Generalized Anxiety Disorder

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Generalized anxiety disorder (GAD), is characterized by unrealistic or excessive anxiety and worry about two or more life circumstances for at least six months.

I. Clinical evaluation

A. Chronic worry is a prominent feature of GAD as opposed to the intermittent terror that characterizes panic disorder. Patients may report that they "can't stop worrying," which may revolve around life concerns relating to money, job, marriage, health, and safety of children.

B. Other features of GAD include insomnia, irritability, trembling, dry mouth, and a heightened startle reflex.

C. Symptoms of depression should be sought because 30-50% of patients with anxiety disorders will also have depression. Drugs and alcohol may contribute to anxiety disorders.

II. Medical disorders causing anxiety symptoms

A. Hyperthyroidism may cause anxiety, tachycardia, palpitations, sweating, dyspnea.

B. Cardiac rhythm disturbances and mitral valve prolapse may cause anxiety symptoms.

C. Substance abuse or dependence with withdrawal symptoms may resemble anxiety.

D. Pharmacologic causes of anxiety include salicylate intoxication, NSAI Ds antihistamine intoxication/withdrawal, phenylpropanolamine pseudo-ephedrine, psychotropics (akathisia), stimulants, selective serotonin reuptake inhibitors. Caffeine, cocaine, amphetamines, theophylline, beta-agonists, over-the-counter decongestants, steroids, and marijuana can cause anxiety.

III. Laboratory evaluation of anxiety disorders

A. Chemistry profile (glucose, calcium, phosphate), TSH.

B. Special Tests. Urine drug screen, cortisol, serum catecholamine level.

IV. Treatment of Anxiety

A. Caffeinated beverages and excess alcohol should be avoided. Daily exercise and adequate sleep (with the use of medication if necessary) should be advised.

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Eliminating Stress and Anxiety From Your Life

Eliminating Stress and Anxiety From Your Life

It seems like you hear it all the time from nearly every one you know I'm SO stressed out!? Pressures abound in this world today. Those pressures cause stress and anxiety, and often we are ill-equipped to deal with those stressors that trigger anxiety and other feelings that can make us sick. Literally, sick.

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