Generalised anxiety disorder: symptoms, diagnosis and treatment

By Cristiano Antonino On Jul 25, 2022

Generalised anxiety disorder, also known as GAD or DAG, according to the English formula, is a clinical form of anxiety disorders. It predominantly affects women (1.5:1), and a prevalence of 3-5% of the population has been estimated

Very often underestimated, not only by patients but also by doctors, it can – but only and exclusively in very extreme cases – also lead to an increased risk of suicide.

As the name implies, the anxiety that characterises the disorder is not concentrated or elicited by a particular object or situation (i.e., it is non-specific)

In commenting on his difficulties, the patient is usually very precise and appropriate in first recognising the discrepancy between the real dimension of the difficulties to be faced and the amount of anxiety they evoke.

The disorder is chronic: it usually presents itself at an early age, so much so that the patient reports being anxious ‘all along’.

Symptoms of generalised anxiety disorder

The characteristic symptoms are those of alarm states, characterised by a psychic condition of general apprehensive expectation, and by numerous physical signs and symptoms of vegetative activation (hyperarousal): migraine, palpitations, dizziness and insomnia, difficulty in concentrating, muscle tension, restlessness may occur.

In addition to these purely ‘physical’ symptoms, there may be cognitive ones such as empty-headedness, derealisation and depersonalisation.

Sleep disturbances, such as interruptions or early awakenings, may be associated with it; sometimes sufferers wake up in the middle of the night and remain in a state of tension, having difficulty resuming sleep.

Diagnosis of generalised anxiety disorder

Diagnostic criteria (DSM 5 – 2013)

A) Excessive anxiety and worry, occurring on most days, for at least 6 months, about numerous events or activities (work, school, social life).

B) The individual finds it difficult to control the worry

C) Anxiety and worry are associated with 3 or more of the following symptoms

Restlessness
Easy fatigability
Difficulty concentrating
Irritability
Muscle tension
Sleep disturbances

D) Anxiety, worry or physical symptoms cause clinically significant distress or hinder areas of social or work functioning.

E) The disorder is not attributable to physiological effects of substances or another medical condition.

F) The disorder is not best explained by symptoms of other mental disorders

Therapy

Benzodiazepines have been used in therapy for many years; although safe drugs with few side effects, their limitation is the onset of tolerance and dependence in long-term use.

For these reasons, SSRIs have recently been used with some success.

Buspirone, an anxiolytic of the azapirone class, has one of its elective indications in GAD.

It is a serotonergic (5-HT1A) agonist and presynaptic dopaminergic antagonist.

Compared to BZDs it has as advantages the selective anxiolytic action, the absence of summation effects with alcohol, the absence of sedation and myorelaxation, the absence of respiratory depression and the impossibility of giving addiction.

However, the anxiolytic effect of buspirone has a latency of about 10-15 days.

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