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Rapid Responses: Rapid Responses published:
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Generalised anxiety disorder?
- Dr Alasdair J Macdonald (17 March 2007)
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Prescription for Worry
- Hugh Mann (18 March 2007)
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Worry or Generalised anxiety
- Saddichha Sahoo (22 March 2007)
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Beta Blockers and Generalised Anxiety Disorder
- Hammad A Khan, Ismail M (23 March 2007)
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Generalized Anxiety is a serious problem...
- David Neunaber (5 May 2007)
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Dr Alasdair J Macdonald, Temporary consultant in child psychiatry Dorset County Hospital, Dorchester DT1 2JY
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Generalised anxiety is easily confused with habitual acute-on-chronic hyperventilation (ICD-10: Somatoform respiratory disorder F45.33). The latter responds quickly to slow breathing exercises (available at www.solutionsdoc.co.uk) Lum LC. Hyperventilation and Anxiety State. Journal of the Royal Society of Medicine 1981; 74:1-4. Clark DM, Salkovskis PM., Chalkley AJ. Respiratory control as a treatment for ‘panic attacks’. Journal of Behaviour Therapy And Experimental Psychiatry 1985; 16:23-30. Macdonald AJ Hyperventilation: a curable cause of symptoms of anxiety. Journal of Primary Care Mental Health and Education, 2004, 7, 105-108. Competing interests: None declared |
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Hugh Mann, Physician Eagle Rock, MO 65641
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Life is precarious, and there are many things to worry about. Our most common worries are money, relationships, and health, in that order. Unfortunately, this order is backwards. That's why we're so unhappy. If we reverse this order, each worry solves the next worry. Good health leads to good relationships. Good health and good relationships lead to financial security. And all three lead to happiness. In order to reduce our worries, we must establish the proper priorities. This is my prescription for worry. Competing interests: None declared |
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Saddichha Sahoo, Resident in Psychiatry Central Institute of Psychiatry, Ranchi, India-834006
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Gale and Davidson have eloquently presented a comprehensive and eminently readable review on generalized anxiety disorder[1]. Most of the community surveys have however used DSM IV criteria to diagnose anxiety which is less stringent and specific than ICD 10 and hence is a “broad” definition of generalized anxiety. This can often mean that normal ‘day to day worriers’ are labeled with a diagnosis of generalized anxiety disorder. However it would be wrong to presume that putting one’s priorities right as suggested by Hugh Mann is a panacea for all problems, since it would trivialize those who are actually suffering from this condition. I also agree that generalized anxiety disorder may be confused with habitual acute-on-chronic hyperventilation as suggested by Dr. MacDonald. However the most defining feature of generalized anxiety is the presence of “free-floating anxiety”, something which sets it apart from other similar conditions. The authors[1] have also suggested, from clinical review, that there have been no differences between benzodiazepines and buspirone. However the drug Buspirone, which is a 5HT-1A agonist, is non- addictive unlike benzodiazepines, making it the drug of choice over benzodiazepines. I do agree that increased evidence is required before the final word is spoken on this topic. 1.Gale C, Davidson O. Generalised anxiety disorder-Clinical Review. BMJ 2007; 334: 579-581 Competing interests: None declared |
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Hammad A Khan, Specialist Registrar Wonford House Hospital, Exeter, EX2 5AF, Ismail M
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Well presented clinical review article on Generalised anxiety disorder by Gale and Davidson however there was no mention of Beta- adrenoceptor blocking drugs in the drug treatments. Beta blockers act as antagonists at Beta-adrenoceptors in the sympathetic nervous system. They are useful in controlling somatic symptoms including palpitations and tremors that have not responded to short term treatment with an anxiolytic. "Beta-adrenoceptor antagonists such as Propranolol have been shown to produce improvement in the symptoms of patients with anxiety states particularly the somatic or automatically mediated features of their condition" (Turner P 1991). "Beta blocking drugs are useful adjuncts to existing treatments for anxiety and are likely to enjoy wider use now that bezodiazepine are being avoided due to their dependence risks" (Tyrer P 1988). In Generalised anxiety disorder Beta blockers are useful for somatic symptoms particularly tachycardia (Taylor D et al 2005). Taylor D, Paton C, Kerwin R. The Maudsley 2005-2006 Prescribing guidelines. Turner P. Acad Med, Singapore 1991 Jan: 20(1):43-5. Tyrer P. Drugs, 1988 Dec; 36(6) 773-83 Competing interests: None declared |
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David Neunaber, doctor Affinity Medical Group Wisconsin USA 54915
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Thanks for a great review. It is crucial to distinguish "normal worry"--however difficult it can be to define--from the debilitating chronic form of worry. Many of my patients feel virtually tortured by their chronic worry. In my experience, the best treatment is multi- faceted and includes both medication and targeted cognitive-behavioral therapy. I've never met a patient who was cured by medicine alone. I think this quote by Kierkegaard sums up the plight of many patients, all of whom deserve our compassion and the best of our efforts: And no Grand Inquisitor has in readiness such terrible tortures as has anxiety, and no spy knows to attack more artfully, ...choosing the instant when you are weakest, nor knows how to lay traps where you will be caught and ensnared, as anxiety knows how, and no sharpwitted judge knows how to interrogate, to examine you as anxiety does, which never lets you escape, ...neither at work nor at play, neither by day nor by night. * — Soren Kierkegaard, The Concept of Dread Competing interests: None declared |
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