Generalized Anxiety Disorder

MDNG PsychiatryDecember 2010
Volume 12
Issue 4

Online CMEGeneralized Anxiety Disorder (American College of Physicians PIER)



Expires:February 1, 2013


This activity was developed “to facilitate the highest quality professional work in clinical applications, teaching, consultation, or research.” Specifically, the program addresses brief interventions that may prevent further anxiety symptoms in children but not adults, appropriate instruments for screening for generalized anxiety disorder (GAD), hospitalization of patients with GAD who are suicidal, non-drug and drug therapy, the importance of patient education, follow-up care.Enter the below URL in your Web browser window, search for “generalized anxiety disorder,” and chose “physician” as your profession to access this course.

Insights Into Generalized Anxiety Disorder



Expires:April 30, 2012


How to recognize GAD, even when comorbid psychiatric conditions are present, how comorbid conditions affect the course of GAD and quality of life of those with the disorder, the neurobiology of patients with GAD and how it differs from people without GAD, available treatments for GAD, and individualized treatments for patients with refractory GAD form the focus of this program.

Pharmacotherapy for Children and Adolescents with Anxiety Disorders



Expires:April 30, 2011

Multimedia:Part of a program that requires participants to read three other articles (“Pharmacotherapy for Pediatric Major Depression,” “Pharmacotherapy of Autism and Related Disorders,” and “Practical Guide to ADHD Pharmacotherapy”) before obtaining credit, this article reviews recent evidence on the effectiveness of pharmacotherapy for treating children and adolescents with anxiety disorders. Psychotropic medication for the treatment of pediatric anxiety disorders and the relative risks and benefits of medication use for children with anxiety disorders compared to psychotherapy alone or combined psychotherapy and medication.


Computer Therapy for the Anxiety and Depressive Disorders Is Effective, Acceptable and Practical Health Care: A Meta-analysis

Journal:PLoS ONE (October 13, 2010)

Authors:Andrews G, Cuijpers P, Craske M, et al.

Purpose:To review evidence that computerized cognitive behavior therapy (CBT) “for the anxiety and depressive disorders is acceptable to patients and effective in the short and longer term.”

Results:For those with anxiety and depressive disorder who might otherwise go without treatment, computerized CBT, especially when administered via the Internet, is capable of providing effective, acceptable, and practical care.

Electrocortical Evidence for Vigilance-avoidance in Generalized Anxiety Disorder

Journal:Psychophysiology (November 12, 2010)

Authors:Weinberg A, Hajcak G

Purpose:To examine “the time-course of neural activity during emotional processing” in patients with generalize anxiety disorder, as both “exaggerated and attenuated responses to emotional stimuli have been documented” in this population.

Results:After asking 21 people with generalized anxiety disorder and 25 healthy controls to passively view emotional and neutral images while their event-related potentials, the researches found an “enhanced P1 for unpleasant compared to neutral images” that was larger in patients with generalized anxiety disorder than in controls. Further, the increased late positive potential to unpleasant versus neutral images was diminished in the former group. The researchers concluded that their findings “provide evidence for early hypervigilance for emotional stimuli, followed by failure to engage in elaborative processing, in” generalized anxiety disorder.

Specificity of Interpersonal Problems in Generalized Anxiety Disorder Versus Other Anxiety Disorders and Depression

Journal:Journal of Nervous & Mental Disease (November 2010)

Authors:Uhmann S, Beesdo-Baum K, Becker E, Hoyer J

Purpose: To examine “the diagnostic specificity of interpersonal problems (IP) in generalized anxiety disorder (GAD),” with the expectation of “generally higher interpersonal distress, and specifically higher levels of nonassertive, exploitable, overly nurturant, and intrusive behavior in n = 58 patients with Diagnostic and Statistical Manual of Mental Disorders, 4th Edition GAD compared with patients with post-traumatic stress disorder (n = 46), other anxiety disorders (n = 47), and unipolar depressive disorders (n = 47).”

Results:In both patients with GAD alone and comorbid GAD, specificity in the sense of heightened interpersonal distress was not supported by any of the above scales, even after accounting for the degree of depressiveness using the Beck Depression Inventory. “GAD patients are rather not characterized by more self-ascribed IPs although they may worry more about interpersonal issues in general,” concluded the authors.

