Generalized anxiety syndrome. Generalized anxiety disorder: description and treatment

Generalized anxiety disorder characterized by excessive, almost daily anxiety and worry for 6 months or more about many events or activities. The causes are unknown, although generalized anxiety disorder is common in patients with alcohol dependence, severe depression, or panic disorder. Diagnosis is based on history and physical examination. Treatment: psychotherapy, drug therapy or a combination of them.

ICD-10 code

F41.1 Generalized anxiety disorder

Epidemiology

Generalized anxiety disorder (GAD) is quite common, affecting approximately 3% of the population each year. Women get sick twice as often as men. GAD often begins in childhood or adolescence, but can also begin in other age periods.

Symptoms of generalized anxiety disorder

The immediate cause for the development of anxiety is not determined as clearly as with other mental disorders ah (for example, anticipation of a panic attack, anxiety in public, or fear of infection); the patient is worried for many reasons, the anxiety changes over time. The most common concerns are about professional commitments, money, health, safety, car repairs, and daily responsibilities. To meet the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), the patient must have 3 or more of the following symptoms: anxiety, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbances. The course is usually fluctuating or chronic, worsening during periods of stress. Most patients with GAD also have one or more comorbid mental disorders, including major depressive episode, specific phobia, social phobia, and panic disorder.

Clinical manifestations and diagnosis of generalized anxiety disorder

A. Excessive worry or worry (anxious expectations) associated with a number of events or activities (for example, work or school) and occurring most of the time for at least six months.

B. Anxiety is difficult to control voluntarily.

B. Anxiety and restlessness are accompanied by at least three out of six the following symptoms(with at least some symptoms present most of the time over the past six months).

1. Anxiety, feeling nervous, on the verge of a breakdown.
2. Fast fatiguability.
3. Impaired concentration.
4. Irritability.
5. Muscle tension.
6. Sleep disorders (difficulty falling asleep and maintaining sleep, restless sleep, dissatisfaction with the quality of sleep).

Note: Children are allowed to have only one of the symptoms.

D. The focus of anxiety or worry is not limited to the motives characteristic of other disorders. For example, anxiety or worry is not associated only with the presence panic attacks(as in panic disorder), the possibility of being embarrassed in public (as in social phobia), the possibility of infection (as in obsessive-compulsive disorder), being away from home (as in separation anxiety disorder), weight gain (as in anorexia nervosa) ), the presence of numerous somatic complaints (as in somatization disorder), the possibility of developing a dangerous disease (as in hypochondria), the circumstances of a traumatic event (as in post-traumatic stress disorder).

D. Anxiety, restlessness, somatic symptoms cause clinically significant discomfort or disrupt the patient’s life in social, professional or other important areas.

E. The disorders are not caused by the direct physiological action of exogenous substances (including substances addictive, or medicines) or general illness(for example, hypothyroidism), and are also not observed only when affective disorders, psychotic disorder and are not associated with a pervasive developmental disorder.

Course of generalized anxiety disorder

Symptoms of generalized anxiety disorder are often observed in patients seeking medical attention general practice. Typically, such patients present with vague somatic complaints: fatigue, muscle pain or tension, mild sleep disturbances. The lack of data from prospective epidemiological studies does not allow us to speak with confidence about the course of this condition. However, retrospective epidemiological studies suggest that generalized anxiety disorder is a chronic condition, as most patients have symptoms for many years before diagnosis.

Differential diagnosis of generalized anxiety disorder

Like other anxiety disorders, generalized anxiety disorder should be differentiated from other mental, somatic, endocrinological, metabolic, neurological diseases. In addition, when making a diagnosis, one should keep in mind the possibility of combination with other anxiety disorders: panic disorder, phobias, obsessive-compulsive and post-traumatic stress disorder. stress disorders. The diagnosis of generalized anxiety disorder is made when the full range of symptoms is detected in the absence of comorbid anxiety disorders. However, in order to diagnose generalized anxiety disorder in the presence of other anxiety conditions, it is necessary to establish that anxiety and worry are not limited to the circumstances and topics characteristic of other disorders. Thus, a correct diagnosis involves identifying symptoms of generalized anxiety disorder in the exclusion or presence of other anxiety conditions. Because patients with generalized anxiety disorder often develop major depression, this condition also needs to be excluded and correctly differentiated from generalized anxiety disorder. Unlike depression, in generalized anxiety disorder anxiety and worry are not associated with affective disorders.

