Clinical Review Extracts from “Clinical Evidence”

Anxiety disorder

BMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7270.1204 (Published 11 November 2000) Cite this as: BMJ 2000;321:1204
  1. Christopher Gale, psychiatrist (c.gale@auckland.ac.nz),
  2. Mark Oakley-Browne, associate professor
  1. University of Auckland, Auckland, New Zealand
  1. Correspondence to: C Gale, Division of Psychiatry, University of Auckland, 4th Floor, 3 Ferncroft St, Grafton, Auckland 1003, New Zealand

    Background

    Definition Generalised anxiety disorder is defined as excessive worry and tension, on most days, for at least six months, together with the following symptoms and signs: increased motor tension (fatiguability, trembling, restlessness, muscle tension); autonomic hyperactivity (shortness of breath, rapid heart rate, dry mouth, cold hands, and dizziness) but not panic attacks; and increased vigilance and scanning (feeling keyed up, increased startling, impaired concentration).

    Interventions

    Beneficial:

    Cognitive therapy

    Likely to be beneficial:

    Buspirone

    Certain antidepressants (paroxetine, imipramine, trazodone, venlafaxine, mirtazepine)

    Trade off:

    Benzodiazepines

    Unknown effectiveness:

    Antipsychotic drugs

    β Blockers

    Incidence/prevalence The assessment of the incidence and prevalence of generalised anxiety disorder is problematic. There is a high rate of comorbidity with other anxiety disorders and depressive disorders.1 Moreover, the reliability of the measures used in epidemiological studies is unsatisfactory.2 One American study that used the criteria of the Diagnostic and Statistical Manual of Mental Disorders, third edition, revised (DSM-III-R), has estimated that one in every 20 people will develop generalised anxiety disorder at some time during their lives.3

    Aetiology/risk factors One small community study found that generalised anxiety disorder was associated with an increase in the number of minor stressors, independent of demographic factors.4 People with generalised anxiety disorder report more somatic symptoms and respond in a rigid, stereotyped manner if placed under physiological stress. Autonomic function is similar to that of control populations, but muscle tension is increased.5 Whether these findings are cause or effect remains uncertain.

    Prognosis Generalised anxiety disorder is a long term condition. It often begins before or during young adulthood and can be a lifelong problem. Spontaneous remission is rare.3

    Aims To reduce anxiety, to minimise disruption of day to day functioning, and to improve quality of life, with minimum adverse effects.

    Outcomes Severity of symptoms and effects on quality …

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