Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-25T11:11:24.308Z Has data issue: false hasContentIssue false
  • English
  • Français

Phenomenology and Course of Generalised Anxiety Disorder

Published online by Cambridge University Press:  02 January 2018

Kimberly A. Yonkers ,
Meredith G. Warshaw ,
Ann O. Massion  and
Martin B. Keller
Kimberly A. Yonkers*
Affiliation:
Departments of Psychiatry and Obstetrics & Gynecology, The University of Texas, Southwestern Medical Center at Dallas
Meredith G. Warshaw
Affiliation:
Brown University, Providence, RI
Ann O. Massion
Affiliation:
Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA
Martin B. Keller
Affiliation:
Butler Hospital, 345 Blackstone Blvd., Providence, RI 02906
*
Professor Yonkers, 5959 Harry Hines Blvd., Dallas, TX 75235-9101
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

The diagnostic category of generalised anxiety disorder (GAD) was originally intended to describe residual anxiety states. Over the years clinical criteria have been refined in an attempt to describe a unique diagnostic entity. Given these changes, little is known about the clinical course of this newly defined disorder. This study investigates the longitudinal course, including remission and relapse rates, for patients with DSM–III–R defined GAD.

Method

Analysis of the 164 patients with GAD participating in the Harvard Anxiety Research Program. Patients were assessed with a structured clinical interview at intake and re-examined at six month intervals for two years and then annually for one to two years. Psychiatric Status Ratings were assigned at each interview point. Kaplan–Meier curves were constructed to assess likelihood of remission.

Results

Comorbidity was high, with panic disorder and social phobia as the most frequently found comorbid disorders. The likelihood of remission was 0.15 after one year and 0.25 after two years. The probability of becoming asymptomatic from all psychiatric symptoms was only 0.08.