Pathogenesis. Of all the anxiety disorders, generalized anxiety disorder is the least studied. The lack of information is partly due to quite dramatic changes in views on this condition over the past 15 years. During this time, the boundaries of generalized anxiety disorder gradually narrowed, while the boundaries of panic disorder expanded. The lack of pathophysiological data is also explained by the fact that patients are rarely referred to psychiatrists for the treatment of isolated generalized anxiety. Patients with generalized anxiety disorder usually have comorbid mood and anxiety disorders, and patients with isolated generalized anxiety disorder are rarely identified in epidemiological studies. Therefore, many pathophysiological studies are rather aimed at obtaining data to differentiate generalized anxiety disorder from comorbid affective and anxiety disorders, primarily panic disorder and major depression, which have a particularly high comorbidity with generalized anxiety disorder.

Genealogical research. A series of twin and genealogical studies have revealed differences between generalized anxiety disorder, panic disorder and major depression. The findings suggest that panic disorder runs in families differently than generalized anxiety disorder or depression; at the same time, the differences between the last two states are less clear. Based on data from a study of adult female twins, scientists have suggested that generalized anxiety disorder and major depression have a common genetic basis, which is manifested by one or the other disorder under the influence of external factors. Scientists also found an association between polymorphisms in a transporter involved in serotonin reuptake and levels of neuroticism, which, in turn, are closely associated with symptoms of major depression and generalized anxiety disorder. The results of a long-term prospective study in children confirmed this point of view. The associations between generalized anxiety disorder in children and major depression in adults were found to be no less strong than those between depression in children and generalized anxiety disorder in adults, as well as between generalized anxiety disorder in children and adults and between major depression in children and adults.

Differences from panic disorder. A number of studies have compared neurobiological changes in panic and generalized anxiety disorders. Although a number of differences have been identified between the two conditions, both differ from mentally healthy individuals on the same dimensions. For example, a comparative study of the anxiogenic response to the administration of lactate or inhalation of carbon dioxide showed that in generalized anxiety disorder this reaction is enhanced compared to healthy individuals, and panic disorder differs from generalized anxiety disorder only by more severe shortness of breath. Thus, in patients with generalized anxiety disorder the reaction was characterized by high level anxiety, accompanied by somatic complaints, but not associated with respiratory dysfunction. In addition, in patients with generalized anxiety disorder, a smoothing of the curve of growth hormone secretion in response to the administration of clonidine was revealed - as in panic disorder or major depression, as well as changes in the variability of cardiac intervals and indicators of activity of the serotonergic system.

Diagnostics

Generalized anxiety disorder is characterized by frequent or persistent fears and worries that arise about, but are apparently excessive in relation to, actual events or circumstances of concern to the person. For example, students often fear exams, but a student who is constantly worried about the possibility of failure, despite good knowledge and consistently high grades, can be suspected of generalized anxiety disorder. People with generalized anxiety disorder may not realize that their fears are excessive, but severe anxiety makes them feel uncomfortable. To be diagnosed with generalized anxiety disorder, symptoms must be present frequently for at least six months, the anxiety must be uncontrollable, and at least three of six physical or cognitive symptoms must be present. These symptoms include: anxiety, fatigue, muscle tension, and insomnia. It should be noted that anxious concerns are a common manifestation of many anxiety disorders. Thus, patients with panic disorder experience concerns about panic attacks, patients with social phobia - about possible social contacts, patients with obsessive-compulsive disorder - about obsessions or sensations. Anxiety in generalized anxiety disorder is more global in nature than in other anxiety disorders. Generalized anxiety disorder is also observed in children. Diagnosis of this condition in children requires the presence of only one of the six physical or cognitive symptoms specified in the diagnostic criteria.

