Anxiety overview

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Anxiety Microchapters

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Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Anxiety from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Vindhya BellamKonda, M.B.B.S [2]

Overview

Anxiety is a physiological state characterized by cognitive, somatic, emotional, and behavioral components. These components combine to create the feelings that we typically recognize as fear, apprehension, or worry. Anxiety is often accompanied by physical sensations such as heart palpitations, nausea, chest pain, shortness of breath, or headache.

Historical Perspective

Sigmund Freud recognized anxiety as a "signal of danger" and a cause of "defensive behavior". He believed we acquire anxious feelings through classical conditioning and traumatic experiences.

We maintain anxiety through operant conditioning; when we see or encounter something associated with a previous traumatic experience, anxious feelings resurface. We feel temporarily relieved when we avoid situations which make us anxious, but this only increases anxious feelings the next time we are in the same position, and we will want to escape the situation again and therefore will not make any progress against the anxiety.

Classification

According to DSM-5 diagnostic criteria, anxiety is classified as follows:

  • Generalized anxiety disorder
  • Panic disorder
  • Separation anxiety disorder
  • Selective mutism
  • Specific phobia
  • Agoraphobia
  • Social anxiety disorder
  • Anxiety disorder due to another medical condition
  • Substance/medication induced anxiety disorder
  • Unspecified anxiety disorder

Pathophysiology

Various theories have been implicated in the pathogenesis of anxiety which are as follows: Biologic( increased sympathetic tone and decreased GABA), psychoanalytic component(Freud described that anxiety is developmentally related to childhood fears of disintegration that derive from the fear of actual or imagined loss of a love object or fear of bodily harm), learning theory ( where anxiety is attributed to continous exposure to stress), bout 5% individuals with anxiety have polymorphic variant of the gene associated with serotonin transporter metabolism.

Causes

Life threatening causes of anxiety include anaphylaxis, acute coronary syndromes, cardiogenic shock, and myocardial infarction. Other common causes of

Anxiety Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Anxiety from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Anxiety overview On the Web

Most recent articles

cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Anxiety overview

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Anxiety overview

CDC on Anxiety overview

Anxiety overview in the news

Blogs on Anxiety overview

Directions to Hospitals Treating Anxiety

Risk calculators and risk factors for Anxiety overview

include anemia, caffeine, diabetes, and hyperthyroidism.

Differential diagnosis

Anxiety must be differentiated from: Majordepressive disorder,bipolar disorder,atypical psychosis, schizophrenia, Substance related disorder, cognitive disorder. Some of medical conditions similar toanxietyaremyocardial infarction/angina pectoris,hyperventilation syndrome hypoglycemia, hyperthyroidism, carcinoid

Epidemiology and demographics

Risk factors

Common risk factors in the development of anxiety disorders are: Depression, Alcohol, low socio-economicstatus, bipolar disorder, urbanization, stress, family history ofanxiety, unemployment,substance abuse

Natural history, complications and prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Imaging Findings

History and symptoms

The most common symptoms of anxiety disorders is inappropriate worry about multiple factors, restlessness, fatigue, insomnia, and impairment in functioning of the individual. The symptoms must be persistent for atleast a duration of six months.

Physical examination

The following are the some of the physical examination findings associated with anxiety disorders:Tachycardia, tremors, sweating, restlessness, twitches, shortness of breath.

Lab tests

The diagnosis of anxiety disordersis mostly clinical, based on a thorough history and physical exam. Lab tests are done to rule out other medical causes that cause anxiety. Some of the lab tests that could help differentiate anxiety causing conditions are as follows: CBC, BMP, urine analysis, urine deug screen, thyroid function tests, urine catecholamines

Electrocardiogram

There are no electrocardiogram findings associated with anxiety disorders.

Imaging studies

e diagnosis of anxiety disorders is mostly clinical, based on a thorough history and physical exam. Imaging studies should not be routinely done, but rather be guided by pertinent findings in the history and physical exam and ruling out secondary causes

Treatment

Medical Therapy | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

References

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