Hostname: page-component-848d4c4894-75dct Total loading time: 0 Render date: 2024-04-30T18:43:10.025Z Has data issue: false hasContentIssue false
  • English
  • Français

The spectrum of generalised anxiety in clinical practice: the role of short-term, intermittent treatment∗

Published online by Cambridge University Press:  06 August 2018

K. Rickels  and
E. Schweizer
Get access Rights & Permissions [Opens in a new window]

Abstract

Background DSM–IV generalised anxiety disorder (GAD) has a high lifetime prevalence, but subthreshold anxiety states are even more common, particularly in family practice.

Method Generalised anxiety is conceptualised as a spectrum of disorders, with transient anxiety at one end and GAD at the other.

Results Based on longterm experience with family practice patients, the authors suggest that most anxious patients, wherever on this continuum they are placed, could be treated with short-term, possibly intermittent, rather than chronic anxiolytic therapy. Data are presented which show that 50% of chronic GAD patients are only in need of such short-term intermittent therapy.

Conclusions Further clinical research is needed to refine short-term, intermittent treatments for anxiety spectrum disorders, to make effective treatments available to those suffering from anxiety but falling short of diagnostic criteria for GAD, and to target more effectively the different treatment strategies.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 173 , Issue S34: Recognition and management of anxiey syndromes , July 1998 , pp. 49 - 54
Copyright
Copyright © The Royal College of Psychiatrists, 1998 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM–IV). Washington, DC: APA.Google Scholar
Angst, J. & Hochstrasser, B. (1994) Recurrent brief depression: the Zurich study. Journal of Clinical Psychiatry, 55 (suppl. 4), 3–9.Google Scholar
Blazer, D. G., Hughes, D., George, L. K., et al (1991) Generalized anxiety disorder. In Psychiatric Disorders in America: The Epidemiologic Catchment Area Study (eds L. N. Robins & D. A. Regier), pp. 180–203. New York: The Free Press.Google Scholar
Cutler, N. R., Sramek, J. J., Keppel-Hesselink, J. M., et al (1993) A double-blind, placebo-controlled study comparing the efficacy and safety of ipsapirone versus lorazepam in patients with generalized anxiety disorder: a prospective multicenter trial. Journal of Clinical Psychopharmacology, 13, 429–437.Google Scholar
Downing, R. W. & Rickels, K. (1974) Mixed anxiety-depression: fact or myth? Archives of General Psychiatry, 30, 312–317.CrossRefGoogle ScholarPubMed
Enkelmann, R. (1991) Alprazolam versus buspirone in the treatment of outpatients with generalized anxiety disorder. Psychopharmacology, 105, 428–432.Google Scholar
Fifer, S. K., Mathias, S. D., Patrick, D. L., et al (1994) Untreated anxiety among adult primary care patients in a health maintenance organization. Archives of General Psychiatry, 51, 740–750.Google Scholar
Fontaine, R., Chouinard, G. & Annable, A. (1984) Rebound anxiety in anxious patients after abrupt withdrawal of benzodiazepine treatment. American Journal of Psychiatry, 141, 848–852.Google Scholar
Freeman, E. W., Rickels, K. M., Sondheimer, S. J., et al (1995) A double-blind trial of oral progesterone, alprazolam, and placebo in treatment of severe premenstrual syndrome. Journal of American Medical Association, 274, 51–57.Google Scholar
Hamilton, M. (1959) The assessment of anxiety states by rating. British Journal of Medical Psychology, 32, 50–55.Google Scholar
Hesbacher, P., Rickels, K., Rial, W., et al (1976) Psychotropic drug prescription in family practice. Comprehensive Psychiatry, 17, 607–615.Google Scholar
Hoehn-Saric, R., McLeod, D. R. & Zimmerli, W. D. (1988) Differential effects of alprazolam and imipramine in generalized anxiety disorder: somatic versus psychic symptoms. Journal of Clinical Psychiatry, 49, 293–301.Google Scholar
Hollister, L. E., Muller-Oerlinghausen, B., Rickels, K., et al (1993) Clinical uses of benzodiazepines. Journal of Clinical Psychopharmacology, 13, 1S–169S.Google Scholar
Kahn, R. J., McNair, D. M., Lipman, R. S., et al (1986) Imipramine and chlordiazepoxide in depressive and anxiety disorders. II: Efficacy in anxious outpatients. Archives of General Psychiatry, 43, 79–85.Google Scholar
Keller, M. B., Lavori, P. W., Endicott, J., et al (1984) Double depression: two year follow-up. American Journal of Psychiatry, 140, 689–694.Google Scholar
Lucki, I., Rickels, K. & Geller, A. M. (1986) Chronic use of benzodiazepines and psychomotor and cognitive test performance. Psychopharmacology, 88, 426–433.Google Scholar
Lydiard, B. R., Ballenger, J. C. & Rickels, K. (1997) A double-blind evaluation of the safety and efficacy of abecarnil, alprazolam, and placebo in outpatients with generalized anxiety disorder. Journal of Clinical Psychiatry, 58 (suppl. 11), 11–18.Google Scholar