If a person experiences excessive daily feelings of restlessness and worry for six months, we can talk about generalized anxiety disorder (GAD).

Causes of generalized anxiety disorder

The exact causes of the disease are unknown. It can often be found in patients suffering from alcohol addiction, as well as panic attacks and severe depression.

This disease is quite common. According to statistics, about 3% of the world's population gets sick every year. Moreover, women get sick twice as often as men. The disease is often found in children and adolescents, but generalized anxiety disorder also occurs in adults.

The disease is characterized by constant anxiety and fears that arise about various circumstances or events that clearly do not require such worries. Students, for example, may experience excessive fear of exams, even if they have good knowledge and high grades. Patients with GAD often do not realize the excessiveness of their fears, but the constant state of anxiety causes them discomfort.

To be confidently diagnosed with GAD, symptoms must have been present for at least six months and the anxiety must have been uncontrolled.

Symptoms of generalized anxiety disorder

With GAD, the immediate cause for anxiety is not identified as clearly as with various panic attacks. The patient may be worried for many reasons. Most often, anxiety arises about professional obligations, constant lack of money, safety, health, car repairs, or other daily responsibilities.

Characteristic symptoms of generalized anxiety disorder are: increased fatigue, restlessness, irritability, decreased concentration, sleep disturbances, and muscle tension. It should be noted that most patients with GAD already have one or more mental disorders, including panic disorder, depressive or social phobia, etc.

Clinically, GAD manifests itself as follows: the patient feels constant anxiety and tension caused by a series of events or actions for six months or more. He cannot control this anxious state, and it is accompanied by the above symptoms.

To diagnose GAD in children, the presence of at least one of six symptoms is sufficient. To diagnose generalized anxiety disorder in adults, at least three symptoms must be present.

In GAD, the focus of worry and anxiety is not limited to the motives that are characteristic of other anxiety disorders. Thus, anxiety and anxiety are not associated solely with the fear of panic attacks (panic disorder), fear of large crowds of people (social phobia), weight gain ( anorexia nervosa), fear of separation in childhood(separation anxiety disorder), the possibility of getting sick dangerous disease(hypochondria) and others. Anxiety causes discomfort in the patient and prevents him from full life.

Typically, symptoms of generalized anxiety disorder are caused by a number of physical disorders(for example, hypothyroidism), as well as taking medications or drugs.

Risk factors

Your chances of developing GAD increase if you have the following factors:

• female;
• low self-esteem;
• exposure to stress;
• smoking, drinking alcohol, drugs or addictive medications;
• prolonged exposure to one or more negative factors(poverty, violence, etc.);
• presence of anxiety disorders in family members.

Diagnosis of generalized anxiety disorder

During the consultation, the doctor performs a physical examination of the patient and asks about the history and symptoms of the disease. Diagnosis of the disease includes testing to identify other diseases that could trigger GAD (for example, thyroid disease).

The doctor asks the patient what medications he is taking, since some of them can cause serious side effects symptoms similar to GAD. The doctor will also ask whether the patient is addicted to tobacco, alcohol or drugs.

An accurate diagnosis of GAD is made when the following factors are present:

• GAD symptoms continue for six months or more;
• they cause significant discomfort in the patient and prevent him from leading a full life (for example, the patient is forced to miss school or work);
• GAD symptoms are constant and uncontrollable.

Treatment for generalized anxiety disorder

Typically, treatment for generalized anxiety disorder consists of the following:

Medicines to treat generalized anxiety disorder include:

• Benzodiazepines, which help relax muscles and prevent them from tightening in response to anxious thoughts. These medications are taken under the strict supervision of a doctor, as they can cause addiction.
• Medicines to reduce anxiety such as buspirone, alprazolam;
• Antidepressants (mainly serotonin reuptake inhibitors).
• Beta blockers for withdrawal physical symptoms GTR.

For the most successful treatment of GAD, it is important to identify the disease as early as possible, as this can reduce the risk of severe psychological complications.

