Talk:Generalized anxiety disorder/Archive 1

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This article was the subject of a Wiki Education Foundation-supported course assignment, between 27 September 2018 and 14 December 2018. Further details are available on the course page. Student editor(s): Bchhan, Arh286, Tandenise, Ikozache.

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Wiki Education Foundation-supported course assignment

This article was the subject of a Wiki Education Foundation-supported course assignment, between 7 January 2019 and 26 April 2019. Further details are available on the course page. Student editor(s): Earnold97. Peer reviewers: Kwhitlow2413.

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Criticisms

The following was inserted underneath the criticisms but it doesn't seem NPOV - it reads like an opinion you would see posted on a forum in response to the criticisms. Needs some kind of rewrite. -- Barrylb 10:22, 15 March 2006 (UTC)

Despite this, it remains for a doctor to diagnose whether a person's condition warrants medical intervention. Every case will not uniquely fit the diagnostic criteria in the DSM IV-TR. In cases where there is some ambiguity as to whether a diagnosis of GAD should be made, counseling may be in order to see if the anxiety can be resolved without the use of medication. Drugs are not a quick fix, but they can and have significantly improved the lives of millions of people dealing with anxiety.

There is something here that does not appear in much literature. It can take a long time for anxiety to be recognised. What happens is that the sufferer has an armoury of excuses which sometimes seem to make sense. Social:"I am not washed - I havent time - my hair's a mess - I'm not presentable - I dont like X - I would be much happier reading a book - you are always going out - you never spend any time with me -" Literally hundreds. Ordinary household requirements: "I'll do it later, could you do it for me - let's have a takeaway tonight - let's have a lazy day - not on Saturday - not on Sunday - I'm tired right now - all you want is a maid - stop nagging " Again hundreds. What I am saying is that the tests for identifying are far too clumsy. The tests need to be expanded to basically cover the fact that every single time there is a posssible symptom of anxiety, there is an excuse. And to every suggestion there is a No. In other words, as an ailment the tests are not catching sufferers. And when it comes to CT there are rejections. "I dont want to go for a walk - I'm feeling very happy lying here - It's too wet to go out to the group - I'm not one of them - " Not only has the treatment no chance - the manufactured excuses lay the groundwork for denial of the condition once again. The ailment protects itself in the first place by refusing recognition through each-case-explanations and it fights back later with (objectively) each-case-explanations and specious muffins or star gazing

If it doesn't appear in much literature, then it probably doesn't belong on Wikipedia. Perodicticus 10:44, 22 September 2006 (UTC)

Very insightful but not suitable for Wikipedia. Can you not find any published sources explaining similar points? 131.111.161.185 (talk) 13:34, 13 April 2011 (UTC)

Perodicticus i could not understand what you were trying to say. Could you explain your point more simply? (Middleton, 12:11, 18 October 2006 (UNSW)

Hi, I am a student that just started editing. I noticed that in classification and external sources box there is no DSM link. Swimmermroe (talk) 18:03, 21 June 2013 (UTC)

Does the article need the caffeine elimination under treatment when it is in potential causes? Swimmermroe (talk) 18:06, 21 June 2013 (UTC)

First of all welcome, and have nice editing. Are sources reliable for this article, & in which section you want to put this, If you have reliable sources it would be good, I think. KhabarNegar ^Talk 18:47, 21 June 2013 (UTC)

Regarding the Risk Factors subsection "Oppression": Does this term seem inappropriate to anyone? It has political and moral connotations, and does not appear to be medical terminology. Furthermore, the risk factors mentioned in this section do not seem to be any better explained or organized under the umbrella term "oppression." Eg, divorced, unemployed, eldery, etc. Gomer2 (talk) 07:50, 6 March 2019 (UTC)

Yeah, it is weird and not in the source, I have fixed it.--Literaturegeek | T@1k? 13:47, 6 March 2019 (UTC)

References are needed

Too many statements are unreferenced. There should be references added here. JonesRD_talk 18:23, 18 March 2007 (UTC)

This form of denial seems to be a barrier to the prognosis of many types of mental illness, and not particularly specific or relevant to general anxiety disorder. 207.215.10.108 20:09, 21 October 2006 (UTC

I would like to see some natural/homeopathic treatment for GAD, maybe St. John's Wort or Omega 3's?

A discussion of st john's wort and other non-refined chemical therapies would be a good addition to this article. The "criticisms" article is definitely biassed against drug therapy for GAD, and I'm not sure the point about there being no proof that drugs help GAD is accurate. sarahj

Sarah: I agree with your observations. Further, I would emphasize your point that the article is biased against chemical intervention. In truth, the eliviation of symptoms via medication is typically necessary for the CBT interventions to work.

