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Chapter 33. Generalized Anxiety Disorder

Rudolf Hoehn-Saric, M.D.; Thomas D. Borkovec, Ph.D.; Kenneth Belzer, Ph.D.
DOI: 10.1176/appi.books.9781585622986.258989

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Generalized anxiety disorder (GAD) is not as sharply delineated as DSM nomenclature makes it appear to be (Noyes and Hoehn-Saric 1998) but is a heterogeneous disorder; patients differ in onset, the type and intensity of worries, the degree of hyperarousal, and their physical manifestations. Worries may be generalized or focused on certain situations; hyperarousal may lead to insomnia or be only present during certain times of the day. Physical complaints tend to cluster to different degrees around muscular, cardiovascular, or gastrointestinal symptoms. In the presence of medical comorbidity, anxiety may crystallize around the physical state. Personality traits influence patients' behavioral responses and can significantly modify the clinical picture. Finally, GAD has a high comorbidity with affective and other anxiety disorders, which, when present, necessitates the formulation of comprehensive treatment plans. Therefore, each patient must be considered individually, according to the type, severity, and chronicity of symptoms; triggers that elicit or aggravate the symptoms; life stressors; coping ability; learning potentials; specific personality traits; and, above all, motivation to change. In most cases, GAD is a chronic condition, but the severity of symptoms may depend greatly on the present degree of stress.

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References

Allgulander C, Dahl AA, Austin C, et al: Efficacy of sertraline in a 12-week trial for generalized anxiety disorder. Am J Psychiatry 161:1642–1649, 2004
[PubMed]
 
Ball SG, Kuhn A, Wall D, et al: Selective serotonin reuptake inhibitor treatment for generalized anxiety disorder: a double-blind, prospective comparison between paroxetine and sertraline. J Clin Psychiatry 66:94–99, 2005
[PubMed]
 
Beardsley RS, Gardocki GJ, Larson DB, et al: Prescribing of psychotropic medication by primary care physicians and psychiatrists. Arch Gen Psychiatry 45:1117–1119, 1988
[PubMed]
 
Beck AT, Emery G: Anxiety Disorders and Phobias: A Cognitive Perspective. New York, Basic Books, 1985
 
Birmaher B, Axelson DA, Monk K, et al: Fluoxetine for the treatment of childhood anxiety disorders. J Am Acad Child Adolesc Psychiatry 42:415–423, 2003
[PubMed]
 
Borkovec TD: Clinical and psychophysiological outcomes from cognitive behavioral therapy for generalized anxiety disorder and the potential importance of targeting interpersonal behavior. Keynote address, annual meeting of the European Association of Behavioural and Cognitive Therapy, Maastricht, Netherlands, September 2002
 
Borkovec TD, Ruscio A: Psychotherapy for generalized anxiety disorder. J Clin Psychiatry 62:37–45, 2001
[PubMed]
 
Borkovec TD, Whisman MA: Psychosocial treatment for generalized anxiety disorder, in Long-Term Treatments of Anxiety Disorders. Edited by Mavissakalian M, Prien RF. Washington, DC, American Psychiatric Publishing, 1996, pp 171–199
 
Borkovec TD, Alcaine O, Behar E: Avoidance theory of worry and generalized anxiety disorder, in Generalized Anxiety Disorder: Advances in Research and Practice. Edited by Heimberg RG, Turk CL, Mennin DS. New York, Guilford, 2004, pp 77–108
 
Brown CS, Rakel RE, Wells BG, et al: A practical update on anxiety disorders and their pharmacological treatment. Arch Intern Med 15:873–884, 1991
 
Catalan J, Gath D, Edmonds G, et al: The effects of nonprescribing of anxiolytics in general practice, I: controlled evaluation of psychiatric and social outcome. Br J Psychiatry 144:593–602, 1984
[PubMed]
 
Cheer SM, Figgitt DP: Spotlight on fluvoxamine in anxiety disorders in children and adolescents. CNS Drugs 16:139–144, 2002
[PubMed]
 
Chou JC, Sussman N: Neuroleptics in anxiety. Psychiatric Annals 18:172–175, 1988
 
Ciraulo DA, Barnhill JG, Ciraulo AM, et al: Parental alcoholism as a risk factor in benzodiazepine abuse: a pilot study. Am J Psychiatry 146:1333–1335, 1989
[PubMed]
 
Coupland NJ, Bell CJ, Potokar J: Serotonin reuptake inhibitor withdrawal. J Clin Psychopharmacol 16:356–362, 1996
[PubMed]
 
Crits-Christoph P, Gibbons MB, Losardo D, et al: Who benefits from brief psychodynamic therapy for generalized anxiety disorder? Canadian Journal of Psychoanalysis 12:301–324, 2004
 
