The cause of GAD

What Causes Generalized Anxiety Disorder?

The exact cause of GAD is not fully known, but a number of factors -- including genetics, brain chemistry and environmental stresses -- appear to contribute to its development.

• Genetics: Some research suggests that family history plays a part in increasing the likelihood that a person will develop GAD. This means that the tendency to develop GAD may be passed on in families.
  
• Brain chemistry: GAD has been associated with abnormal levels of certain neurotransmitters in the brain. Neurotransmitters are special chemical messengers that help move information from nerve cell to nerve cell. If the neurotransmitters are out of balance, messages cannot get through the brain properly. This can alter the way the brain reacts in certain situations, leading to anxiety.
  
• Environmental factors: Trauma and stressful events, such as abuse, the death of a loved one, divorce, changing jobs or schools, may lead to GAD. GAD also may become worse during periods of stress. The use of and withdrawal from addictive substances, including alcohol, caffeine and nicotine, can also worsen anxiety.
  

How Common Is Generalized Anxiety Disorder?

About 4 million adult Americans suffer from GAD during the course of a year. It most often begins in childhood or adolescence, but can begin in adulthood. It is more common in women than in men.

How Is Generalized Anxiety Disorder Diagnosed?

If symptoms are present, the doctor will begin an evaluation by asking questions about your medical history and performing a physical examination. Although there are no laboratory tests to specifically diagnose anxiety disorders, the doctor may use various tests to look for physical illness as the cause of the symptoms.

The doctor bases his or her diagnosis of GAD on reports of the intensity and duration of symptoms -- including any problems with functioning caused by the symptoms. The doctor then determines if the symptoms and degree of dysfunction indicate a specific anxiety disorder. GAD is diagnosed if symptoms are present for more days than not during a period of at least six months. The symptoms also must interfere with daily living, such as causing you to miss work or school.

http://www.medicinenet.com/anxiety/page3.htm
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Symptoms of Generalized Anxiety Disorder

Generalized Anxiety Disorder

GAD is characterized by excessive, exaggerated anxiety and worry about everyday life events. People with GAD tend to always expect disaster and can't stop worrying about health, money, family, work or school. In people with GAD, the worry often is unrealistic or out of proportion for the situation. Daily life becomes a constant state of worry, fear and dread. Eventually, the anxiety so dominates the person's thinking that it interferes with daily functioning, including work, school, social activities and relationships.

What Are the Symptoms of GAD?

GAD affects the way a person thinks, but the anxiety can lead to physical symptoms, as well. Symptoms of GAD include:

• Excessive, ongoing worry and tension
• An unrealistic view of problems
• Restlessness or a feeling of being "edgy"
• Irritability Muscle tension
• Headaches
• Sweating
• Difficulty concentrating
• Nausea
• The need to go to the bathroom frequently
• Tiredness
• Trouble falling or staying asleep
• Trembling
• Being easily startled
  

In addition, people with GAD often have other anxiety disorders (such as

panic disorder, obsessive-compulsive disorder and phobias), suffer from depression, and/or abuse drugs or alcohol.

http://www.medicinenet.com/anxiety/page3.htm

Anxiety Attack Statistics

Anxiety Attack Statistics

Prevalence of Anxiety disorder: approximately 2.4 million Americans (NIMH)

Prevalence Rate: approx 1 in 113 or 0.88% or 2.4 million people in USA

Incidence (annual) of Panic disorder: 1.7% of US adults annually (NIMH)

Incidence Rate: approx 1 in 58 or 1.70% or 4.6 million people in USA

Incidence extrapolations for USA for Anxiety disorder:
4,624,000 per year, 385,333 per month, 88,923 per week, 12,668 per day, 527 per hour, 8 per minute, 0 per second.

Lifetime risk for Panic disorder: 3 million Americans (NIMH); 1.6% adults (USSG)
Prevalence of Anxiety disorder: Anxiety disorder strikes between 3 and 6 million Americans, and is twice as common in women as in men.
Incidence of Panic disorder: About 1.7% of the adult U.S. population ages18 to 54 - approximately 2.4 million Americans - has anxiety panic disorder in a given year.
Prevalence of Anxiety disorder discussion: Approximately 2.4 million American adultsages 18 to 54, or about 1.7 percent of people in this age group in a given year, have anxiety disorder.

In the United States, 1.6 percent of the adult population, or more than 3 million people, will have anxiety panic disorder at some time in their lives.

