Upon completion of the chapter, the reader will be able to:
Explain the pathophysiologic mechanisms underlying anxiety disorders.
Recognize common presenting symptoms of generalized anxiety disorder (GAD), panic disorder (PD), social anxiety disorder (SAD), and posttraumatic stress disorder (PTSD).
List treatment goals for patients with GAD, PD, SAD, and PTSD.
Identify appropriate lifestyle modifications and over-the-counter medication use in these patients.
Compare the efficacy and tolerability profiles of psychotherapy and pharmacotherapy interventions for anxiety disorders.
Design a patient-specific pharmacotherapy treatment plan for patients with GAD, PD, SAD, and PTSD.
Develop a monitoring plan for patients with anxiety disorders.
Formulate appropriate educational information to be provided to a patient receiving pharmacotherapy for anxiety disorders.
Anxiety disorders are among the most frequent mental disorders encountered by clinicians.1,2 All anxiety disorders are highly comorbid and share features of fear and anxiety that differ from developmentally typical fear or anxiety by being excessive, persistent, and resulting in behavioral disturbances.1 Anxiety disorders are associated with significant patient and family burden, functional impairment, and increased risk of developing comorbid major depressive disorder (MDD).1-4
Initial detection and diagnosis generally falls to primary care clinicians, to whom most patients present in the context of other complaints.4 Anxiety disorders are often missed or attributed incorrectly to other medical illnesses, and most patients are treated inadequately.4 Untreated anxiety disorders are associated with increased healthcare utilization, morbidity and mortality, and a poorer quality of life.1-4
EPIDEMIOLOGY AND ETIOLOGY
Data from the National Comorbidity Survey, Replication not revised (NCS-R) estimate the lifetime prevalence of anxiety disorders in adults (18-64), collectively is 33.7%.3 This estimate includes PTSD and OCD, although the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) recategorized it to a trauma and stressor-related disorders and obsessive-compulsive and related disorders, respectively.1 The estimated lifetime prevalence for each anxiety disorder is specific phobia 13.8%, social anxiety disorder 13%, generalized anxiety disorder 6.2%, panic disorder 5.2%, and posttraumatic stress disorder 8%.3
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.5
PTSD, PD, and GAD have median ages of onset of 23, 24, and 31 years, respectively, whereas SAD develops earlier, 13 years.6 It is likely that anxiety disorders are underdiagnosed and that symptoms are present for years prior to diagnosis.
Anxiety disorders are chronic, and symptoms tend to wax and wane, with fewer than one-third of patients experiencing ...