Mandos, L. A., Rickels, K., Cutler, N., et al (1995) Placebo controlled comparison of the clinical effects of rapid discontinuation of ipsapirone and lorazepam after 8 weeks of treatment for generalized anxiety disorder. International Clinical Psychopharmacology, 10, 251–256.Google Scholar
Murphy, S. M., Owen, R. & Tyrer, S. P. (1989) Comparative assessment of efficacy and withdrawal symptoms after 6 and 12 weeks’ treatment with diazepam or buspirone. British Journal of Psychiatry, 154, 529–534.CrossRefGoogle ScholarPubMed
NIMH Consensus Conference (1984) Drugs and insomnia. Journal of the American Medical Association, 251, 2410–2414.Google Scholar
Olfson, M., Broad head, W. E., Weissman, M. M., et al (1996) Subthreshold psychiatric symptoms in a primary care group practice. Archives of General Psychiatry, 53, 880–886.Google Scholar
Pecknold, J. C., Matas, M., Howarth, B. G., et al (1989) Evaluation of buspirone as an antianxiety agent: buspirone and diazepam vs. placebo. American Journal of Psychiatry, 34, 766–771.Google Scholar
Rickels, K. (1985) Alprazolam in the management of anxiety. In Drug Treatment of Neurotic Disorders – Focus on Alprazolam (eds M. H. Lader & H. C. Davies), pp. 84–93. Edinburgh: Churchill Livingstone.Google Scholar
Rickels, K., Wiseman, K., Norstad, N., et al (1982) Buspirone and diazepam in anxiety: a controlled study. Journal of Clinical Psychiatry, 43, 81–86.Google Scholar
Rickels, K., Case, W. G., Downing, R. W., et al (1983) Long term diazepam therapy and clinical outcome. Journal of the American Medical Association, 250, 767–771.Google Scholar
Rickels, K., Case, W. G., Downing, R. W., et al (1998) One-year follow-up of anxious patients treated with diazepam. Journal of Clinical Psychopharmacology, 6, 32–36.Google Scholar
Rickels, K., Fox, I. L., Greenblatt, D. J., et al (1988) Clorazepate and lorazepam: clinical improvement and rebound anxiety. American Journal of Psychiatry, 145, 312–317.Google Scholar
Rickels, K., Schweizer, E., Csanalosi, I., et al (1988) Long-term treatment of anxiety and risk of withdrawal: prospective comparison of clorazepate and buspirone. Archives of General Psychiatry, 45, 444–450.Google Scholar
Rickels, K., Schweizer, E. (1990) The clinical course and longterm management of generalized anxiety disorder. Journol of Clinical Psychopharmacology, 10, 101S–110S.Google Scholar
Rickels, K., Schweizer, E., Case, W. G., et al (1990) Long-term therapeutic use of benzodiazepines. I. Effects of abrupt discontinuation. Archives of General Psychiatry, 47, 899–907.Google Scholar
Rickels, K., Downing, R., Schweizer, E., et al (1990) Antidepressants for the treatment of generalized anxiety disorder: a placebo-controlled comparison of imipramine, trazodone and diazepam. Archives of General Psychiatry, 50, 884–895.Google Scholar
Rickels, K. & Schweizer, E. (1995) Maintenance treatment studies in anxiety disorders: some methodological notes. Psychopharmacology Bulletin, 31, 115–123.Google Scholar
Rickels, K. & Schweizer, E., DeMartinis, N., et al (1997) Gepirone and diazepam in generalized anxiety disorder: a placebo-controlled trial. Journal of Clinical Psychopharmacology, 17, 272–277.Google Scholar
Robinson, D. S., Rickels, K., Feighner, J., et al (1990) Clinical effects of the 5-HTIA partial agonists in depression: a composite analysis of buspirone in the treatment of depression. Journal of Clinical Psychopharmacology, 10, 67S–76S.Google Scholar
Schweizer, E., Rickels, K., Case, W. G., et al (1990) Long-term therapeutic use of benzodiazepines. II. Effects of gradual taper. Archives of General Psychiatry, 47, 908–915.Google Scholar
Shepherd, M., Cooper, B., Brown, A. C., et al (1966) Psychiatric Illness in General Practice, pp. 78–81. London: Oxford University Press.Google Scholar
Sherbourne, C. D., Wells, K. B., Meredith, L. S., et al (1996) Comorbid anxiety disorder and the functioning and well-being of chronically ill patients of general medical providers. Archives of General Psychiatry, 53, 889–895.Google Scholar
Small, G. W. & Bystritsky, A. (1997) Double-blind, placebo-controlled trial of two doses of abecarnil for geriatric anxiety. Journal of Clinical Psychiatry, 58 (suppl. 11), 24–29.Google Scholar
Spitzer, R. L., Williams, J. B., Kroenke, K., et al (1994) Utility of a new procedure for diagnosing mental disorders in primary care. Journal of the American Medical Association, 272, 1749–1756.Google Scholar
Winokur, A., Rickels, K., Greenblatt, D. J., et al (1980) Withdrawal reaction from long-term low-dosage administration of diazepam. Archives of General Psychiatry, 37, 101–105.Google Scholar
Wittchen, H-U., Zhao, S., Kessler, RC., et al (1994) DSM–III–R generalized anxiety disorder in the national comorbidity survey. Archives of General Psychiatry, 51, 355–364.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.