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{{SI}}
__NOTOC__
{{CMG}};  '''Associate Editor(s)-in-Chief:''' [[User: Shankar Kumar |Shankar Kumar, M.B.B.S.]] [mailto:kumarshankar@wikidoc.org]]
{{Template:Anxiety}}


==Overview==
{{CMG}};  Associate Editor(s)-in-Chief: {{Vbe}}, [[User:Shankar kumar| Shankar kumar,M.B.B.S.]]
'''Anxiety''' is a '''physiological''' state characterized by [[cognitive]], [[somatic]], [[emotion]]al, and [[behavior]]al components (Seligman, Walker & Rosenhan, 2001). 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 [[tension headache|headache]].
{{SK}} Angst, trouble, anxiety disorder.


The cognitive component entails expectation of a diffuse and uncertain danger. Somatically the body prepares the organism to deal with threat (known as an emergency reaction): [[blood pressure]] and [[heart rate]] are increased, sweating is increased, bloodflow to the major muscle groups is increased, and [[immune system|immune]] and [[Digestion|digestive]] system functions are inhibited. Externally, somatic signs of anxiety may include pale skin, sweating, trembling, and [[mydriasis|pupillary dilation]]. Emotionally, anxiety causes a sense of dread or panic and physically causes nausea, and chills. Behaviorally, both voluntary and involuntary behaviors may arise directed at escaping or avoiding the source of anxiety and often maladaptive, being most extreme in [[anxiety disorder]]s. However, anxiety is not always pathological or maladaptive: it is a common emotion along with fear, anger, sadness, and happiness, and it has a very important function in relation to survival.
== [[Anxiety overview|Overview]] ==


Neural circuitry involving the [[amygdala]] and [[hippocampus]] is thought to underlie anxiety (Rosen & Schulkin, 1998). When confronted with unpleasant and potentially harmful stimuli such as foul odors or tastes, [[Positron emission tomography|PET-scans]] show increased bloodflow in the amygdala (Zald & Pardo, 1997; Zald, Hagen & Pardo, 2002). In these studies, the participants also reported moderate anxiety. This might indicate that anxiety is a protective mechanism designed to prevent the organism from engaging in potentially harmful behaviors. 
== [[Anxiety historical perspective|Historical Perspective]] ==


==Anxiety disorders==
== [[Anxiety classification|Classification]] ==


[[Anxiety disorders]]
== [[Anxiety causes|Causes]] ==
===Complete Differential Diagnosis of the Causes of Anxiety ===
== [[Anxiety differential diagnosis|Differentiating Anxiety from other Diseases]] ==
(By organ system)
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Acute Coronary Syndromes]], [[Hypertension]], [[Myocardial infarction]], [[Orthostatic intolerance]], [[Postural orthostatic tachycardia syndrome]], [[Supraventricular tachycardia]]


|-
== [[Anxiety epidemiology and demographics| Epidemiology and Demographics]]==
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"| [[Barium nitrate]], [[Irukandji syndrome]]


