Neuromedia

Generalized anxiety

Stéphane Bastianetto

Generalized anxiety is the most frequently encountered mental disorder, especially in the elderly. It is often associated with depressive disorders.

There is a feeling of apprehension of a danger that is both imminent and unpredictable. This feeling is subjective and appears disproportionately.

When the anxiety is isolated, it is called primary anxiety. The type of disorder can be determined by considering its causes and how it evolved, as well as the circumstances under which it appeared.

Primary anxiety disorders are generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, and phobic disorder.

When anxiety is accompanied by a mental or physical illness (e.g. hypochondria,  depression), it is often referred to as secondary anxiety.

The symptoms are diverse and neurovegetative: general excitability, tachycardia, palpitations, dyspnea, dry mouth, tremors, excessive sweating, dizziness. They can also be the sign of a medical pathology. For example, palpitations may be the first signs of heart disease, while tremors may suggest Parkinsonian syndrome.

Certain behavioral disorders are often associated: wandering, wandering, insomnia, alcoholism or abuse of tranquillizers, character disorders. This anxiety can also be observed visually in the form of a worried expression, changes in mimicry, posture and mobility.

Generalized anxiety is characterized by the presence of several symptoms of excessive anxiety or worry occurring over a period of at least six months.

Generalized anxiety alone represents 70% of primary anxiety disorders in the elderly. The individual has difficulty controlling his preoccupations, which are associated with somatic symptoms (e.g. irritability, insomnia) and subjective distress.

Historical

The terms anxiety and anguish originate from the Indogermanic verbal root “ankh” which means “to tighten”, “to choke”, which recalls certain signs (tight throat, feeling of suffocation).

The term “panic” originates from the ancient Greek god of forests and riverbanks Pan who according to legend sowed panic among the Persians at the battle of Marathon.

While anxiety is associated with a physical cause (anxiety of dying during a heart attack) leading to physical manifestations (eg palpitation), anxiety is associated with apprehension of an event and fear of a real external danger (eg a bombardment).

The description of anxiety appears at the end of the 19th century with the German doctors Bndict and Westphal, the latter introducing the term “agoraphobia”.

At the beginning of the 20th century, Janet introduced the concept of what would become obsessive compulsive disorder.

Until the early 1980s, anxiety disorders were part of the non-psychotic disorders called « neuroses », including hysteria, neurasthenia, psychasthenia, anorexia and personality disorders.

Prevalence

Anxiety disorders have a lifetime prevalence of about 15%. Anxiety disorders are marked by an early onset, with an age of onset of 11 years. Specific phobias are the earliest, i.e. before the age of 10.

More specifically, generalized anxiety disorder has a lifetime prevalence of approximately 6% and tends to increase with age.

The other anxiety disorders appear later, with a median age between 20 and 30 years.

A quarter of anxiety disorders are considered serious, compared to almost half for mood disorders and obsessive-compulsive disorders and 80% for bipolar disorders.

Unlike other types of disorders (phobic, obsessive-compulsive or panic), they tend to persist. Women are two times more affected than men.

However, it is quite possible that GAD is obscured by the symptomatology of other psychiatric conditions.

It very often coexists with another mental disorder: social or specific phobia, panic disorder or depressive state.

Due to the presence of somatic disorders, these patients consult not only a general practitioner, but also pulmonologists, gastroenterologists or cardiologists.

A study finds 46% late onset of generalized anxiety in a population of elderly subjects . Another study reports that symptoms of anxiety are present in about 25% of elderly people in the community, reaching 50% in people placed in medical care.

Diagnostic criteria for generalized anxiety disorder

The diagnostic criteria of the American psychiatry manual DSM IV make it possible to differentiate generalized anxiety disorder from normal anxiety. These criteria are:

1. At least one excessive worry and fearful expectation lasting several days for at least 6 months, and stimulated by events or activities (such as work or school performance).

2. Anxiety that is difficult to control, even uncontrollable.

3. At least three of the following six symptoms present for more than one day during the past 6 months): 
– Agitation, over-excitement 
– ​​Tiredness 
– Trouble concentrating 
– Irritability 
– Muscle tension 
– Sleep disturbances (difficulty sleeping or insufficient sleep or restless)

4. The object of concern is not limited. If the object is limited (eg separation, trauma), the anxiety disorder will be classified differently: separation anxiety disorder, post-traumatic anxiety.

5. Suffering and impairment of significant social, professional activities

6. The disorder is not due to substance abuse (drugs, or medications), medical condition (hyperthyroidism), or mental illness.

Signs and symptoms of generalized anxiety disorder

Here are the main symptoms:

Comorbidity

Generalized anxiety in the elderly is associated with comorbidity. Anxiety symptoms can be linked to three types of disorders:

Etiology

The cause is unknown and multifactorial, combining both an alteration of certain neurotransmitters and psychosocial factors.

Genetic factors: Studies show that the risk is three times higher among first-degree relatives of patients with generalized anxiety.

Neurochemical factors. The areas that seem to be affected in GAD are the limbic system and the prefrontal cortex and more precisely the cortico-subcortical neural circuit which includes:

There is therefore a dysfunction of this coritco-subcortical circuit.

A neuroimaging study (functional MRI technique) indicates that people prone to generalized anxiety disorder have hyperactivity of the amygdala (brain structure present in the limbic system) and hypoactivity of the prefrontal cortex. Serotonin is a neurotransmitter thought to be involved in anxiety.

It can be hypothesized that the decreased activity of the GABA inhibitory system leads to hyperactivation of the limbic system which is associated with the symptoms of anxiety. This would explain why benzodiazepines, which inhibit GABA activity, have an anxiolytic effect.

Psychosocial factors. According to the cognitive-behavioural model, the different parameters processing information would not be perceived in an equitable manner, favoring the negative and threatening representation of an anxiety-provoking situation. The development of an anxiety disorder can occur through observational learning, in which a person develops a disorder (or phobia) by observing a person displaying anxiety (or fear). Parents can play a role in increasing the risk (overprotective mother, parent who is not very warm and critical of the child, separation).

What are the treatments for anxiety?

Once you’ve been diagnosed with anxiety, you can explore treatment options with your doctor. For some people, medical treatment is not necessary. Lifestyle changes may be enough to cope with the symptoms.

In moderate or severe cases, however, treatment can help you overcome symptoms and lead a more manageable daily life.

Treatment for anxiety falls into two categories: psychotherapy and medication. Meeting with a therapist or psychologist can help you learn tools and strategies for dealing with anxiety when it arises.

Medications typically used to treat anxiety include antidepressants and benzodiazepines.

What natural remedies are used to treat generalized anxiety disorder?

Lifestyle changes can be an effective way to combat some of the stress and anxiety you may face every day. Most of the natural « cures » consist of taking care of your body, participating in healthy activities and eliminating unhealthy ones.

These include: