1. Generalized Anxiety Disorder: Clinical Features and Diagnosis
Flavio Guzman, MD

2. Overview Introduction Epidemiology Diagnosis: DSM V Rating scales
Differential diagnosis

3. GAD – Concept Overview Excessive and inappropriate worrying
Baldwin, David S., et al. "Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: A revision of the 2005 guidelines from the British Association for Psychopharmacology." Journal of Psychopharmacology 28.5 (2014):

4. GAD - Concept Overview Additional symptoms
Excessive and inappropriate worrying
Baldwin, David S., et al. "Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: A revision of the 2005 guidelines from the British Association for Psychopharmacology." Journal of Psychopharmacology 28.5 (2014):

5. GAD - Concept Overview Additional symptoms Often comorbid
Excessive and inappropriate worrying
Baldwin, David S., et al. "Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: A revision of the 2005 guidelines from the British Association for Psychopharmacology." Journal of Psychopharmacology 28.5 (2014):

6. Epidemiology

7. Epidemiology Epidemiological Catchment Area Study: DSM V:
DSM III criteria for GAD
Twice as common in women than in men
12-month prevalence rate: 3.8%, 2.7%
DSM V:
Adolescents: 12-month prevalence rate of 0.9%
Adults: 12-month prevalence rate of 2.9%
Lifetime morbid risk: 9 %
Stein, Dan J., Eric Hollander, and Barbara Olasov Rothbaum. Textbook of anxiety disorders. 2nd ed. Washington, DC: American Psychiatric Pub., 2010.
Diagnostic and statistical manual of mental disorders: DSM-5.. 5th ed. Washington, D.C.: American Psychiatric Association, 2013.

8. Diagnosis

9. Generalized anxiety disorder: DSM V
Occurring more days than not for at least 6 months
Excessive anxiety and worry: apprehensive expectation
Diagnostic and statistical manual of mental disorders: DSM-5.. 5th ed. Washington, D.C.: American Psychiatric Association, 2013.

10. Generalized anxiety disorder: DSM V
Health
Finances
Excessive anxiety and worry: apprehensive expectation
Job responsibilities
Diagnostic and statistical manual of mental disorders: DSM-5.. 5th ed. Washington, D.C.: American Psychiatric Association, 2013.

11. Generalized anxiety disorder: DSM V
Safety/health of family members
Excessive anxiety and worry: apprehensive expectation
Diagnostic and statistical manual of mental disorders: DSM-5.. 5th ed. Washington, D.C.: American Psychiatric Association, 2013.

12. Generalized anxiety disorder: DSM V
Excessive worry over minor matters (daily hassles and time management)
“Do you worry excessively about minor matters?”
Effective for ruling out the diagnosis of GAD
Excessive anxiety and worry: apprehensive expectation
(Dugas et al 2005)

13. Nonpathological anxiety vs GAD
Generalized anxiety disorder
Worries
Not excessive, manageable
Interfere with psychosocial functioning
Pervasive, longer duration, occur without precipitants
Physical symptoms
Much less frequent
Common
Diagnostic and statistical manual of mental disorders: DSM-5.. 5th ed. Washington, D.C.: American Psychiatric Association, 2013.

14. GAD in DSM V 3 of 6 symptoms: Additional symptoms
Restlessness or feeling keyed up or on edge
Being easily fatigued
Difficulty concentrating or mind going blank
Irritability
Muscle tension
Sleep disturbance
Additional symptoms
In children, only 1 of 6 is required
Diagnostic and statistical manual of mental disorders: DSM-5.. 5th ed. Washington, D.C.: American Psychiatric Association, 2013.

15. Comorbidity in GAD More than 2/3 of patients with GAD:
Additional axis I disorder
Depression
Social phobia
Panic disorder
OCD
More than 2/3 of patients with GAD:
More than 2/3 of patients with GAD
Wittchen, Hans-Ulrich, et al. "DSM-III-R generalized anxiety disorder in the National Comorbidity Survey." Archives of general psychiatry 51.5 (1994):
Stein, Dan J., Eric Hollander, and Barbara Olasov Rothbaum. Textbook of anxiety disorders. 2nd ed. Washington, DC: American Psychiatric Pub., 2010.

16. Rating Scales

17. Rating scales for GAD Rating instruments:
Penn State Worry Questionnaire
GAD-7
Hamilton Rating Scale for Anxiety
Spitzer, Robert L., et al. "A brief measure for assessing generalized anxiety disorder: the GAD-7." Archives of internal medicine  (2006):
Stein, Dan J., Eric Hollander, and Barbara Olasov Rothbaum. Textbook of anxiety disorders. 2nd ed. Washington, DC: American Psychiatric Pub., 2010.

18. Differential diagnosis

19. Differential diagnosis
Depression
OCD
Panic disorder
Adjustment disorders
Anxiety disorder due to a medical condition
Substance/medication-induced anxiety disorder
Baldwin, D. Generalized anxiety disorder: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis In: UpToDate, Stein MB, UpToDate, Waltham, MA.(Accessed on October 1, 2014.)
Diagnostic and statistical manual of mental disorders: DSM-5.. 5th ed. Washington, D.C.: American Psychiatric Association, 2013.

20. GAD vs Depression GAD Depression Insidious onset Protracted course
Worry about future possible events
Think self-critically on previous events and circumstances
Hopelessness
Early morning awakening
Suicidality
Stein, Dan J., Eric Hollander, and Barbara Olasov Rothbaum. Textbook of anxiety disorders. 2nd ed. Washington, DC: American Psychiatric Pub., 2010.

21. Key Points Epidemiology Diagnosis Comorbidity
More common in women than in men
Lifetime morbid risk: 9%
Diagnosis
Worry and anxiety:
Excessive, difficult to control
At least 6 months
Physical symptoms:
3 of 6: restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbance.
GAD-7 can be useful
Comorbidity
Common: two-thirds of patients