|-
== [[Anxiety risk factors|Risk Factors]] ==
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| [[Alpha-Methyltryptamine]], [[Amantadine]], [[Amineptine]], [[Amphetamine]], [[Aniracetam]], [[Anorexia nervosa]], [[Aripiprazole ]], [[Benzylpiperazine]], [[Biperiden]], [[Bortezomib ]], [[Buprenorphine]], [[Buprenorphine Sublingual and Buprenorphine and Naloxone Sublingual ]], [[Bupropion]], [[Buspirone]], [[Butorphanol Injection ]], [[Caffeine]], [[Carbamazepine ]], [[Clofarabine Injection ]], [[Cocaine]], [[Dexamethasone Oral ]], [[Dextroamphetamine and Amphetamine ]], [[Dicyclomine ]], [[Diethylcathinone]], [[Diethylpropion ]], [[Diphenhydramine]], [[Doxylamine]], [[ECA stack]], [[Efavirenz ]], [[Enoxacin ]], [[Ethcathinone]], [[Fentanyl Oral Transmucosal ]], [[Fentanyl Skin Patches ]], [[Fexofenadine and Pseudoephedrine ]], [[Fludrocortisone Acetate ]], [[Fluoxetine]], [[Fluphenazine ]], [[Fluticasone Oral Inhalation ]], [[Gabapentin]], [[Glatiramer acetate]], [[Glycopyrrolate ]], [[Haloperidol]], [[Heroin]], [[Hydrocodone]], [[Hydrocortisone Injection ]], [[Hydrocortisone Oral ]], [[Hydroxyzine]], [[Imatinib ]], [[Interferon beta-1a Subcutaneous Injection ]], [[Interferon Beta-1b Injection ]], [[Leuprolide ]], [[Levetiracetam ]], [[Levodopa]], [[Liothyronine ]], [[Lofepramine]], [[Loratadine]], [[MDPV]], [[MeOPP]], [[Mesalamine ]], [[Methamphetamine]], [[Methylenedioxymethamphetamine]], [[Methylphenidate Transdermal ]], [[Methylprednisolone Oral ]], [[Methylprednisolone Sodium Succinate Injection ]], [[Metrazol]], [[Mirtazapine]], [[Moclobemide]], [[Modafinil]], [[Monoamine oxidase inhibitor]], [[Motofen]], [[Nabilone ]], [[Naltrexone ]], [[Norfloxacin ]], [[Norplant]], [[Nortriptyline ]], [[Orlistat ]], [[Oxaliplatin injection ]], [[Paroxetine]], [[Pentostatin ]], [[PFPP]], [[Phenylephrine]], [[Pipradrol]], [[Piracetam]], [[Posaconazole ]], [[Promethazine ]], [[Pseudoephedrine]], [[Psychiatric medication]], [[Psychoactive drug]], [[Pyrovalerone]], [[Quetiapine]], [[Reboxetine]], [[Rilmenidine]], [[Risperidone]], [[Ropinirole ]], [[Selective serotonin reuptake inhibitor]], [[Serotonin syndrome]], [[Serotonin-norepinephrine reuptake inhibitor]], [[Sertraline]], [[Sibutramine ]], [[Temozolomide ]], [[Topiramate]], [[Tramadol]], [[Trazodone]], [[Triamcinolone Oral ]], [[Triazolam]], [[Trifluoperazine Oral ]], [[Trifluoromethylphenylpiperazine]], [[Trimipramine ]], [[Yohimbine]], [[Ziprasidone ]], [[Zopiclone]], [[Oculogyric crisis]]
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| [[Adrenal tumor]], [[Hyperthyroidism]], [[Insulinoma]], [[Pheochromocytoma]]
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| [[Nitrogen narcosis]]
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| [[Variegate porphyria]]
 
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| [[Rabies]]
 
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| [[Benign fasciculation syndrome]], [[Deep water blackout]], [[Post-concussion syndrome]], [[Huntington's disease]]
 
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| [[Premenstrual syndrome]]
 
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"| [[Oculogyric crisis]]
 