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– a mental disorder, the main symptom of which is persistent anxiety not associated with specific objects or situations. Accompanied by nervousness, fussiness, muscle tension, sweating, dizziness, inability to relax and constant but vague premonitions of misfortune that could happen to the patient himself or his loved ones. Usually occurs in situations of chronic stress. The diagnosis is established on the basis of anamnesis, patient complaints and data additional research. Treatment – ​​psychotherapy, drug therapy.

ICD-10

F41.1

General information

Causes of generalized anxiety disorder

The main manifestation of GAD is pathological anxiety. Unlike ordinary situational anxiety, provoked by external circumstances, such anxiety is a consequence of the physiological reactions of the body and psychological characteristics patient's perceptions. The first concept of the mechanism of development of pathological anxiety belongs to Sigmund Freud, who, among other mental disorders, described generalized anxiety disorder (anxiety neurosis).

The founder of psychoanalysis believed that pathological anxiety, along with other symptoms of neurotic disorders, arises in a situation of internal conflict between the Id (instinctive drives) and the Super-Ego (moral and moral standards). Freud's followers developed and expanded this concept. Modern psychoanalysts believe that anxiety disorder is a reflection of a deep-seated internal conflict that arose in a situation of constant insurmountable threat to the future or in circumstances of prolonged unsatisfaction of the patient’s basic needs.

Proponents of behaviorism view anxiety disorders as a result of learning, the emergence of a stable conditioned reflex reaction to frightening or painful stimuli. One of the most popular currently is the cognitive theory of Beck, who considered pathological anxiety as a violation of the normal reaction to danger. A patient with anxiety disorder focuses his attention on possible negative consequences external situation and one's own actions.

Selective attention creates distortions in the perception and processing of information, as a result of which a patient suffering from an anxiety disorder overestimates the danger and feels powerless in the face of circumstances. Due to constant anxiety, the patient quickly gets tired and does not even do the necessary things, which leads to problems in life. professional activity, social and personal sphere. Accumulating problems, in turn, increase the level of pathological anxiety. A vicious circle arises, becoming the underlying anxiety disorder.

The impetus for the development of GAD can be a deterioration in family relationships, chronic stress, conflict at work, or a change in the usual routine: going to college, moving, getting a new job, etc. Among the risk factors for anxiety disorder, psychologists consider low self-esteem and lack of resilience to stress, a sedentary lifestyle, smoking, drug use, alcohol, stimulants (strong coffee, tonic drinks) and some medications.

The characteristics and personality of patients matter. Generalized anxiety disorder often develops in impressionable, vulnerable patients who tend to hide their experiences from others, as well as in patients suffering from alexithymia (insufficient ability to recognize and express own feelings). It has been established that GAD is also often diagnosed in people who have experienced physical, sexual or psychological abuse. Another factor contributing to the development of an anxiety disorder is long-term poverty and lack of prospects for improving one’s financial situation.

There are studies indicating a connection between GAD and changes in the levels of neurotransmitters in the brain. However, most researchers consider anxiety disorders to be a mixed condition (partly congenital, partly acquired). The genetically determined tendency to worry about minor reasons is aggravated by the erroneous actions of parents and teachers: excessive criticism, unrealistic demands, non-recognition of the child’s merits and achievements, lack of emotional support in significant situations. All of the above creates a feeling of constant danger and inability to cope with the situation, becoming fertile ground for the development of pathological anxiety.

Symptoms of generalized anxiety disorder

There are three main groups of GAD symptoms: unfixed anxiety, motor tension and increased activity vegetative nervous system. Unfixed anxiety is manifested by a constant premonition of possible trouble, which may threaten the patient with anxiety disorder or his loved ones. There is no connection between anxiety and a specific object or situation: today the patient may imagine a car accident in which a delayed partner could get into, tomorrow - worry that the child will be left for the second year because of bad grades, the day after tomorrow - worry about a possible conflict with colleagues. Distinctive feature anxiety in generalized anxiety disorder is a vague, vague, but persistent premonition of terrible, catastrophic consequences, usually extremely unlikely.

