Novel approaches to treatment of generalized anxiety disorder.
OBJECTIVE
The present paper reviews recent studies on the clinical presentation of generalized anxiety disorder (GAD) and the current level of evidence for treatment with medications and psychotherapy.


RESULTS
An apprehensive state of mind, regardless of the quality of stimuli, is at the core of GAD, causing a pervasive cognitive dysfunction that is separate from that seen in depression and obsessive compulsive disorder. When treatments reduce anxiety-related symptoms and insomnia, patients report a restoration of social functioning, probably as a consequence of improved decision-making, cooperative skills, and risk assessment. Late-onset GAD symptoms in the elderly may be caused or aggravated by cerebrovascular events, loneliness, bereavement, substance use, and the prospect of death. Insomnia in GAD may be primary or caused by common medications. Practice guidelines fail to capture the needs of the entire range of patients with GAD as they build on patients without comorbidity who have been selected for phase III trials. They are also biased to reduce cost.


CONCLUSIONS
The past 10 years have seen a range of safe and effective treatments for GAD. Late-onset GAD presents a new challenge to researchers and practitioners. The current state of knowledge about GAD does not justify radical revisions of the diagnostic criteria in the ongoing revisions of the Diagnostic and Statistical Manual of Mental Disorders-IV and the International Statistical Classification of Diseases-10 nosologies.
Allgulander
Christer
C
Department of Clinical Neuroscience, Section of Psychiatry, Karolinska Institutet, Stockholm, Sweden. Christer.Allgulander@ki.se
D000367:Age Factors; D014151:Anti-Anxiety Agents / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000628:therapy*; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D039721:Diagnostic and Statistical Manual of Mental Disorders; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012064:Relaxation Therapy
D014151:Anti-Anxiety Agents