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Generalized anxiety disorder

German: generalisierte Angststörung

1 Definition

Generalized anxiety disorder is a certain kind of anxiety disorder which is characterized by fear that becomes uncontrollable.

2 Symptoms

Affected patients live in constant worry and anxious apprehension concerning all areas of daily life. Thoughts often revolve around expected negative results and consequences. Affected individuals experience inner unrest, are easily fatigued, irritable and have trouble concentrating. In situations of fear they have an increased muscle tone due to the increased psychological tension and are often affected by sleep disorders. Due to persistent fears, affected persons over time develop avoidance and reassurance behaviors which is typical for the disorder. To warrant a diagnosis according to ICD-10 (F41.1), the above symptoms have to persist for at least 6 months.

2.1 Examples of avoidance behavior

  • Frequent telephone calls with relatives
  • Not opening letters or bills
  • Avoiding driving a car
  • Not answering the phone at times
  • Frequent visits to the doctor
  • Reassuring with the social environment that seems excessive

2.2 Frequent areas of fear

  • Health
  • Finances
  • Work
  • Family and social environment
  • World affairs
  • Relationships

3 Epidemiology

Frequency of generalized anxiety disorder peaks at 20-30 years of age. Women are affected more frequently and on average fall ill earlier than men. Lifetime prevalence lies somewhere between 3 and 5 %; point prevalence is about 1-3%. Unmarried individuals are more frequently affected by anxiety disorders.

4 Differential diagnoses

  • Personality disorders
  • Depression with symptoms of delusion
  • Different anxiety disorders (panic disorders or specific phobias)
  • Hypochondriac disorders

5 Therapy

5.1 Therapy without medication

5.2 Pharmaceutical therapy

Pharmaceutical therapy uses benzodiazepines for short therm therapy in acute periods. Others drugs that are used are neuroleptics, mood stabilizers, lithium and antidepressants. Those drugs can be supplemented with phytotherapy (valerian, hops, lavender tea, St John's wort).

5.2.1 Preferred medication for long term therapy

5.2.2 Non-preferred medication for long term therapy

  • Buspirone, 15-60 mg/day - usually 30 mg/day
  • Imipramine, 75-200 mg/day - usually 100-150 mg/day
  • Opipramol, 100-300 mg/day - usually 200 mg/day

5.2.3 Medication for short term therapy

6 Progression

The disorder can appear in episodes that are sometimes less and sometimes more intense. As a result, the clinical presentation can fluctuate in intensity.

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