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Generalized Anxiety Disorder: Rethinking Diagnosis and Rating

Published online by Cambridge University Press:  07 November 2014

Dan J. Stein
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Extract

Faye is a 44-year-old woman who presented complaining of tension. She felt tense in her muscles, her whole body felt “on edge,” and she was unable to relax or to fall asleep easily. The tension was not only physical but also mental, she experienced anxiety on and off throughout the day, had multiple worries, and often felt irritable. Ever since she could remember, she had been somewhat highly strung, but in her thirties she took a more stressful job, and there were often times when the physical symptoms became more intense and even interfered with her work function. During these periods of increased anxiety, she resorted to using benzodiazepine tablets prescribed by her primary care physician for poor sleep.

Type
Pearls in Clinical Neuroscience
Information
CNS Spectrums , Volume 10 , Issue 12 , December 2005 , pp. 930 - 934
Copyright
Copyright © Cambridge University Press 2005

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References

REFERENCES

1.Walker, DL, Toufexis, DJ, Davis, M. Role of the bed nucleus of the stria terminalis versus the amygdala in fear, stress, and anxiety. Eur J Pharmacol 2003;463:199–216.Google Scholar
2.Rauch, SL, Savage, CR, Alpert, NM, Fischman, AJ, Jenike, MA. The functional neuroanatomy of anxiety: a study of three disorders using positron emission tomography and symptom provocation. Biol Psychiatry. 1997;42:446–452.CrossRefGoogle ScholarPubMed
3.Carey, PD, Warwick, J, Niehaus, DJ, et al.Single photon emission computed tomography (SPECT) of anxiety disorders before and after treatment with Citalopram. BMC Psychiatry. 2004;4:30.CrossRefGoogle ScholarPubMed
4.MacLeod, AK, Byrne, A. Anxiety, depression, and the anticipation of future positive and negative experience. J Abnorm Psychol. 1993;102:238–247.Google Scholar
5.Wu, JC,Buchsbaum, MS, Hershey, TG, Hazlett, E, Sicotte, N, Johnson, JC. PET in generalized anxiety disorder. Bui Psychiatry, 1991;29:1181–1199.Google Scholar
6.De Bellis, MD, Casey, BJ, Dahl, RE, et al.A pilot study of amygdala volumes in pediatric generalized anxiety disorder. Biol Psychiatry. 2000;48:51–57.Google Scholar
7.Mathew, SJ, Mao, X, Coplan, JD, et al.Dorsolateral prefrontal cortical pathology in generalized anxiety disorder: a proton magnetic resonance spectroscopic imaging study. Am J Psychiatry. 2004;161:1119–1121.Google Scholar
8.Stein, DJ, Hugo, F. Neuropsychiatric aspects of anxiety disorders. In: Yudofsky, SC, Hales, RE, eds. The American Psychiatric Publishing Textbook of Neuropsychiatry and Clinical Neurosciences. Washington, DC: American Psychiatric Publishing; 2002.Google Scholar
9.Ruck, C, Andreewitch, S, Flyckt, K, et al.Capsulotomy for refractory anxiety disorders: long-term follow-up of 26 patients. Am J Psychiatry. 2003;160:513–521.Google Scholar
10.Maron, E, Kuikka, JT, Ulst, K, Tiihonen, J, Vasar, V, Shlik, J. SPECT imaging of serotonin transporter binding in patients with generalized anxiety disorder. Eur Arch Psychiatry Clin Neurosci. 2004;254:392–396.Google Scholar
11.Hoehn-Saric, R, Schlund, MW, Wong, SH. Effects of Citalopram on worry and brain activation in patients with generalized anxiety disorder. Psychiatry Res. 2005;131:11–21.Google Scholar
12.Tiihonen, J, Kuikka, J, Rasanen, P, et al.Cerebral benzodiazepine receptor binding and distribution in generalized anxiety disorder: a fractal analysis. Mol Psychiatry. 1997;2:463–471.CrossRefGoogle ScholarPubMed
13.Nutt, DJ. Neurobiological mechanims in generalized anxiety disorder. J Clin Psychiatry. 2001;62(suppl):22–27.Google Scholar
