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Mensagem  Convidad em Dom Jun 30, 2013 11:58 am


Diagnostic criteria from the DSM-IV for GAD include excessive anxiety and worry about a number of events or activities, occurring more days than not for at least six months, that are out of proportion to the likelihood or impact of feared events. Affected patients also present with somatic symptoms, including fatigue, muscle tension, memory loss, and insomnia, and, as noted above, other psychiatric disorders.
They often have little insight into the connection between reported worries, current life stress, and their physical symptoms.

A seven-item anxiety questionnaire (GAD-7) has been developed and validated in a primary care setting. This patient self-assessment tool may facilitate screening, but positive screens should be followed by clinician interview to establish the diagnosis of GAD. A score of 10 or greater on the GAD-7 represents a reasonable cut point for identifying cases of GAD with a sensitivity of 89 percent and specificity of 82 percent. Cut points of 5, 10, and 15 have been established as representing mild, moderate, and severe levels of anxiety on the GAD-7.The GAD-7 tool has been validated to screen for generalized anxiety, aswell as for other types of anxiety (panic disorder, social anxiety disorder, and posttraumatic stress disorder). Additionally, the first two items of the GAD-7 tool (referred to as theGAD-2), with a cutoff score of 3 or more leading to further evaluation,may be equally sensitive to the GAD-7.

Many patients have the full constellation of symptoms that meet the DSM-IV criteria, but have had symptoms for a shorter period than the required six months. These individuals often have symptoms of anxiety as a result of a specific stressor, or symptoms that occur within three months of the onset of a stressor; they fulfill the DSM-IV diagnostic criteria for "adjustment disorder with anxious mood" rather than GAD. Patients with adjustment disorder may have considerable impairment in social relationships and occupational functioning. Patients should be screened for comorbid psychiatric disorders and an organic etiology for anxiety by careful history taking, a complete physical examination, and appropriate laboratory studies:

The initial interview should be open-ended and unhurried; family members should be involved when appropriate.

The medical history should focus upon possible contributory factors relating to current medical disorders, medication side effects, or substance abuse.

The psychosocial history should screen for comorbid psychiatric disorders such as major depression and agoraphobia, stressful life events, family psychiatric history, current social history, substance abuse history (including caffeine, nicotine, and alcohol), and past sexual, physical
and emotional abuse, or emotional neglect.

Laboratory studies to consider include a complete blood count, chemistry panel, serum thyrotropin (TSH),urinalysis, electrocardiogram (in patients over 40 with chest pain or palpitations), and any other specific studies required to diagnose a suspected medical cause of anxiety. Urine or serum toxicology measurements or drug levels can be obtained for drugs or medications suspected in the etiology of anxiety.

REFERÊNCIA: UpToDate - Generalized anxiety disorder: Epidemiology, clinical manifestations, and diagnosis


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Mensagem  Convidad em Dom Jun 30, 2013 12:23 pm


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