Generalised anxiety disorder

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Christopher Gale, senior lecturer and consultant psychiatrist1,
Oliver Davidson, associate professor and clinical psychologist2

¹Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, PO Box 913, Dunedin, New Zealand, and Mental Health Services, Otago District Health Board, Dunedin
²Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, PO Box 913, Dunedin, New Zealand, and Psychology Associates, Dunedin

Correspondence to: C Gale christopher.gale{at}stonebow.otago.ac.nz

Generalised anxiety disorder is a syndrome of ongoing anxiety and worry about many events or thoughts that the patient generally recognises as excessive and inappropriate. However, the nature of “generalised worry” has been hard to describe in a categorical manner. The criteria required for making a diagnosis are evolving: these criteria clearly increase or decrease markedly the threshold for diagnosis.1

SUMMARY POINTS

Generalised anxiety disorder is a syndrome of ongoing anxiety and worry about many events or thoughts that the patient generally recognises as excessive and inappropriate
Most people with generalised anxiety disorder also have other mood and anxiety disorders
Several treatment efficacy trials have been conducted but few effectiveness trials with generally representative samples
Cognitive behaviour therapy is more efficacious than non-directive psychotherapy or no treatment
Anxiety management treatment is also better than no treatment and its efficacy may equal that of cognitive behaviour therapy
Antidepressants, benzodiazepines, buspirone, and kava are efficacious but often have clinically significant adverse effects

About 1%-5% of the general population report having generalised anxiety disorder. Many of these people also have other disorders, and those with generalised anxiety disorder report a considerable level of disability. Long term follow-up studies suggest that generalised anxiety disorder is a condition that worsens the prognosis for any other condition, and that people who have only generalised anxiety disorder are likely to develop further conditions. The availability of and evidence for efficacious treatments has increased in the past five years.

Sources and selection criteria

We used the Clinical Evidence database2 then searched for community surveys, randomised controlled trials, and systematic reviews—using the term “generalised anxiety disorder”—in Medline, Embase, and the Cochrane Library up to June 2006.

Who is likely to get generalised anxiety disorder?

Most of the recent literature uses DSM-IV criteria for generalised anxiety disorder; the ICD-10 criteria place greater weight on somatic symptoms and explicitly limit comorbidity (box).