User:Ongmianli/Portfolios/Generalized anxiety disorder

DSM-IV Criteria: Generalized Anxiety Disorder

(Includes Overanxious Disorder of Childhood)

• A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).
• B. The person finds it difficult to control the worry.
• C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months).

1. Restlessness or feeling keyed up or on edge
2. Being easily fatigued
3. Difficulty concentrating or mind going blank
4. Irritability
5. Muscle tension
6. Sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)

(Note: Only one item is required in children.)

• D. The focus of the anxiety and worry is not confined to features of an Axis I disorder, e.g., the anxiety or worry is not about having a Panic Attack (as in Panic Disorder), being embarrassed in public (as in Social Phobia), being contaminated (as in Obsessive-Compulsive Disorder), being away from home or close relatives(as in Separation Anxiety Disorder), gaining weight (as in Anorexia Nervosa), having multiple physical complaints (as in Somatization Disorder), or having a serious illness (as in Hypochondriasis), and the anxiety and worry do not occur exclusively during Posttraumatic Stress Disorder.
• E. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social,occupational, or other important areas of functioning.
• F. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism) and does not occur exclusively during a Mood Disorder, a Psychotic Disorder, or a Pervasive Developmental Disorder.

Proposed DSM-5 Criteria: Generalized Anxiety and Worry Disorder

• A. Excessive anxiety and worry (apprehensive expectation) about two (or more) domains of activities or events (for example, domains like family, health, finances, and school/work difficulties)
• B. The excessive anxiety and worry occur on more days than not for three months or more
• C. The anxiety and worry are associated with one or both of the following symptoms:

a. Restlessness, feeling keyed up, or on edge

b. Muscle tension

• D. The anxiety and worry are associated with one or more of the following behaviors:

a. Marked avoidance of situations in which a negative outcome could occur

b. Marked time and effort preparing for situations in which a negative outcome could occur

c. Marked procrastination in behavior or decision-making due to worries

d. Repeatedly seeking reassurance due to worries

• E. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social,occupational, or other important areas of functioning.*
• F. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism) and does not occur exclusively during a Mood Disorder, a Psychotic Disorder, or a Pervasive Developmental Disorder.*
• G. The anxiety and worry are not restricted to symptoms of another disorder, such as Panic Disorder (e.g.,anxiety about having a panic attack), Social Anxiety Disorder (e.g., being embarrassed in public), Obsessive-Compulsive Disorder (e.g, anxiety about being contaminated), Separation Anxiety Disorder (e.g., anxiety about being away from home or close relatives), Anorexia Nervosa (e.g., fear of gaining weight), Somatization Disorder(e.g., anxiety about multiple physical complaints), Body Dysmorphic Disorder (e.g., worried about perceived appearance flaws), Hypochondriasis (e.g,. belief about having a serious illness), and the anxiety and worry do not occur exclusively during Posttraumatic Stress Disorder.*

 (*)An option that is still under discussion is the possibility of deleting criteria E, F, and G

Diagnostic Changes

There were no diagnostic changes in the DSM-5.

Demographic Information

This section describes the demographic setting of the population(s) sampled, base rates of diagnosis, country/region sampled and the diagnostic method that was used. Using this information, clinicians will be able to anchor the rate of Generalized Anxiety Disorder that they are likely to see in their clinical practice.

Setting	Reference	Base Rate	Demography	Diagnostic Method
Elementary and Middle School population	Gadow et al., 2005	3.3% (males), 2.0% (females)	New York	Child Symptom Inventory (CSI-4)
High school epidemiological	Lewinsohn et al., 1993	1.29% (Lifetime)	Northwestern USA high schools	KSADS
Adult Epidemiology	Kessler et al., 2005	5.7% (Lifetime), 3.1% (Past Year)	All of U.S.A.	World Health Organization Composite International Diagnostic Interview (WMH-CIDI)
University affiliated Primary Care Clinic- ages 8-17	Chavira et al, 2004	3.2%	California	ADIS
Child and Adolescent- elevated risk sample from rural NC	Great Smoky Mountain Study; Bittner et al. 2007	<13 years old= 1.8%, >/=13 years old=4.0%	Rural NC, elevated risk sample	Child and Adolescent Psychiatric Assessment (CAPA)- parent and child
Outpatient Clinic- ages 6-12	Gadow et al., 2005	19.4% (males), 27.8% (females)	New York	Child Symptom Inventory (CSI-4)
Anxiety Disorder clinic- 5-18 year olds	Last, Strauss et al., 1987	15%	Pittsburgh	Interview Schedule for Children- parent and child reports (ISC)
Anxiety Disorder clinic- 9-13 year olds	Kendall et al., 1997	58%	Philadelphia	ADIS

