|
|
|
|
Generalized Anxiety Disorder |
Overcoming Anxiety (Home) > Generalized Anxiety Disorder Generalized Anxiety Disorder: Symptom and TreatmentIn 1896, Kraepelin classified the psychiatric disorders into 13 categories. One of them, the ‘‘psychogenic neurosis’’ was the first attempt to classify anxiety disorders. However, common opinion regarded anxiety as an aspecific phenomenon, a mere symptom that was present in a variety of disorders rather than the expression of a disease in itself. The Freudian concept of ‘‘anxiety neurosis’’ may represent the first attempt to consider severe and chronic anxiety as a true medical condition deserving the status of an independent nosologic entity. Later, a distinction was introduced between ‘‘anxiety neurosis’’ and ‘‘hysteric anxiety’’. The first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-I) in the early 1950s adopted a large part of the Freudian view. Anxiety disorders were classified under ‘‘anxious reaction’’, which concept referred to Freud’s anxiety neurosis, and ‘‘phobic reaction’’, which referred to the hysteric neurosis. In 1968, the DSM-II introduced some modifications into the neurosis concept, but remained under the influence of the psychoanalytic system. ‘‘Neuroses’’ were divided into anxiety neurosis, hysteric neurosis, phobic neurosis, obsessive-compulsive neurosis, depressive neurosis, hypochondriac neurosis, neurasthenic neurosis and depersonalisation neurosis. Traditional doctrines about pathological anxiety were challenged in the early 1960s, when the first effective psychotropics became available. Klein first noticed that patients with the so-called ‘‘anxiety neurosis’’ appeared to respond in two different ways to treatment with the new psychotropics. Indeed, while the first benzodiazepines had proven remarkably effective for anxiety, some patients with‘‘anxiety neurosis’’ failed to improve with the new anxiolytics. Paradoxically, those patients benefited from imipramine, which had just been introduced as an antidepressant. Klein observed that the patients who failed to benefit from benzodiazepines, but improved with imipramine, were those who reported to have frequent bursts of paroxysmal anxiety, in addition to a chronic background. It appeared that imipramine was able to block their repetitive ‘‘attacks’’ that represented their worse symptoms. In contrast, subjects who did benefit from benzodiazepines failed to report this type of paroxysmal anxiety. Accordingly, Klein proposed a new subdivision in Freud’s anxiety neurosis. He coined the vocal ‘‘panic’’ for the bursts of acute anxiety, and introduced the terms of panic attacks (PA) and panic disorder (PD). Based on the different pharmacosensitivity, panic attacks should be considered a separate type of anxiety, qualitatively different from chronic, generalised anxiety. Anxiety neurosis was to be divided into two different disorders. In 1975, the Research Diagnostic Criteria (RDC) started with a new classification system, which formed the precursor of the current DSM classification. Under the influence of Klein’s hypothesis, the RDC mentioned for the first time general anxiety disorders (GAD) as a separate entity. Consequently, when the DSM-III was published, the subcategory of anxiety neurosis was changed into ‘‘anxiety states’’ and included panic disorder (PD), generalised anxiety disorder (GAD) and obsessive-compulsive disorder (OCD), contrasting with ‘‘phobic states’’, which included simple and social phobia. GAD was defined as a generalised and persistent feeling of anxiety. Persistent was operationalised as complaints of at least one month’s duration. The symptoms were divided into four categories, including autonomic hyperactivity, motor tension, apprehensive expectation and vigilance/scanning. To qualify for the diagnosis, a patient should suffer at least from symptoms out of three of four categories. The GAD diagnosis excluded those patients with criteria for any other axis I mental disorder. However, it was obvious that nearly all patients with a primary diagnosis of an anxiety disorder, except simple phobia, do show symptoms mentioned under the category of GAD. Actually, GAD was to be considered as a residual category among the anxiety disorders. Nevertheless, some clinical studies indicated that various patients were suffering from GAD regardless of their primary diagnosis. For instance, some patients successfully treated for another anxiety disorder still reported feelings of discomfort, fitting into the category of generalised anxiety. These findings led to a new definition of GAD in DSM III-R. GAD was to be defined as a primary diagnostic category rather than a residual disorder. It was considered that GAD may be diagnosed when other axis I disorders are present. The new definition assigned a central place to the criteria of ‘‘apprehensive expectation’’, and ‘‘worry’’, as the main characteristic of this disorder. Pathological worrying was operationalised as excessive and/or unrealistic and not circumscribed to one single life circumstance (worry about finances, work, family). In addition, the worries should not be caused by the presence of other mental disorders like the worry about panic attacks in the case of a PD, or about public speaking in the case of social phobia. The DSM III-R also revised the somatic symptom criteria. The patient should present with at least six from a list of 18 symptoms, which are divided in three categories: motor tension, autonomic hyperreactivity and vigilance/scanning. The criterion of duration of complaints was extended to at least six months. The exclusion criteria were limited to a current affective disorder or psychotic disorder.
|
Bookmark This Page: Add to Favorites Add to Del.icio.us Send to a Friend Resources: |
|||||||||||||||||
