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INTRODUCTION: Generalized Anxiety Disorder (GAD)
"I
always thought I worried about everything. I was alarmed and unable to
relax. Sometimes, the feeling came and went and sometimes was constant.
Could last several days. I worried about what was going to make for
dinner or what would be a good gift for someone. I just could not stop
worrying about any details. "
"When I touched my back problems,
missed work and I felt terribly bad about this situation. Then I
worried about losing work. My life was miserable until I got treatment.
"
"She suffered serious sleep problems. There were times when I
woke up startled in the middle of the night. I had trouble
concentrating, even reading the newspaper or a novel. Sometimes I felt
a little dizzy. My heart was racing or pounding. And that worried me
even more. I always imagined worse than reality. If I had a
stomachache, I thought it was an ulcer. "
People with
generalized anxiety disorder (GAD) spend the day filled with
exaggerated worry and tension, even when there is little or nothing to
provoke it. They anticipate disaster and are overly concerned about
health issues, money, family problems, or difficulties at work.
Sometimes the mere thought of getting through the day produces anxiety.
GAD
is diagnosed when a person worries excessively about a variety of
everyday problems for at least six months. People with GAD seem to get
rid of their concerns, even though they usually realize that their
anxiety is more intense than the situation warrants. They can not
relax, startle easily and have difficulty concentrating. They often
have trouble falling asleep or staying asleep. Physical symptoms that
often accompany the anxiety include fatigue, headaches, muscle tension,
muscle aches, difficulty swallowing, trembling, twitching,
irritability, sweating, nausea, lightheadedness, having to go to the
bathroom frequently, feeling out air and hot flashes.
When their
anxiety level is mild, people with GAD can function socially and hold
down a job. Although not avoid certain situations as a result of their
disorder, people with GAD can have difficulty carrying out simple
activities of daily living if your anxiety is severe.
GAD
affects about 6.8 million adults and affects estadounidenses1 twice as
many women as men. The disorder develops gradually and can begin at any
point in the cycle of life, although the years of highest risk are
between childhood and middle age.2 There is evidence that genes play a
modest role in trastorno.13
Other anxiety disorders, depression,
or abuse of sustancias2, 4 often accompany GAD, which rarely occurs
alone. Normally, the GAD is treated with medication or
cognitive-behavioral therapy, but also coexisting conditions should be
treated with appropriate therapies.
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Classification according to ICD-10 F41 Other anxiety disorders F41.1 Generalized anxiety disorder ICD-10 online (WHO version 2011) Generalized
anxiety disorder (GAD), according to ICD-10 (F41.1) is a form of "other
anxiety disorders." It becomes independent of the fear and lose their
relevance and relation. Contents [hide] 1 Symptoms 2 development and maintenance 3 Therapy 4 Literature 5 Sources Symptoms [Edit]
The
patient experienced a generalized and persistent fear that is not (as
in the phobic disorders) are restricted to certain environmental
conditions, but rather floats freely. Contents of fear is in most
cases an unfounded concern and fears of future accidents or illnesses
that affect one or even relatives, as well as a large number of other
worries and forebodings. The patient has to cope with little or unable
to perform routine tasks. He has anxiety, which can hardly force for a
normal lifestyle. The anxiety occur in many situations. The person
concerned gets panic of crowds, elevators, public transportation, in
simple and everyday situations in which the fear of the person
concerned for the average citizen does not understand. The lifetime
prevalence of 4-5%, the disease usually begins between the 20th and 30
Age, women are affected more often than men, often associated with
stressful life circumstances. The course is variable, but tends to
fluctuate and become chronic. Concerns are: Family / social relationships Work and power Health concerns Finances Everyday The
fear manifests itself in patients by physical symptoms such as tremors,
palpitations, dizziness, derealization and depersonalization, nausea,
anxiety, relax inability to hot flashes, muscle tension, impaired
concentration, nervousness, insomnia, tension headaches, dizziness,
tingling. After the ICD-10 criteria, the following symptoms for at least several weeks, usually to be met for several months on most days: Concerns (concerns about future calamity, nervousness, difficulty concentrating, etc.) motor tension (physical restlessness, tension headaches, tremors, inability to relax) autonomic hyperarousal (dizziness, sweating, tachycardia and tachypnoea, abdominal pain, dizziness, dry mouth, etc.) Psychological
symptoms (feeling of dizziness, uncertainty and lightheadedness,
derealization and depersonalization, fear of losing control, fear of
dying) There must be no organic cause or match the criteria for a
depressive episode, phobic disorder, obsessive compulsive disorder or
panic disorder, although depressive symptoms may occur temporarily with
a generalized anxiety disorder. After the ICD-10 research criteria,
generalized anxiety disorder can therefore occur simultaneously with a
major depressive episode. In this case, only the criteria for panic
disorder, phobias, obsessive-compulsive disorder, or a hypochondriacal
disorder no longer be met. People suffering from a generalized
anxiety disorder studied, mostly because of his physical ailments to
the doctor. Often it takes many years to recognize is that behind its
physical symptoms of chronic anxiety. The physical symptoms of those
affected are usually the result of their negative thoughts, their
concerns and thoughts. The disease has been underestimated before.
