Two clinical pictures of Generalised Anxiety Disorder (GAD) predominate.
The acute form is characterised by a sudden onset, often reactive to an external stress. The course is short and the prognosis is good.
The chronic form may or may not be preceded by an external event and a prolonged fluctuating course is common. Such patients may have also premorbid anxious personalities.
Attacks of anxiety are central to both the acute and chronic forms. These occur suddenly with feelings of fear and loss of control. Somatic features of increased sympathetic tone occur with sweating, palpitations, dry mouth, a feeling of chest constriction etc. The symptoms are more pervasive than in panic disorder, causing sleep and appetite disturbance.
It is interesting to note that some investigators have found that up to one third of patients with anxiety neuroses have mitral valve pathology. This may be due to the excess demands placed on the heart by anxiety.
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