14.Dalton, KM, Kalin, NH, Grist, TM, Davidson, RJ. Neural-cardiac coupling in threat-evoked anxiety. J Cogn Neurosri. 2005;17:969–980.Google Scholar
15.Kendler, KS, Neale, MC, Kessler, RC, Heath, AC, Eaves, LJ. Major depression and generalized anxiety disorder. Same genes, (partly) different environments? Arch Gen Psychiatry. 1992;49:716–722.Google Scholar
16.Torgersen, S. Comorbidity of major depression and anxiety disorders in twin pairs. Am J Psychiatry. 1990;147:1199–1202.Google Scholar
17.Hettema, JM, Neale, MC, Kendler, KS. A review and meta-analysis of the genetic epidemiology of anxiety disorders. Am J Psychiatry. 2001; 158:1568–1578.Google Scholar
18.Munafo, MR, Clark, T, Flint, J. Does measurement instrument moderate the association between the serotonin transporter gene and anxiety-related personality traits? A meta-analysis. Mol Psychiatry. 2005;10:415–419.Google Scholar
19.Kosel, M, Rudolph, U, Wielepp, P, et al.Diminished GABA(A) receptor-binding capacity and a DNA base substitution in a patient with treatment-resistant depression and anxiety. Neuropsychopharmacology. 2004;29:347–350.Google Scholar
20.Mineka, S, Watson, D, Clark, LA. Comorbidity of anxiety and unipolar mood disorders. Annu Rev Psychol. 1998;49:377–412.CrossRefGoogle ScholarPubMed
21.Marks, IM, Nesse, RM. Fears and fitness: an evolutionary analysis of anxiety disorders. Ethol Sociobiol. 1994;15:247–261.Google Scholar
22.Stein, DJ, Bouwer, C. A neuro-evolutionary approach to the anxiety disorders. J Anxiety Disord. 1997;11:409–429.Google Scholar
23.Ruscio, AM, Lane, M, Roy-Byrne, P, et al.Should excessive worry he required for a diagnosis of generalized anxiety disorder? Results from the US National Comorbidity Survey Replication. Psychol Med. 2005;35:1761–1772.Google Scholar
24.Kessler, RC, Brandenburg, N, Lane, M, et al.Rethinking the duration requirement for generalized anxiety disorder: evidence from the National Comorbidity Survey Replication. Psychol Med. 2005;35:1073–1082.Google Scholar
25.Rickels, K, Rynn, MA. What is generalized anxiety disorder? J Clin Psychiatry. 2001;62(suppl 11):4–12.Google Scholar
26.Stein, D. The Cognitive-Affective Neuroscience of Depression and Anxiety Disorders. London, England: Martin Dunitz; 2003.Google Scholar
27.Kapczinski, F, Lima, MS, Souza, JS, Schmitt, R. Antidepressants for generalized anxiety disorder. Cochrane Database Syst Rev. 2003;2:CD003592.Google Scholar
28.Gale, CK, Oakley-Browne, M. Generalized anxiety disorder. Am Fam Physician. 2003;67:135–138.Google Scholar
29.Mitte, K, Noack, P, Steil, R, Hautzinger, M. A meta-analytic review of the efficacy of drug treatment in generalized anxiety disorder. J Clin Psychopharmacol. 2005;25:141–150.Google Scholar
30.Gould, RA, Otto, MW, Pollack, MH, Yap, L. Cognitive behavioural and pharmacological management of generalised anxiety disorder: a preliminary meta-analysis. Behav Ther. 1997;28:285–305.Google Scholar
31.Ballenger, JC, Davidson, JR, Lecrubier, Y, et al.Gmsensus statement on generalized anxiety disorder from the International Gmsensus Group on Depression and Anxiety. J Clin Psychiatry. 2001;62:53–58.Google Scholar
32.Bandelow, B, Zohar, J, Hollander, E, et al.World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the pharmacological treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders. World J Biol Psychiatry. 2002;3:171–199.Google Scholar
33.Maier, W, Gansicke, M, Freyberger, HJ, Linz, M, Heun, R, Lecrubier, Y. Generalized anxiety disorder (ICD-10) in primary care from a cross-cultural perspective: a valid diagnostic entity? Acta Psychiatr Scand. 2000;101:29–36.Google Scholar
34.Sherbourne, CD, Wells, KB, Meredith, LS, Jackson, CA, Camp, P. Comorbid anxiety disorder and the functioning and well-being of chronically ill patients of general medical providers. Arch Gen Psychiatry. 1996;53:889–895.Google Scholar