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Upon completion of the chapter, the reader will be able to:

  1. Describe pathophysiologic findings in patients with generalized anxiety, panic, and social anxiety disorder.

  2. List common presenting symptoms of generalized anxiety, panic, and social anxiety disorders.

  3. Identify the desired therapeutic outcomes for patients with generalized anxiety, panic, and social anxiety disorders.

  4. Discuss appropriate lifestyle modifications and over-the-counter medication use in these patients.

  5. Recommend psychotherapy and pharmacotherapy interventions for patients with generalized anxiety, panic, and social anxiety disorders.

  6. Develop a monitoring plan for anxiety patients placed on specific medications.

  7. Educate patients about their disease state and appropriate lifestyle modifications, as well as psychotherapy and pharmacotherapy for effective treatment.




  • Image not available. The goals of therapy for generalized anxiety disorder (GAD) are to acutely reduce the severity and duration of anxiety symptoms and restore overall functioning. The long-term goal in GAD is to achieve and maintain remission.

  • Image not available. Antidepressants are considered first-line agents in the management of chronic GAD.

  • Image not available. Benzodiazepines are recommended for acute treatment of GAD when short-term relief is needed, as an adjunct during initiation of antidepressant therapy, or to improve sleep.

  • Image not available. The acute phase of panic disorder (PD) treatment lasts about 12 weeks and should result in marked reduction in panic attacks, ideally total elimination, and minimal anticipatory anxiety and phobic avoidance. Treatment should be continued to prevent relapse for an additional 12 to 18 months before attempting discontinuation.

  • Image not available. Patients with PD are more likely to experience stimulant-like side effects of antidepressants than patients with major depression. Antidepressants should be initiated at lower doses in patients with PD than in depressed patients and those with other anxiety disorders.

  • Image not available. Antidepressants should be tapered when treatment is discontinued to avoid withdrawal symptoms, including irritability, dizziness, headache, and dysphoria.

  • Image not available. The dose of benzodiazepine required for improvement in PD generally is higher than that used in other anxiety disorders.

  • Image not available. Based on their tolerability and efficacy, selective serotonin reuptake inhibitors are considered the drugs of choice for social anxiety disorder (SAD).

  • Image not available. The onset of response to antidepressants in SAD is delayed and may be as long as 8 to 12 weeks. Patients responding to medication should be continued on treatment for at least 1 year.

  • Image not available. Pharmacotherapy for patients with SAD should lead to improvement in physiologic symptoms of anxiety and fear, functionality, and overall well-being.


Anxiety is a normal response to stressful or fearful circumstances. Most people experience some degree of anxiety in reaction to stressful situations, such as final exams or giving a speech. This allows an individual to adapt to or manage the stressful or threatening situation. Anxiety symptoms generally are short lived and do not necessarily impair function. Anxiety that becomes excessive, causes irrational thinking or behavior, and impairs a person's functioning is considered an anxiety disorder.


Anxiety disorders are among the most frequent mental disorders encountered by clinicians. They often are missed or attributed incorrectly to other ...

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