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"| [[Bupropion]], [[Dicyclomine ]], [[Efavirenz ]], [[Fexofenadine and Pseudoephedrine ]], [[Fluoxetine]], [[Nabilone ]], [[Ziprasidone ]]
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| [[Acrophobia]], [[Acute stress disorder]], [[Addiction]], [[Adjustment disorder]], [[Adult attention-deficit disorder]], [[Affective spectrum]], [[Agoraphobia]], [[Algophobia]], [[Androphobia]], [[Binge eating disorder]], [[Bipolar disorder]], [[Bruxism]], [[Castration anxiety]], [[Child abuse]], [[Chronic stress]], [[Claustrophobia]], [[Combat stress reaction]], [[Cyberchondria]], [[Depression]], [[Dermatillomania]], [[Dhat syndrome]], [[Drug addiction]], [[Dual disorder]], [[Eating disorder]], [[Emotional conflict]], [[Equinophobia]], [[Existential anxiety]], [[Fear]], [[Fear of bees]], [[Fear of childbirth]], [[Fear of children]], [[Female hysteria]], [[Generalized anxiety disorder]], [[Gerontophobia]], [[Glossophobia]], [[Gymnophobia]], [[Holiday stress]], [[Huntington's disease]], [[Hypersomnia]], [[Hypervigilance]], [[Hypochondria]], [[Hysterical contagion]], [[Insomnia]], [[Jerusalem syndrome]], [[Medical students' disease]], [[Mental breakdown]], [[Night terror]], [[Nyctophobia]], [[Obsessive-compulsive disorder]], [[Palinopsia]], [[Panic disorder]], [[Paranoia]], [[Paranoid-schizoid position]], [[Parkinson's disease]], [[Penis panic]], [[Post traumatic stress disorder ]], [[Posttraumatic stress disorder]], [[Pseudodysphagia]], [[Psychiatric Disorders]], [[Psychological trauma]], [[Ringxiety]], [[Separation anxiety disorder]], [[Serious Emotional Disturbance]], [[Social anxiety]], [[Social Anxiety Disorder]], [[Social phobia]], [[Sociophobia]], [[Somniphobia]], [[Stage fright]], [[Stiff person syndrome]], [[Stranger anxiety]], [[Stress (medicine)]], [[Substance abuse]], [[Sunday night blues]], [[Tanorexia]], [[Technostress]], [[Test anxiety]], [[Traumatic stress]], [[Trichodynia]], [[Trichotillomania]], [[Trypanophobia]], [[Workplace stress]], [[Serotonin syndrome]]
 
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| [[Hyperventilation]], [[Hyperventilation syndrome]], [[Pulmonary edema]], [[Pulmonary Embolism]], [[Respiratory alkalosis]]|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| [[Antipsychotic (withdrawal)]], [[Benzodiazepine withdrawal syndrome]], [[Dosulepin hydrochloride (withdrawal)]], [[Phenibut (withdrawal)]]
|-
|}
 
===Complete Differential Diagnosis of the Causes of Anxiety===
(In alphabetical order)
 
 
{{MultiCol}}
 
*[[Abciximab ]]
 
*[[Acrophobia]]
 
*[[Acute Coronary Syndromes]]
 
*[[Acute stress disorder]]
 
*[[Addiction]]
 
*[[Adjustment disorder]]
 
*[[Adrenal tumor]]
 
*[[Adult attention-deficit disorder]]
 
*[[Affective spectrum]]
 
*[[Agoraphobia]]
 
*[[Algophobia]]
 
*[[Alpha-Methyltryptamine]]
 
*[[Amantadine]]
 
*[[Amineptine]]
 
*[[Amphetamine]]
 
*[[Androphobia]]
 
*[[Aniracetam]]
 
*[[Anorexia nervosa]]
 
*[[Antipsychotic (withdrawal)]]
 
*[[Aripiprazole ]]
 
*[[Barium nitrate]]
 
*[[Benign fasciculation syndrome]]
 
*[[Benzodiazepine withdrawal syndrome]]
 
*[[Benzylpiperazine]]
 
*[[Binge eating disorder]]
 
*[[Biperiden]]
 
*[[Bipolar disorder]]
 
*[[Bortezomib ]]
 
*[[Bruxism]]
 
*[[Buprenorphine]]
 
*[[Buprenorphine Sublingual and Buprenorphine and Naloxone Sublingual ]]
 
*[[Bupropion]]
 
*[[Buspirone]]
 
*[[Butorphanol Injection ]]
 
*[[Caffeine]]
 
*[[Carbamazepine ]]
 
*[[Castration anxiety]]
 
*[[Child abuse]]
 
*[[Chronic stress]]
 
*[[Claustrophobia]]
 
*[[Clofarabine Injection ]]
 
*[[Cocaine]]
 
*[[Combat stress reaction]]
 
*[[Cyberchondria]]
 
*[[Deep water blackout]]
 
*[[Depression]]
 
*[[Dermatillomania]]
 
*[[Dexamethasone Oral ]]
 