Davidson JRT, DuPont RL, Hedges D, et al: Efficacy, safety, and tolerability of venlafaxine extended release and buspirone in outpatients with generalized anxiety disorder. J Clin Psychiatry 60:528–535, 1999
[PubMed]
 
Davidson JR, Bose A, Korotzer A, et al: Escitalopram in the treatment of generalized anxiety disorder: double-blind, placebo controlled, flexible-dose study. Depress Anxiety 19:234–240, 2004
[PubMed]
 
Durham RC: Predictors of treatment outcome, in Worry and Psychological Disorders: Theory, Assessment, and Treatment. Edited by Davey GCL, Wells A. New York, Wiley, 2006, pp 379–397
 
Glassman AH, Bigger JT: Cardiovascular effects of therapeutic doses of tricyclic antidepressants. Arch Gen Psychiatry 38:815–820, 1981
[PubMed]
 
Goldfried MR: Systematic desensitization as training in self-control. J Consult Clin Psychol 37:228–234, 1971
[PubMed]
 
Goodnick PJ, Puig A, DeVane CL, et al: Mirtazapine in major depression with comorbid generalized anxiety disorder. J Clin Psychiatry 60:446–448, 1999
[PubMed]
 
Gould RA, Otto MW, Pollack MH, et al: Cognitive behavioral and pharmacological treatment of generalized anxiety disorder: a preliminary meta-analysis. Behav Ther 28:285–305, 1997
 
Gould RA, Safren SA, Washington DO, et al: A meta-analytic review of cognitive-behavioral treatments, in Generalized Anxiety Disorder: Advances in Research and Practice. Edited by Heimberg RG, Turk CL, Mennin DS. New York, Guilford, 2004, pp 248–264
 
Greenblatt DJ, Shader RI: Clinical use of the benzodiazepines. Ration Drug Ther 15(10):1–6, 1981
[PubMed]
 
Griffiths RR, McLeod DR, Bigelow GE, et al: Relative abuse liability of diazepam and oxazepam: behavioral and subjective dose effects. Psychopharmacology 84:147–154, 1984
[PubMed]
 
Hedges DW, Reimherr FW, Strong RE, et al: An open trial of nefazodone in adult patients with generalized anxiety disorder. Psychopharmacol Bull 32:671–676, 1996
[PubMed]
 
Hoehn-Saric R, McLeod DR, Zimmerli WD: Differential effects of alprazolam and imipramine in generalized anxiety disorder: somatic versus psychic symptoms. J Clin Psychiatry 49:293–301, 1988
[PubMed]
 
Hoehn-Saric R, Schlund MW, Wong SHY: Effect of citalopram on worry and brain activation in patients with generalized anxiety disorder. Psychiatry Res Neuroimaging 131:11–21, 2004
[PubMed]
 
Hollister LE, Muller-Oerlinghausen B, Rickels K, et al: Clinical uses of benzodiazepines. J Clin Psychopharmacol 13 (suppl 1):1S–169S, 1993
 
Jacobson E: Progressive Relaxation. Chicago, IL, University of Chicago Press, 1938
 
Jensen JP, Bergin AE, Greaves DW: The meaning of eclecticism: new survey and analysis of components. Professional Psychology: Research and Practice 21:124–130, 1990
 
Lin KM, Lau JK, Smith R, et al: Comparison of alprazolam plasma levels in normal Asian and Caucasian male volunteers. Psychopharmacology 96:365–369, 1988
[PubMed]
 
Luborsky L: Principles of Psychoanalytic Psychotherapy: A Manual for Supportive-Expressive Treatment. New York, Basic Books, 1984
 
Luborsky L, Singer B: Comparative studies of psychotherapies. Is it true that "everyone has won and all must have prizes"? Arch Gen Psychiatry 32:995–1008, 1975
[PubMed]
 
Marks J: The benzodiazepines—for good or evil. Neuropsychobiology 10:115–126, 1983
[PubMed]
 
McLeod DR, Hoehn-Saric R, Labib AS, et al: Six weeks of diazepam treatment in normal women: effects on psychomotor performance and psychophysiology. J Clin Psychopharmacol 8:83–99, 1988
[PubMed]
 
McLeod DR, Hoehn-Saric R: Perception of physiological change in normal and pathological anxiety, in Biology of Anxiety Disorders. Edited by Hoehn-Saric R, McLeod DR. Washington, DC, American Psychiatric Press, 1993, pp 223–243
 
Meoni P, Hackett D, Lader M: Pooled analysis of venlafaxine XR efficacy on somatic and psychic symptoms of anxiety in patients with generalized anxiety disorder. Depress Anxiety 19:127–132, 2004
[PubMed]
 
