Dissolving the burden of generalized anxiety disorder.

Generalized anxiety disorder (GAD) is a common disorder marked by excessive anxiety, worry, and somatic manifestations lasting over 6 months. GAD occurs relatively early in life in the majority of individuals; it is often chronic and comorbid with other anxiety disorders, affective disorders, and/ or medical conditions. GAD is as functionally debilitating as major depression even without comorbidity and, hence, is associated with considerable economic and societal burdens as well as health care utilization. Underrecognition of GAD and undertreatment of this disorder are major factors contributing to the individual and societal burden of GAD. Earlier long-term studies in GAD reported low remission rates despite treatment. More recent data support the potential for achieving remission in GAD with appropriate treatment. There is a critical need to enhance mental health literacy programs and translate the efficacy data into effectiveness schemes in clinical practice by improving disease management strategies. A conceptual basis for achieving these goals is provided by moving from a disorder model to a disease model in psychiatric practice. This move allows for staging of psychiatric illnesses, with GAD as a prototypical example. For the clinician, the critical paradigm shift is in modifying the treatment goal from the attenuation of symptoms, as in a "response," to the achievement of a state of "remission" (i.e., a virtually asymptomatic state). Remission of symptoms allows for improvement of psychosocial functioning and quality of life and potentially wellness. In this review, a synopsis of the epidemiology, natural history, economic and social cost, and clinical management issues is given as a road map to dissolving the burden of GAD.