Conclusions

This prospective study confirms the chronicity associated with GAD and extends this finding to define the one and two year remission rates for the disorder. Likelihood of remission for GAD and any other comorbid condition after one year was half the annual remission rate for GAD alone.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 168 , Issue 3 , March 1996 , pp. 308 - 313
Copyright
Copyright © 1996 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd edn revised) (DSM–III–R). Washington, DC: APA.Google Scholar
Anderson, D. J., Noyes, R. & Crowe, R. R. (1984) A comparison of panic disorder and generalized anxiety disorder. American Journal of Psychiatry, 141, 572–575.Google Scholar
Barlow, D. H., Blanchard, E. B., Vermilyea, J. A., et al (1986) Generalized anxiety and generalized anxiety disorder: Description and reconceptualization. American Journal of Psychiatry, 143, 40–44.Google ScholarPubMed
Blazer, D. G., Hughes, D., George, L. K., et al (1991) In Psychiatric Disorders in America (1st edn) (eds Robins, L. N. & Regier, D. A.), pp. 181–203. New York: Free Press.Google Scholar
Boyd, J. H., Burke, J. D., Gruenberg, E., et al (1984) Exclusion criteria of DSM–III. A study of co-occurrence of hierarchy-free syndromes. Archives of General Psychiatry, 41, 983–989.Google Scholar
Brawman-Mintzer, O., Lydiard, R. B., Emmanuel, N., et al (1993) Psychiatric comorbidity in patients with generalized anxiety disorder. American Journal of Psychiatry, 150, 1216–1218.Google Scholar
Breir, A., Charney, D. S. & Heninger, G. R. (1986) Agoraphobia with panic attacks. Archives of General Psychiatry, 43, 1029–1036.Google Scholar
Brown, T. A., Barlow, D. H. & Liebowitz, M. R. (1994) The empirical basis of generalized anxiety disorder. American Journal of Psychiatry, 151, 1272–1280.Google Scholar
Endicott, J. & Spitzer, R. L. (1978) A diagnostic interview: The schedule for affective disorders and schizophrenia (SADS-L). Archives of General Psychiatry, 35, 837–844.CrossRefGoogle Scholar
Fava, A., Grandi, S. & Canestrati, R. (1988) Prodomal symptoms in panic disorder with agoraphobia. American Journal of Psychiatry, 145, 1564–1567.Google Scholar
Garvey, M. J., Cook, B. & Noyes, R. Jr. (1988) The occurrence of a prodrome of generalized anxiety in panic disorder. Comprehensive Psychiatry, 29, 445–449.Google Scholar
Huxley, P. J., Goldberg, D. P., Maguire, G. P., et al (1979) The prediction of the course of minor psychiatric disorders. British Journal of Psychiatry, 135, 535–543.Google Scholar
Kalbfleish, J. G. & Prentice, R. L. (1980) The Statistical Analysis of Failure Time Data. New York: John Wiley and Sons.Google Scholar
Kedward, H. B. & Cooper, B. (1966) Neurotic disorders in urban practice: A three-year follow-up. Journal of the Royal College of Physicians of London, 12, 148–163.Google Scholar
Keller, M. B., Lavori, P. W. & Nielson, E. (1987a) SCALUP (SCID-P plus SADS-L). Available from authors (Dr Keller).Google Scholar
Keller, M. B., Lavori, P. W., Friedman, E., et al (1987b) The longitudinal interval follow-up evaluation: A comprehensive method for assessing outcome in prospective longitudinal studies. Archives of General Psychiatry, 540–548.Google Scholar
Keller, M. B., Yonkers, K. A., Warsaw, M. G., et al (1994) Remission and relapse in subjects with panic disorder and panic with agoraphobia: A prospective short-interval naturalistic follow-up. Journal of Nervous and Mental Disorders, 182, 290–296.Google Scholar
Kendler, K. S., Neagle, M. C., Kessler, R. C., et al (1992) Generalized anxiety disorder in women. A population-based twin study. Archives of General Psychiatry, 49, 267–272.Google Scholar
Massion, A., Warshaw, M. & Keller, M. (1993) Quality of life and psychiatric morbidity in panic disorder versus generalized anxiety disorder. American Journal of Psychiatry, 150, 600–607.Google Scholar
Noyes, R., Clancey, J., Hoenk, P. R., et al (1980) The prognosis of anxiety neurosis. Archives of General Psychiatry, 37, 173–178.CrossRefGoogle ScholarPubMed
Perry, J. C., Steketee, G., Massion, A., et al (1993) The Psychosocial Treatment Interview: A method format for follow-along studies. Available from Dr Perry, Jewish General Hospital 3755 Cote St. Catherine Road, Montreal, Quebec H3T1E2.Google Scholar
Raskin, M., Peeke, H. V. S., Dickman, W., et al (1982) Panic and generalized disorders. Archives of General Psychiatry, 39, 687–689.CrossRefGoogle Scholar
SAS Institute, Inc. (1990) Statistical Analysis Software. Available from SAS Circle, Box 8000, Cary, NC, 27512–8000.Google Scholar
Schapira, K., Roth, M., Kerr, T. A., et al (1972) The prognosis of affective disorders: the differentiation of anxiety states from depressive illness. British Journal of Psychiatry, 121, 175–181.Google Scholar
Spitzer, R. L., Williams, J. B., Gibbon, M., et al (1988) Structured Clinical Interview for DSM–III–R–Patient Version (SCID-P). New York: New York State Psychiatric Institute.Google Scholar
von Korff, M., Eaton, W. & Keyl, P. (1985) The epidemiology of panic attacks and panic disorder: Results from three community surveys. American Journal of Epidemiology, 122, 970–981.Google Scholar
White, K., Goldenberg, I., Yonkers, K. A., et al (1992) The infrequency of “pure culture” diagnoses among anxiety disorders. Clinical Neuropharmacology, 15 (Suppl. 1), 56B.Google Scholar
Wittchen, H.-U. (ed.) (1988) Natural course and spontaneous remissions of untreated anxiety disorder: Results of the Munich follow-up study (MFS). In Panic and Phobias 2: Treatments and Variables Affecting Course and Outcome. New York: Springer-Verlag.Google Scholar
Wittchen, H.-U., Zhao, S., Kessler, R. C., et al (1994) DSM–III–R Generalised anxiety disorder in the National Comorbidity Survey. Archives of General Psychiatry, 51, 355–364.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.