Facial Nerve Problems (cont.)

How are the causes of facial nerve dysfunction diagnosed?

Causes of facial nerve disorder vary from unknown to life threatening. Sometimes, there is a specific treatment for the problem. Accordingly, it is important to investigate why the problem has occurred. The specific tests used for diagnosis will vary from patient to patient, but include:

1. Hearing tests: Hearing tests are done to assess the status of the auditory nerve. The stapedial reflex test can evaluate the branch of the facial nerve that supplies motor fibers to one of the muscles in the middle ear.
2. Balance tests: Will help find out if part of the auditory nerve is involved.
3. Tear tests: The loss of the ability to form tears may help to locate the site and severity of a facial nerve lesion.
4. Taste tests: The loss of taste in the front of the tongue may help locate the site and severity of a facial nerve lesion.
5. Salivation test: Decreased flow of saliva may help locate the site and severity of a facial nerve lesion.
6. Imaging studies: These tests help determine if there is infection, atumor, a bone fracture, or any other abnormality. These studies usually include a CT scan and/or a MRI scan.
7. Electrical nerve stimulation tests: Stimulation of the nerve by an electrical current tests whether the nerve can still cause muscles to contract. It can be used to evaluate progression of the disease. For example, if testing indicates equal muscle response on both sides of the face, the patient can be expected to have complete return of facial function in three to six weeks without significant deformity.

What is and what causes Bell's palsy?

Bell's palsy (Bell palsy) is paralysis of the facial nerve of unknown cause. The diagnosis is made when no other cause can be identified. Although Bell's palsy is thought to be caused by a viral infection of the facial nerve, this hasn't been proven. Other names for this condition are "idiopathic facial palsy" or Antoni's palsy.

Bell's palsy is usually a self-limiting, non-life-threatening condition that resolves spontaneously, usually within six weeks. The incidence is 15 to 30 new cases per 100,000 people per year. There is no predominant age or racial predilection; however, it is 3.3 times more common during pregnancy and slightly more common in menstruating females. In general, the incidence increases with advancing age. Children under the age of 13 seem less at risk of developing Bell's palsy than older individuals.

What are the symptoms of Bell's palsy?

The typical symptoms of Bell's palsy include:

• Acute unilateral paralysis of facial muscles is present; the paralysis involves all muscles, including the forehead.
• About half the time, there is numbness or pain in the ear, face, neck or tongue.
• There is a preceding viral illness in 60% of patients.
• There is a family history of Bell's palsy in 4% to 10% of patients.
• Less than 1% of patients have bilateral problems.
• There may be a change in hearing sensitivity (often increased sensitivity).

What is the mechanism of injury in Bell's palsy?

While the actual mechanism of injury of the facial nerve in Bell's palsy is unknown, one proposed mechanism of injury includes:

• Primary viral infection (herpes) sometime in the past.
• The virus lives in the nerve (geniculate ganglion) from months to years.
• The virus becomes reactivated at a later date.
• The virus reproduces and travels along the nerve.
• The virus infects the cells surrounding the nerve (Schwann cells) resulting in inflammation.
• The immune system responds to the damaged Schwann cells, which causes inflammation of the nerve and subsequent weakness or paralysis of the face.
• The course of the paralysis and the recovery will depend upon the degree and amount of damage to the nerve.

What are treatment options of facial nerve paralysis?

There are no medications specifically approved to treat Bell's palsy. Underlying medical conditions that lead to facial nerve disorder are treated specifically according to the specific condition that is responsible for the damage to the nerve. Steroid medications (corticosteroids) are the best treatment for Bell's palsy, and it is recommended that all patients be treated. The usual amount is one milligram per kilogram body weight of prednisone (or steroid alternative) per day for 7 to 14 days. Recently, antiviral medications like acyclovir(Zovirax) given in conjunction with steroids have been demonstrated to increase recovery. Doses of the antiviral agent will vary with the drug chosen.

Although physical therapy and electrotherapy probably have no significant benefit, facial exercises can help prevent contractures of affected muscles. Surgical facial nerve decompression is controversial in Bell's palsy. Some physicians recommend surgical decompression during the first two weeks in patients showing the most severe nerve degeneration; however, there can be a substantial risk of hearing loss with this surgery.