Also, I cleaned up the intro, so that each sentence didn't keep referencing the same article. Hope you approve. Cheers! DashaKat 13:12, 28 May 2007 (UTC)

I've merged the Introduction section into the lead and included sources. The rest of the article definitely needs work on being verified. GridEpsilon 05:12, 28 May 2007 (UTC)

This is improving now. JonesRD_talk 16:13, 28 May 2007 (UTC)

I looked through the references and many of them are not from a free source. For example these were the numbers of the references when I checked 5, 7, 10, 15, 21, 24, 27, 28, 32, 33, 46, 48, 49, 50. And many don't have a link, which can simply be to the wiki book page, these are easy to spot but when I checked there numbers were 3, 6, 11, 12, 13, 16, 17, 34, 40, 44. I think the non-free sources are hard to fix but important. Swimmermroe (talk) 17:01, 10 July 2013 (UTC)

Compare and contrast with panic disorder

I saw wrong things in Panic Disorder and this article should also be compared to Panic Disorder to help educate. —The preceding unsigned comment was added by 207.151.240.12 (talk) 18:34, 6 April 2007 (UTC).

Page name

The page has been renamed to Generalized anxiety disorder to reflect the name of the disorder. GridEpsilon 23:04, 28 May 2007 (UTC)

Mention pregabalin

Pregabalin merits a mention somewhere on this page, I think. Reb42 15:36, 21 July 2007 (UTC)

A previous poster gave Pregabalin its own section, filled with transparent marketing hoo-hah. I removed that and added it to the list of "Other Drugs" instead, as there's no reason it should get this special treatment. Details should be added to the Pregabalin article itself. --tgeller (talk) 18:13, 17 June 2010 (UTC)

I added it and I am certainly no shill for the drug companies. The content added is sourced to reviews of the medical literature, which is considered to be the best quality sources to use for medical content, per WP:MEDRS. I have an opposite view, my view would be there is no reason for well sourced content sourced to recent reviews to be deleted based on an editor saying it is "marketing hoo-hah". I am happy to discuss differing points of view if you still do not agree with the content being added to the article.--Literaturegeek | T@1k? 00:46, 15 July 2010 (UTC)

U.S.-based name for condition?

The article discusses only the DSM-IV standards and U.S. stats; this makes me wonder whether there is an international standard for this diagnosis or if this name is limited to the U.S. To clarify: For a condition such as ADHD, the DSM-IV has its criteria, while the condition and criteria are laid out differently by, say, ICD. I wasn't sure if some international criteria exist for GAD, or if the international community has a different break-out of the anxiety spectrum disorders. It would be good if the article addressed this, either by providing ICD standards or by identifying similar conditions existing in the ICD paradigm. Lawikitejana 23:00, 18 August 2007 (UTC)

The DSM is a subset of the ICD. Any linguistic differences are a function of the differences between UK English and US English. --DashaKat 15:08, 19 August 2007 (UTC)

this is not accurate. DSM is not a subset of ICD. Earlypsychosis (talk) 17:29, 20 March 2009 (UTC)

I agree that this page presents itself like GAD is an American illness. Maybe statistics of its prevalence in America should be included in a separate page, I am visualizing a page with statistics from other countries as well. Keep in mind this is not an American encyclopedia. It might be nice to be less narrow with the scope of the article. --QatBurglar (talk) 16:17, 26 January 2009 (UTC)

the article places an unbalanced emphasis on diagnosis classification - generalised anxiety as a distinct category, as outlined in DSM. There are other models of anxiety (e.g. cognitive specificity [doi:10.1016/j.physletb.2003.10.071] and Starcevic V, Berle D (2006). "Cognitive specificity of anxiety disorders: a review of selected key constructs". Depress Anxiety. 23 (2): 51–61. doi:10.1002/da.20145. PMID 16402368.) Earlypsychosis (talk) 17:28, 20 March 2009 (UTC)

Sources

Find sources: Google (books · news · scholar · free images · WP refs) · FENS · JSTOR · TWL

Bot report : Found duplicate references !

In the last revision I edited, I found duplicate named references, i.e. references sharing the same name, but not having the same content. Please check them, as I am not able to fix them automatically :)

• "WHO" :
  • WHO
  • [http://www.who.int/bulletin/pdf/2000/issue4/bu00-0485.pdf "Relating the burden of anxiety and depression to effectiveness of treatment"], World Health Organization.

