Generalised anxiety disorder (GAD)

• What is Generalised Anxiety Disorder (GAD)
• Statistics on Generalised Anxiety Disorder (GAD)
• Risk Factors for Generalised Anxiety Disorder (GAD)
• Progression of Generalised Anxiety Disorder (GAD)
• Symptoms of Generalised Anxiety Disorder (GAD)
• Clinical Examination of Generalised Anxiety Disorder (GAD)
• How is Generalised Anxiety Disorder (GAD) Diagnosed?
• Prognosis of Generalised Anxiety Disorder (GAD)
• How is Generalised Anxiety Disorder (GAD) Treated?
• Generalised Anxiety Disorder (GAD) References

What is Generalised Anxiety Disorder (GAD)

Generalised Anxiety Disorder (GAD) is a psychological disease.

This condition is characterised by excessive worry about actual circumstances, events or conflicts that occur in everyday life.

Anxiety disorders are classified according to whether the anxiety is persistent (general anxiety) or episodic, with the episodic conditions classified according to whether the episodes are regularly triggered by the same cue (phobia) or not (panic disorder).

Statistics on Generalised Anxiety Disorder (GAD)

General anxiety disorder occurs in 3-8% of the population. The disorder may start at any time in life, including childhood. The majority of patients presenting with the disorder report that they have been anxious for as long as they can remember. GAD occurs somewhat more often among women than among men.

Risk Factors for Generalised Anxiety Disorder (GAD)

The most important risk factor for the development of any anxiety disorder is a family history of anxiety disorder. It is estimated that this condition affects 25% of first degree relatives of a person with GAD.

Behavioral inhibition¹, an early temperament associated with aversion to novel situations, has been found to be associated with later development of anxiety disorders.

Progression of Generalised Anxiety Disorder (GAD)

This condition begins at variable ages, most commonly in early childhood. The course is usually long-term with the severity of symptoms decreasing as the patient gets older. As the duration of illness increases, the patient becomes more likely to develop depression, especially if the condition remains untreated.

How is Generalised Anxiety Disorder (GAD) Diagnosed?

Investigation of anxiety disorders is largely inappropriate as the test itself may become a source of anxiety for the patient. The condition is only investigated if there is strong suspicion of a medical cause of anxiety following history and physical examination. Investigat6ion may involve performing an ECG and blood tests for thyroid disease, adrenal disease and blood sugar levels.

Prognosis of Generalised Anxiety Disorder (GAD)

If the condition remains untreated, the prognosis is poor. Most patients will develop secondary depression, requiring medical and psychological therapy for the management of depression. With treatment the prognosis is good, as the risk of developing secondary depression is reduced.

How is Generalised Anxiety Disorder (GAD) Treated?

As with most psychiatric illness, generalised anxiety disorder is best treated with both psychotherapy and anti-anxiety medications. There are a number of types of psychotherapy suitable for the treatment of panic disorder. These include relaxation therapy, behaviour therapy and cognitive behavioural therapy.

Medications are used to assist psychotherapy as a primary form of treatment. Medications such as sedatives and antidepressants are used in this setting to reduce the frequency and severity of panic attacks. The most commonly used sedatives are the benzodiazepines such as diazepam, however their use beyond 4-6 weeks is discouraged with the emergence of dependence beyond this duration. The most commonly used antidepressant for this condition are the SSRI’s such as flluoxetine and sertraline. Antidepressant medications will usually require three months of therapy to achieve adequate effect, but have the advantage that they do not induce patient dependency.

Another class of drugs commonly used for generalised anxiety disorder are the beta-blockers. These drugs block the body’s response to anxiety, preventing the occurrence of palpitations, sweating and tremor in the event of a panic attack. They can also be taken in anticipation of a stressful situations to reduce the effect of anxiety on the body.

Useful resource

The MindSpot Clinic is a free telephone and online service for Australian adults troubled by symptoms of anxiety or depression. The service is run by a team of health professionals and provides free Online Screening Assessments, free Treatment Courses and can assist in finding local services that can help. To speak to one of the team call 1800 614 434 between 8am -8pm AEST Monday to Friday and 8am – 6pm AEST on Saturday or visit MindSpot Clinic.

More information

For more information on how psychotherapy can be used in the treatment of anxiety, see Psychotherapy for Anxiety

Generalised Anxiety Disorder (GAD) References

[1] Kagan J: Temperamental contributions to social behavior. American Psychologist 1989;44:668-674.
[2] Kumar P, Clark M. Clinical Medicine. Fourth Ed. WB Saunders, 2002.
[3] Sadock BJ., Sadock VA. Kaplan and Sadock’s Pocket Handbook of Clinical Psychiatry 3rd edition. Lippincott Williams and Wilkins 1996.