What is the treatment for eye problems from facial nerve disorder?

Patients with facial nerve paralysis have difficulty keeping their eye closed because the muscles which close the eye cannot work. Serious complications can occur if the cornea of the eye becomes too dry. Treatment consists of:

• protective glasses which can prevent dust from entering the eye;
• manual closure of the eye with a finger to keep it moist -- patients should use the back of their finger rather than the tip to insure that the eye is not injured;
• artificial tears or ointments to help keep the eye lubricated;
• taping or patching the eye closed with paper tape while asleep; and
• in cases in which recovery is incomplete, a temporary or permanent narrowing of the eye opening (tarsorrhaphy) may be necessary.

What surgical reconstruction options are available?

Reconstructive options for patients with facial muscle weakness or paralysis include one or more of the following:

• Nerve repair or nerve grafts: Facial nerve regeneration occurs at a rate of one millimeter per day. If a nerve has been cut or removed, direct microscopic repair is the best option.
• Nerve transposition: Often the tongue nerve (hypoglossal nerve) or the other facial nerve can be connected to the existing facial nerve. For example, the patient can then train themselves to move their face by moving their tongue.
• Muscle transposition or sling procedures: The temporalis muscle or masseter muscle (some of the only muscles on the face not supplied by the facial nerve), can be moved down and connected to the corner of the mouth to allow movement of the face.
• Muscle transfers: Free muscles from the leg (gracilis) can be used to provide both muscle bulk and function. Often a cross facial nerve transposition is done to provide similar nerve supply to the donor muscle flap.
• Ancillary eyelid or oral procedures: In addition to one of the above, often it is necessary to include a brow lift or facelift, partial lip resection, eyelid repositioning, lower eyelid shortening, upper eyelid weights, or eyelid springs in reconstructive surgery following severe facial nerve palsies.

What is the prognosis for facial nerve problems?

The prognosis for facial nerve damage depends on the underlying cause. Many patients who have required surgery to remove tumors may have unavoidable permanent injury to the facial nerve, whereas more than 70% of persons who experience Bell's palsy will have complete recovery. The best outcomes occur with rapid diagnosis and treatment.

Can facial nerve problems be prevented?

At one time it was thought that exposure to cold air or a strong wind were predisposing factors leading to idiopathic facial nerve palsy (Bell's palsy); we now know that these ideas were incorrect. As the majority of causes for idiopathic facial nerve problems are unknown, it is difficult to predict with any accuracy specific items to avoid. Choosing ahealthy lifestyle to decrease the risk of diabetes, cancer, or infection may help prevent some cases of facial nerve palsy.

REFERENCES:

Marsk, E., et al. "Prediction of nonrecovery in Bell's palsy using Sunnybrook grading." Laryngoscope 122.4 (2012): 901-906.

Peitersen, E. "The natural history of Bell's palsy." The American Journal of Otology 4.2 (1982): 107-111.

Sullivan, F. M., et al. "Early treatment with prednisolone or acyclovir in Bell's palsy." The New England Journal of Medicine 357:16 (2007): 1598-1607.

Sullivan, F. M., et al. " A randomised controlled trial of the use of aciclovir and/or prednisolone for the early treatment of Bell's palsy: the BELLS study." Health Technology Assessment 47:iii-iv, ix-xi (2009) 1-130.

Teixeira, L. J., et al. "Physical therapy for Bell s palsy (idiopathic facial paralysis)." Cochrane Database of Systematic Reviews. 3 (2008): CD006283.

Facial Nerve Problems and Bell's Palsy (Bell Palsy)

Facial nerve problems and Bell's palsy facts

• Facial nerve disorders affect the muscles of the face.
• There are many causes of facial nerve disorders.
• A number of tests can be helpful to diagnose the cause of a facial nerve disorder.
• The treatment of a facial nerve disorder depends on the cause and severity.

What is the facial nerve?

The facial nerve is a nerve that controls the muscles on the side of the face. It allows us to show expression, smile, cry, and wink. Injury to the facial nerve can cause a socially and psychologically devastating physical defect; although most cases resolve spontaneously, treatment may ultimately require extensive rehabilitation or multiple procedures.

