Saturday, January 30, 2010


This is a chronic (longer than 6 months) disorder characterized by excessive anxiety and worry about various life circumstances. Patients who have generalized anxiety disorder are pathologically anxious about everything. They are generally mistrustful of their own general level of competence and basic merit. They have a low threshold for anxiety and find it difficult to handle even the normal anxiety-provoking situations.

It is estimated that about 2 % of the general population suffer from generalized anxiety disorder. Onset is usually before age 20, the peak age group is 20-25 years. A history of childhood fears and social inhibition may be present. Women are more prone.

Aetiology and Psychopathology:
Though there may be genetic predisposition to develop this disorder, environmental factors are more important in the aetiology of GAD. Emotional conflicts in early childhood interfere with normal development of personality, especially when there is genetic predisposition. When this abnormal personality is confronted with the everyday stresses of life, the defense mechanisms which are used to anxiety normally become inadequate and fail.

Clinical features:
Patients with generalized anxiety disorder have persistent, excessive, and/or unrealistic worry associated with other signs and symptoms, which commonly include muscle tension, impaired concentration,autonomic arousal, feeling "on edge" or restless, and sleep disturbances. Patients with GAD readily admit to worrying excessively over minor matters with clinically significant distress or impairment in social, occupational or other areas of functioning.
The common symptoms are palpitation, trembling / shaking, excessive sweating, and dryness of mouth, breathlessness, chest pain, abdominal pain, headache, and heaviness of head, dizziness and unsteadiness, frequency of micturition, diarrhoea and disturbances of sleep.
Other general symptoms include hot flushes / cold chills; numbness or tingling sensations.
Common Signs are: Elevation of blood pressure, tachycardia, increased respiratory rate and sweating etc.
A person with GAD has tense, anxious, apprehensive appearance. Increased muscular tension is shown in his facial expression, and it produces tremors and aches in various parts of the body. He is irritable, forgetful, and complains of tiredness and lack of concentration. The person finds it difficult to control the worry.
Differential diagnosis:
Thyrotoxicosis has to be ruled out. Thyroid swelling, exophthalmia, and abnormal thyroid function tests suggest thyrotoxicosis. Cold and moist hands are common in GAD in contrast to warm and moist hands in thyrotoxicosis.

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