Generalized anxiety disorder: symptoms, causes, and treatment methods

According to the International classification of diseases, 10th issue (ICD-10), anxiety disorders are divided into phobic anxiety disorders, and the so-called “other anxiety disorders”, which include panic disorder, generalized anxiety disorder, and mixed anxiety-depressive disorder, obsessive-compulsive disorder, and severe stress reactions and adjustment disorders, which includes post-traumatic stress disorder. Most of them are reviewed in the relevant sections (see the articles about phobias, post-traumatic stress disorder, panic disorder, and obsessive-compulsive disorder), so this article will focus on only two disorders - generalized anxiety and mixed anxiety-depressive disorder.

The main feature of a generalized anxiety disorder (ICD-10 F41.1) is anxiety that is generalized and persistent, is not limited to any specific environmental circumstances, and does not even arise with a clear preference in these circumstances (i.e. is "non-fixed "). For a diagnosis to be made, the patient's primary symptoms of anxiety must be present for at least several weeks.

Short information about generalized anxiety disorder

Most often, the disorder is manifested in:

1. Fears (anxiety about future failures, worry, difficulty concentrating, etc.);
2. Motor tension (fussiness, tension headaches, tremors, inability to relax);
3. Vegetative hyperactivity (sweating, tachycardia or tachypnea, epigastric discomfort, dizziness, dry mouth, etc.).

The term mixed Anxiety and Depressive Disorder is used when the patient presents with symptoms of both anxiety and depression, but neither are individually distinctly dominant or severe enough to warrant a diagnosis.

It is easy to see that the diagnostic criteria for these conditions are less clear-cut than, for example, panic disorder and are more likely built on the principle of exclusion. Symptoms of generalized anxiety disorder have features of diffuse, generalized anxiety of moderate or low intensity, which is characterized by indefinite anxiety, constant over time. This is its main difference from panic disorder, in which attacks of the anxiety of excessive intensity occur.

This type of anxiety condition is called "free-floating anxiety"; vague anxiety is expressed in a state of internal tension, a premonition of unhappiness and threats, which are often provoked by real minor conflicts and frustrating situations. At the same time, in the patient's personal coordinates system, such situations grow into huge problems and seem insoluble. Anxiety is often accompanied by increased aggressiveness. Constant internal tension leads to disruptions in the activity of the autonomic-endocrine system, which is in constant excitement and readiness to fight and flight, which, in turn (according to the principle of a vicious circle), increases the state of internal tension. The same applies to the musculoskeletal system - muscle tension gradually increases and tendon reflexes increase, which underlies the feeling of fatigue and myalgias (muscle pains).

According to most researchers, generalized anxiety disorder does not represent a single diagnostic category, but rather reflects a special disturbing phenomenon that occurs in different diagnoses. So, in some of its phenomenological manifestations, it is close to the anxiety of expectation, characteristic of panic disorder. At the same time, in contrast to the latter, generalized anxiety reactions are characterized by less involvement of vegetative manifestations (i.e. increased heart rate, sweating, dizziness, etc.), an earlier and more gradual onset of the disease, and a more favorable prognosis. It should also be borne in mind that some patients with panic disorder may develop a generalized anxiety disorder in the future and vice versa.

In general, the incidence of generalized anxiety coexistence with other anxiety disorders is high: with panic attacks (56%), obsessive-compulsive disorder (35%), and social phobia (32-42%). Coexistence with depression, according to different authors, reaches 23-87%.
From the point of view of some psychiatrists, the diagnosis of generalized anxiety disorder does not make sense at all, since such conditions, due to the nonspecificity of manifestations, can occur within the framework of neuroses, psychogenic reactions, decompensation of character accentuations, and psychopathies of anxiety-suspicious type, etc.

Treatment of generalized anxiety

For the treatment of generalized anxiety disorder (GAD), both tranquilizers (mainly of the benzodiazepine series) and antidepressants can be used. Alprazolam (Xanax, Cassadan), which combines the properties of tranquilizer and an antidepressant, is of particular importance in the treatment of GAD. The effective dose of the drug is 1.5-2 mg/day. A good result is given by sedative antidepressants in small or medium doses - doxepin, amitriptyline, as well as mianserin and trazodone. Serotonergic antidepressants (except for Fluoxetine), for instance, Paroxetine, are also successfully used; unlike benzodiazepine tranquilizers, they can be used for long-term maintenance therapy.

The strategies for conducting psychotherapy are almost the same as those used in the treatment of other anxiety disorders. The most frequently used behavioral psychotherapy built on the logical conviction of the patient, which consists of consistent contact of the patient with the stimuli avoided by him or her and the conscious slowing down of the pathological reaction arising in this case.

Key practical recommendations for the treatment of generalized anxiety

Note: adapted according to Amy B. Locke et al., Diagnosis and Management of Generalized Anxiety Disorder in Adults (2015). GAD – generalized anxiety disorder, PD – panic disorder. Reliance degrees: A - reliable, high quality patient-centered evidence; B - limited, patient-centered evidence; C- disease-oriented evidence, good practice, expert opinion, or case series research.

Behavioral therapy techniques used to treat generalized anxiety disorder and anxiety-related symptoms

Note: The correct use of these techniques requires specialized training. Severely anxious patients should consider seeking a trained professional.

Post by: Christopher Ames, MD, pshychiatrist, Medibank, Sydney, New South Wales, Australia