*[[Dextroamphetamine and Amphetamine ]]
 
*[[Dhat syndrome]]
 
*[[Dicyclomine ]]
 
*[[Diethylcathinone]]
 
*[[Diethylpropion ]]
 
*[[Diphenhydramine]]
 
*[[Dosulepin hydrochloride (withdrawal)]]
 
*[[Doxylamine]]
 
*[[Drug addiction]]
 
*[[Dual disorder]]
 
*[[Eating disorder]]
 
*[[ECA stack]]
 
*[[Efavirenz ]]
 
*[[Emotional conflict]]
 
*[[Enoxacin ]]
 
*[[Equinophobia]]
 
*[[Ethcathinone]]
 
*[[Existential anxiety]]
 
*[[Fear]]
 
*[[Fear of bees]]
 
*[[Fear of childbirth]]
 
*[[Fear of children]]
 
*[[Female hysteria]]
 
*[[Fentanyl Oral Transmucosal ]]
 
*[[Fentanyl Skin Patches ]]
 
*[[Fexofenadine and Pseudoephedrine ]]
 
{{ColBreak}}
 
*[[Fludrocortisone Acetate ]]
 
*[[Fluoxetine]]
 
*[[Fluphenazine ]]
 
*[[Fluticasone Oral Inhalation ]]
 
*[[Gabapentin]]
 
*[[Generalized anxiety disorder]]
 
*[[Gerontophobia]]
 
*[[Glatiramer acetate]]
 
*[[Glossophobia]]
 
*[[Glycopyrrolate ]]
 
*[[Gymnophobia]]
 
*[[Haloperidol]]
 
*[[Heroin]]
 
*[[Holiday stress]]
 
*[[Huntington's disease]]
 
*[[Hydrocodone]]
 
*[[Hydrocortisone Injection ]]
 
*[[Hydrocortisone Oral ]]
 
*[[Hydroxyzine]]
 
*[[Hypersomnia]]
 
*[[Hypertension]]
 
*[[Hyperthyroidism]]
 
*[[Hyperventilation]]
 
*[[Hyperventilation syndrome]]
 
*[[Hypervigilance]]
 
*[[Hypochondria]]
 
*[[Hysterical contagion]]
 
*[[Imatinib ]]
 
*[[Insomnia]]
 
*[[Insulinoma]]
 
*[[Interferon beta-1a Subcutaneous Injection ]]
 
*[[Interferon Beta-1b Injection ]]
 
*[[Irukandji syndrome]]
 
*[[Jerusalem syndrome]]
 
*[[Leuprolide ]]
 
*[[Levetiracetam ]]
 
*[[Levodopa]]
 
*[[Liothyronine ]]
 
*[[Lofepramine]]
 
*[[Loratadine]]
 
*[[MDPV]]
 
*[[Medical students' disease]]
 
*[[Mental breakdown]]
 
*[[MeOPP]]
 
*[[Mesalamine ]]
 
*[[Methamphetamine]]
 
*[[Methylenedioxymethamphetamine]]
 
*[[Methylphenidate Transdermal ]]
 
*[[Methylprednisolone Oral ]]
 
*[[Methylprednisolone Sodium Succinate Injection ]]
 
*[[Metrazol]]
 
*[[Mirtazapine]]
 
*[[Moclobemide]]
 
*[[Modafinil]]
 
*[[Monoamine oxidase inhibitor]]
 
*[[Motofen]]
 
*[[Myocardial infarction]]
 
*[[Nabilone ]]
 
*[[Naltrexone ]]
 
*[[Night terror]]
 
*[[Nitrogen narcosis]]
 
*[[Norfloxacin ]]
 
*[[Norplant]]
 
*[[Nortriptyline ]]
 
*[[Nyctophobia]]
 
*[[Obsessive-compulsive disorder]]
 
*[[Oculogyric crisis]]
 
*[[Orlistat ]]
 
*[[Orthostatic intolerance]]
 
*[[Oxaliplatin injection ]]
 
*[[Palinopsia]]
 
