

Placebos are associated with large effects.

Benzodiazepines are not recommended as first line pharmacotherapy for anxiety disorders because of associated risks with psychological and physiological dependence, misuse, and overdose mortality when used with opioids.

Cognitive behavioral therapy (CBT) is psychotherapy, focused on teaching and practicing skills to reduce anxiety and has demonstrated efficacy for anxiety disorder symptom reduction.

Combining CBT and medication is not routinely recommended, but may be useful for severe anxiety or patients refractory to either therapy alone.

Without treatment recovery rates from anxiety 12 years after initial clinical evaluation are approximate 37 to 58%.

Approximately 45 to 65% of patients respond to initial treatment.

Remission rates or about 40% for social anxiety disorder, 51% for generalized anxiety disorder and 48% for panic disorder.

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