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American Family Physician Feb 1989Generalized anxiety disorder is a syndrome characterized by excessive anxiety or apprehension concerning two or more of life's circumstances. Presenting signs and... (Review)
Review
Generalized anxiety disorder is a syndrome characterized by excessive anxiety or apprehension concerning two or more of life's circumstances. Presenting signs and symptoms often include somatic complaints, such as tremor, dyspnea, palpitations, lightheadedness and nausea. Treatment includes supportive psychotherapy and antianxiety drugs, primarily benzodiazepines. In some cases, antidepressants may prove beneficial.
Topics: Antidepressive Agents; Anxiety Disorders; Benzodiazepines; Depressive Disorder; Humans; Panic
PubMed: 2644785
DOI: No ID Found -
The Journal of Clinical Psychiatry 1999Social anxiety disorder is characterized by marked fear of performance, excessive fear of scrutiny, and fear of acting in a way that will be embarrassing. Although the... (Review)
Review
Social anxiety disorder is characterized by marked fear of performance, excessive fear of scrutiny, and fear of acting in a way that will be embarrassing. Although the incidence of social anxiety disorder is approximately 13%, this disorder has been termed "the neglected anxiety disorder" because it is often missed as a diagnosis. Social anxiety disorder has an early onset in most patients and tends to manifest during adolescence. However, many patients do not receive therapy until a comorbid disorder (e.g., panic) is diagnosed later in life. There are 2 distinct subtypes of social anxiety disorder, generalized and nongeneralized, that differ in terms of symptoms, course of illness, morbidity, pathophysiology, and response to treatment. Both pharmacologic and psychotherapeutic treatments are effective, and the 2 modalities have complementary strengths. The selective serotonin reuptake inhibitors may be considered first-line therapy for the generalized subtype of social anxiety disorder because of proved efficacy and well-tolerated adverse effect profiles. Other agents may be useful for treatment-refractory patients. However, there is a substantial rate of relapse even after prolonged treatment. There is evidence that patients who receive cognitive-behavioral therapy may have lower rates of relapse. Early and aggressive treatment of social anxiety disorder may prevent development of comorbid disorders and can substantially improve patients' quality of life.
Topics: Adolescent; Adult; Anxiety Disorders; Cognitive Behavioral Therapy; Comorbidity; Diagnosis, Differential; Female; Humans; Male; Mental Disorders; Mood Disorders; Paroxetine; Phobic Disorders; Quality of Life; Selective Serotonin Reuptake Inhibitors; Treatment Outcome
PubMed: 10487252
DOI: No ID Found -
Turk Psikiyatri Dergisi = Turkish... 2007In recent years, a growing number of clinical and epidemiological studies have reported high rates of comorbid anxiety disorder in patients with bipolar disorder. These... (Review)
Review
In recent years, a growing number of clinical and epidemiological studies have reported high rates of comorbid anxiety disorder in patients with bipolar disorder. These studies have stated that comorbid anxiety disorder in bipolar patients is the rule rather than the exception. Lifetime anxiety disorder comorbidity rates among bipolar disorder patients are estimated to be between 24% and 93%, based on several different clinical and epidemiological studies. Bipolar patients usually are diagnosed with comorbid multiple anxiety disorders rather than a single one. Anxiety disorder comorbidity is associated with greater psychopathology, decreased treatment response, poor outcome, and increased suicidality. Current prevalent treatment approaches almost always give priority to the symptomatic treatment of bipolar episodes, which inevitably influences the provision of adequate attention and care to the diagnosis and treatment of a comorbid anxiety disorder. This approach has important therapeutic and clinical implications, such as delays in treatment leading to resistance to drugs and severe functional losses. Therefore, the treating psychiatrist needs to carefully evaluate, diagnose, and treat comorbid anxiety disorders in the early stages to avoid any unpleasant consequences and to improve the quality of life of patients. In this paper, an overview of comorbid anxiety disorder in bipolar disorders is presented, with a special emphasis on its prevalence, its relationship to sociodemographic and clinical variables, and possible therapeutic approaches.
