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PHARMACOTHERAPY PRINCIPLES AND PRACTICE CARE PLANS & CASES

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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

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

  1. Describe pathophysiology of generalized anxiety, panic, and social anxiety disorders (SAD).

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

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

  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 SAD.

  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.

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INTRODUCTION

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Anxiety disorders are among the most frequent mental disorders encountered by clinicians. All anxiety disorders share features of fear and anxiety that differ from developmentally normative fear or anxiety by being excessive, persistent, and resulting in behavioral disturbances.

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Anxiety disorders are often missed or attributed incorrectly to other medical illnesses, and most patients are treated inadequately.1 The burden of diagnosis usually falls to primary care clinicians, to whom most patients present in the context of other complaints. Untreated anxiety disorders may result in increased health care utilization, morbidity and mortality, and a poorer quality of life.

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EPIDEMIOLOGY AND ETIOLOGY

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Epidemiology

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Prevalence
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The lifetime prevalence of anxiety disorders collectively is 28.8% with specific phobia (12.5%) and social anxiety disorder (SAD) (12.1%) being the most common.2,3 Data from the National Comorbidity Survey, Revised (NCS-R) estimate the lifetime prevalence of generalized anxiety disorder (GAD) for those 18 years of age and older to be 5.7%, and rates for panic disorder (PD), 4.7%.3,4

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Anxiety disorders are more prevalent among women than men (2:1).2 Prevalence rates across the anxiety spectrum increase from the younger age group (18–29 years) to older age groups (30–44 and 45–59 years); however, rates are substantially lower for those older than age 59 years.3

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Course of Illness
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PD and GAD have a median age of onset of 24 and 31 years, respectively, whereas SAD develops earlier (median age 13 years).3 Although GAD and PD may not manifest fully until adulthood, as many as half of adult anxiety patients report subthreshold symptoms during childhood.5

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Anxiety disorders are chronic, and symptoms tend to wax and wane, with fewer than one-third of patients experiencing spontaneous symptom remission.6 The risk for relapse and recurrence of symptoms is also high for anxiety disorders. In a 12-year follow-up study of anxiety disorder patients, recurrence rates ranged from 58% of PD and GAD patients to 39% of SAD patients.7

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Remission, if achieved with treatment, is ...

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