Common condition defined as chronic, excessive worry for at least 6 months that causes distress or impairment.
At least 3 key symptoms out of a possible 6 are required to make a diagnosis: restlessness or nervousness, easy fatigability, poor concentration, irritability, muscle tension, or sleep disturbance.
It is in part a diagnosis of exclusion: medical conditions, medications or substances, and other mental disorders should be ruled out as a primary cause.
Physical examination and laboratory studies are generally normal if no coexisting medical problems or substance abuse issues exist.
Treatment is with either pharmacotherapy, psychotherapy, or a combination.
Generalized anxiety disorder (GAD) is defined as at least 6 months of excessive worry about everyday issues that is disproportionate to any inherent risk, causing distress, or impairment. The worry is not confined to features of another mental disorder, or as a result of substance abuse or a general medical condition. At least 3 of the following symptoms are present most of the time: restlessness or nervousness, being easily fatigued, poor concentration, irritability, muscle tension, or sleep disturbance.  Other common complaints are autonomic in nature, such as sweating, lightheadedness, palpitations, dizziness, and epigastric discomfort.  Anxiety may be "free-floating" (i.e., not restricted to, or even strongly predominating in, any particular environmental circumstances).  Examples of worries include fears that the patient or a relative will shortly become ill or have an accident.
Emeritus Professor Medical Director
Anxiety Treatment and Research Centre
McMaster University and St Joseph’s Hospital
RPS has personally received royalties for articles published in UpToDate (Wolters Kluwer) and the Compendium of Therapeutic Choices, 2nd edition (Canadian Pharmacists Association).
Dr Richard P. Swinson would like to gratefully acknowledge Dr Elizabeth Hoge and Dr Phebe Tucker, previous contributors to this monograph. EH is an author of a number of references cited in this monograph. PT has done research for the companies GlaxoSmithKline, Bristol-Myers Squibb, Wyeth Pharmaceuticals, Astra-Zeneca, Cephalon, Inc., and Ortho-McNeil. She has also done consultancies for Forest Pharmaceuticals and received honoraria from Pfizer, Inc. and Forest Pharmaceuticals.
University of Alabama
School of Medicine Tuscaloosa Campus
College of Community Health Sciences
LD declares that she has no competing interests.
Southern District Health Board
Department of Psychological Medicine
Dunedin School of Medicine
CG declares that he is a contributor to the American College of Physicians Physician Information and Educational Resource (PIER); has been on the speaking bureau for Jannsen Cilag, Astra Zeneca, and Lilly Pharmaceticals; and has attended conferences paid for by Lilly Pharmaceuticals.
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