Generalised anxiety disorder

Figure 19.8 A schematic representation of the GABAa receptor shift hypothesis. This proposes that patients with panic disorder have dysfunctional GABAa receptors such that the actions of drugs that behave as antagonists in normal subjects are expressed as inverse agonism in panic patients. It is unlikely that this theory extends to generalised anxiety disorder (GAD), for which benzodiazepine agonists are highly effective treatments, but it could explain why these drugs are relatively ineffective at treating panic disorder. (Based on Nutt et al. 1990)...

Sramek JJ, Zarotsky V, Cutler NR. Generalised anxiety disorder. Drugs 2002 62 1635-1648. 

Panic disorder Agoraphobia with panic disorder Agoraphobia without panic disorder Specific phobia Social phobia Generalised anxiety disorder Mild anxiety and depression disorder Obsessive compulsive disorder Acute stress disorder Post-traumatic stress disorder (PTSD) Adjustment disorder Panic disorder without agoraphobia Panic disorder with agoraphobia Agoraphobia Specific phobia Social phobia (also called social anxiety disorder) Generalised anxiety disorder Obsessive compulsive disorder Acute stress disorder Post-traumatic stress disorder (PTSD)... 

Anxiolytic The most commonly prescribed type of psychotropic drug, used chiefly to treat generalised anxiety disorders. 

Venlafaxine is a serotonin and noradrenaline re-uptake inhibitor indicated in depression and may be used in generalised anxiety disorder. Venlafaxine can cause diarrhoea and headache as side-effects. It does not cause blurred vision. 

Panic disorder Generalised anxiety disorder Social anxiety disorder Specific phobias... 

Bond Al, Wingrove 1, Valerie CH, Lader MH. Treatment of generalised anxiety disorder with a short course of psychological therapy, combined with buspirone or placebo. 1 Affect Disord 2002 72 267-271. 

It is used in the management of generalised anxiety disorder or the short term relief of symptoms of anxiety. It is also indicated for the treatment of panic disorders with or without agoraphobia. 

In psychiatry, BDZs are used where moderate to severe anxiety symptoms arise due to acute stress. In such situations, their use should be short term, preferably for no longer than two weeks. Their main use tends to be in patients presenting with generalised anxiety disorder (GAD). Characteristically, this is a fluctuating condition with exacerbations at times of stress and chronic, milder symptoms on a longer-term basis. 

Pomara N, Willoughby LM, Sidtis J, Cooper TB, Greenblatt DJ. Cortisol response to diazepam its relationship to age, dose, duration of treatment and presence of generalised anxiety disorder. Psychopharmacology 2005 178 1-8. 

Vaz-Serra A, Figueira ML, Bessa-Peixoto A, Firmino H, Albuquerque R, Paz C, Dolgner A, Vaz-Silva M, Almeida L. Mexazolam and alprazolam in the treatment of generalised anxiety disorder. Clin Drug Invest 2001 21 257-63. 

Disorders that would formerly have been grouped under neuroses include depression in the absence of psychotic s)nnptoms, anxiety disorders (e.g. panic disorder, generalised anxiety disorder, obsessive-compulsive disorder, phobias and post-traumatic stress disorder), eating disorders (e.g. anorexia nervosa and bulimia nervosa) and sleep disorders. 

Formerly, antidepressants were thought to be less effective in generalised anxiety disorder than in panic disorder. Evidence now suggests that the SSRI, paroxetine and the SNRI, venlafaxine are beneficial. 

Buspirone may be used in generalised anxiety disorder as an alternative to a benzodiazepine. 

I 5-HTia partial agonists (e.g. buspirone) can decrease anxiety in generalised anxiety disorder (GAD) but are not effeetive in panie disorder. 

I Panic attacks and generalised anxiety disorder (GAD) can emerge from alcohol dependence. 

I Both fluvoxamine and sertraline have been reported in short-term RCTs to be efficacious in paediatric generalised anxiety disorder. 

Chapter 22 Generalised anxiety disorder fGADf Preparation Assessment... 

---