Broadening of Generalized Anxiety Disorders Definition Does not Affect the Response to Psychiatric Care: Findings from the Observational ADAN Study

Abstract

Objective: To elucidate the consequences of broadening DSM-IV criteria for generalized anxiety disorder (GAD), we examined prospectively the evolution of GAD symptoms in two groups of patients; one group diagnosed according to DSM-IV criteria and the other, according to broader criteria.

Method: Multicentre, prospective and observational study conducted on outpatient psychiatric clinics. Patients were selected from October 2007 to January 2009 and diagnosed with GAD according to DSM-IV criteria (DSM-IV group) or broader criteria. Broader criteria were considered 1-month of excessive or non-excessive worry and only 2 of the associated symptoms listed on DSM-IV for GAD diagnosis. Socio-demographic data, medical history and functional outcome measures were collected three times during a 6-month period.

Results: 3,549 patients were systematically recruited; 1,815 patients in DSM-IV group (DG) and 1,264 in broad group (BG); 453 patients did not fulfil inclusion criteria and were excluded. Most patients (87.9% in DG, 82.0% in BG) were currently following pharmacological therapies (mainly benzodiazepines) to manage their anxiety symptoms. The changes observed during the study were: 49.0% and 58.0%, respectively of patients without anxiety symptoms as per HAM-A scale at the 6 month visit (p=0.261) and 59.7% and 67.7%, respectively (p=0.103) of responder rates (> 50% reduction of baseline scoring).

Conclusion: Broadening of GAD criteria does not seem to affect psychiatric care results in subjects with GAD, is able to identify the core symptoms of the disease according to the DSM-IV criteria and could lead to an earlier diagnosis.

Keywords: Diagnostic and Statistical Manual of Mental Disorders; Generalized anxiety disorder; Hamilton Anxiety Rating Scale; Self-reported quality of life..

Fig. (1)

Step-by-step cohort selection according to inclusion criteria.

Fig. (2)

Drugs used for GAD treatment at basal and 6 month visits. A) DSM-IV criteria group. B) Broaden criteria group. Data presented as percentage of patients in each group. Differences not significant when not indicated. All changes, except for other, were statistically significant when compared to the baseline visit (p<0.001 in all cases). # p< 0.05, † p<0.01 and ‡ p<0.001 when comparing DSM-IV and broad criteria groups in both visits.

Fig. (3)

Reduction on HAM-A scale and subscale scores at 3 and 6 months visit for both DSM-IV and broad criteria groups. A) Psychiatric anxiety sub-scores, B) Somatic anxiety sub-scores and C) Total scores. Data presented as change in scale score. * p< 0.001 vs. basal visit, # p< 0.05 DSM-IV vs. broad criteria scores.

Fig. (4)

Score evolution for the CGI-S scale scores by study group. All changes were statistically significant when compared to the basal visit (p<0.001). *p< 0.001 and # p< 0.05 when comparing DSM-IV and broad criteria groups.

Fig. (5)

Reduction versus baseline in the percentage of patients presenting with each individual anxiety symptom at the 6 months visit by study group. All changes were statistically significant when compared within group to the baseline visit (p<0.001). # p< 0.05 when comparing DSM-IV and broad criteria groups.