*[[Panic disorder]]
 
*[[Paranoia]]
 
*[[Paranoid-schizoid position]]
 
{{ColBreak}}
 
*[[Parkinson's disease]]
 
*[[Paroxetine]]
 
*[[Penis panic]]
 
*[[Pentostatin ]]
 
*[[PFPP]]
 
*[[Phenibut (withdrawal)]]
 
*[[Phenylephrine]]
 
*[[Pheochromocytoma]]
 
*[[Pipradrol]]
 
*[[Piracetam]]
 
*[[Posaconazole ]]
 
*[[Post traumatic stress disorder ]]
 
*[[Post-concussion syndrome]]
 
*[[Posttraumatic stress disorder]]
 
*[[Postural orthostatic tachycardia syndrome]]
 
*[[Premenstrual syndrome]]
 
*[[Promethazine ]]
 
*[[Pseudodysphagia]]
 
*[[Pseudoephedrine]]
 
*[[Psychiatric Disorders]]
 
*[[Psychiatric medication]]
 
*[[Psychoactive drug]]
 
*[[Psychological trauma]]
 
*[[Pulmonary edema]]
 
*[[Pulmonary Embolism]]
 
*[[Pyrovalerone]]
 
*[[Quetiapine]]
 
*[[Rabies]]
 
*[[Reboxetine]]
 
*[[Respiratory alkalosis]]
 
*[[Rilmenidine]]
 
*[[Ringxiety]]
 
*[[Risperidone]]
 
*[[Ropinirole ]]
 
*[[Selective serotonin reuptake inhibitor]]
 
*[[Separation anxiety disorder]]
 
*[[Serious Emotional Disturbance]]
 
*[[Serotonin syndrome]]
 
*[[Serotonin-norepinephrine reuptake inhibitor]]
 
*[[Sertraline]]
 
*[[Sibutramine ]]
 
*[[Social anxiety]]
 
*[[Social Anxiety Disorder]]
 
*[[Social phobia]]
 
*[[Sociophobia]]
 
*[[Somniphobia]]
 
*[[Stage fright]]
 
*[[Stiff person syndrome]]
 
*[[Stranger anxiety]]
 
*[[Stress (medicine)]]
 
*[[Substance abuse]]
 
*[[Sunday night blues]]
 
*[[Supraventricular tachycardia]]
 
*[[Tanorexia]]
 
*[[Technostress]]
 
*[[Temozolomide ]]
 
*[[Test anxiety]]
 
*[[Topiramate]]
 
*[[Tramadol]]
 
*[[Traumatic stress]]
 
*[[Trazodone]]
 
*[[Triamcinolone Oral ]]
 
*[[Triazolam]]
 
*[[Trichodynia]]
 
*[[Trichotillomania]]
 
*[[Trifluoperazine Oral ]]
 
*[[Trifluoromethylphenylpiperazine]]
 
*[[Trimipramine ]]
 
*[[Trypanophobia]]
 
*[[Variegate porphyria]]
 
*[[Workplace stress]]
 
*[[Yohimbine]]
 
*[[Ziprasidone ]]
 
*[[Zopiclone]]
 
 
{{EndMultiCol}}


== Diagnosis ==
== Diagnosis ==
The Generalized Anxiety Disorder [GAD]-2 scale can screen for the four most common [[anxiety disorder]]s ([[posttraumatic stress disorder]], [[generalized anxiety disorder]], [[panic disorder]], and [[social anxiety disorder]]) and the Generalized Anxiety Disorder [GAD]-7 scale can add certainty.<ref name="pmid17339617">{{cite journal |author=Kroenke K, Spitzer RL, Williams JB, Monahan PO, Löwe B |title=Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection |journal=Ann. Intern. Med. |volume=146 |issue=5 |pages=317-25 |year=2007 |pmid=17339617 |doi=|url=http://annals.org/cgi/content/full/146/5/317}}</ref>
[[Anxiety history and symptoms|History and Symptoms]] | [[Anxiety physical examination|Physical Examination]] | [[Anxiety laboratory findings|Laboratory Findings]] | [[Anxiety electrocardiogram|ECG]] | [[Anxiety other diagnostic studies|Other Diagnostic Studies]]