Persistent anxiety persists for weeks, months, or even years. Constant worry about future failures exhausts the patient and worsens his quality of life. A patient with an anxiety disorder has difficulty trying to concentrate, gets tired easily, is easily distracted, and constantly suffers from a feeling of powerlessness. There is irritability, increased sensitivity to loud sounds and bright lights. Possible memory impairment due to absent-mindedness and fatigue. Many patients with anxiety disorder complain of depressed mood, and sometimes transient obsessions are detected.

In severe cases non-drug treatment anxiety disorder is carried out against the background of pharmacotherapy. Drug therapy usually prescribed at the initial stage to reduce the severity of symptoms, quickly improve the patient's condition and provide favorable conditions for effective psychotherapy. As a rule, tranquilizers and antidepressants are used for anxiety disorders. To avoid the development of dependence, the period of taking tranquilizers is limited to several weeks. For persistent tachycardia, drugs from the group of beta blockers are sometimes used.

Prognosis for anxiety disorder

The prognosis for anxiety disorder depends on many factors. If the symptoms are mild, contact a psychotherapist early, follow the doctor’s recommendations, good social adaptation At the time of the onset of symptoms of an anxiety disorder and the absence of other mental disorders, complete recovery is possible. Epidemiological studies conducted by American experts in the field mental health, showed that in 39% of cases all symptoms disappear within 2 years after the first treatment. In 40% of cases, manifestations of an anxiety disorder persist for 5 years or more. A wavy or continuous chronic course is possible.

Send specific messages to the heart, lungs, muscles and other organs through nerves throughout the body. Hormonal alarm signals come through the blood - for example, adrenaline is released. Taken together, these “messages” lead to the body speeding up and intensifying its work. The heart beats faster than usual. Nausea occurs. The body is covered with trembling (tremor). Sweat increases. It is impossible to avoid dry mouth, even if a person drinks a lot of liquid. Chest and headache hurt. Sucks in the pit of the stomach. Shortness of breath appears.

Excitement healthy body must be distinguished from painful, pathological anxiety. Normal anxiety is useful and necessary when experiencing stress. It warns of danger or a situation of possible confrontation. The individual then decides whether he should "take the fight" (for example, take a difficult exam). If too high, the subject understands that he needs to get away from such an event as quickly as possible (for example, when attacked wild beast).

But there is a special type of anxiety in which a person’s condition becomes painful, and manifestations of anxiety prevent him from carrying out normal life activities.

With GAD a person long time is in fear. Often extreme confusion is unmotivated, i.e. the reason for it cannot be understood.

Symptoms of pathological anxiety may, at first glance, be similar to manifestations of normal, healthy anxiety state, especially when it comes to so-called “anxious individuals.” For them, anxiety is an everyday norm of well-being, and not a disease. To distinguish generalized anxiety disorder from the norm, you need to find at least three of the following symptoms in a person:

• anxiety, nervous excitement, impatience manifests itself much more often than in usual living conditions;
• fatigue sets in faster than usual;
• it is difficult to gather attention, it often fails - as if it is turned off;
• the patient is more irritable than usual;
• muscles are tense and cannot be relaxed;
• sleep disturbances appeared that were not there before.

Anxiety that occurs for only one of these reasons is not a sign of GAD. Most likely, obsessive anxiety for any single reason means a phobia - a completely different disease.

Generalized anxiety disorder occurs between the ages of 20 and 30. Women get sick more often than men. The causes of this disorder are unknown, so it often seems that they do not exist at all. However, a number of indirect factors can influence the development of such a condition. This

• heredity: there are many in the family anxious personalities; had relatives who suffered from GAD;
• during the patient's childhood suffered psychological trauma: he was poorly communicated with in the family, one of the parents or both died, a syndrome was identified, etc.;
• after suffering major stress (for example, a family crisis), generalized anxiety disorder developed. The crisis is over, the provoking factors have been exhausted, but the signs of GAD remain. From now on, any minor stress, which has always been easy to cope with, maintains the symptoms of the disease.

