Anxiety

• Anxiety disorders are characterized by excessive or inappropriate fear or anxiety.
• Fear is manifested by a transient increase in sympathetic activity (“fight or flight” physiologic response, thoughts, feelings, behaviors) in a situation perceived to be dangerous or threatening.
• Anxiety involves apprehension regarding a future threat.
• The criteria for most anxiety disorders involve symptoms that cause clinically significant distress or impairment in social and/or occupational functioning.
• Etiology of PTSD: TRAUMA T raumatic event R eexperience A voidance U nable to function M onth or more of symptoms A rousal increased
• Cognitive processing therapy is a modified form of cognitive-behavioral therapy in which thoughts, feelings, and meanings of the event are revisited and questioned
• Addictive medications such as benzodiazepines should be avoided in the treatment of PTSD because of the high rate of comorbid substance use disorders
• Posttraumatic stress disorder (PTSD) stressor = life threatening! Adjustment disorder stressor ≠ life threatening
• Anxiety disorders are caused by a combination of genetic, biological, environmental, and psychosocial factors.
• Primary anxiety disorders can only be diagnosed after determining that the signs and symptoms are NOT due to the physiological effects of a substance, medication, or another medical condition.
• Major neurotransmitter systems implicated in anxiety disorders include norepinephrine (NE), serotonin (5-HT), and gamma-aminobutyric acid (GABA).
• Anxiety disorders are the most common form of psychopathology.
• Anxiety disorders are more frequently seen in women compared to men, approximately 2:1 ratio.
• Assess for psychopathology if an individual’s symptoms are causing Social and/or Occupational Dysfunction (SOD).
• Treatment of anxiety disorders involves determining the severity of symptoms and initiating psychotherapy for mild anxiety.
• Consider a combination of therapy and medication for moderate to severe anxiety.
• Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are first-line medications for anxiety disorders.
• Benzodiazepines work quickly and effectively, but regular use results in dependence.
• Minimize the use, duration, and dose of benzodiazepines.
• Generalized anxiety disorder (GAD) is characterized by excessive, anxiety/worry about various daily events/activities for at least 6 months.
• GAD is associated with difficulty controlling the worry and ≥3 symptoms: restlessness, fatigue, impaired concentration, irritability, muscle tension, insomnia.
• Symptoms of GAD are not caused by the direct effects of a substance, or another mental disorder or medical condition.
• Symptoms of GAD cause significant social or occupational dysfunction.
• The lifetime prevalence of GAD is 5-9%.
• GAD rates are higher in women compared to men (2:1).
• One-third of the risk for developing GAD is genetic.
• The median age of onset of GAD is 30 years.
• The course of GAD is chronic, with waxing and waning symptoms.
• Patients with GAD are often described as worriers.
• Typical associated symptoms of GAD include insomnia, fatigue, and impaired concentration.
• Symptoms of GAD have been present for over 6 months.
• A complete physical exam and medical workup should be performed to rule out other medical conditions or substance use contributing to or causing the patient’s anxiety symptoms.
• Treatment options for GAD include psychotherapy (usually CBT) and pharmacotherapy (typically SSRIs).
• A combination of both modalities may achieve better remission rates than either treatment alone.
• For patients with anxiety, evaluate for caffeine use and recommend significant reduction or elimination.
• Exercise can significantly reduce anxiety.
• The worries associated with GAD are free-floating across various areas, as opposed to being fixed on a specific trigger.
• Rates of full remission are low for GAD.
• GAD is highly comorbid with other anxiety and depressive disorders.
• The most effective treatment approach for GAD combines psychotherapy and pharmacotherapy: CBT, SSRIs (e.g., sertraline, citalopram) or SNRIs (e.g., venlafaxine).