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Generalized Anxiety DisorderYou should limit or avoid completely:
Psychological and Physical Symptoms of GAD
Excessive caffeine is the
most commonly unrecognized 'impersonator' of substance-induced generalized
anxiety. Caffeine intoxication can mimic both GAD and panic disorder. When
the symptoms mimic GAD, the person has typically consumed larger and larger
amounts of caffeine, sometimes unsuspectingly, over several weeks or months.
While an individual may initially have consumed caffeine to combat fatigue,
unintentional consumption of toxic levels may occur through frequent use of
over-the-counter medications or beverages not known by the consumer to
contain caffeine. Initial episodes of stimulant-induced anxiety usually
disappear when the substance is discontinued. The exception is individuals
at increased genetic risk (i.e. those with first- degree relatives who
suffer from GAD), who may still suffer from anxiety after the
discontinuation of caffeine or other stimulants. Individuals who are
physiologically dependent on caffeine require gradual tapering of their
caffeine intake. Conversely, anxiety symptoms can result from withdrawal of
alcohol or other substances, including caffeine.
Anxiety is a poorly
appreciated but common consequence of caffeine withdrawal in individuals
with a history of high caffeine consumption. GAD may therefore be caused
both by chronic use caffeine and by caffeine withdrawal. GAD can occur in
association with other psychiatric disorders, notably depression and other
mood disorders, other anxiety disorders and early on in schizophrenia.
Generalized anxiety disorder (GAD). The first step towards successful management of GAD is identifying the problem. Patients with coexisting depression and anxiety tend to be identified and treated by primary care physicians, but those with pure GAD uncomplicated by depression often go unrecognized. However, even when GAD is unaccompanied by depression, high rates of social and work impairment are seen. Even if recognized, patients with pure GAD tend to be inadequately treated for their condition. This is unfortunate because many patients with pure GAD can be managed effectively by counseling and, if necessary, other psychological therapies. A series of, for example, four or five consultations over several weeks will often clarify the cause of anxiety and allow the patient to recognize their own role in controlling the condition.
Patients with more severe
anxiety or those who do not respond to counseling alone
may benefit from behavioral therapy and support from the
family physician or practice nurse, or from community
psychiatric services. Relaxation therapies may also be
useful. For patients who do not respond to psychological
treatment alone, a short course of medication may help
to control their symptoms. The choice of drug depends on
the needs of the individual patient.
Benzodiazepines are the agents of first choice if a
rapid anxiolytic response is required. Antidepressants
are appropriate for patients with concomitant
depression. Several trials have shown venlafaxine to be
effective in both the short term (8 weeks) and the long
term (6 months). Some SSRls have also shown efficacy in
this indication. • Buspirone is suitable for the
short-term management of anxiety if a quick response is
not required. However, the efficacy of buspirone has
been questioned.
Beta blockers are often
useful in patients in whom
mild physical symptoms, such
as palpitations,
predominate. Patients who do
not respond to primary care
treatment should be referred
for specialist assessment.
Few such patients require
hospitalization; most are
treated as outpatients, with
the continuing involvement
of the primary care team.
Can People with Generalized Anxiety Disorder Also Have Other Physical and Emotional Illnesses?Research shows that Generalized Anxiety Disorder often coexists with depression, substance abuse, or other anxiety disorders. Other conditions associated with stress, such as irritable bowel syndrome, often accompany Generalized Anxiety Disorder. Patients with physical symptoms such as insomnia or headaches should also tell their doctors about their feelings of worry and tension. This will help the patient's health care provider to recognize that the person is suffering from Generalized Anxiety Disorder.
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