GAD in some cases develops as a secondary concomitant disease in those suffering from depression and schizophrenia.

The diagnosis of GAD is made if its symptoms have developed and persisted for 6 months.

Is it possible to overcome generalized anxiety disorder? The treatment of this disease has been studied quite well. The manifestation of the disease may not be severe, but in the worst cases it can make the patient unable to work. In the sudden mode, difficult and lighter periods change; under stress (for example, the patient has lost his job or separated from a loved one), spontaneous exacerbations are possible.

Patients with GAD tend to smoke incredibly heavily, drink alcohol, and use drugs. This way they distract themselves from the disturbing symptoms, and for a while it really helps. But it is quite obvious that by “supporting” themselves in this way, they can completely lose their health.

Treatment for GAD cannot be quick and, unfortunately, does not provide full recovery. In the same time healing process, if carried out in courses over many years, will provide significant relief of symptoms and a qualitative improvement in life.

Its task at the first stage is to show the patient what changes need to be made in the ideas and thoughts that provoke anxiety. Then the patient is taught to build his thinking without harmful, useless and false premises - so that it works realistically and productively.

Individual consultations are conducted, during which the person practices problem-solving techniques.

Where technical and financial conditions allow, there are group courses to combat alarming symptoms. They teach relaxation, give great importance strategies for overcoming difficulties.

For self-help, psychological support centers (if they exist) can provide literature and videos teaching relaxation and how to overcome stress. Described special moves relief of anxiety.

Drug therapy is based on the use of two types of drugs: buspirone and antidepressants.

Buspirone is considered the best medicine Its action has not been fully studied. It is only known that it affects the production of a special substance in the brain - serotonin, which is presumably responsible for the biochemistry of anxiety symptoms.

Antidepressants, although not a direct target of anxiety, can be effective in treating it.

Currently, benzodiazepine drugs (for example, diazepam) are increasingly prescribed for the treatment of GAD. Despite their apparent ability to relieve anxiety, benzodiazepines are addictive, causing them to stop working. Moreover, anti-addiction must be carried out additional treatment. In severe cases of GAD, diazepam is prescribed for a period of no more than 3 weeks.

Antidepressants and buspirone are not addictive.

To achieve the greatest effect, combine cognitive therapy and treatment with buspirone.

Advances in modern pharmacology allow us to expect new medications in the coming years that will help completely cure generalized anxiety disorder.

According to DSM-III-R, generalized anxiety disorder is chronic (lasting more than 6 months) and is characterized by excessive worry and preoccupation regarding two or more life circumstances. A subject suffering from generalized anxiety appears to be morbidly anxious about everything.

Prevalence. Many studies report that generalized anxiety occurs in 2-5% of the general population. However, some studies have suggested that generalized anxiety disorder is not as common and that many patients diagnosed with this disorder have another anxiety disorder. The ratio of the incidence of the disease in women to that in men is 2:1; however, the ratio among patients receiving treatment for this disorder is approximately 1:1. The disorder most often develops around age 20, but can occur at any age. Only one third of patients suffering from generalized anxiety seek help from a psychiatrist. Many patients contact their primary care physicians, cardiologists, or pulmonary specialists.

Causes. The noradrenergic, GABAergic, and serotonergic systems of the frontal lobe and limbic system are thought to be involved in the pathophysiology of this disorder. These patients tend to increase sympathetic tone, and they overreact and adapt very slowly to stimuli of the autonomic nervous system.

The EEG revealed a number of pathological abnormalities from the a-rhythm and evoked potentials of the brain. EEG sleep studies show that there is an increase in periods of sleep interruption, a decrease in stage 1 sleep, and a decrease in the FBS complex - changes that differ from those observed in depression.

Some data genetic research indicate that some aspects of this disorder may be inherited. It is observed in 25% of immediate relatives, more often in women than in men. Male relatives are more likely to suffer from alcoholism-related disorders. Although results from twin studies are inconsistent, they report a concordance rate of 50% for monozygotic and 15% for dizygotic twins.