The facial nerve is the seventh of the twelve cranial nerves. Everyone has two facial nerves, one for each side of the face. The facial nerve travels with the hearing nerve (the eighth cranial nerve) as it travels in and around the structures of the middle ear. It exits the front of the ear at the stylomastoid foramen (a hole in the skull base), where it then travels through the parotid gland. In the parotid gland it divides into many branches that provide motor function for the various muscles and glands of the head and neck.

What are symptoms of a facial nerve problem?

Facial nerve problems may result in facial muscle paralysis, weakness, or twitching of the face. Dryness of the eye or the mouth, alteration of taste on the affected side, or even excessive tearing or salivation can be seen as well. However, the finding of one of these symptoms does not necessarily imply a specific facial nerve problem; the physician needs to make a careful investigation in order to make a precise diagnosis. Symptoms of a facial nerve problem can vary in severity depending upon the extent of the injury to the nerve. Symptoms may range from mild twitching to full paralysis of the muscles on one side of the face.

What conditions affect the facial nerve?

There are numerous causes of facial nerve disorder:

• Trauma such as birth trauma, skull base fractures, facial injuries, middle ear injuries, or surgical trauma
• Nervous system disease including stroke involving the brain stem
• Infection of the ear or face, or herpes zoster of the facial nerve (Ramsay Hunt syndrome)
• Tumors including acoustic neuroma, schwannoma, cholesteatoma, parotid tumors, and glomus tumors
• Toxins due to alcoholism or carbon monoxide poisoning
• Bell's palsy, which is also called idiopathic facial nerve paralysis (see below); this condition is sometimes associated with diabetes mellitus orpregnancy

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Generalized anxiety disorder facts

• Generalized anxiety disorder (GAD) is a mood disorder that is characterized by multiple and/or nonspecific worries that interfere with the person's life in some way.
• The most common anxiety disorders are specific phobias. Other anxiety disorders include social anxiety disorder, panic disorder, generalized anxiety disorder, obsessive compulsive disorder, and posttraumatic stress disorder.
• GAD is quite common, affecting millions of people.
• While there is no single cause of GAD, there are many factors that increase the risk of developing this disorder.
• Signs and symptoms of anxiety can include those that are emotional or behavioral and ways of thinking that are responses to feeling as if one is in danger.
• The similarities and differences in symptoms of anxiety in adults compared to children and adolescents depend on the diagnosis.
• There seem to be gender differences in the expression of anxiety.
• If a medical or mental healthprofessional suspects that you have GAD, you will likely undergo an extensive medical interview and physical examination.
• Treatment of GAD usually involves some combination of lifestyle changes, psychotherapy, and/or medication.
• As anything that is ingested carries risk of side effects, it is important for the anxiety disorder sufferer to work closely with the prescribing doctor to decide whether treatment with medications is an appropriate intervention, and if so, which medication should be administered.
• There are many possible complications associated with anxiety.
• Various lifestyle choices and family interventions can help prevent anxiety.
• GAD usually requires treatment for it to resolve.
• There are many support groups for people who suffer from generalized anxiety disorder.
• What is generalized anxiety disorder (GAD)?
• 
  
• Generalized anxiety disorder (GAD) is a mood disorder that is characterized by multiple and/or nonspecific worries. The fear associated with GAD interferes with the person's ability to sleep, think, or function in some other way. Symptoms of anxiety are even described in the word itself. Specifically, the word anxiety comes from the Latin word anxietas, which means to choke or upset. The symptoms therefore include emotional or behavioral symptoms as well as ways of thinking that are responses to feeling as if one is in danger.
• 
  
• 
  
• What are the different types of anxiety?

• Anxiety can range from the constructive kind that elevates performance as with performance anxiety, to disorders of anxiety, in that the individual suffers from a level of fear, angst, or dread that interferes with his or her ability to function. The most common anxiety disorders are specific phobias. Other anxiety disorders include social anxiety disorder, panic disorder, generalized anxiety disorder, obsessive compulsive disorder, and posttraumatic stress disorder.

• How common is generalized anxiety disorder?

• GAD is quite common. In fact, it is the most common anxiety disorder seen by most primary care doctors. About 5% of people will develop GAD over the course of their lifetime. That translates to millions of GAD sufferers. This illness usually begins when individuals are in their early 20s. Panic and generalized anxiety occur in about 0.7% of children in any one-year period, up to 20% over the course of childhood.