DumZiBoT (talk) 15:02, 9 August 2008 (UTC)

Herbal : Picamilon

Picamilon is a less well known drug that anecdotaly is very effective at treating anxiety. People on the british drugs-forum site often say it's better than kava. It might be worth mentioning alongside kava sense kava is included. [I have used both and like them both]. The picamilon wikipedia article has some sources verifying its ability to treat generalized anxiety disorder.

http://en.wikipedia.org/wiki/Picamilon ~~unregistered [16 Feb 2009] —Preceding unsigned comment added by 157.182.186.112 (talk) 04:30, 17 February 2009 (UTC)

Copyright problems with diagnostic criteria

The American Psychiatric Association has not released its Diagnostic and Statistical Manual of Mental Disorders into public domain, but claims copyright. The Wikimedia Foundation has received a letter of complaint (Ticket:2010030910040817, for those with access) about the use of their diagnostic criteria in this and a number of other articles. Currently, this content is blanked pending investigation, which will last approximately one week. Please feel free to provide input at the copyright problems board listing during that time. Individuals with access to the books would be particularly welcome in helping to conduct the investigation. Assistance developing a plan to prevent misuse of the APA's material on Wikipedia projects would also be welcome. Thank you. Moonriddengirl ^(talk) 14:07, 11 March 2010 (UTC)

Generalized anxiety disorder a description

Generalized anxiety disorder (GAD) is an excessive anxiety and worry that is difficult to control, it cause’s serious distress or interferes with daily activities. GAD is considered to be a chronic disorder but is very common. It starts usually in young adulthood (20’s) and last through to the mid-50. Women are twice as likely as men to develop GAD.(June, 2008) This disorder can be triggered by events like anxiety provoking news such as a sagging economy, international political conflicts, and natural disasters, or dealing with personal stress for example worries about job security or health. There are many symptoms associated with this disorder such as restlessness or feeling on edge, tiring easily, difficulty concentrating, irritability, muscle tension, and sleep problems.(June, 2011) GAD was observed to be chronic for a decade or longer with deteriorations during times of stress. There have been many studies done to find the severity and length of GAD, for example one of these findings are that GAD patients tended to spend more time being anxious than did patients with panic disorder(2). Studies have gone back as far as Sigmund Freud trying to distinguish between definition, symptoms, causes, and length of this disorder. Some argue that GAD is genetic and is found because previous family members had the disorder, while others find that it is because of powerful social trends that account for the high levels of reported anxiety, notably the self-help and recovery movements.(July, 2009)

So to summarize the research I have done, Generalized Anxiety Disorder is a real disorder and is difficult to manage when you are a person that suffers from it. I feel there is a lot more research that can be done on this disorder as there are some differences in outcomes of studies, and also finding that the studies and research that have been done are somewhat out dated. The best description I found was the statement “People who worry about everything- and nothing in particular”. Generalized Anxiety Disorder

References Anderson DJ, NoyesR, Crowe RR (1984) A comparison of panic disorder and generalized anxiety disorder. Am J Psychiatry 141:572 576 Generalized anxiety disorder.(2011, June). Harvard Mental Health Letter, 27(12). Retrieved from ebscohost, ISSN 10575022, accession number 62806442. Database, academic premier. Ian R Dowbiggin PhD (2009, July)High Anxieties: The social construction of anxiety disorders, ISSN 07067436 accession number 44122580. Database, academic premier. Angst J, Gamma A, Baldwin DS, Gross AV, Rossler W. (2008, June).The generalized anxiety spectrum: prevalence, onset, course and outcome. ISSN 09401334, accession number 36533124. Database, academic premier. Doi:10.1007/s00406-008-0832-9 — Preceding unsigned comment added by Tazmaquila (talk • contribs) 09:35, 27 September 2011 (UTC)

Proposed merger

User:Blanchardb has suggested that Improvements in General Anxiety Disorder Symptoms with Physical Activity be merged into this article - but did not open a section on the talk page for this discussion, so here it is.

My point of view: User:ErinGrocott has just started working on this article. Let us give her some time to write the article, and then see if the merger still seems necessary, or if the article can stand on its own feet.Lova Falk talk 08:27, 23 October 2012 (UTC)

The article has been deleted, so the merger discussion is off. Lova Falk talk 10:01, 10 November 2012 (UTC)

Neutrality Issues Regarding Benzodiazepines

Hey all, as I'm reading this article it strikes me that there's maybe a disproportionate amount of anti-benzo bias here. For instance, the first time "benzodiazepine" appears in the article, apart from the table of contents, is in a sentence that begins "Long-term use of benzodiazepines can worsen underlying anxiety." I'm all for people being fully informed about the upsides and downsides of their medications; but, at the same time, how is that sentence the proper way to introduce a discussion of an entire family of anxiolytic drugs? Similarly, the actual "Benzodiazepine" section is front loaded with talk about how benzos cause cognitive impairment and make you do worse at school and on the job, etc., even before we get to an actual definition or description of the medication.