Topics: Anxiety Disorders; Bipolar Disorder; Comorbidity; Humans
PubMed: 17364269
DOI: No ID Found -
Primary Care Jun 2016Investigation for a possible anxiety disorder should be considered in patients with multiple or persistent anxiety symptoms or multiple somatic complaints without a... (Review)
Review
Investigation for a possible anxiety disorder should be considered in patients with multiple or persistent anxiety symptoms or multiple somatic complaints without a clear somatic etiology. The ideal treatment for anxiety disorders is a combination of pharmacologic and behavioral strategies. As primary care health care evolves, it is expected that the management of mental health disorders (including anxiety disorders) will largely occur in the context of collaborative care models in which patients and primary care clinicians are assisted by trained case managers who help facilitate a more comprehensive, holistic treatment plan between primary care and mental health providers.
Topics: Anxiety Disorders; Complementary Therapies; Humans; Primary Health Care; Psychotherapy; Selective Serotonin Reuptake Inhibitors; Surveys and Questionnaires
PubMed: 27262005
DOI: 10.1016/j.pop.2016.02.002 -
Anxiety, Stress, and Coping Jan 2009This review considers recent research assessing psychophysiological reactivity to fear imagery in anxiety disorder patients. As in animal subjects, fear cues prompt in... (Review)
Review
This review considers recent research assessing psychophysiological reactivity to fear imagery in anxiety disorder patients. As in animal subjects, fear cues prompt in humans a state of defensive motivation in which autonomic and somatic survival reflexes are markedly enhanced. Thus, a startle stimulus presented in a fear context yields a stronger (potentiated) reflex, providing a quantitative measure of fearful arousal. This fear potentiation is further exaggerated in specific or social phobia individuals when viewing pictures or imagining the phobic object. Paradoxically, fear imagery studies with more severe anxiety disorder patients--panic disorder with agoraphobia, generalized anxiety disorder, or anxious patients with comorbid depression--show a blunted, less robust fear potentiated response. Furthermore, this reflex blunting appears to systematically be more pronounced over the anxiety disorder spectrum, coincident with lengthier chronicity, worsening clinician-based judgments of severity and prognosis, and increased questionnaire-based indices of negative affectivity, suggesting that normal defensive reactivity may be compromised by an experience of long-term stress.
Topics: Animals; Anxiety Disorders; Diagnosis, Differential; Fear; Heart Rate; Humans; Imagery, Psychotherapy; Mammals; Phobic Disorders; Reflex, Startle; Sweating; Violence
PubMed: 19096959
DOI: 10.1080/10615800802478247 -
The Journal of Clinical Psychiatry 2004Benzodiazepines are advantageous treatments for anxiety disorders because they work quickly. However, benzodiazepines can vary in terms of efficacy across anxiety... (Review)
Review
Benzodiazepines are advantageous treatments for anxiety disorders because they work quickly. However, benzodiazepines can vary in terms of efficacy across anxiety disorders. Benzodiazepines have been found to be a superior treatment in social anxiety disorder. While benzodiazepines are effective in the treatment of generalized anxiety disorder, other treatments such as selective serotonin reuptake inhibitors may be more effective. Also, research indicates that benzodiazepines may not be effective in the treatment of posttraumatic stress disorder. Therefore, physicians need to consider the type of anxiety disorder before prescribing a benzodiazepine as a treatment.
Topics: Anxiety Disorders; Humans; Phobic Disorders; Stress Disorders, Post-Traumatic
PubMed: 15078116
DOI: No ID Found -
Expert Review of Neurotherapeutics Oct 2006Generalized anxiety disorder is a highly prevalent and under-recognized public health problem associated with significant impairment and serious disability. Generalized... (Review)
Review
Generalized anxiety disorder is a highly prevalent and under-recognized public health problem associated with significant impairment and serious disability. Generalized anxiety disorder is the most common anxiety disorder among adults over the age of 60 years. This article discusses distinguishing features of generalized anxiety disorder, such as disorder-specific worry domains and associated features. The relation of the disorder to normal aging, major depression and health is also discussed. Current psychosocial treatment strategies are outlined, with a particular focus on cognitive behavior therapy.
