Being increased irritability ...

As of increased irritability, they show resentment, crying, ready to "blow up over nothing." For example, if someone close slightly delayed, a patient rushes to every phone call, waiting for the preconditions in the news about the incident an accident. When the husband crosses the threshold of the house, she immediately begins an internal relief, but to refrain from "reprimand" she usually can not. Another patient, coming to the house and saw the car at the front door of the ambulance, immediately suggests that - that something had happened was with her child, throwing a run on the fifth floor and had difficulty hitting the key in the lock, the patient finds his son alive and well after which he immediately gets a "dressing down" on any occasion tucked. These so-called psychological symptoms of anxiety are often found only in the directed questioning the patient or in a conversation with his relatives. Much more often, patients with GAD actively apply specifically somatic complaints and complaints of sleep disturbance, especially in the violation of sleep caused by repeated "scrolling" in your head the events of the day and expected future, as well as disrupted sleep. If a patient complains of "stress", it should also alert the physician to identify GAD [12]. Among the external signs of a patient with GAD can usually be noted restless movement, restlessness, a habit that a fumble hands, tremor of fingers, frown, tense face, deep breaths or shortness of breath, pale face, frequent swallowing movements. International group to develop recommendations for GAD [12] offers primary care physicians to practice with the aim of screening for GAD patients to ask two questions: 1) did you feel you most of the time over the last 4 weeks of anxiety, stress or anxiety? 2) How often do you have a sense of tension, irritability and sleep disturbances? If at least one of these questions is yes, you need an in-depth questioning to the active symptoms of GAD. In clinical practice, often it happens that in the presence of psychological and somatic symptoms of anxiety increased their number or duration is insufficient for setting a definite diagnosis of GAD according to criteria of ICD-10, in which case talk about subsyndromal anxiety. Some aspects of pathogenesis Estimated neurophysiological mechanism of development of symptoms of GAD is shown in Figure 1. Cognitive theory of the origin of GAD, developed by A. Beck, treats anxiety as a reaction to perceived danger. Individuals who are prone to develop anxiety reactions, there is a persistent distortion protsessavospriyatiya and information processing, resulting in consider themselves unable to cope with the threat, monitor the environment. The attention of anxious patients selectively directed specifically to the possible hazards [72]. Patients with GAD, on the one hand, firmly believe that anxiety is a kind of effective mechanism that allows them to adapt to the situation, but on the other hand, perceive their anxiety as uncontrollable and dangerous.