Let me be clear: I'm not defending benzos. I'm just trying to defend responsible and proportionally helpful dissemination of information. I would hate to think of someone recently diagnosed with GAD coming to this page and deciding--because they're by definition worrying excessively--that they're categorically going to rule out the use of benzodiazepines. I think this article, as written, encourages that kind of thinking. And I don't think it's our place to make medical decisions for other people--or to coerce them into making those decisions because we want our convictions taken seriously. That's not neutrality. — Preceding unsigned comment added by 2602:306:32C5:98C0:21E:C2FF:FEAB:F7AD (talk) 08:44, 11 January 2013 (UTC)

Thank you for your feedback! Neutrality though, is not the same as giving each side of an argument equal weight, it is giving more prominent viewpoints (as published in reliable sources) more weight. You can read more about this here. So, if you find reliable sources describing the advantages of benzo's (the best would be a review that discusses both the advantages and the disadvantages), please be bold and edit the article! With friendly regards, Lova Falk talk 16:25, 12 January 2013 (UTC)

Changes

As part of a psychology course, I will be editing this page. The good part is that, as part of the course, I will have to announce any edits on the talk page,so look for specifics in future posts. The other nice part is that before I can post anything, it will be reviewed by other students, my professor, and a TA. Langtor (talk) 16:31, 21 February 2013 (UTC)

Welcome! Please remember that Wikipedia is not an academic paper or essay! Wikipedia articles should not be based on WP:primary sources, but on reliable, published secondary sources (for instance, journal reviews and professional or advanced academic textbooks) and, to a lesser extent, on tertiary sources (such as undergraduate textbooks). WP:MEDRS describes how to identify reliable sources for medical information, which is a good guideline for many psychology articles as well. With friendly regards, Lova Falk talk 17:40, 23 February 2013 (UTC)

Copy Editing

As part of my assignment for my course, I was asked to copy edit the article and offer my advice on how to improve the article. I have fixed some sentence structures, punctuation, and spelling errors and now I will offer some ideas here on the talk page. I noticed that in some of the sections, new terms or types of treatment were written out but there were no links. An example would be the components of CBT. Though each component was explained, adding links to their respective pages for more information would be helpful. On the same vein, there should be a link for The World Council of Anxiety.

Adding something explaining metaworry (worrying about worrying) that goes along with GAD and the circular thinking of anxiety that is similar to depression could be a beneficial add to the article.

I also noticed that under SSRIs, it is explained that these are antidepresent drugs, but this section doesn't explain why the antidepresents actually help with anxiety, so adding more information on this could clear up confusion for the readers. Also there is no explanation for why the Other Drugs section is useful in treating GAD or why eliminating caffeine helps. Thank you for your time! BriannaMaxim (talk) 18:51, 6 May 2013 (UTC)

Baribiturate section

As part of my assignment for my course, I was asked to update this article with information that may be missing. I included a section regarding barbiturates under the treatment section as it does have a history with GAD and ties into the topic of benzos. Please let me know if there are any signs of non-neutral text or if anything is missing or superfluous. Thanks for your time. Mortona8 (talk) 20:19, 6 May 2013 (UTC)

Propose of better organization for the Treatment section

Hi guys! I am working on this article as part of my class assignment. I have an opinion regarding the structure of the Treatment section. I think it would be better if there are 3 sections (psychotherapy, pharmaceutical treatments, caffeine elimination)instead of 5. I came up with this because SSRI, Pregabalin and other drugs mentioned here are all pharmaceutical treatments, so it seems awkward to be listed separately. Please write a comment about my suggestion! Thank you Saehee0908 (talk) 17:51, 11 June 2013 (UTC)

I don't think combining the three is a good idea, the two are different classes of drug, thus different method of treatment. Raquel Baranow (talk) 22:21, 12 June 2013 (UTC)

I believe that while they are separate forms of treatment, SSRIs, Pregbalin, Benzodiazepines, and the Other drugs sections could be better served with a header "Pharmacological Treatments" in the same way that Psychotherapy is headed and divided into several different methods of therapy treatment. If anyone else feels that the current organization is better, please feel free to weigh in. Mortona8 (talk) 00:14, 18 June 2013 (UTC)

There should be a section added to treatment on Complementary and Integrative medicine, in the meantime I added an external reference to the National Center for Complementary and Integrative Health. If anyone wants to write it get in touch and I can give you the best references for it.~~ — Preceding unsigned comment added by HealthLibrarian (talk • contribs) 17:30, 7 November 2018 (UTC)