Clinical Trials

Attention Training for Generalized Anxiety Disorder

Study Type:Interventional

Age/Gender Requirement:18-65 years (male/female)

Sponsor:San Diego State University

Purpose: To “develop and test a new computerized treatment for generalized anxiety disorder” based on a four-week attention modification program protocol consisting of eight 30-minute sessions.

The Impact of Generalized Anxiety Disorderand Social Anxiety Disorder on the Processing of Information and Learning

Study Type:Observational

Age/Gender Requirement:18-50 years (male/female)

Sponsor:National Institute of Mental Health

Purpose:To increase researchers' understanding of the biological basis of generalized anxiety disorder and social anxiety disorder” through an understanding of “how the brain activity associated with specific thoughts and feelings may play a role in these anxiety disorders,” with the hope that this “knowledge will be used to design interventions to help those with these illnesses.”

Mechanisms of Sleep Disturbance in Children with Generalized Anxiety Disorder

Study Type: Observational

Age/Gender Requirement:7-11 years (both)

Sponsor:Children's Research Institute

Purpose: To “examine the sleep characteristics of children with generalized anxiety disorder (GAD) compared to a control group of children without GAD to see how sleep behaviors and daytime behaviors are related.”

The Educated PatientTM

Anxiety Disorders Association of America: Generalized Anxiety Disorder (GAD)

Direct patients to this resource from the Anxiety Disorders Association of America for an overview of generalized anxiety disorder. Here, they can also learn about the difference between GAD and general anxiety about the economy, link to information on cognitive-behavioral therapy, learn about available medications, complete a self-test for GAD, download a brochure, and link to more on available treatment options. Also of great use are a couple stories of hope: “Working Hard at Life” and “Redefining My Life.”

Generalized Anxiety Disorder (GAD): Symptoms, Treatment, and Self-Help

This site from Helpguide—a non-profit website created by a couple who lost their daughter to a suicide they feel could have been avoided if she had easy access to supportive health information—thoroughly reviews GAD. Information is provided in short paragraphs and bulleted lists for easy review. Along with the review of normal worrying vs. GAD, signs and symptoms, self-help, when to seek professional help, and treatment options, the site provides links to related articles on understanding anxiety, therapy for anxiety, medications for anxiety, and how to stop worrying.

NIMH — Anxiety Disorders

From the always-reliable National Institute of Mental Health comes this resource, last reviewed just days before writing, which thoroughly covers generalize anxiety disorder, OCD, panic disorder, PTSD, and social phobia/SAD. Along with sections for each specific disorder listed above—covering symptoms, treatment, diagnosis, and much more, the resource offers information on finding mental health services in one’s local area, related news, feature publications, and a link to current trials that are studying at anxiety. Site visitors should be sure to use the table of contents on the right side of page once they’ve selected a specific disorder to learn about more, so they don’t miss out on the wealth of information that isn’t immediately provided on the opening page. Many of the sections locate here are also available in Spanish.

Pharma Focus

Cymbalta (duloxetine)

Clinical Trials

A Study in Pediatric Patients with Generalized Anxiety Disorder

Study Type: Interventional

Age/Gender Requirement:7-17 years (male/female)

Sponsor: Eli Lilly and Company

Purpose: To determine “if duloxetine (60-120 mg) given once a day by mouth for 10 weeks to children and adolescents, is better than placebo when treating generalized anxiety disorder.”

Duloxetine in Elderly Generalized Anxiety Disorder

Study Type:Interventional

Age/Gender Requirement:65 years (male/female)

Sponsor: Eli Lilly and Company

Purpose: To “test the safety and efficacy of duloxetine versus placebo in elderly patients suffering from generalized anxiety disorder.”

From the HCPLive Network

Anxiety, Panic Attacks, OCD, Stress & Phobias, the Solution

Tell your patients about this video on anxiety, panic attacks, OCD, stress, phobias, and more.

Anxiety and Chronic Pain: A Bad Combination for Teens

Adolescents already suffering from chronic pain may have their pain symptoms increase in accordance with their levels of anxiety.

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