Generalized anxiety disorder
[16] The pathophysiology of GAD implicates several regions of the brain that mediate the processing of stimuli associated with fear, anxiety, memory, and emotion (i.e., the amygdala, insula, and the frontal cortex).
In more severe, last resort cases, potent anxiolytics such as diazepam, clonazepam, and alprazolam are used, though not as first-line drugs as benzodiazepines are frequently abused and habit forming.
[38] In August 2018, Wiley Stress & Health published a meta-analysis of 39 studies comprising 21,736 subjects that found a small-to-medium association between smartphone use and anxiety.
[41] In February 2020, Psychiatry Research published a systematic review and meta-analysis of 14 studies that found positive associations between problematic smartphone use and anxiety and positive associations between higher levels of problematic smartphone use and elevated risk of anxiety,[42] while Frontiers in Psychology published a systematic review of 10 studies of adolescent or young adult subjects in China that concluded that the research reviewed mostly established an association between social networks use disorder and anxiety among Chinese adolescents and young adults.
[49] In August 2021, a meta-analysis was presented at the 2021 International Conference on Intelligent Medicine and Health of articles published before January 2011 that found evidence for a negative impact of social media on anxiety.
[50] In January 2022, The European Journal of Psychology Applied to Legal Context published a meta-analysis of 13 cross-sectional studies comprising 7,348 subjects that found a statistically significant correlation between cybervictimization and anxiety with a moderate-to-large effect size.
[51] In March 2022, JAMA Psychiatry published a systematic review and meta-analysis of 87 studies with 159,425 subjects 12 years of age or younger that found a small but statistically significant correlation between screen time and anxiety in children,[52] while Adolescent Psychiatry published a systematic review of research published from June 2010 through June 2020 studying associations between social media use and anxiety among adolescent subjects aged 13 to 18 years that established that 78.3% of studies reviewed reported positive associations between social media use and anxiety.
[53] In April 2022, researchers in the Department of Communication at Stanford University performed a meta-analysis of 226 studies comprising 275,728 subjects that found a small but positive association between social media use and anxiety,[54] while JMIR Mental Health published a systematic review and meta-analysis of 18 studies comprising 9,269 adolescent and young adult subjects that found a moderate but statistically significant association between problematic social media use and anxiety.
[55] In May 2022, Computers in Human Behavior published a meta-analysis of 82 studies comprising 48,880 subjects that found a significant positive association between social anxiety and mobile phone addiction.
[56] In August 2022, the International Journal of Environmental Research and Public Health published a systematic review and meta-analysis of 16 studies comprising 8,077 subjects that established a significant association between binge-watching and anxiety.
Cost–benefit analyses, sometimes referred to as the “smoke detector principle,”[66] propose that false alarms (unnecessary worry) are less costly than failing to detect real threats.
In individuals with GAD, however, this adaptive threshold appears to be set too low or activated too often, generating pervasive worry about routine events and relatively minor stressors.
[67] Empirical work supports the idea that GAD involves heightened reactivity in brain regions associated with threat detection, including the amygdala.
Researchers have also found links between GAD and elevated inflammation markers, suggesting a possible physiological correlate for the chronic anxiety seen in the disorder.
Although anxiety’s defensive functions may have been advantageous in unpredictable environments, modern contexts can render this vigilance maladaptive when it persists as near-constant worry and avoidance.
This view places GAD at the extreme end of a continuum, where otherwise beneficial anxiety responses overshoot, leading to significant distress and functional impairment.
[citation needed] Psychotherapeutic interventions[14] include a plurality of therapy types that vary based upon their specific methodologies for enabling individuals to gain insight into the working of the conscious and subconscious mind and which sometimes focus on the relationship between cognition and behavior.
[75] This psychological therapy teaches mindfulness (paying attention on purpose, in the present, and in a nonjudgmental manner) and acceptance (openness and willingness to sustain contact) skills for responding to uncontrollable events and therefore manifesting behaviors that enact personal values.
Thus, IUT focuses on helping patients in developing the ability to tolerate, cope with and accept uncertainty in their life in order to reduce anxiety.
[70] The objective of CBT is to enable individuals to identify irrational thoughts that cause anxiety and to challenge dysfunctional thinking patterns by engaging in awareness techniques such as hypothesis testing and journaling.
The main objective of SPT is to allow the individual the ability to work through their emotional problems from childhood traumas (CT) through play using sand and toy figures.
[70][93] BZs have a number of effects that make them a good option for treating anxiety including anxiolytic, hypnotic (induce sleep), myorelaxant (relax muscles), anticonvulsant, and amnestic (impair short-term memory) properties.
[109] Common side effects include nausea, sexual dysfunction, headache, diarrhea, constipation, restlessness, increased risk of suicide in young adults and adolescents,[110] among others.
[71][119][120][121] Side effects common to both SNRIs include anxiety, restlessness, nausea, weight loss, insomnia, dizziness, drowsiness, sweating, dry mouth, sexual dysfunction and weakness.
[122] In comparison to SSRIs, the SNRIs have a higher prevalence of the side effects of insomnia, dry mouth, nausea and high blood pressure.
[122][123] Both SNRIs have the potential for discontinuation syndrome after abrupt cessation, which can precipitate symptoms including motor disturbances and anxiety and may require tapering.
[124][125] Like other serotonergic agents, SNRIs have the potential to cause serotonin syndrome, a potentially fatal systemic response to serotonergic excess that causes symptoms including agitation, restlessness, confusion, tachycardia, hypertension, mydriasis, ataxia, myoclonus, muscle rigidity, diaphoresis, diarrhea, headache, shivering, goose bumps, high fever, seizures, arrhythmia and unconsciousness.
Long-term trials have shown continued effectiveness without the development of tolerance and additionally, unlike benzodiazepines, it does not disrupt sleep architecture and produces less severe cognitive and psychomotor impairment.
[citation needed] Early primates, such as the Homo Erectus, developed Achilles tendons and foot arches from its earlier ancestor, the tree-swinging Austrlopithecus.
[141] Accumulating evidence indicates that patients with comorbid depression and anxiety tend to have greater illness severity and a lower treatment response than those with either disorder alone.