Good evening, I know it's rather late, but I am working on this article for a class assignment. I noticed that there was a need for further citation, and reference to any potential treatment differences regarding cognitive behavioral therapy, and medication management. I was curious to know whether any further meta-analyses have been examined to procure further evidence for the statement referencing no significant differences between cognitive behavioral therapy, and SSRIs etc. I am new to this whole environment and appreciate any and all advice, criticism, and consideration regarding the material within this article. Thank you all. Earnold97 (talk) 06:29, 28 January 2019 (UTC)

Comorbidity section

Hello this is Swimmermroe (talk) 22:41, 29 June 2013 (UTC), I just added to and edited the comorbidity section. Including the addition of a GAD and depression subtitle, which I think will be very useful if we can get some more info for this section. I also marked two places where citation is needed. I am thinking that a section is needed for substance abuse and another for stress related symptoms. Although currently there is not enough information to warrant a title. If there is enough information for ADHD comorbidity then a section for that as well but otherwise merely an other section would suffice.Swimmermroe (talk) 23:33, 1 July 2013 (UTC)

Hi this is Swimmermroe (talk) 16:55, 10 July 2013 (UTC) again, I am thinking about having a section under comorbidity about the implications of comorbidity on treatment. I have done a little research but not nearly enough for a section, any suggestions?

I definitely think the comorbidity section is relevant, and I also think the addition of a section under the comorbidity section on the effects of treatment would be helpful. I propose the insertion of information from a study on comorbidity with GAD and disorders previously mentioned, that explains treatments were just as helpful for those with only GAD and those symptoms of other disorders (panic disorder, phobias etc.) as well. This information seems necessary with the addition of the comorbidity section to better understand the effects of comorbidity and GAD. --Sg0414 (talk) 00:59, 18 April 2015 (UTC)

Suggestions for improving the article

I believe that this article is very well written, however I do have a few suggestions for improving its quality. First, under the prevalence rates for Canada there needs to be a citation, maybe look at references 8, 9, or 4 for data. Under the heading of ‘Potential causes’ there is a suggestion that GAD may have a potential genetic component, I think it would be beneficial to do some research and create a subheading that explains the genetic predisposition of GAD, it could be a great time to talk about the nature versus nurture effect on the causes of GAD. Also, under the ‘Intolerance of uncertainty therapy’ there is a link to a main article of the same name that does not exist, I suggest to take down the link. Additionally, in the ‘Other drugs’ section there is a list of the psychotropic drugs that are used as a treatment of GAD but there are no citations that provide a reference to whether these drugs are actually used and their effectiveness that the reader could refer back to if needed, I also feel that the list might be unhelpful to the reader because it contains a lot of complicated pharmaceutical terminology, I would suggest to maybe provide more clarification as to how these drugs work.Villasa4 (talk) 05:42, 14 July 2013 (UTC)

Thanks! I have been looking at improving the citations, and I just removed that broken link. The genetics sub-section is a good idea, and I think your right there needs to be a little explanation in the pharmaceutical section. Although the links to other pages do give in depth explanation. Swimmermroe (talk) 16:54, 15 July 2013 (UTC)

Potential Causes section

I recently added a 'hereditary' section to potential causes. I also moved some information from epidemiology to another new 'other' section. I will be adding a small amount of information and 2 sources to the hereditary section. Swimmermroe (talk) 20:20, 23 July 2013 (UTC)

Assessment and Diagnosis Sandbox Edits for Generalized Anxiety Disorder

Hello all, I have made changes in my Sandbox about this topic focusing on evidence-based assessment and diagnosis. It would be great if people would look at it and leave comments on my talk page before I post it on the article.

The sandbox link can be found here (https://en.wikipedia.org/wiki/User:Aldole15/sandbox).

I appreciate it! YenLingChen (talk) 20:45, 3 November 2014 (UTC)

see Talk:Autism_spectrum#Assessment_and_Diagnosis_Sandbox_Edits_for_Autism_Spectrum_Disorder Jytdog (talk) 00:17, 4 November 2014 (UTC)

and see User_talk:YenLingChen Jytdog (talk) 00:20, 4 November 2014 (UTC)

addition to "other"

384400k about this dif - this is really WP:TECHNICAL - can you please rewrite in plain Englsh? To be frank I don't even understand it.  :) thanks. Jytdog (talk) 14:33, 11 December 2014 (UTC)

DSM and ICD criteria

I think there may be a problem with the criteria, but I wanted to check before rushing in and making a silly edit. First of all, in 2010 the DSM material was apparently removed because of copyright problems. Has it come back unintentionally, or is the copyright issue now resolved somehow?