Topics: Age Factors; Aged; Aged, 80 and over; Anxiety Disorders; Humans; Middle Aged; Psychotherapy; Social Support
PubMed: 17078785
DOI: 10.1586/14737175.6.10.1439 -
Current Psychiatry Reports May 2017The review focused on associations between temperament dimensions and clinical features in different anxiety disorders, likewise in obsessive-compulsive disorder in... (Review)
Review
PURPOSE OF REVIEW
The review focused on associations between temperament dimensions and clinical features in different anxiety disorders, likewise in obsessive-compulsive disorder in clinical samples of adults. A literature search was conducted in the Medline and PsycINFO databases covering the years 2010-2016. A systematic review and grading of the level of evidence for an association between temperament dimension scores and clinical features in each disorder were performed.
RECENT FINDINGS
Twenty papers reporting 18 different studies were included. Five of the papers focused on panic disorder (PD), five on social anxiety disorder (SAD), three on post-traumatic stress disorder (PTSD), one on generalized anxiety disorder (GAD), three on obsessive-compulsive disorder (OCD), and an additional three papers on several anxiety disorders. The review consolidates the finding that trait anxiety, especially as assessed by Cloninger's model or the five-factor model, is a phenomenon common to all anxiety disorders and OCD. More follow-up studies including large samples are needed to differentiate the dimensional profiles of trait anxiety in specific disorders.
Topics: Adult; Anxiety Disorders; Humans; Psychiatric Status Rating Scales; Psychological Techniques; Stress Disorders, Post-Traumatic; Temperament
PubMed: 28417269
DOI: 10.1007/s11920-017-0779-5 -
Expert Review of Neurotherapeutics Mar 2005Generalized anxiety disorder is a highly debilitating psychologic disorder associated with cognitive, affective, behavioral and physiologic forms of rigidity and... (Review)
Review
Generalized anxiety disorder is a highly debilitating psychologic disorder associated with cognitive, affective, behavioral and physiologic forms of rigidity and dysfunction. Chronic and uncontrollable worry, a future-oriented and highly negative form of verbal thought, is its hallmark symptom. Cognitive behavioral therapy, the most well-established psychologic treatment for generalized anxiety disorder, entails techniques designed to target and reduce dysfunction in each of these mutually interrelating domains. This review serves as an introduction to cognitive behavioral therapy for generalized anxiety disorder, including conceptualization, treatment methods and evidence for efficacy. Future directions for augmenting treatment efficacy are also discussed.
Topics: Anxiety Disorders; Cognitive Behavioral Therapy; Expert Testimony; Humans; Imagery, Psychotherapy; Relaxation Therapy
PubMed: 15853494
DOI: 10.1586/14737175.5.2.247 -
Seishin Shinkeigaku Zasshi =... 2012In addition to genetic factors, the role of epigenetic and other environmental factors in the promotion of anxiety disorder has attracted much attention in psychiatric... (Review)
Review
In addition to genetic factors, the role of epigenetic and other environmental factors in the promotion of anxiety disorder has attracted much attention in psychiatric research. When stress is encountered in the environment, the hypothalamus-pituitary adrenal system (HPA system) is activated and cortisol is secreted. CRHR gene function is closely related to this response. As a result of haplotype analysis of CRHR genes in depression and panic disorder patients, it was found that genetic polymorphism of CRHR1 and CRHR2 was related to both disorders. It is reported that abused children are more susceptible to developing depression and anxiety disorder upon reaching adulthood, but there also exist genetic polymorphisms that may moderate this relationship. Direct methylation of DNA (typically repressing gene expression) and modification of chromatin structure (complexes of histone proteins and DNA) via acetylation (typically facilitating gene expression) represent epigenetic modifications that are thought to influence behavioral phenotypes. For example, it is rare that schizophrenia develops in identical twins brought up together in the same environment, and thus phenotypic differences cannot be explained simply by genetic polymorphism. We also evaluated salivary cortisol and amylase reactivity (indices of the HPA system and sympathoadrenal medullary system, respectfully) after electrical stimulation stress and Trier Social Stress Test (TSST) administration. Here we found differences in the cortisol stress response between electrical stimulation and TSST stressors, in contrast to the theory of Selye. In addition, we found alterations in activity patterns and difficulties integrating sensorimotor information in panic disorder patients, suggesting links between sensorimotor integration and stress in panic disorder. Moreover, state and trait anxiety may be associated with stabilograph factors.
Topics: Anxiety; Anxiety Disorders; Depressive Disorder; Diagnosis, Differential; Humans; Pituitary-Adrenal System; Stress, Psychological
PubMed: 23198596
DOI: No ID Found