• What are causes and risk factors for anxiety?

• While there is no single cause of GAD, women tend to develop this condition and most other anxiety disorders more often than men, and individuals with a family history of anxiety and depression are more at risk for having GAD. Younger adults are more likely to have GAD or social anxiety disorder compared to older adults. Other risk factors for developing social anxiety disorder include being of Native-American ethnicity and having a low income. Being of Asian, Hispanic, or black ethnicity, as well as residing in a more populated region, seems to reduce the risk of social anxiety disorder.
• 
  
• Inhibited temperament, parental anxiety, and having family and friends who somehow support avoidant coping mechanisms are risk factors for developing an anxiety disorder. Adolescents who smoke have been found to be at risk for developing anxiety. In children, girls, particularly those who begin puberty early, seem to be more likely to develop anxiety than their age peers of both genders.
• 
  
• Life stresses, involving health problems and family disagreements, have been found to be associated with developing an anxiety disorder. Certain other life stresses put people at risk for developing anxiety as well. For example, in a study of African-American, Afro-Caribbean, and non-Hispanic white individuals, non race-based discrimination was found to be a risk factor for developing anxiety in each of those groups while race-based discrimination was found to increase the likelihood of only the African-American people in developing anxiety.

• What are anxiety symptoms and signs?

  Common symptoms and signs of anxiety can include
  • restlessness or feeling edgy,
  • becoming tired easily,
  • trouble concentrating,
  • feeling as if the mind is going "blank,"
  • irritability,
  • muscle tension,
  • sleep problems (trouble falling or staying asleep or having sleep that is not restful).
  Anxiety that is associated with specific (specific or simple phobia) or social fears (social phobia) may also result in avoidance of certain situations or an elevation to the level of panic symptoms. In addition to the more general symptoms of anxiety previously described, worry that is associated with a traumatic event (posttraumatic stress disorder) may also result in the following symptoms:
  • Avoidance of people, places, or situations that are reminiscent of the traumatic event
  • Re-experiencing the trauma in repeated nightmares or flashbacks
  • Difficulty trusting others
  • Excessive attention to staying safe or keeping loved ones safe (for example, hypervigilance)
  • A tendency to startle easily
  • A sense of a bleak or foreshortened future
  When anxiety intensifies to the level of becoming a panic attack, signs and symptoms can include
  • palpitations;
  • chest pain, chest tightness, feeling like one is having a heart attack;
  • shortness of breath or trouble breathing;
  • sweating of the palms;
  • nausea or other stomach upset;
  • trembling or shaking;
  • feeling dizzy, unsteady, lightheaded, or faint;
  • derealization (feelings of unreality) or depersonalization (feeling detached from oneself);
  • fear of losing control or going insane;
  • numbness or tingling sensations;
  • chills or hot flashes;
  • feeling like one is choking;
  • a sense of impending doom;
  • feeling like one is dying.
  Anxiety symptoms and signs in children and teenagers
  The similarities and differences in symptoms of anxiety in adults compared to children and adolescents depend on the specific condition that is causing the anxiety. For example, symptoms of obsessive compulsive disorder (OCD) are quite similar in children and teens compared to adults except that children and teens are less likely to recognize that their thoughts or behaviors are irrational. That is also true of minors who suffer from social phobia or specific phobia.
  In addition to some of the differences in the symptoms themselves, before puberty, males seem to develop OCD more commonly than girls, and after puberty, females seem to have OCD more often than males. In children and adolescents, boys and girls seem to develop panic disorder and generalized anxiety disorder at equal rates. Disorders that tend to occur with OCD (co-morbid) are more commonly attention deficit hyperactivity disorder (ADHD) and tics in prepubescent people, versus other anxiety disorders and depression in teens and adults.
  Symptoms of anxiety in children and teens tend to be consistent with how they express feelings in general. For example, lacking the higher ability to express feelings verbally compared to older children, younger children tend to express anxiety by complaining of physical symptoms like stomach upset or headaches. They are also more likely to cry, have tantrums, or become clingy. Compared to anxiety symptoms in children, in teens, the symptoms of anxiety will more closely approximate those in adults. However, adolescents are more likely than adults to exhibit anxiety by becoming irritable or angry.
  Children with an anxiety disorder tend to develop the illness in early childhood, with symptoms being persistent, coming and going into adulthood.
  Anxiety symptoms and signs in men and women
  Studies indicate that men seem to experience different types of effects of anxiety compared to women. Specifically, men tend to exhibit more psychological symptoms of anxiety, like tension, irritability, and a sense of impending doom. In contrast, women tend to develop more physical symptoms like chest pain, palpitations, shortness of breath, and nausea. Further, it seems that women with such physical symptoms of anxiety are more at risk for developing heart problems.

