The Symptom Profile of Generalized Anxiety Disorder in Iraqi Patients.

Generalized Anxiety Disorder (GAD) is a common psychiatric disorder, which may cause significant distress and disability. This study was an attempt to identify the symptom frequency of this significant disorder among the patients attending the only out patient clinic in Al-Diwanyia Teaching Hospital (180 Km south of Baghdad). Headache (75%), Fatigue (70%), Palpitation (67.5%), Chest pain (66.6%) and Persistent irritability (64.1%) were the most frequent symptoms in 120 outpatients with a diagnosis of GAD.


Introduction
DSM-III R defined GAD as "The essential features is generalized, persistent anxiety of at least one month duration without the specific symptoms that characterized phobic disorders, panic disorders, or obsessive compulsive disorder. The diagnosis is not made if the disturbance is due to another physical or mental disorder" ICD-10 needs a period of at least six months, with prominent tension, worry, and feelings of apprehensions. Now there is increasing attention of GAD, because anxiety disorder may have many consequences including decreased equality of life, economic dependence, multiple somatic complaints, maladaptive personality triats and increased mortality due to suicide and cerebrovascular causes. Aims 1. To detect the frequency of symptoms among outpatients with a diagnosis of GAD in Al-Diwanyia Teaching Hospital. 2. To study the possible relationships of these symptoms and the sociodemographic characteristics of the sample 3. To explore the associated symptoms with GAD.

Materials andMethod
120 patients involved in this study from the outpatient clinic (51 males and 69 females), diagnosed as suffering from GAD, during the period from the first October 2006 to first of July 2007.The diagnosis by senior psychiatrist and then interviewed by the use of semi structured psychiatric interview based on ICD-10(WHO, 1993).No other mental illnesses or suspected physical illnesses among the cases.

Results
Sociodemographic characteristics:The sample consist of 51 males and 69 females (42.5 %and 57.5% respectively ).The age groups (20-29years )account for 55% of all patients ,followed by age group (30-39 years ) account for 18.3%.The least one was age group (50-59 years)account for only 2.5% of the sample .
Single patients were the most common (50%), single were the most frequent among male patients (33%), while among the females, the married were most frequent (32%).
The results also revealed that the most frequent associated symptoms were depressed mood (35%) of all patients and phobic symptoms 5%.

Discussion
The results of this study revealed high rates of somatic symptoms, this might be explained by that frequency of seeking help among patients in our community might be much higher among those cases who have somatic symptoms than those who do not .This findings is consistent with the study of Shekher et al 1988 which found that the most common diagnosis applied to 123 Indian Psychiatric outpatients who presented with somatic symptoms without any evidence of physical disease, was GAD. This also similar with the study of Taiann Cheng (1989)who stated that psychiatric patients in less developed societies without knowledge of mental disorders often interpret their illness as physical in origin and reported only somatic discomforts to their doctors . The results contradict Martin et al (1993) who find seven symptoms to be more frequent, they were (irritability, restlessness, muscle tention, difficult concentration, sleep difficulties, feeling keyed up and easy fatigability).