Area under Curve (AUCs) and Likelihood Ratios for Generalized Anxiety Disorder Potential Screening Measures

Screening Measure (Primary Reference)	AUC	LR+	LR-	Citation	Clinical Generalizability
Penn State Worry Questionnaire (PSWQ; Meyer, Miller, Metzger, & Borkovec, 1990)	0.74 (N=164)	1.8 (65+)	0.5 (<65)	Fresco, D.M., Mennin, D.S., Heimberg, R.G., Turk, C.L. (2003)	Generalized Anxiety Disorder vs. social anxiety disorder, adults presenting to specialty anxiety clinic
Penn State Worry Questionnaire- Child Version (Chorpita et al., 1997)	Information not available			Chorpita, B.F., Tracey, S.A., Brown, T.A., Collica, T.J., & Barlow, D.H., 1997.	Generalized Anxiety Disorder vs. any other disorder (including other anxiety disorders); children presenting to a clinic specializing in anxiety
Screen for Child Anxiety Related Emotional Disorders- Child Form (SCARED; Birmaher et al., 1997, Birmaher et al., 1999)	0.70 (N=243); 0.66<GAD scale<0.86	1.4 (15+); GAD scale=2.0 (8+)	0.6 (<15); GAD scale=0.4 (<8)	Birmaher et al., 1997	Anxiety vs. other diagnoses, children ages 9-18 presenting to a clinic specializing in mood and anxiety
Screen for Child Anxiety Related Emotional Disorders- Parent Form (SCARED; Birmaher et al., 1997, Birmaher et al., 1999)	Similar to child form- specific information not available			Birmaher et al., 1997	Anxiety vs. other diagnoses, children ages 9-18 presenting to a clinic specializing in mood and anxiety
Generalized Anxiety Disorder Questionnaire-IV (GAD-Q-IV; Newman et al., 2002)	0.93 (N=143)	7.5 (5.7+)	0.2 (<5.7)	Newman, M.G., Zuellig, A.R., Kachin, K.E., Constantino, M.J., Przeworski, A., Erickson, T. et al. (2002)	GAD vs. any other disorder (including other anxiety disorders); Undergraduate students seeking treatment

Brief Screening Tools

The following are brief screening tools that typically take less than 5 minutes to administer to accurately diagnose Generalized Anxiety Disorder:

• Penn State Worry Questionnaire
• Penn State Worry Questionnaire- Child Version
• Screen for Child Anxiety Related Emotional Disorders - Child Form
• Screen for Child Anxiety Related Emotional Disorders - Parent Form

Clinically Significant Change Benchmarks with Common Instruments and Mood Rating Scales

Listed below are clinically significant change benchmarks of common screening instruments used for Generalized Anxiety Disorder.

	Cut-scores			Critical Change (unstandardized scores)
Measure	A	B	C	95%	90%	SEdifference
Penn State Worry Questionnaire (Chelminski & Zimmerman, 2002)	51	73	59	9	8	4.8
Penn State Worry Questionnaire- Past Week (Stober & Bittencourt, 1998)	47	b	b	9	7	4.4
Penn State Worry Questionnaire- Child Version (Chorpita et al., 1997)	16	18	17	8	7	4.0
Screen for Child Anxiety Related Emotional Disorders- Child Version (SCARED; Birmaher et al., 1997)
Anxiety vs. Other Disorders
Total	a	41	22	12	10	5.9
Generalized Anxiety Scale	a	16	8	9	8	4.7
GAD vs Other Anxiety Disorders
Generalized Anxiety Scale	2	17	9	9	7	4.5 }