  How is generalized anxiety disorder diagnosed?

  Many health care professionals may help individuals with GAD: licensed mental health therapists, family physicians, or other primary care professionals, specialists whom you see for a medical condition, emergency physicians, psychiatrists, psychologists, psychiatric nurses, and social workers. If one of these professionals suspects that you have GAD, you will likely undergo an extensive medical interview and physical examination. As part of this examination, you may be asked a series of questions from a standardized questionnaire or self-test to help assess your risk of anxiety. Anxiety may be associated with a number of other medical conditions or can be a side effect of various medications. For this reason, routine laboratory tests are often performed during the initial evaluation to rule out other causes of your symptoms. Occasionally, an X-ray, scan, or other imaging study may be needed. Well-recognized diagnostic criteria for generalized anxiety disorder are as follows:
  • Excessive anxiety and worry that occurs more days than not for at least six months. The worries are either generalized or are about a number of events or activities (such as work or school performance).
  • The person finds it difficult to control the worry.
  • The anxiety and worry are associated with three (or more) of the previously described symptoms (with at least some symptoms present for more days than not for the past six months).
  • The focus of the anxiety and worry is not confined to features of other mood or to a thought disorder (such as social phobia, OCD, PTSD,schizophrenia, etc.).
  • The anxiety, worry, or physical symptoms cause clinically significant distress or impairment an important area of functioning, like work, school, or socially.
  • The illness is not due to the direct physical effects of a substance (like a drug of abuse or a medication) or a general medical condition (likehyperthyroidism) and does not only occur during a mood disorder, psychotic disorder, or a pervasive developmental disorder.

  What is the treatment for anxiety?

  There are a variety of treatments available for controlling anxiety, including several effective medications and specific forms of psychotherapy. In terms of medications,buspirone (Buspar) is known to be quite effective for treating GAD. However, it seems to be less effective in managing many other disorders that often co-occur (are comorbid) with GAD. Therefore, specific members of the selective serotonin reuptake inhibitor (SSRI) and the selective serotonin and norepinephrine reuptake inhibitor (SSNRI) drug classes, which are also approved by the U.S. Food and Drug Administration (FDA) for effective treatment of GAD, are prescribed more often. Examples of SSRI medications includefluoxetine (Prozac), sertraline (Zoloft),paroxetine (Paxil), citalopram (Celexa), andescitalopram (Lexapro). Examples of SNRI medications are duloxetine (Cymbalta) andvenlafaxine (Effexor). Although buproprion (Wellbutrin) is primarily known to primarily treat depression, preliminary research suggests that it may also be helpful in the treatment of anxiety.

  Benzodiazepine medications likeclonazepam (Klonopin) and lorazepam(Ativan) are more useful in stopping severe anxiety symptoms, like those that occur in panic disorder or in posttraumatic stress disorder rather than the ongoing worry that is usually associated with GAD. Althoughalprazolam (Xanax) is often used to treatpanic attacks, its short duration of action can sometimes result in having to take it several times per day. Medications from the beta-blocker family (for example,propranolol [Inderal]) are sometimes used to provide rapid relief of the physical symptoms associated with a panic attack. Some individuals who suffer from severe panic attacks may benefit from treatment with neurontin (Gabapentin), which was initially developed to treat seizures, or may benefit from a neuroleptic medication like risperidone (Risperdal), olanzapine(Zyprexa), quetiapine (Seroquel), or aripiprazole (Abilify). Zolpidem (Ambien) has been found helpful in treating the insomnia that can often be a symptom of anxiety.

