Generalized anxiety disorder (GAD) is highly prevalent psychiatric disorder in primary care population and is a source of major morbidity. However, the underawareness and undertreatment of GAD, which is due to insufficient knowledge about the disorder, often hinder the proper management of this chronic condition. Other characteristic features such as chronic course of GAD, frequent comorbidity with other anxiety and depressive disorders, and the controversy regarding the best diagnostic criteria should be fully discussed. First of all, proper and accurate diagnosis is crucial for an appropriate management. Primary care management of GAD and associated comorbidities includes education about the nature of GAD and counseling about treatment alternatives and coping strategies is an important first step. The most effective treatment of GAD is combined psychotherapeutic and pharmacotherapeutic approach. The major psychotherapeutic approaches to GAD are cognitive-behavioral therapy with relaxation techniques. Pharmacological treatment for GAD includes benzodiazepine, buspirone, and antidepressants. In this review, these combined treatment at the view point of primary practitioners was described.

Stress can be defined generally as reponses to stressors on the body or in a definition more focused on the central nervous system, it can be defined as alterations in neuropsychological homeostatic processes. There is a psychological aspect to stress, related to issues such as memory, emotion, arousal, and also a biological aspect which included activation of specific brain and endocrine circuits. This article reviews a series of neurobiological mechanisms aimed at understanding what are pathways by which stress is perceived, processed, and transduced into a neuroendocrine response. Multiple brain structures are involved in the organization of responses to stressful stimuli. Among them the hypothalamus, septohippocampal structures, amygdala, cingulate and prefrontal cortices, hindbrain regions such as the brainstem catecholamine cell body group (A2/C2 cell groups in the nucleus of the tractus solitaris; A1/C1 cell groups in the ventrolateral medulla; A6 cell groups in the locus ceruleus), the parabrachial nucleus, cuneiform nucleus, and dorsal raphe nucleus are prominent structures. We reviewed with the focus on the classic stress circuits: the limbic-hypothalamic-pituitary-adrenal axis (LHPA) and locus ceruleus-norepinephrine (LC-NE) system. Our review indicates that the LHPA stress circuit and LC- NE system are the complex systems with multiple control mechanisms and that these mechanisms are altered in pathological states, such as chronic stress and depression. The holistic features described in this reviews can provide insight into the nature and location of brain circuits and neurotransmitter receptors involved in stress and the treatment of stress-related disorders.