اختلال اضطراب فراگیر: بیماری همراه وجود

Generalized anxiety disorder (GAD) frequently occurs comorbidly with other conditions, including depression and somatic complaints. Comorbid GAD sufferers have increased psychologic and social impairment, request additional treatment, and have an extended course and poorer outcome than those with GAD alone; therapy should alleviate both the psychic and somatic symptoms of GAD without negatively affecting the comorbid condition. The ideal treatment would provide relief from both GAD and the comorbid condition, reducing the need for polypharmacy. Physicians need suitable tools to assist them in the detection and monitoring of GAD patients—the GADI, a new, self-rating scale, may meet this requirement. Clinical data have shown that various neurobiologic irregularities (e.g., in the GABA and serotonin systems) are associated with the development of anxiety. Prescribing physicians must take into account these abnormalities when choosing a drug. Effective diagnosis and treatment should improve patients' quality of life and their prognosis for recovery.

Generalized anxiety disorder (GAD) is one of the most common conditions that occurs comorbidly with other disorders, particularly other anxiety and depressive disorders. Indeed, comorbidity of mood and anxiety disorders is a hallmark feature of GAD (Judd et al., 1998 and Ninan, 2001). Research into GAD is far behind that of many other psychiatric disorders, the main reason being that until fairly recently many eminent physicians still believed that GAD was not a separate disorder, but rather a variant of depression. This misapprehension arose because GAD often occurs comorbidly with depression, which can mask the symptoms of GAD. Consequently it has taken some time to establish that GAD does occur as a discreet condition, and that it definitely is not a form of depression. This was, and still can be, a big hindrance to the progression of research into this important, although somewhat neglected, psychiatric condition. GAD is frequently comorbid with major depressive disorder (MDD), panic disorder (PD), social anxiety disorder (SAD), specific phobia (SP), and post-traumatic stress disorder (PTSD), and is additionally associated with chronic pain conditions, medically unexplained somatic symptoms, and sleep disorders—in fact many physicians believe that much of the insomnia reported by their patients is actually a variant of GAD. These patterns of comorbidity increase the individual and economic burden of GAD and add to the challenge of treatment. Indeed, comorbidity should be thought of as a challenge rather than a nuisance—it is very important clinically, both when considering neurobiologic disorders and the individual comorbidities. This article will discuss the issues surrounding GAD and its various comorbidities. In addition, we will also address the need for appropriate tools to aid the diagnosis of this condition, and appraise the potential role of various neurobiologic mechanisms in the development and treatment of GAD.