Generalized anxiety disorder natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Irfan Dotani

Overview

In the National Comorbidity Survey (2005), 58% of patients diagnosed with major depression were found to have an anxiety disorder. Accumulating evidence indicates that patients with comorbid depression and anxiety tend to have greater illness severity and a lower treatment response than those with either disorder alone. In addition, social function and quality of life are more greatly impaired. Approximately one-quarter of the patients with generalized anxiety disorder, will develop panic disorder.

Natural History, Complications and Prognosis

  • In the National Comorbidity Survey (2005), 58% of patients diagnosed with major depression were found to have an anxiety disorder; among these patients, the rate of comorbidity with GAD was 17.2%, and with panic disorder, 9.9%.
  • Patients with a diagnosed anxiety disorder also had high rates of comorbid depression, including 22.4% of patients with social phobia, 9.4% with agoraphobia, and 2.3% with panic disorder.[1]
    • For many, the symptoms of both depression and anxiety are not severe enough (i.e. are subsyndromal) to justify a primary diagnosis of either major depressive disorder (MDD) or an anxiety disorder.
  • Patients can also be categorized as having mixed anxiety-depressive disorder, and they are at significantly increased risk of developing full-blown depression or anxiety. Appropriate treatment is necessary to alleviate symptoms and prevent the emergence of more serious disease.[2]
  • Accumulating evidence indicates that patients with comorbid depression and anxiety tend to have greater illness severity and a lower treatment response than those with either disorder alone. In addition, social function and quality of life are more greatly impaired.
  • Patients with physical symptoms such as insomnia or headaches should also tell their doctors about their feelings of worry and tension.[3]
    • This will help the patient's health care provider to recognize whether the person is suffering from GAD.
  • Approximately one-quarter of the patients with generalized anxiety disorder, will develop panic disorder.[4]

References

  1. Morissette SB, Tull MT, Gulliver SB, Kamholz BW, Zimering RT (2007). "Anxiety, anxiety disorders, tobacco use, and nicotine: a critical review of interrelationships". Psychol Bull. 133 (2): 245–72. doi:10.1037/0033-2909.133.2.245. PMID 17338599.
  2. Kessler RC, Keller MB, Wittchen HU (March 2001). "The epidemiology of generalized anxiety disorder". Psychiatr. Clin. North Am. 24 (1): 19–39. PMID 11225507.
  3. Newman MG, Przeworski A, Fisher AJ, Borkovec TD (2010). "Diagnostic comorbidity in adults with generalized anxiety disorder: impact of comorbidity on psychotherapy outcome and impact of psychotherapy on comorbid diagnoses". Behav Ther. 41 (1): 59–72. doi:10.1016/j.beth.2008.12.005. PMC 2827339. PMID 20171328.
  4. Shalev I, Moffitt TE, Braithwaite AW, Danese A, Fleming NI, Goldman-Mellor S; et al. (2014). "Internalizing disorders and leukocyte telomere erosion: a prospective study of depression, generalized anxiety disorder and post-traumatic stress disorder". Mol Psychiatry. 19 (11): 1163–70. doi:10.1038/mp.2013.183. PMC 4098012. PMID 24419039.

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