Generalized anxiety disorder and reaction to stress
Generalized anxiety disorder (GAD) and reaction to stress is the problem of considerable concern for doctors and their patients. The case is that generalized anxiety disorder and reaction to stress often reveal themselves together and may certainly influence upon each other. Among the sad consequences of this association are sleep disturbances that are characteristic for generalized anxiety disorder and reaction to stress. Patients may experience difficulties at falling asleep and anxiety at awakening. The sleep is frequently faltering with unpleasant dreams. From time to time the patients experience nightmares, so the patients wake up with feeling of horror. Sometimes they recall the nightmares, and another time do not know why they have woken up in anxiety. Patients with generalized anxiety disorder and reaction to stress may wake up not rested. Early awakening in the mornings is not characteristic feature of this disorder and if it appears, it is necessary to assume that it is a part of depressive disorder.
Differential diagnosis
Anxiety disorder is not caused or does not meet the criteria of:
- Somatic disease, such as hyperthyroidism, hypoglycemia, pheochromocytoma. For excluding the thyrotoxicosis it is necessary to pay attention to such symptoms as enlargement of the thyroid gland, exophthalmos, and atrial fibrillation. Pheochromocytoma or hypoglycemia should be suspected in cases when anxiety symptoms arise incidentally without any observable situational reasons. The beginning symptoms of serious somatic diseases, such as oncological conditions, can be as well accompanied by the pronounced anxiety. It is particularly true for the patients whose relatives or friends died as a result of similar diseases. In such cases it is useful to ask the patient with anxiety whether he knows somebody who had similar symptoms. However, it is necessary to take into account here that the opposite diagnostic mistake can be committed: generalized anxiety disorder and reaction to stress with pronounced somatic symptoms of anxiety may be taken for somatic disease. In such cases, patients may undergo unnecessary and traumatic examinations, surgical interventions, etc., that can increase the uneasiness. The correct diagnosis is established more often if the doctor always remembers that palpitations, headaches, frequent micturition, discomfort in the stomach area may be the symptoms of generalized anxiety disorder and reaction to stress;
- Organic mental disorder or the disorder due to psychoactive substance use, such as the abuse of amphetamines or benzodiazepine withdrawal. Involutional depression or senile dementia is from time to time accompanied by the generalized anxiety. However, the characteristic memory disturbances allow making the exact diagnosis. Dependence on various medications or alcohol may also be accompanied by pronounced uneasiness. However this anxiety is stronger in the mornings while in general anxiety disorder and reaction to stress the uneasiness is not connected to the time of the day.
- Panic disorder and panic symptoms;
- Phobic anxiety disorders;
- Obsessive-compulsive disorder;
- Hypochondriacal disorder;
- Schizophrenia. Patients with schizophrenia may sometimes experience anxiety earlier than other symptoms are revealed. Quite often the questioning of the patient what he thinks of the reasons that caused these symptoms may help: the patient may name such unusual reasons that it gets possible to reveal the latent and characteristic for schizophrenia ideas;
- Depressive episode. Serious diagnostic mistakes are committed in the differential diagnostics of general anxiety disorder with agitated depression. These mistakes can be avoided if asking the disturbed patient the questions concerning depressive and suicide ideas. It is also necessary to remember that the symptoms of anxiety diagnosed as a part of depressive disorder are more strongly expressed in the morning.