Treating Generalized Anxiety Disorder

Main Category: Anxiety / Stress
Article Date: 01 Dec 2004 - 11:00 PDT

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Generalized anxiety disorder (GAD) is one of the most common psychiatric illnesses in the United States among children and adults. While the condition is highly treatable with psychosocial therapies, medication, or both, only about one-third of those suffering from the condition receive treatment.

According to the Anxiety Disorders Association of America (ADAA), generalized anxiety disorder (GAD)-a chronic, persistent, and disabling condition-is associated with significant use of resources in various healthcare settings. Patients with GAD are usually plagued by excessive and unrealistic worry that recurs for six months or longer. The anxiety in patients with this condition produces a degree of suffering that is underestimated by some physicians. GAD significantly decreases quality of life and, if left untreated, has been associated with additional physical and psychological problems for the patient later in life.

Approximately 5% of Americans will develop GAD during their lifetime, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), and the current prevalence of the disorder in the general U.S. population ranges between 2% and 3%. Despite this relatively high prevalence, GAD continues to be under-recognized and under-treated, according to Jerilyn Ross, MA, LICSW. "Most people with GAD are likely to think their problem is physiological and therefore would present to their primary care physician. The challenge for physicians is to then identify patients with GAD who require treatment and to recommend appropriate therapies."

Recognizing GAD

The physician plays a key role in screening and diagnosing GAD, but there are challenges to detecting the condition. "GAD is not always on the physician's radar screen," explains Jerilyn Ross. "Some patients with GAD may appear to be hypochondriacal since the patient's complaints are often non-specific. The signs may not be obvious or clear."

There is a critical need for time-efficient screening and monitoring for GAD, Ross says. "Physicians typically have only about 10 minutes to see their patients and are understandably more likely to focus on physical illnesses rather than the possibility of GAD. Compounding the problem is that patients are often ashamed or embarrassed about having anxiety disorders due to the stigma associated with them. Frequently, patients are unaware that they have a real and treatable illness, so they won't talk to their doctor about what they're experiencing. In these cases, it is critical that physicians recognize the warning signs and pay attention to what the patient says and doesn't say. If GAD is suspected, it is important for physicians to ask patients questions to determine whether or not the condition warrants GAD diagnosis and treatment." (See Figure 1 for questions recommended to determine patient GAD status.)

Patients with GAD do not always provide definitive clues for appropriate diagnostic decisions; the condition usually presents as a multiplicity of complaints, according to the ADAA. "GAD needs to be differentiated from other medical and psychiatric conditions," says Ross. "The diagnosis is complex and many medical conditions can be masked by the symptoms and vice versa." The DSM-IV provides key points for physicians to consider when diagnosing GAD, and a list of risk factors (see Figure 2)……………. CONTINUES……..www.physweekly.com