The other question relates to the ICD criteria. The linked page "F41.1" doesn't contain the text which has been quoted. Instead there is a general description of GAD but no actual list of criteria. I'm not sure if this is because the ICD doesn't give lists of criteria in the way the DSM does, or if the link just points to an unhelpful place.

Pchown (talk) 22:36, 29 April 2015 (UTC)

I have found some interesting information about the history of the diagnosis that I will be adding in the coming days. Should this go in the diagnosis section of in a separate section?Jcantrell67 (talk) 04:46, 21 April 2016 (UTC)

NEJM review

doi:10.1056/NEJMcp1502514 JFW | T@lk 14:14, 19 November 2015 (UTC)

WikiProject Autism???

Can someone please explain to me how this article fits within the scope of WikiProject: Autism? As someone with generalized anxiety disorder I find this kind of offensive. It's ridiculous, I would like an explanation, please. ThatGirlTayler (talk) 20:06, 31 March 2017 (UTC)

ICD-10 criteria

This section has the reference before the content and I don't a problem with this. But the content that follows the reference is not contained in the source. Am I understanding this correctly?

Best Regards,

Barbara (WVS) ✐ ✉ 22:18, 17 April 2017 (UTC)

You are refering to this[1]?

Have added a better ref Doc James (talk · contribs · email) 22:57, 17 April 2017 (UTC)

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Pregabalin contradiction

I just noticed that the article is contradictory about the effects of pregabalin:

Pregabalin (Lyrica) acts on the voltage-dependent calcium channel ... Its therapeutic effect appears after 1 week of use ...

and

The anxiolytic effects of pregabalin appear rapidly after administration, closer to the benzodiazepines in time of onset (albeit perhaps one hour slower), which gives pregabalin an advantage over many anxiolytic medications such as antidepressants.

If someone knows which of these is right, perhaps they could clarify the article. — Preceding unsigned comment added by Pchown (talk • contribs) 11:15, 26 September 2018 (UTC)

I suspect one reference was misrepresented. I changed it.--Literaturegeek | T@1k? 01:04, 28 September 2018 (UTC)

Benzo

User:Ikozache about this and this please use secondary sources per WP:MEDRS and please read WP:EDITORIALIZING. Thanks. Jytdog (talk) 18:01, 11 October 2018 (UTC)

Pharmacological Treatment for Generalized Anxiety Disorder

Group 21 of UCSF's School of Pharmacy Health Policy class will update the portion of the article involving the pharmacotherapy of generalized anxiety disorder. This will include details of different medications used for generalized anxiety disorder based on guidelines and evidence-based medicine. This includes information collected from American Psychiatric Association (APA), as well as other case-studies and clinical trials. Tandenise (talk) 05:26, 17 October 2018 (UTC)

Some changes and additions were made to the Selective Serotonin Reuptake Inhibitor section. This is the new information that was added: Pharmaceutical treatments for GAD include selective serotonin reuptake inhibitors (SSRIs). These are the preferred first line of treatment. FDA approved SSRIs used for this purpose include escitalopram and paroxetine. However, consider offering sertraline first due to it's cost-effectiveness compared to other SSRIs used for generalized anxiety disorder and a lower risk of withdrawal compared to SNRIs. If sertraline is found to be ineffective, then it is recommended to try another SSRI or SNRI.

Common side effects include nausea, sexual dysfunction, headache, diarrhea, constipation, restlessness, increased risk of suicide in young adults and adolescents, among others. Sexual side effects, weight gain, and higher risk of withdrawal are more common in paroxetine than escitalopram and sertraline. In older populations or those taking concomitant medications that increase risk of bleeding , SSRIs may further increase the risk of bleeding. Overdose of an SSRI or concomitant use with another agent that causes increased levels of serotonin can result in serotonin syndrome., which can be life threatening. Tandenise (talk) 18:43, 2 November 2018 (UTC)

We intend to add a table with all of the pharmacological treatment options as a quick visual summary of the drug options. — Preceding unsigned comment added by Arh286 (talk • contribs) 19:04, 2 November 2018 (UTC)

New information added to the other medications section: Buspirone is an FDA approved first line agent, to be used if SSRI/SNRIs are contraindicated or fail as a treatment. Like the SSRI/SNRIs buspirone has a 2-4 week delayed onset of action and a maximum benefit seen at 4-6 weeks. Common side effects include dizziness, nausea, and headache. This is a well-tolerated drug with no sedation or sexual side effects, which are commonly seen with SSRI/SNRIs. However, buspirone is not as effective in patients who have been previously treated with benzodiazepines.