Nemeroff CB, DeVane CL, Pollock BG: Newer antidepressants and the cytochrome P450 system. Am J Psychiatry 153:311–320, 1996
[PubMed]
 
Newman MG, Crits-Christoph P, Connelly MB, et al: Participant factors in the treatment of anxiety disorders, in Effective Principles of Change. Edited by Castonguay LG, Beutler LE. New York, Oxford University Press, 2006, pp 121–154
 
Noyes RJ, Hoehn-Saric R: The Anxiety Disorders. Cambridge, UK, Cambridge University Press, 1998
 
Nutt DJ: Overview of diagnosis and drug treatments of anxiety disorders. CNS Spectrums 10:49–56, 2005
[PubMed]
 
Öst L: Applied relaxation: description of a coping technique and review of controlled studies. Behav Res Ther 25:397–409, 1987
 
Pande AC, Crockatt JG, Feltner DE, et al: Pregabalin in generalized anxiety disorder: a placebo-controlled trial. Am J Psychiatry 160:533–540, 2003
[PubMed]
 
Power KG, Jerrom DW, Simpson RJ, et al: A controlled comparison of cognitive behavior therapy, diazepam and placebo in the management of generalized anxiety. Behavioural Psychotherapy 17:1–14, 1989
 
Power KG, Simpson MB, Swanson V, et al: A controlled comparison of cognitive-behavior therapy, diazepam, and placebo, alone and in combination, for the treatment of generalized anxiety disorder. Journal of Anxiety Disorders 4:267–292, 1990
 
Preskorn SH: Pharmacokinetics of antidepressants: why and how are they relevant to treatment. J Clin Psychiatry 54 (9 suppl):14–34, 1993
 
Rajagopalan M, Kurian G, John E: Symptom relief with amitriptyline in the irritable bowel syndrome. J Gastroenterol Hepatol 13:738–741, 1998
[PubMed]
 
Research Unit on Pediatric Psychopharmacology Anxiety Study Group: Fluvoxamine for the treatment of anxiety disorders in children and adolescents. N Engl J Med 344:1279–1285, 2001
 
Rice KM, Blanchard EB: Biofeedback in the treatment of anxiety disorders. Clin Psychol Rev 2:557–577, 1982
 
Rickels K, Schweizer E: The clinical course and long-term management of generalized anxiety disorder. J Clin Psychopharmacol 10:101–109, 1990
 
Rickels K, Gordon PE, Zamostien BB, et al: Hydroxyzine and chlordiazepoxide in anxious neurotic outpatients: a collaborative controlled study. Compr Psychiatry 11:457–474, 1970
[PubMed]
 
Rickels K, Downing R, Schweizer E, et al: Antidepressants for the treatment of generalized anxiety disorder: a placebo-controlled comparison of imipramine, trazodone, and diazepam. Arch Gen Psychiatry 50:884–895, 1993
[PubMed]
 
Rynn MA, Brawman-Mintzer O: Generalized anxiety disorder: acute and chronic treatment. CNS Spectrums 9:716–723, 2004
[PubMed]
 
Salzman C, Shader RI, Greenblatt DJ, et al: Long vs. short half-life benzodiazepines in the elderly. Arch Gen Psychiatry 40:293–297, 1983
[PubMed]
 
Sheehan D: Attaining remission in generalized anxiety disorder: venlafaxine extended release comparative data. J Clin Psychiatry 62 (suppl 19):26–31, 2001
 
Sheehan DV, Mao CG: Paroxetine treatment of generalized anxiety disorder. Psychopharmacol Bull 37 (suppl 1):64–75, 2003
 
Stocchi F, Nordera G, Jakinen R, et al: Efficacy and tolerability of paroxetine for long-term treatment of generalized anxiety disorder. J Clin Psychiatry 64:250–258, 2003
[PubMed]
 
Suinn RM, Richardson F: Anxiety management training: a nonspecific behavior therapy program for anxiety control. Behav Ther 2:498–510, 1971
 
Tallman JH, Paul SM, Skolnick P: Receptors for the age of anxiety: pharmacology of the benzodiazepines. Science 207:274–281, 1980
[PubMed]
 
Tyrer P: The Role of Bodily Feelings in Anxiety. London, Oxford University Press, 1976
 
Varia I, Rauscher F: Treatment of generalized anxiety disorder with citalopram. Clin Psychopharmacol 17:103–107, 2002
[PubMed]
 
Wolpe J: Psychotherapy by Reciprocal Inhibition. Stanford, CA, Stanford University Press, 1958
 
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