GAD is characterised by excessive anxiety and worry occurring on more days than not for a period of at least six months (APA, 2000). The person finds it difficult to control this worry and is distressed by it and, as a consequence, is compromised in their daily functioning. Lewis and Rosenberg (1990) report that TBI patients often experience anxiety of a generalised and free-floating type consisting of persistent tension, worry and fearfulness, which is experienced in an intense and overwhelming way but without much comprehension due to their inability to understand or adapt to these external and internal stimuli.
GAD in the TBI-affected patient is also frequently associated with depression (Jorge, Robinson, Starkstein et al., 1993) with comorbidity rates ranging from 33 to 65% (Stavrakaki & Vargo, 1986). For example, Jorge, Robinson, Starkstein et al. (1993) studied a mixed TBI sample, all of whom were diagnosed with GAD (n = 7) and also met the criteria for major depression. Merskey and Woodforde (1961) noted that of their 27 cases of minor TBI referred for assessment in the absence of medico-legal considerations, 7 cases (25.9%) had endogenous depression while 9 cases (33.3%) featured a diagnosis of mixed anxiety and depression. Van Reekum, Bolago, Finlayson, Garner, and Links (1996) assessed 18 subjects (10 with severe TBI and 8 with mild or moderate TBI) an average of 4.9 years following the TBI using the SADS-L (Endicott & Spitzer, 1978). Of the sample, 11 (58%) received a post-TBI diagnosis of major depression. Bipolar affective disorder was found in three subjects (16%) and cyclothymia in a further 2 subjects. Seven subjects (37%) received a diagnosis of anxiety disorder, with 5 of the 7 featuring generalised anxiety disorder. The remainder had panic disorder (1), with the others having mixed phobias and obsessive compulsive disorder. Four of the seven developed their anxiety states following the injury.
Fann, Uomoto, and Katon (2000) evaluated 50 consecutive patients referred to a university brain rehabilitation clinic and noted that 24% of these patients had a diagnosis of GAD at the time of interview. Thirty-four percent of the patients had had a previous history of GAD. Only 2% of the sample featured panic disorder, a level consistent with that observed in the uninjured population.
As a rule, the likelihood of GAD following a TBI is fairly low and in those cases in which it does occur, the diagnosis commonly occurs in association with depression or a prior history of the condition.
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