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INTRODUCTION
The etymology of anxiety
The term stems from the Greek angho (ανXθ):"to squeeze, embrace, or throttle." The meaning evolved to"weighed down with grief, burdens, trouble" and concurrently tothe Latin anxietas : "troubled in mind."
Primary care physicians should be able to recognize and treat basic anxietydisorders. Among the anxiety disorders listed by the Diagnostic andStatistical Manual of Mental Disorders, Fourth Edition (DSM-IV) aregeneralized anxiety disorder, anxiety due to a general medical condition,panic disorder with and without agoraphobia, and substance-induced anxietydisorder
Anxiety disorders best referred to a psychiatrist include agoraphobiawithout panic disorder, specific and social phobias, obsessive-compulsivedisorder, post-traumatic stress disorder, and acute stress disorder
Anxiety may present as insomnia, headaches, ongoing fears, musculoskeletalpain, or gastrointestinal disturbance
GENERALIZED ANXIETY DISORDER
Epidemiology
The lifetime prevalence of generalized anxiety disorder (GAD) is 5.1%. The1-year prevalence is3.1% 1
Women are affected about 1.9 times as often asmen 1
GAD is frequently associated with mood disorders, other anxiety disorders,and substance abuse
Treatment
Initial therapy may consist of the administration of a benzodiazepine for 2to 6 weeks or buspirone hydrochloride for several months
Antidepressant medications need to be taken 3 to 4 weeks before the onsetof action. If used, they are often initially paired with a benzodiazepine
Cognitive therapy is also effective for GAD; it may be better thanpharmacotherapy. The combination of cognitive therapy and medication improvesoutcome over treatment with medicationalone 2
There is no well-designed study of the long-term treatment ofGAD 3
Buspirone
Among patients with GAD who take buspirone, 54% have significant clinicalimprovement compared with 28% of patients who takeplacebo 4
Buspirone and benzodiazepines have similarefficacy 5
Buspirone is effective only if taken regularly
Adverse effects-headache, nausea, and dizziness-are mild andinfrequent. Unlike benzodiazepines, buspirone does not impair memory,cognitive performance, or driving skills. It has no sedative-hypnoticeffects
Buspirone has no potential for dependence, withdrawal symptoms, or reboundanxiety after drug withdrawal
In one observational study, buspirone was shown to be safe to use for aslong as 1 year 6
Probably less relapse occurs after buspirone treatment than after treatmentwith benzodiazepines
Benzodiazepines
The Hamilton Anxiety Scale
The Hamilton Anxiety Scale, often used in clinical trials, contains 14symptoms (7 psychic and 7 somatic), each rated from 0 to 4 points forseverity. The maximum score for the psychic and somatic sections is 28...