Lifestyle

Group 21 of UCSF's School of Pharmacy Health Policy class would like to add an additional heading titled "Lifestyle".

Lifestyle factors including stress management, stress reduction, relaxation, exercise, sleep hygiene, caffeine, and alcohol can influence the persistence of anxiety. Bchhan (talk) 19:25, 2 November 2018 (UTC)

Serotonin norepinephrine reuptake inhibitors

Group 21 of UCSF's School of Pharmacy Health Policy class would like to add an additional heading titled "Serotonin norepinephrine reuptake inhibitors" under the medications section. Whereas now the SNRIs are only mentioned under other psychiatric medications, we would like to add some information on this important class of medications.

Serotonin norepinephrine reuptake inhibitors

First line Pharmaceutical treatments for GAD also include serotonin norepinephrine reuptake inhibitors (SNRIs). FDA approved SNRIs used for this purpose include duloxetine (Cymbalta) and venlafaxine (Effexor). Despite their efficacy, many psychiatrists prefer to use SSRIs first in the treatment of Generalized Anxiety Disorder. Side effects common to both SNRIs include nausea, weight loss, insomnia, dizziness, drowsiness, sweating, dry mouth and weakness. Sexual side effects like those of the SSRIs are also common with SNRIs.

Ikozache (talk) 22:19, 2 November 2018 (UTC)

"Despite their efficacy, many psychiatrists prefer to use SSRIs..." this sounds a bit as if SNRIs are more efficient than SSRI. The - to my knowledge - most recent systematic review on SSRI/SNRI in GAD doesn't support this: https://www.bmj.com/content/342/bmj.d1199).

Lucleon (talk) 22:41, 2 November 2018 (UTC)

Hi! Thanks for your insight. Perhaps we should say 'Despite comparable efficacy...'? ikozache — Preceding unsigned comment added by Ikozache (talk • contribs) 21:46, 8 November 2018 (UTC)

Pharmacy Student Peer Reviews

Peer Review by Group 9:

1) Does the draft submission reflect a neutral point of view? If not, specify...

I thought that most edits were very neutral! There is only one I'd like to comment on. Under "Selective serotonin reuptake inhibitors" the sentence that says "However, consider offering sertraline first..." The wording here seems a little persuasive to me. Maybe consider rewording it to say something like "Sertraline is considered a good first choice because..." Not sure if this is too nit-picky, but this was the only edit that seemed somewhat un-neutral to me. Besides that, really great and informative edits!

-Colleen mccann (talk) 02:00, 7 November 2018 (UTC)

2) Are the points included verifiable with cited secondary sources that are freely available? If not, specify...

Links to the NICE guidelines are freely available and well-cited. However, there are added citations to the Applied Therapeutics textbook, which is not freely accessible. Also, the addition of the “Lifestyle” subheading has information that completely lacks references. --Dumbpepper (talk) 00:19, 9 November 2018 (UTC)Dumbpepper

3) Are the edits formatted consistent with Wikipedia’s manual of style? If not, specify… For the most part, I think that my peers did a great job in making their edits consistent with the Wikipedia’s manual of style. I have suggested some minor revision listed below! I have also added more general suggestions for the article as a whole as well.

“Stress is a factor that can trigger anxiety, therefore keeping stress levels low through stress management, stress reduction, and relaxation may be beneficial. Physical activity has shown to have a positive impact whereas low physical activity may be a risk factor for anxiety disorders.”

•Consider ending the sentence after anxiety with a period. Then continue on with “Therefore, keeping […]. •Consider adding a comma between impact and whereas.

“Lifestyle factors including stress management, stress reduction, relaxation, exercise, sleep hygiene, caffeine, and alcohol can influence the persistence of anxiety.” •Consider using a colon to list the different lifestyle stress management allowing for an easier read for the reader. •Example: “Lifestyle factors including: stress management, stress reduction, relaxation, exercise, sleep hygiene, caffeine, and alcohol can influence the persistence of anxiety.”

“Buspirone is an FDA approved first line agent, to be used if SSRI/SNRIs are contraindicated or fail as a treatment. Like the SSRI/SNRIs buspirone has a 2-4 week delayed onset of action and a maximum benefit seen at 4-6 weeks. Common side effects include dizziness, nausea, and headache. This is a well-tolerated drug with no sedation or sexual side effects, which are commonly seen with SSRI/SNRIs. However, buspirone is not as effective in patients who have been previously treated with benzodiazepines.” •Consider changing “an” to “a” •Consider revising the first sentence for smoother read to: “Burspirone is a FDA approved first line agent if SSRIs or SNRIs are contraindicated or have failed as first line treatment.” •Consider adding a comma in between SSRIs/SNRIs and buspirone in the second sentence. •Consider revising to “[…] buspirone has a delayed onset of action of 2 to 4 weeks and a maximum benefits seen at 4 to 6 weeks.”

