Anxiety

Excessive, almost daily, anxiety and worry for >= 6 mo about a number of activities or events.

Generalized anxiety disorder is common, affecting 3 to 5% of the population within a 1-yr period. Women are twice as likely to be affected as men. The disorder often begins in childhood or adolescence but may begin at any age.

The anxiety and worry are so great that they are difficult to control. The severity, frequency, or duration of the worry greatly exceeds what the situation, if it should occur, warrants. The focus of the worry is not restricted as it is in other psychiatric disorders (eg, to having a panic attack, being embarrassed in public, or being contaminated). Common worries include work responsibilities, money, health, safety, car repairs, and chores. A person with this disorder must also experience three or more of the following symptoms: restlessness, unusual fatigability, difficulty concentrating, irritability, muscle tension, and disturbed sleep. The course is usually fluctuating and chronic, with worsening during stress.

Benzodiazepines  in small to moderate doses are often effective, although sustained use can cause physical dependence. Consequently, the benzodiazepine should be tapered slowly rather than stopped abruptly, if it is to be discontinued. The relief obtained usually outweighs any mild adverse effects and the possibility of drug dependence.

Buspirone is also effective for some patients, although its onset of effect takes about 2 wk, whereas benzodiazepines work within minutes. Buspirone does not cause dependency. Some antidepressants are also effective.

The benefits of behavior therapy are limited because specifying anxiety triggers to which the person can be exposed is difficult. Relaxation and biofeedback may be of some help, although few studies have documented their efficacy. Insight-oriented psychotherapy has not been systematically studied in this disorder.

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