===GAD-2===
== Treatment ==
The Generalized Anxiety Disorder (GAD) - 2 scale is<ref name="pmid17339617"/>:
[[Anxiety medical therapy|Medical Therapy]] | [[Anxiety non-medical therapy|Non-medical Therapy]] | [[Anxiety Surgery| Surgery]] | [[Anxiety primary prevention|Primary Prevention]] | [[Anxiety secondary prevention|Secondary Prevention]] | [[Anxiety cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Anxiety future or investigational therapies|Future or Investigational Therapies]]


"During the past month, have you been bothered a lot by:"
== Case Studies ==
[[Anxiety case study one|Case #1]]


1. 'nerves' or feeling anxious or on edge?         
== Related Chapters ==
:'Not at all' = 0pts; 'Several days' = 1 pt; 'More than half of the days' =2 pts; 'Nearly every day' =3 pts
2. worrying about a lot of different things?
:'Not at all' = 0pts; 'Several days' = 1 pt; 'More than half of the days' =2 pts; 'Nearly every day' =3 pts
 
The performance of the GAD-2 in diagnosing any anxiety disorder is<ref name="pmid17339617"/>:
 
2 or more points:
* [[sensitivity (tests)|sensitivity]] 86%
* [[specificity (tests)|specificity]] 70%
3 or more points:
* [[sensitivity (tests)|sensitivity]] 65%
* [[specificity (tests)|specificity]] 88%
 
===GAD-7===
The Generalized Anxiety Disorder (GAD) - 7 scale is copyrighted. Its full text is available at http://annals.org/cgi/content/full/146/5/317/FA1 <ref name="pmid17339617"/>:
 
The performance of the GAD-7 in diagnosing any anxiety disorder is<ref name="pmid17339617"/>:
 
8 or more points:
* [[sensitivity (tests)|sensitivity]] 77%
* [[specificity (tests)|specificity]] 82%
 
== History and Symptoms ==
* Detailed history
*:* Duration
*:* Onset
*:* Type of anxiety
* Events causing anxiety
*:* Stressors
*:* Medical illnesses
* Drug and medication history
== Physical Examination ==
* Physical exam important to rule out organic medical diseases
===Anxiety in palliative care===
Some research has strongly suggested that treating anxiety in [[cancer]] patients improves their quality of life. The treatment generally consists of counseling, relaxation techniques or pharmacologically with benzodiazepines.
==Theories==
===Two factor theory of anxiety===
 
[[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.
 
==Types of anxiety==
===Existential anxiety===
 
::''See more under [[existential crisis]].''
 
[[theology|Theologians]] like [[Paul Tillich]] and psychologists like [[Sigmund Freud]] have characterized anxiety as the reaction to what Tillich called, "The trauma of nonbeing." That is, the human comes to realize that there is a point at which he or she might cease to be (die), and their encounter with reality becomes characterized by anxiety.
[[Religion]], according to both Tillich and Freud, then becomes a carefully crafted coping mechanism in response to this anxiety since they redefine death as the end of only the corporal part of human personal existence, assuming an immortal [[soul]].
What then becomes of this soul and through what criteria is the cardinal difference of various [[religious faith]]s.
 
Philosophical ruminations are a part of this condition, and this is part of [[obsessive-compulsive disorder]]. They are typically about sex and religion or death.
 
According to [[Viktor Frankl]], author of ''[[Man's Search for Meaning]]'', when faced with extreme mortal dangers the very basic of all human wishes is to find a [[meaning of life]] to combat this "trauma of nonbeing" as death is near and to succumb to it (even by [[suicide]]) seems like a way out.
 
