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ME/CFS since 1995; activity level 6?
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Generalized Anxiety Disorder
Murray B. Stein, M.D., M.P.H., and Jitender Sareen, M.D.
N Engl J Med 2015; 373:2059-2068November 19, 2015
I think that this piece is related to a recent diagnostic quiz in the journal, which alarmed but did not entirely surprise me in that it offered a list of psychiatric diagnoses but not a single physiological one.
It makes several claims for 'evidence', based on research that I suspect is of poor quality as it sounds oh-so-familiar.
This conflict of interest is given at the end:
Some other quotes that cause me to question the validity of the claims and general psychiatric gist of the piece are:
Isn't worrying excessively the definition of GAD? The reference to chronic gastrointestinal symptoms is a big clue IMO, which is not adequately addressed in this article. Having personally reduced my anxiety levels dramatically through diet and supplements, and read of others who have done the same, it seems extremely remiss for the authors not to mention this. Has it not yet filtered through to such a respected journal as the NEJM? Instead they are allowing an article that promotes the usual dubious 'evidence' and the usual treatments, which have very limited efficacy IME and IMO, and some can be dangerous.
So why should it be encouraged? Shades of PACE here...
When I was an anxiety-ridden child there were no computers and very little on TV. My time was spent making my own entertainment, which included country walks. I did, however, have gastrointestinal problems and a diet full of sugar and starch. Did children only start getting GAD when computers and smartphones were invented? I don't think so.
The authors say it's OK. So that's all right then.
Really? I haven't heard about this, but have heard about increasing evidence for SSRIs increasing suicidality, amid withholding of data about this risk. I think it involves unpublished studies.
Murray B. Stein, M.D., M.P.H., and Jitender Sareen, M.D.
N Engl J Med 2015; 373:2059-2068November 19, 2015
I think that this piece is related to a recent diagnostic quiz in the journal, which alarmed but did not entirely surprise me in that it offered a list of psychiatric diagnoses but not a single physiological one.
It makes several claims for 'evidence', based on research that I suspect is of poor quality as it sounds oh-so-familiar.
This conflict of interest is given at the end:
Dr. Stein reports receiving consulting fees from Janssen, Pfizer, and Tonix Pharmaceuticals, and from Care Management Technologies for providing a review of health service protocols.
Some other quotes that cause me to question the validity of the claims and general psychiatric gist of the piece are:
In primary care, patients with this disorder often present with physical symptoms such as headaches, muscle tension, gastrointestinal symptoms, back pain, and insomnia.
another peak of new-onset cases occurs in older adulthood, often in the context of chronic physical health conditions.
The predominant presentation in primary care (rather than mental health) settings is physical symptoms such as headaches or gastrointestinal distress.5 In children, generalized anxiety disorder often manifests as recurrent abdominal pain and other somatic symptoms6 that may cause them to stay out of school.
Er, where are the mental illnesses in that lot?Patients with generalized anxiety disorder have increased risks of other mental and physical health conditions (e.g., chronic pain syndromes, asthma or chronic obstructive pulmonary disease, and inflammatory bowel disease).9
Actually this seems to me to be more of a typical issue with doctors, who are unable to say "I don't know." Perhaps they project this onto their patients - this is claimed to be a common psychological problem - mistaking your psychological problems/fears as being someone else's!A psychological construct known as intolerance of uncertainty — the tendency to react negatively to situations that are uncertain — has been shown to be a relatively specific characteristic of persons with generalized anxiety disorder.15
Patients with generalized anxiety disorder generally have an affirmative response to the question “Do you worry excessively about minor matters?” That question is worth asking of patients with insomnia, a depressed mood, chronic gastrointestinal and other pain symptoms, or other unexplained recurrent health concerns.
Isn't worrying excessively the definition of GAD? The reference to chronic gastrointestinal symptoms is a big clue IMO, which is not adequately addressed in this article. Having personally reduced my anxiety levels dramatically through diet and supplements, and read of others who have done the same, it seems extremely remiss for the authors not to mention this. Has it not yet filtered through to such a respected journal as the NEJM? Instead they are allowing an article that promotes the usual dubious 'evidence' and the usual treatments, which have very limited efficacy IME and IMO, and some can be dangerous.
Since insomnia is a prominent symptom of generalized anxiety disorder, the patient should be encouraged to practice positive sleep-hygiene behaviors (i.e., to maintain a regular sleep schedule, avoid smoking or the use of nicotine during the evening, and avoid alcohol and the prolonged use of devices with light-emitting screens, such as smartphones, laptops, and television, before bedtime). However, randomized trials are lacking to support specific benefits of sleep hygiene for patients with generalized anxiety disorder.
So why should it be encouraged? Shades of PACE here...
When I was an anxiety-ridden child there were no computers and very little on TV. My time was spent making my own entertainment, which included country walks. I did, however, have gastrointestinal problems and a diet full of sugar and starch. Did children only start getting GAD when computers and smartphones were invented? I don't think so.
Selective serotonin-reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs) are generally considered to be first-line pharmacotherapies for generalized anxiety disorder, with response rates in the range of 30 to 50%.23,32 A recent meta-analysis suggested the possibility of publication and reporting biases in clinical trials of these agents for the treatment of anxiety, but the authors concluded that these biases probably did not lead to a systematic inflation of effect sizes.33
The authors say it's OK. So that's all right then.
The evidence base is growing for the use of SSRIs and SNRIs for the treatment of anxiety disorders, including generalized anxiety disorder, in children and adolescents.35
Really? I haven't heard about this, but have heard about increasing evidence for SSRIs increasing suicidality, amid withholding of data about this risk. I think it involves unpublished studies.
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