Psychosocial theories contain the same principles discussed earlier regarding the genesis of anxiety disorders in an individual. (More detailed review This topic is covered in sections devoted to normal anxiety and pathological anxiety.)

Clinical signs and symptoms

The clinical signs and symptoms, i.e., diagnostic criteria for generalized anxiety disorder, contained in DSM-III-R are given below:

A. Unrealistic and excessive anxiety and worry(anticipatory expectations) about two or more life events (for example, worrying about a possible misfortune with a child who is not actually in any danger, or worrying about a financial situation without any real basis, lasting for 6 months or longer , during which the subject worries about these things. In children and adolescents, this may take the form of anxiety and worry about schoolwork, physical development and social success).

B. If there is another disorder Axis I, the focus of anxiety and worry identified in A, is not related to it (e.g., anxiety and worry does not concern the fear of panic attacks, as in the case of panic disorder), with the fear of embarrassment in a public place (as in social phobias), fear of pollution (as in obsessive-compulsive disorder) or weight gain (as in anorexia nervosa).

B. This disorder does not occur only during periods of mood disorder or psychosis.

G.P o at least 6 of the following 18 symptoms occur frequently during periods of anxiety(symptoms seen only during panic attacks are not included):
Motor voltage:

1. trembling, twitching or feeling of chills,
2. tension, pain, severe muscle soreness,
3. anxiety,
4. easy fatigue,

Autonomic hyperactivity:

1. shallow breathing and feeling of suffocation,
2. palpitation or increased heart rate (tachycardia),
3. sweating or cold clammy hands,
4. dry mouth,
5. dizziness or weakness,
6. nausea, diarrhea or other stomach disorders,
7. redness (with a feeling of heat) or chills,
8. frequent urination,
9. difficulty swallowing or a lump in the throat,

Alertness and feeling of being followed:

1. feeling on edge or on the edge,
2. exaggerated apprehension reaction
3. difficulty concentrating or feeling “blank in the head” due to anxiety,
4. difficulty falling asleep and staying asleep,
5. irritability.

D. It is impossible to detect an organic factor that would cause and maintain these disorders(eg, hyperthyroidism, caffeine intoxication).

It is noted that with generalized anxiety, the number of cardiac and respiratory system smaller and not as heavy as with panic disorders, but symptoms from gastrointestinal tract and muscles are also strongly expressed. Common symptom is depression. It is very important to recognize the cause or focus of the patient's anxiety, since this information is important for the differential diagnosis.

Course and prognosis. By definition, generalized anxiety disorder is a chronic condition that can last a lifetime. 25% of these patients develop panic disorders. According to DSM-III-R, this disorder is sometimes followed by a major depressive episode.

Diagnosis

Diagnosis is made based on the above criteria listed in the DSM-III-R. The focus of anxiety cannot be a single point and cannot be associated with anticipation anxiety, as is observed in panic reactions and obsessive-compulsive disorders. If a patient suffers from a mood disorder, in order to diagnose him with a disorder in the form of generalized anxiety, it is necessary that manifestations of anxiety be observed in him in the absence active symptoms mood disorders. There are no specific subtypes of generalized anxiety.

Differential diagnosis for generalized anxiety, it is carried out with somatic diseases that can cause anxiety. It is especially important to exclude caffeine intoxication, stimulant abuse, alcohol withdrawal and withdrawal symptoms due to abuse sedatives and sleeping pills. The mental status examination should carefully examine the possibility of phobic disorder, panic reactions, and obsessive-compulsive disorder. Other diseases considered in the differential diagnosis are adjustment disorder accompanied by anxious mood, depression, dysthymia, schizophrenia, somatoform disorders and deperspiralization.

The following example illustrates a case of generalized anxiety disorder:

A 27-year-old male electrician, married, complains of dizziness, clammy palms, severe heart palpitations, and ringing in the ears for more than 18 months. He also had a dry mouth, periods of uncontrollable rocking, a constant feeling of being “on the edge” and a feeling of alertness that made it difficult for him to concentrate. These sensations had occurred over the previous two years; they were not associated with specific, discrete periods of time.