  Before SSRIs and SSNRIs became available, medications from the group known as the tricyclic antidepressants (TCAs) were often used to address panic disorder. Although TCAs have been found to be equally effective in treating panic attacks, SSRIs and SSNRIs have been proven to be safer and better tolerated. Therefore TCAs are used much less often than they used to be. When used in the appropriate person with close monitoring, these medications can be quite effective as part of treatment for panic disorder.

  For individuals who may be wondering how to avoid panic attacks using treatment without prescribed medications, natural remedies may be an option. While treatment like hypnosis and herbal supplements that containkava have been found to be helpful for some people with some anxiety disorders, the research data are still considered to be too limited for many physicians to recommend treatment with other natural remedies like valerianor passionflower. Also, care should be taken when taking any dietary supplements, since dietary supplements and "natural" remedies are not regulated in terms of quality, content, or effectiveness.

  The psychotherapy component of treatment for anxiety disorders is at least as important as the medication treatment. In fact, research shows that psychotherapy alone or the combination of medication and psychotherapy treatment are more effective than medication alone in overcoming anxiety for both adults and children. It has also been found to be potentially effective for people with autism in addition to anxiety. The most common type of therapy used to treat anxiety is cognitive behavioral therapy (CBT). This form of therapy seeks to help those with an anxiety disorder identify and decrease the irrational thoughts and behaviors that reinforce anxiety symptoms and can be administered either individually, in group therapy, and even in partner-assisted therapy. CBT that seeks to help the anxiety sufferer decrease the tendency to pay excessive attention to potential threats has also been found to be helpful.

  Behavioral techniques that are often used to decrease anxiety include relaxation techniques and gradually increasing exposure to situations that may have previously precipitated anxiety in the individual. Helping the anxiety sufferer to understand and how to handle the emotional forces that may have contributed to developing symptoms (anxiety-focused psychodynamic psychotherapy) has also been found to be effective in teaching an individual with panic disorder how to prevent an anxiety attack or to decrease or stop a panic attack once it starts.

  Often, a combination of psychotherapy and medications produces good results. Improvement is usually noticed in a fairly short period of time, about two to three months. Thus, appropriate treatment for anxiety can prevent symptoms or at least substantially reduce their severity and frequency, bringing significant relief to many people with anxiety. There are also self-care measures that people with anxiety can do to help make treatment more effective. Since substances like caffeine, alcohol, and illicit drugs can worsen anxiety, those things should be avoided. Other tips to prevent or manage anxiety symptoms include engaging in aerobic exercise and stress-management techniques like deep breathing, massage therapy, and yoga, since these self-help activities have also been found to help decrease the frequency and severity of symptoms. Although many people breathe into a paper bag when afflicted by the hyperventilation that can be associated with panic, the benefit received may be the result of the individual believing it will remedy the symptoms (placebo effect). Also, breathing into a paper bag when one is having trouble breathing can make matters worse when the hyperventilation is the result of conditions of oxygen deprivation, like anasthma attack or a heart attack.

  People with an anxiety disorder may also need treatment for other emotional problems. Depression has often been associated with anxiety, as have alcohol and drug abuse. Recent research also suggests that suicideattempts are more frequent in people with an anxiety disorder. Fortunately, these problems associated with panic disorder can be overcome effectively, just like panic disorder itself. Sadly, many people with anxiety do not seek or receive treatment.

  What are the side effects of anxiety medications?

  As anything that is ingested carries risk of side effects, it is important for the anxiety disorder sufferer to work closely with the prescribing doctor to decide whether treatment with medications is an appropriate intervention and if so, which medication should be administered. The kinds of side effects caused by a medication are highly specific to the specific medication itself and the medication class as a whole. The person being treated should therefore discuss potential medications with their treating physician and be closely monitored for the possibility of side effects that can vary from minor to severe and can uncommonly even be life-threatening. Due to the possible risks to the fetus of a mother being treated for anxiety with medication, psychotherapy should be the first treatment tried when possible in pregnant women.

  What are complications of generalized anxiety disorder?