“Notably, there have been two reported cases of death associated with benzodiazepine withdrawal, although they may be confounded by the presence of concomitant medications.”

•Consider ending the sentence at “withdrawal” with a period. The continue with “Although […]” in another sentence. Also consider replacing “they” to “these reported cases”.

General recommended edits for the article: - Wikipedia’s manual of style: •When you list via bullets or numbers, you should have a consistent layout Edits to be made: •Section: Other comorbidities oThe bullet for Italy is not consistent with the other bullet points for the other counties oIn addition, most of the bullets included the percentage that was associated with adults (ex: Australia, Canada, and United States); However, Italy and Taiwan only includes the percentage with no age group associated with it oAlso, throughout the whole article, the percentage was presented as the symbol %; the bullet points should also change the word percentage with the actual symbol

- Wikipedia’s manual of style: •Should not have spaces in between the commas and the sentence preceding it Edits to be made: •Section: Selective serotonin reuptake inhibitors o“[…] risk of bleeding , SSRIs may further increase the risk of bleeding.” Remove the additional between “bleeding” and the comma

- Wikipedia’s manual of style: •The work “current” should be avoided in the body of the article. This is because things change with time. So it is unclear was is technically “current” and what is not. Edits to be made: •Section: Cognitive Behavioral Therapy o“Finally, problem solving focuses on dealing with current problems […]” o“Therefore, there’s a need for enhancement of current components of CBT”. o Current should be specified Grracelee (talk) 19:51, 8 November 2018 (UTC)

4) Is there any evidence of plagiarism or copyright violation? If yes, specify...

-In the section: Cognitive Behavioral Therapy: the citation for sentence 1 [39] is not accessible to the general public. -The section: Cognitive Behavioral Therapy does not have enough in-text citations to be reliable. The citation [41] references a book but does not provide page numbers. -There does not seem to be any plagiarism in the section: Selective Serotonin Reuptake Inhibitors. However, the sentence: "Overdose of an SSRI or concomitant use with another agent that causes increased levels of serotonin can result in serotonin syndrome, which can be life threatening" requires a citation. -In the section "Benzodiazepines," the sentence: "Benzodiazepines are most often prescribed to people with generalized anxiety disorder" needs a citation (also I'm not sure if that's true). -Citation [57] is not freely accessible to the general public. JenniferKaiser2020 (talk) 23:25, 8 November 2018 (UTC)

 — Preceding unsigned comment added by Colleen mccann (talk • contribs) 01:24, 7 November 2018 (UTC) 

Peer Review By Group 29:

1. Does the draft submission reflect a neutral point of view? If not, specify… The section does have a neutral point of view. One change I would modify is the wording of "consider offering sertraline first" as this is persuasive, maybe reword this as "guidelines suggest trying sertraline first"Laurencline (talk) 20:31, 7 November 2018 (UTC)

2.Are the points included verifiable with cited secondary sources that are freely available? If not, specify… The points included are verifiable with cited secondary sources. All the sources cited for this edit are freely available except "Koda-Kimble and Young’s applied therapeutics : the clinical use of drugs (10 ed.). LIPPINCOTTWILLIAMS &WILKINS. 2013. ISBN 978-1-60913-713-7". This is a textbook that is not free and it is a tertiary source. Jetuaimer (talk) 21:48, 7 November 2018 (UTC)

3.Are the edits formatted consistent with Wikipedia’s manual of style? If not, specify… -Pertaining to only my classmates edits. The lifestyle section is missing the proper references. For the SNRI section, the "P" in pharmaceutical does not have to be capitalized, potentially include links to the brand name drugs but its not required. In this same section General Anxiety Disorder does not have to be capitalized. Please see https://en.wikipedia.org/wiki/Wikipedia:Manual_of_Style#Capital_letters for more info. In regards to the buspirone section, potentially consider separating it from the "Other psychiatric medications", Wikipedia's manual of style has an emphasis of retaining existing styles, it would seem more appropriate to add buspirone to the detailed list of medications. ThomasLeung1 (talk) 02:01, 8 November 2018 (UTC)

4. Is there any evidence of plagiarism or copyright violation? If yes, specify. There is no evidence of plagiarism or copyright violation. All of the additional comments included by our respective peers were cited. Skimming through the articles they referenced, I also did not see any copying/pasting, or close paraphrasing. Sallytpham (talk) 17:11, 8 November 2018 (UTC)