In connection with these disorders, he was examined by his attending physician, a neurologist, a neurosurgeon, and a chiropractor.

He was prescribed a hypoglycemic diet, received psychotherapy for a “tormenting nerve,” and was suspected of having an “inner ear disease.”

Within two recent years he had few special contacts due to the nature of his nervous system. Although he was sometimes forced to stop working if the condition was unbearable, he continues to work in the same company where he trained immediately after leaving school. He tries to hide his painful experiences from his wife and children, in front of whom he wants to look “perfect,” but notes that he experiences certain difficulties in relationships with them, since he is very nervous.

Discussion. Symptoms of motor tension (uncontrollable rocking), autonomic hyperactivity (sweating, clammy palms, palpitations), as well as increased vigilance and a sense of being watched (“always on edge,” feeling like one is being watched) indicate an anxiety disorder. Because the pathological manifestations are not limited to specific periods, as in panic disorders, and are not focused around discrete stimuli, as in phobic disorders, the diagnosis is generalized anxiety disorder.

Although the patient consulted doctors many times about his pathological symptoms, no fear of any specific disease excludes the diagnosis of hypochondria.

Clinical approach

Pharmacological therapy. The decision to prescribe an anxiolytic drug is usually rarely made after the doctor's first visit to the patient. Given the chronic nature of the disorder, the treatment plan must be carefully considered.

Benzodiazepines are the drug of choice for this disorder. In the case of generalized anxiety disorder, medications can be prescribed on a rgp basis, so that the patient takes a quick-acting benzodiazepine as soon as he feels the anxiety has become excessive. An alternative approach is to prescribe steady doses of benzodiazepines for a limited period of time concurrently with psychosocial therapy. The use of benzodiazepines for this disorder is associated with a number of difficulties. Approximately 25-30% of patients do not show clinical improvement, while tolerance and dependence may develop. Some patients have impaired attention, which increases the risk of accidents when driving a car or working at work.

Non-benzodiazepine and anxiolytic, can be recommended as the most the best remedy for these patients. Although it has a delayed onset, it does not cause many of the complications associated with benzodiazepines. Tricyclic antidepressants and monoamine oxidase inhibitors were previously thought to be ineffective in the treatment of generalized anxiety; however, there is evidence that this is not the case. E-adrenergic blockers, such as anaprilin, are used to treat peripheral manifestations of anxiety, and antihistamines used for the benefit of patients who are particularly likely to become addicted to benzodiazepines.

Psychosocial therapy. The behavioral approach to generalized anxiety disorder emphasizes cognitive coping strategies, relaxation, rumination, and bioreinforcement.

The most important role belongs to psychotherapy, especially in combination with thinking about anxiety. If it is determined that such therapy is suitable for the patient, the choice of method depends on the reason underlying this anxiety. General rule is that the presence of neurotic problems associated with characterological characteristics requires the participation of a psychoanalyst or one or more courses of prolonged therapy. If there is psychological problem ion is associated with a specific external phenomenon, short-term therapy can be quite effective in helping patients resolve their conflicts and get relief from pathological manifestations.

Most patients note that when they have the opportunity to discuss their problems with an interested and compassionate doctor, their anxiety is significantly reduced. Often, after identifying initially hidden precipitating events over the course of several interviews, the question of which supportive technique should be used becomes clear. Convincing the patient that his fears are unfounded, encouraging him not to avoid anxiety-provoking stimuli, and providing him with the opportunity to talk with a doctor about his experiences provide significant help to the patient, even if the techniques do not lead to a complete cure. If doctors believe that a patient's external environment is causing him anxiety, they can themselves or with the help of patients or their families change the environment so that it helps reduce stress. It should be remembered that the reduction of symptoms allows the patient to more effectively cope with his daily activities and relationships with others, which in itself provides additional rewards and satisfaction, which in themselves are healing.