Il disturbo d’ansia generalizzato è caratterizzato da un’ansia persistente, non legata alla presenza di particolari circostanze ambientali. I sintomi possono essere i seguenti: preoccupazioni, apprensione, tensione, cefalea, facile faticabilità, irrequietezza, incapacità a rilassarsi, difficoltà di concentrazione, insonnia, manifestazioni neurovegetative (palpitazioni, sudorazione, tremore, bocca secca). L’ansia è solitamente più accentuata rispetto alle circostanze e il soggetto manifesta difficoltà a controllarla. Le preoccupazioni riguardano generalmente la famiglia, il lavoro o la scuola, i problemi economici e la salute. L’ esordio psicopatologico avviene tra i 20 ed i 40 anni. Il decorso è cronico episodico (secondo il DSM-5, manuale diagnostico statistico dei disturbi mentali, la sintomatologia deve essere presente per la maggior parte dei giorni per almeno 6 mesi).

Video intitolato “GAD Symptoms: 6 Generalized Anxiety Disorder Symptoms”, caricato su youtube da Beating Anxiety il 01/03/2015

I disturbi del sonno sono estremamente comuni nei soggetti affetti da disturbo d’ansia generalizzato. Ciò fa ipotizzare la presenza di meccanismi fisiopatologici condivisi dai due disturbi. In uno studio individui affetti da insonnia primaria (ovvero non associata ad altri disturbi) sono stati messi a confronto con soggetti affetti da disturbo d’ansia generalizzato e con soggetti sani. Tutti i partecipanti alla ricerca sono stati valutati tramite risonanza magnetica funzionale a 3 tesla (fMRI a 3-T). Nei soggetti affetti da insonnia primaria e nei controlli è stato registrato il sonno per 2 settimane utilizzando diari e actigrafia. Grazie a questa ricerca è stato possibile valutare il ruolo della corteccia cingolata anteriore rostrale la quale, esercitando un controllo superiore dell’attività dell’amigdala, svolgerebbe un ruolo essenziale nel circuito regolatore delle emozioni. La connettività tra le aree della corteccia cingolata anteriore rostrale e l’amigdala sembrerebbe significativamente maggiore nei soggetti sani mentre negli individui con insonnia primaria sarebbe intermedia tra quella dei soggetti sani e quella degli individui con disturbo d’ansia generalizzato. Se presente insonnia primaria la connettività media sembrerebbe diminuita con un sonno peggiore (Pace-Schott et al., 2017).

La terapia del disturbo d’ansia generalizzato, se la diagnosi viene posta tardivamente o il decorso della patologia è cronico, è generalmente farmacologica (a base di farmaci serotoninergici, triciclici e/o benzodiazepine). In caso di diagnosi precoce utile sembra intraprendere un percorso di psicoterapia (come la terapia cognitivo-comportamentale) che nei casi gravi può essere associato ad un trattamento farmacologico.

Riferimenti:

American Psychiatric Association (2014). Mini DSM-5, criteri diagnostici, edizione italiana, Raffaello Cortina Editore.

Pace-Schott EF et al (2017). Resting state functional connectivity in primary insomnia, generalized anxiety disorder and controls. Psychiatry Res. 265: 26-34.

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Di Tiziana Corteccioni

Dott.ssa Tiziana Corteccioni
Medico chirurgo, Specialista in Psichiatria, Psicoterapeuta   

Medico Psichiatra e Psicoterapeuta ad orientamento clinico cognitivo-comportamentale.
Da Ottobre 2010 collabora con il Centro Ricerche Musicali di Roma nel progetto “Musica Emozioni” rivolto a soggetti con difficoltà sul piano emotivo. E' coautrice di pubblicazioni scientifiche.
Da Novembre 2013 collabora con l'Associazione di Clinica Cognitiva del Lazio.
Esercita attività come psichiatra e psicoterapeuta presso vari centri clinici a Roma ed a Perugia nei quali si occupa prevalentemente del trattamento farmacologico e psicoterapeutico di disturbi del sonno, depressione, disturbo bipolare, attacchi di panico, fobie, disturbo ossessivo-compulsivo, disturbi alimentari, disturbi di personalità, dipendenze e schizofrenia.

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