The Psychiatric clinics of North America
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The literature reviewed here is consistent in showing that GAD is a common mental disorder that typically has an early age of onset, a chronic course, and a high degree of comorbidity with other anxiety and mood disorders. Comorbid GAD is often temporally primary, especially in relation to mood disorders, and is associated with an increased risk for the subsequent onset and severity of secondary disorders. The weight of evidence reviewed here argues against the view expressed by early commentators that GAD is better conceptualized as a prodrome, residual, or severity marker of other disorders than as an independent disorder. ⋯ Unfortunately, little is known about this possibility because, as mentioned earlier, few people with pure GAD seek treatment. Why this is true is unknown. Given the early onset of GAD and its strong effects in predicting the subsequent onset, severity, and persistence of other disorders, efforts are needed to collect epidemiologic data on the reasons for the low rate of help seeking among people with pure GAD and to develop outreach strategies that may correct this situation.
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Psychiatr. Clin. North Am. · Mar 2001
ReviewOverview and clinical presentation of generalized anxiety disorder.
1. To distinguish GAD from panic disorder is not difficult if a patient has frequent, spontaneous panic attacks and agoraphobic symptoms, but many patients with GAD have occasional anxiety attacks or panic attacks. Such patients should be considered as having GAD. ⋯ Finally, the adjective excessive, not used in the definition of other primary diagnostic criteria, such as depressed mood for MDD, should be omitted (Table 3). 6. One may want to consider the distinction of trait (chronic) from state (acute) anxiety, but whether the presence of some personality characteristics, particularly anxious personality or Cluster C personality and increased neuroticism, as an indicator of trait [table: see text] anxiety is a prerequisite for anxiety disorders; occurs independently of anxiety disorders; or is a vulnerability factor that, in some patients, leads to anxiety symptoms and, in others, does not, is unknown. 7. Symptoms that some clinicians consider cardinal for a diagnosis of GAD, such as extreme worry, obsessive rumination, and somatization, also are present in other disorders, such as MDD. (ABSTRACT TRUNCATED)
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Psychiatr. Clin. North Am. · Dec 2000
ReviewVagus nerve stimulation. A potential therapy for resistant depression?
VNS builds on a long history of investigating the relationship of autonomic signals to limbic and cortical function and is one of the newest methods to physically alter brain function. VNS is a clinically useful anticonvulsant therapy in treatment resistant patients with epilepsy, and pilot data suggest that it has potential as an antidepressant therapy. The known anatomic projections of the vagus nerve suggest that VNS also might have other neuropsychiatric applications. Additional research is needed to clarify the mechanisms of action of VNS and the potential clinical utility of this intriguing new somatic portal into the CNS.
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Psychiatr. Clin. North Am. · Sep 2000
ReviewAdvances in the neurobiology of obsessive-compulsive disorder. Implications for conceptualizing putative obsessive-compulsive and spectrum disorders.
Several approaches to the spectrum of obsessive-compulsive spectrum disorders have been put forward, each based on a rather different framework. To some extent, overlaps exist among these approaches, indicating that the neurobiology of OCD and related disorders is increasingly consolidated; however, important differences exist between these approaches, and many questions are unanswered, demonstrating that more work is necessary to fully delineate OCD and its subtypes and their relationships to other putative obsessive compulsive spectrum disorders. ⋯ It reminds investigators to consider possibly overlapping and differentiating mechanisms in several disorders. Ultimately, the delineation of such mechanisms will allow for a more rigorous approach to the putative obsessive-compulsive spectrum disorders.
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Given the high rates of comorbidity, patients commonly present with multiple diagnoses to PESs or crisis services. Clinicians must be well versed in the evaluation, differential diagnosis, and treatment of patients with substance-abuse disorders or other Axis I, II, or III conditions if they are to provide state-of-the-art treatment of patients in need of emergency care.