  There are many possible complications associated with anxiety. Mothers who struggle with anxiety during pregnancy are more likely to have babies who are of low birth weight. Children with anxiety often also suffer from depression, behavioral problems, and substance abuse. They are at risk for having anxiety as adults, as well as attempting suicide and becoming psychiatrically hospitalized. In terms of achievement, children and teens with anxiety experience a higher rate of failing in school and as adults, of having low paying jobs.

  Can anxiety be prevented?

  Just as inhibited temperament, parental anxiety, and family and friends supporting avoidant coping mechanisms are risk factors for developing an anxiety disorder, encouraging the use of healthier ways to deal with stress can help prevent anxiety. Educating parents on how anxiety fits into their understanding of childhood development and the role of over protecting parents in developing anxiety disorders have been found to help prevent anxiety disorders in children. Maintaining a regular exercise program can be key to minimizing and perhaps preventing anxiety.

  What is the prognosis of generalized anxiety disorder?

  Generalized anxiety disorder can be quite chronic, in that the average length of time the illness lasts is 20 years if untreated. It can significantly interfere with the lives of individuals who have it and usually requires treatment for it to resolve. Therefore, people with generalized anxiety disorder are usually thought to need treatment for at least a year to prevent its recurrence.

  Are there support groups for those with generalized anxiety disorder?

  The following are examples of support groups for anxiety disorders:

  ABIL, Inc. (Agoraphobics Building Independent Lives)
  ABIL1996@aol.com

  A.I.M. (Agoraphobics in Motion)
  anny@ameritech.net

  Freedom From Fear
  http://www.freedomfromfear.org

  Phobics Anonymous
  619-322-COPE

  Where can people find additional information on generalized anxiety disorder?

  American Academy of Child and Adolescent Psychiatry
  http://www.aacap.org

  American Counseling Association
  http://www.counseling.org

  American Psychiatric Association
  http://www.psych.org

  American Psychological Association
  http://helping.apa.org

  Anxiety Disorders Association of America
  http://www.adaa.org/

  National Anxiety Foundation
  3135 Custer Dr.
  Lexington, KY 40517-4001
  606-272-7166

  National Association of Social Workers
  http://www.naswdc.org

  National Mental Health Association
  http://www.nmha.org

  National Panic/Anxiety Disorder News, Inc.
  http://www.npadnews.com

  REFERENCES:
  
  Amir N, Beard C, Cobb M, Bomyea J. Attention modification program in individuals with generalized anxiety disorder. Journal of Abnormal Psychology 2009 February; 118(1): 28-33.
  
  Arehart-Treichel J. Anxiety symptoms linked to women's cardiac events. Psychiatric News 2009 December; 44(24): 26-37.
  
  Arehart-Treichel J. Extended GAD treatment keeps relapse rates low. Psychiatric News 2011 February; 46(3): 24.
  
  Baldwin D, Woods R, Lawson R, Taylor D. Efficacy of drug treatments for generalized anxiety disorder: systematic review and meta-analysis. British Medical Journal 2011 March; 342.
  
  Ballenger JC, Davidson JRT, Lecrubier Y, Nutt DJ, et al. Consensus statement on generalized anxiety disorder from the international consensus group on depression and anxiety. Journal of Clinical Psychiatry 2001; 62(suppl 11): 53-58.
  
  Beesdo K, Knappe S, Pine DS. Anxiety and anxiety disorders in children and adolescents: developmental issues and implications for DSM-V. Psychiatric Clinics of North America 2009 September; 32(3): 483-524.
  
  Blumenthal H, Leen-Feldner EW, Babson KA, Gahr JL, Trainor CD, Frala JL. Elevated social anxiety among early maturing girls. Developmental Psychology 2011 July; 47(4): 1133-1140.
  
  Bystritsky A, Kerwin L, Feusner JD, Vapnik T. A pilot controlled trial of buproprion XL vs. escitalopram in generalized anxiety disorder (GAD). Pscychopharmacology Bulletin 2008; 41(1): 1-9.
  
  Cuthbert B. Early prevention in childhood anxiety disorders. American Journal of Psychiatry 2010; 167:1428-1430.
  
  Fava M, Asnis GM, Shrivastava R, Lydiard B, et al. Zolpidem extended-release improves sleep and next-day symptoms in comorbid insomnia and generalized anxiety disorder. Journal of Clinical Psychopharmacology 2009 June; 29(3): 222-230.
  
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