===Test anxiety===<!-- This section is linked from [[Educational psychology]] -->
Test anxiety is the uneasiness, apprehension, or nervousness felt by students who have a fear of failing an exam. Students suffering from test anxiety may experience any of the following: the association of grades with personal worth, embarrassment by a teacher, taking a class that is beyond their ability, fear of alienation from parents or friends, time pressures, or feeling a loss of control.  Emotional, cognitive, behavioral, and physical components can all be present in test anxiety. Sweating, dizziness, headaches, racing heartbeats, nausea, fidgeting, and drumming on a desk are all common. An optimal level of arousal is necessary to best complete a task such as an exam; however, when the anxiety or level of arousal exceeds that optimum, it results in a decline in performance. Because test anxiety hinges on fear of negative evaluation, debate exists as to whether test anxiety is itself a unique anxiety disorder or whether it is a specific type of social phobia. In 2006, approximately 49% of high school students were reportedly suffering from this condition.
 
While the term ''test anxiety'' refers specifically to students, many adults share the same experience with regard to their career or profession.  The fear of failing a task and being negatively evaluated for it can have a similarly negative effect on the adult.
 
===Stranger anxiety===
{{main|Stranger anxiety|socialization}}
Anxiety when meeting or interacting with unknown people is a common stage of development in young people. 
 
So-called "stranger anxiety" in younger people is ''not'' a phobia in the classic sense; rather it is a developmentally appropriate fear by young children of those who do ''not'' share a 'loved-one', caretaker or parenting role. In adults, an excessive fear of other people is not a developmentally common stage.
 
==Treatment==
 
* Patient education
* Biofeedback
* Cognitive behavioral therapy
== Pharmacotherapy ==
 
=== Acute Pharmacotherapies ===
* For obsessive-compulsive disorder:
*:* [[SSRI]]s (selective [[serotonin reuptake inhibitors]]) in high doses
* For general [[anxiety disorder]], pharmacology proves to be beneficial:
*:* [[Antidepressant]]s
*:* [[Benzodiazepines]] (some concern over dependency)
*:* [[Buspirone]]
* For panic disorder:
*:* [[Tricyclic antidepressant]]s
*:* [[SSRI]]s ([[selective serotonin reuptake inhibitors]])
*:* [[Benzodiazepine]]s
 
==References==
{{reflist|2}}
 
==Sources==
* Rosen, J.B. & Schulkin, J. (1998): "From normal fear to pathological anxiety". ''Psychological Review''. '''105'''(2); 325-350.
* Seligman, M.E.P., Walker, E.F. & Rosenhan, D.L. (2001). ''Abnormal psychology'', (4th ed.) New York: W.W. Norton & Company, Inc.
* Zald, D.H., Hagen, M.C. & Pardo, J.V. (2002). "Neural correlates of tasting concentrated quinine and sugar solutions". ''J. Neurophysiol.'' '''87'''(2), 1068-75.
* Zald, D.H. & Pardo, J.V. (1997). "Emotion, olfaction, and the human amygdala: amygdala activation during aversive olfactory stimulation." ''Proc Nat'l Acad Sci'' USA. '''94'''(8), 4119-24.
 
== See also ==
{{Wikiquote|Anxiety}}
{{Wiktionary|anxiety}}
* [[Anxiety disorder]]
* [[Anxiety disorder]]
* [[Anxiolytic]]
* [[Anxiolytic]]
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* [[Panic attack]]
* [[Panic attack]]
* [[Panic disorder]]
* [[Panic disorder]]
 
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Latest revision as of 03:25, 23 November 2022

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 On the Web

Most recent articles

cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Anxiety

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Anxiety

CDC on Anxiety

Anxiety in the news

Blogs on Anxiety

Directions to Hospitals Treating Anxiety

Risk calculators and risk factors for Anxiety

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vindhya BellamKonda, M.B.B.S [2], Shankar kumar,M.B.B.S. Synonyms and keywords: Angst, trouble, anxiety disorder.

Overview

Historical Perspective

Classification

Causes

Differentiating Anxiety from other Diseases

Epidemiology and Demographics

Risk Factors

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | ECG | Other Diagnostic Studies

Treatment

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

Case Studies

Case #1

Related Chapters


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