Anxiety (Generalized Anxiety Disorder)
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- A condition characterized by persistent, excessive, and difficult-to-control worry associated with significant symptoms of motor tension, autonomic hyperactivity, and/or disturbances of sleep or concentration
- System(s) affected: nervous (increased sympathetic tone and catecholamine release); secondary effects on other symptoms such as cardiac (tachycardia), pulmonary (dyspnea), and GI (nausea, irregular bowels)
- 12-month prevalence rate: 1.8%
- Lifetime prevalence rate: 3.7%
- More common in high- versus low-income countries: 5% versus 1.6%
- Elderly prevalence as high as 7–10%
- Onset can occur any time in life but is typically during adulthood; median age of onset in the United States is 31 years.
- Predominant sex: female > male (2:1)
- Generally recurrent and chronic in nature; gradual in onset; fluctuates in severity; complete remission less likely (1)
Etiology and Pathophysiology
- May be mediated by abnormalities of neurotransmitter systems (i.e., serotonin, norepinephrine, and γ-aminobutyric acid [GABA])
- Associated with altered regional brain function (increased activity in the amygdala and prefrontal cortex)
- Strongly linked to depression in heritability studies
- A variant of the serotonin transporter gene (5HT1A) or other genes may contribute to both conditions.
- Caucasian race
- Adverse life events
- Family history
- Lack of social support
- Comorbid psychiatric disorders (2)
- Physical activity and cardiorespiratory fitness are associated with decreased generalized anxiety and depression.
- Cognitive-behavioral therapy (CBT) and parental intervention in children with early anxiety may protect against the development of GAD (2).
Commonly Associated Conditions
- Major depressive disorder (>60%), dysthymia, bipolar disorder, schizophrenia
- Alcohol/drug abuse
- Cigarette smoking in adolescence
- Panic disorder, agoraphobia, simple phobia, social anxiety disorder, anorexia nervosa, posttraumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), ADHD
- Somatoform and pain disorders