Refractory generalized anxiety disorder.
Generalized anxiety disorder (GAD) has a lifetime prevalence in the US population of about 5.7%. Typically, GAD begins in early adulthood and tends to have a chronic and persistent course. The disorder frequently presents comorbidly with other conditions, and about 90% of patients with GAD have at least 1 comorbid lifetime psychiatric disorder. Patients with GAD tend to be high users of medical services; the disorder is associated with significant physical as well as psychological symptomatology and impacts health, family relationships, and employment. Pharmacologic and psychosocial treatments are available for GAD. Different side effect profiles, speed of onset of action, and discontinuation requirements of individual drugs need to be taken into account when selecting treatment. Treatment selection should include consideration of comorbidity, psychological function, social impairment, and refractoriness, as well as the need for ongoing intervention for many individuals. Innovative treatments, including anticonvulsants, atypical antipsychotics, and others, as well as treatment targeting concomitant insomnia, may help improve outcomes for affected individuals.
Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. mpollack@partners.org
Mark H
MH
Pollack
D014151:Anti-Anxiety Agents / Q000627:therapeutic use*; D000927:Anticonvulsants / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000188:drug therapy* / Q000453:epidemiology*; D053961:Azabicyclo Compounds / Q000627:therapeutic use; D001569:Benzodiazepines / Q000627:therapeutic use; D002065:Buspirone / Q000627:therapeutic use; D002908:Chronic Disease; D015283:Citalopram / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy; D015897:Comorbidity; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D000069582:Eszopiclone; D006801:Humans; D008605:Mental Health Services / Q000706:statistics & numerical data; D009446:Neurobiology; D018696:Neuroprotective Agents / Q000627:therapeutic use; D010879:Piperazines / Q000627:therapeutic use; D015995:Prevalence; D012008:Recurrence; D019782:Riluzole / Q000627:therapeutic use; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D014481:United States / Q000453:epidemiology
D014151:Anti-Anxiety Agents; D000927:Anticonvulsants; D000929:Antidepressive Agents, Tricyclic; D014150:Antipsychotic Agents; D053961:Azabicyclo Compounds; D001569:Benzodiazepines; D002065:Buspirone; D015283:Citalopram; D000069582:Eszopiclone; D018696:Neuroprotective Agents; D010879:Piperazines; D019782:Riluzole; D017367:Selective Serotonin Reuptake Inhibitors