Generalized anxiety disorder diagnosis

Roerig JL. Diagnosis and management of generalized. Anxiety disorder. J Am Pharm Assoc 1999 39(6) 811-21. 

The diagnosis generalized anxiety disorder, not otherwise specified refers to a free-floating state of anxiety that is not firmly bounded. For example, a person with a diagnosis of generalized anxiety would be differentiated from someone who suffers specifically from panic disorders or from another particular phobia. 

Note. BROF = brofaromine CIT = citalopram CLO = clomipramine CT = cognitive therapy Dx = diagnosis EXP = exposure in vivo FLU = fluvoxamine FLUOX = fluoxetine GAD = generalized anxiety disorder 5-HTP = 5-hydrox3rtryptophan IMl = imipramine MAP = maprotiline OCD = obsessive-compulsive disorder PAR = paroxetine PD = panic disorder PLA = placebo PPM = psychological panic management RIT = ritanserin ... 

R. Hoehn-Saric (1998). Generalized anxiety disorder Guidelines to diagnosis and treatment. 

Part II of the book outlines several mental-health diagnostic categories schizophrenia, mood disorders, depression, bipolar disorders, and specific anxiety disorders including generalized anxiety disorder and obsessive compulsive disorder. Each chapter provides a case example, consideration in diagnosis, and the interventions utilized. Medications used to treat these disorders and relevant psychosocial interventions are outlined. Each chapter emphasizes the need for accurate treatment planning and documentation and offers suggestions to facilitate this process. 

Panic Disorder. As previously noted, panic disorder and GAD should in theory at least be fairly easy to distinguish. Yet, patients commonly confuse the two when describing their symptoms. It is common that a patient with GAD will describe an anxiety attack or panic attack that comes on gradually and lasts several hours (or even days). This does not represent a true panic attack but a periodic fluctuation in the severity of their generalized anxiety. It should be noted, however, that patients with a principal diagnosis of GAD might occasionally experience panic attacks. In... 

Another issue is that many primary care physicians have difficulty distinguishing between depressive and anxiety disorders. This has led to the impression that patients in a general medical setting are more likely to have an admixture of symptoms, rather than a clearly defined condition. That depressed patients have anxiety symptoms and anxiety-disordered patients have depressive symptoms, as assessed by the Flamilton scales, are used to support this clinical impression, which ignores the fact that these scales were developed to quantitate symptoms only after a definitive syndromic diagnosis had been made. 

The person may continue to feel nervous or upset for several hours, but the attack itself lasts only a matter of minutes. If a patient says, "Tve had a continuous panic attack for the past three days," he or she may be having intense anxiety symptoms, but not a true panic attack. In anxiety disorders without panic attacks, the anxiety symptoms can be very unpleasant, but are much less intense they also can be prolonged or generalized—that is, present most of the day and lasting from days to years. The distinction between anxiety and panic is very important when it comes to making an accurate diagnosis and choosing appropriate treatments. The symptoms of anxiety are as follows ... 

Medications that have been used as treatment for anxiety and depression in the postwithdrawal state include antidepressants, benzodia2epines and other anxiolytics, antipsychotics, and lithium. In general, the indications for use of these medications in alcoholic patients are similar to those for use in nonalcoholic patients with psychiatric illness. However, following careful differential diagnosis, the choice of medications should take into account the increased potential for adverse effects when the medications are prescribed to alcoholic patients. For example, adverse effects can result from pharmacodynamic interactions with medical disorders commonly present in alcoholic patients, as well as from pharmacokinetic interactions with medications prescribed to treat these disorders (Sullivan and O Connor 2004). 

Tyrcr P, Seivewright N, Ferguson B and Tyrer J (1992). The general neurotic syndrome A coaxial diagnosis of anxiety, depression and personality disorder. Acta Psychiatra Scan-dinavica, 85, 201-206. 

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