Prevalence statistics about Anxiety Panic disorder: The following statistics relate to the prevalence of Anxiety Panic disorder:

• 3 million American adults (NIMH)
• 1.7% of the adult U.S. population ages 18 to 54 (NIMH)

http://www.medicinenet.com/anxiety/page3.htm

Seafood Allergy and Reactions to RCM

Myth Persists on Seafood Allergy, Contrast Link

An old medical myth—that patients who are allergic to seafood are at risk of adverse reactions to radiologic contrast media (RCM) —persists even among cardiologists, despite having been thoroughly debunked, Dr. Andrew D. Beaty reported at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

In a survey of 231 specialists at six academic medical centers, 69% of the physicians admitted asking patients about seafood allergy before radiologic procedures using contrast media. Of those surveyed, 37% of the physicians admitted withholding contrast media or premedicating seafood-allergic patients with corticosteroids or antihistamines before the procedure.

Many studies over the past 30 years have failed to find any special relationship between seafood allergy and adverse reactions to radiologic contrast media (RCM). According to some, atopic patients in general may have a fourfold to fivefold increased risk of adverse events in response to RCM. However, the baseline rate of these events is so low that even if these studies were to be confirmed in larger populations, less than 1% of atopic patients would be affected.

About 10 million procedures using RCM are conducted every year in the United States. Life-threatening reactions occur in about 0.2% of patients receiving high-osmolarity contrast media and 0.04% of those getting low-osmolarity contrast media.

The origin of the seafood allergy myth is unknown. But Dr. Beaty, of St. Louis University, has traced it at least as far as a 1975 paper in the American Journal of Roentgenology that stated that 15% of patients who experienced adverse reactions to RCM reported having seafood allergy (Am. J. Roentgenol. Radium Ther. Nucl. Med. 1975;124:145–52). The authors of that study hypothesized that the iodine in seafood cross-reacted with the iodine in RCM. They never verified those patient reports, however, and similar percentages of patients with adverse reactions in their study reported allergies to other common foods such as milk and eggs.

Since then, it has been determined that seafood allergy is mediated by immunoglobulin E (IgE) antibodies to proteins in meat, with iodine playing no role. Furthermore, IgE does not mediate severe RCM reactions. The combination of these two findings effectively discounts the hypothesis of iodine cross-reactivity.

For his study, Dr. Beaty and his colleagues mailed anonymous questionnaires to 231 faculty members at six prominent academic medical centers in the Midwest. Of the individuals queried, 49% responded.
The survey consisted of eight brief questions, but only two of them related to seafood allergy and RCM. The other six were intended as distractors.

The first seafood-related question was, “Do you or someone on your behalf inquire about a history of seafood or shellfish allergy prior to administration of contrast media?” Sixty-five percent of the radiologists and 89% of the cardiologists answered, “Yes.”

The second question was, “Would you withhold RCM administration or recommend pretreatment with corticosteroids and/or antihistamines based on a history of seafood or shellfish allergy?” Thirty-five percent of the radiologists and 50% of the cardiologists answered, “Yes.”

While 69% of the total respondents said that they would ask patients about seafood allergy, only 37% said that they would change management based on that information. That suggests that about 32% would ask the question even if the answer would not affect patient management.

Merely asking that question may serve to perpetuate the myth among patients, Dr. Beaty said. He pointed to a separate study indicating that 65% of patients with seafood allergy had either read or been told by their physician to avoid RCM, and 92% believed that iodine in seafood was responsible for their allergy (Allergy Asthma Proc. 2005;26:468–9).

Several physicians in the audience rose to describe their experiences with this medical myth. One described a radiologic technician who received an official reprimand for failing to ask a patient about seafood allergy. Another physician said that at his institution no allergic patients were allowed to receive RCM unless they were premedicated.

A third physician said that at his institution, the computer system automatically categorized every patient with a seafood allergy as being sensitive to RCM, and every patient who was sensitive to RCM as having a seafood allergy. That has now been changed, but patients who were seen before the change will have that erroneous information persist in their records until someone changes it manually.

Cardiology News, Volume 5, Issue 4, Page 19 (April 2007)

Bipolar disorder and dissociation:Lethal Combination

Bipolar Affective Disorder and Dissociation: A Potentially Lethal Combination

Tanya L. Hanstock
The Nexus Unit, Newcastle, Australia, The Bipolar Program, Newcastle, Australia

In isolation, bipolar disorder and dissociation can place adolescents at risk of self-harm or suicide. However, when these are combined, they place an adolescent at serious risk of self-harming behavior or suicide completion.

It appears from the scarcity in the literature to be rare for adolescents to have the combination of bipolar disorder and dissociation.

This article outlines the case of an older adolescent girl with a comorbid combination.

This case study highlights how the comorbidity of bipolar disorder and dissociation increases a patient's lethality risk and how both disorders may contribute to the volatile destabilization of the other.

Risk management strategies are proposed in relation to the assessment of risk and preparedness for discharge from inpatient facilities.

Keywords: adolescents • bipolar disorder • children • comorbidity • dissociation

Clinical Case Studies, Vol. 6, No. 2, 131-142 (2007)
© 2007 SAGE Publications

http://ccs.sagepub.com/cgi/content/abstract/6/2/131