Today we know that it is associated with severe impairment of quality
of life. Development and maintenance [Edit] Click here for General anxiety disorder treatment
The
basic cause for the emergence of generalized anxiety disorder, genetic
and social factors are assumed. The GAS is inherited but not specific,
it seems to exist rather an inherited biological vulnerability to the
development of pathological anxiety. This biological vulnerability to
the experience of anxiety can lead to stress which is caused by social
factors. Stress-generating social factors are most critical life
events. The experienced stress can lead to the characteristic of GAS
anticipatory anxiety (worry). This anticipatory anxiety is
characterized by negative feelings associated with "related to the
perceived inability to predict upcoming events in control conditions or
desired results, or to achieve" [1]. This leads mainly to a shift of
attention to internal, self-evaluative content and excessive vigilance
against anxiety-provoking stimuli. Vigilance in turn leads to many
different life circumstances are perceived as threatening. The GAS
seems to be maintained by the concerns: By Borkovec and colleagues [2]
concerns are a form of mental avoidance. The process of caring dampens
the emotional processing of fear-inducing stimuli and also leads to
somatic Suppressionseffekten: the anxiety-provoking stimuli (due to
cognitive processing) and streamlines the people are peaceful by
self-concern. This short-term improvement of the emotional and physical
being, reinforcing a negative effect: The fear is maintained. Further
discuss cognitive factors are inter-dimensional and
ExternalEmailAddress misperceptions arising from the result from the
patient to himself observed changes such as reduced concentration and
disruption of working memory: I'm not up to the task, possess little
control or ability damage to master difficult situations, the concerns
me. Due to the negative control experiments Metasorgen can arise that
increase the frequency of worry and even trigger avoidance behavior and
reinsurance. But also positive Metasorgen as "preventive care is the
same" can reinforce the worry process. Through the control, prevention
and reinsurance can not take place so that habituation and no end of
worry process, and the cycle swings up. Therapy [Edit] Click here for General anxiety disorder treatment
In
psychodynamic psychotherapy, both the psychic structure, as well as the
fears and anxiety-inducing situations is associated processes. Here,
the "fear-preserving conditions," an equally great attention is given
to how the contents of the fears or the triggering conditions in the
life of the affected. Also biographical contexts can be vermittlet
during therapy, these are, in contrast to other anxiety disorders, but
never in the foreground. At the height of the transfer of security
needs of the person concerned is at the center. This is followed by the
address of the therapist's interventions. Themes can also be binding in
therapy come into play. There are also short-term psychodynamic
psychotherapy that have proven in the treatment of GAS as effective as
cognitive-behavioral therapy programs. [3] [4]
In a
cognitive-behavioral therapy is the first objective is that the patient
experienced a behavioral analysis and mediation of a specific fault
model, an understanding of his disorder, and this creates a willingness
to behavioral interventions such as the confrontation with the fear in
sensu (mentally) or in vivo (in real life, ie in the specific
situation) to participate. In this way he can learn new behavior
patterns by himself and his anxiety is experienced in practice that he
feared the inevitable consequences. Through cognitive therapy elements,
such as cognitive restructuring, reality testing, or the processing of
the Entkatastrophisieren Metasorgen the patient to acquire a new
outlook on life and a new perspective on their own abilities. The
effectiveness of cognitive behavior therapy has increased sharply,
while improved since the researchers used clinical techniques.
Another
important element is the Applied relaxation therapy, represents but in
severe cases that are not otherwise able to benefit from psychotherapy,
because their fears and tensions are too large, a drug therapy offers
with antidepressants, especially SSRIs or SNRI, in order to produce a
treatment capacity at all. However, this negative can be expected with
additional anxiety and discontinuations due to side effects or the fear
of stopping the medicine. Many clients with generalized anxiety
disorder to seek primary care physicians to seek treatment for their
anxiety and somatic complaints. In this case, are often wrongly
prescribed benzodiazepines to relieve nervousness. However, there are
fast habituation effects. Benzodiazepines also produce quickly
dependence, which makes it difficult to discontinuation of medication
[5].
