Generalized+Anxiety+Disorder



** Fact Sheet ** [1] Crits-Cristoph, P., Newman, M.G. et al. Combined medication and cognitive therapy for generalized anxiety disorder. Journal of Anxiety Disorders. 2011, 25,1087-1094.
 * 1) A. Generalized Anxiety Disorder
 * 2) B. It is not well known the exact cause of GAD but researchers have found areas of the brain that are linked to fear and anxiety for development of better treatments as well as analyzing how stress and environmental factors play a role.2 Imaging studies of the amygdala and associated neural circuits has shown increased reactivity to stimuli, showing that there are deficits in emotional processing that the affected person is unaware of.4 There are also several psychological theories to understand GAD such as the function of worry is to avoid, intolerance of uncertainty and the belief that worry prevents catastrophes.4
 * 3) C. Central Nervous System -> Brain -> amgydala, anterior cingulated cortex, prefrontal medial cortex
 * 4) D. Several thought leaders have made substantial contributions to our understanding of GAD: Gavin Andrews, Jules Angst, David Baldwin, Borwin Bandelow, Johan den Boer, Tom Borkovec, Jonathan Davidson, Jack Gorman, Marty Keller, Kenneth Kendler, Donald Klein, David Nutt, Stefano Pallanti, Mark Pollack, Karl Rickels, David Sheehan, Dan Stein, and Hans-Ulrich Wittchen.
 * 5) E. Common symptoms: characterized as an individual having a pervasive and uncontrollable amount of worry4 and also experience significant impairments in psychosocial function.1  Individuals don’t necessarily go to receive treatment only for worry but for symptoms such as difficulty concentrating, fatigue, irritability, difficulty falling asleep, restlessness and physical symptoms such as muscle tension (shakiness, headaches) and stomach problems (nausea, diarrhea).3 Another problem with GAD is that the worry seems to just pile up from one problem to another, which can be related to the importance of environmental factors that can cause GAD.3
 * 6) F. Standard treatments: Generalized anxiety disorder has two methods of treatment, cognitive-behavioral psychotherapy (CBT) and psychopharmacological therapy.1 CBT constitutes cognitive reconstruction, applied relaxation as well as training in recognition of situational, behavioral cues of anxiety, education on the nature of anxiety and training in arousal reduction coupled with coping skill rehearsal.1 A healthy lifestyle with good exercise and nutrition may help symptoms as well as avoiding caffeine, illicit drugs and cold medication.3 This is the only psychotherapy method that has empirical evidence, but unfortunately about half of clinical patients display ongoing clinical symptoms after treatment.1 The most studied psychopharmacological treatment has been benzodiazepines, but selective serotonin reuptake inhibitor (SSRI) and selective norepinephrine reuptake inhibitor (SNRI) antidepressants are now considered the first-line pharmacotherapies used for GAD.1 A study showed that a satisfactory response to these antidepressants occurred in 60% of patients with full remission of symptoms in only 37%.1 It is stated that a combination of CBT and medication is the best treatment3, but as of 2011 there has not been much research devoted to the use of both of these therapies, with only two studies have conducted.1
 * 7) G. Current Research: The most recent international guideline for drug treatment of GAD was published in October 2008 by a task force appointed by the World Federation of Biological Societies of Psychiatry. Anxiety disorders are genetically complex, and the phenotypes may be the expression of gene by gene as well as gene by environment inter- actions. Candidate gene findings have not been specific and replicable. This aspect of GAD makes genome-wide scanning of tens of thousands of probands and controls are necessary to advance the field.
 * 8) H. References:

[2] National Institute of Mental Health. Generalized Anxiety Disorder: When Worry Gets Out of Control. U.S. Department of Health and Human Services, 2010. []

[3] Pub Med Health. Generalized Anxiety Disorder. A.D.A.M., Inc.: Revised 2012. []

[4] Allgulander, C. Generalized anxiety disorder: A review of recent findings. Journal of Experimental and Clinical Medicine. 2012, 4, 88-91.

[5] Berger, A. Edelsberg, J., Bollu, V. et al. Health care utilization and costs in patients with generalized anxiety disorder initiating add-on therapy with benzodiazepines. Health Outcomes Research in Medicine. 2012, 3, e45-e54.

[6] Dell’osso, B. & Lader, M. Do benzodiazepines still deserve a major role in the treatment of psychiatric disoders? A critical reappraisal. European Psychiatry. Article in press.

[7] Chebib, M. & Johnston, G.A.R. GABA-activated ligand gated ion channels: Medicinal chemistry and Molecular biology. J. of Med Chem. 200, 43, 1427-1447.