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American Family Physician May 2015Generalized anxiety disorder (GAD) and panic disorder (PD) are among the most common mental disorders in the United States, and they can negatively impact a patient's... (Review)
Review
Generalized anxiety disorder (GAD) and panic disorder (PD) are among the most common mental disorders in the United States, and they can negatively impact a patient's quality of life and disrupt important activities of daily living. Evidence suggests that the rates of missed diagnoses and misdiagnosis of GAD and PD are high, with symptoms often ascribed to physical causes. Diagnosing GAD and PD requires a broad differential and caution to identify confounding variables and comorbid conditions. Screening and monitoring tools can be used to help make the diagnosis and monitor response to therapy. The GAD-7 and the Severity Measure for Panic Disorder are free diagnostic tools. Successful outcomes may require a combination of treatment modalities tailored to the individual patient. Treatment often includes medications such as selective serotonin reuptake inhibitors and/or psychotherapy, both of which are highly effective. Among psychotherapeutic treatments, cognitive behavior therapy has been studied widely and has an extensive evidence base. Benzodiazepines are effective in reducing anxiety symptoms, but their use is limited by risk of abuse and adverse effect profiles. Physical activity can reduce symptoms of GAD and PD. A number of complementary and alternative treatments are often used; however, evidence is limited for most. Several common botanicals and supplements can potentiate serotonin syndrome when used in combination with antidepressants. Medication should be continued for 12 months before tapering to prevent relapse.
Topics: Adult; Anti-Anxiety Agents; Antidepressive Agents; Anxiety Disorders; Comorbidity; Diagnosis, Differential; Dietary Supplements; Humans; Life Style; Panic Disorder; Patient Education as Topic; Phytotherapy; Prevalence; Psychiatric Status Rating Scales; Psychotherapy; Referral and Consultation; Relaxation Therapy; Selective Serotonin Reuptake Inhibitors; Severity of Illness Index
PubMed: 25955736
DOI: No ID Found -
Dialogues in Clinical Neuroscience Jun 2017Generalized anxiety disorder (GAD) is a prevalent and highly disabling mental health condition; however, there is still much to learn with regard to pertinent... (Review)
Review
Generalized anxiety disorder (GAD) is a prevalent and highly disabling mental health condition; however, there is still much to learn with regard to pertinent biomarkers, as well as diagnosis, made more difficult by the marked and common overlap of GAD with affective and anxiety disorders. Recently, intensive research efforts have focused on GAD, applying neuroimaging, genetic, and blood-based approaches toward discovery of pathogenetic and treatment-related biomarkers. In this paper, we review the large amount of available data, and we focus in particular on evidence from neuroimaging, genetic, and neurochemical measurements in GAD in order to better understand potential biomarkers involved in its etiology and treatment. Overall, the majority of these studies have produced results that are solitary findings, sometimes inconsistent and not clearly replicable. For these reasons, they have not yet been translated into clinical practice. Therefore, further research efforts are needed to distinguish GAD from other mental disorders and to provide new biological insights into its pathogenesis and treatment.
Topics: Anxiety Disorders; Biomarkers; Diagnosis, Differential; Humans; Mental Disorders; Neuroimaging; Prevalence
PubMed: 28867939
DOI: 10.31887/DCNS.2017.19.2/dnutt -
Advances in Therapy Sep 2021
Topics: Anxiety Disorders; Depression; Depressive Disorder, Major; Humans
PubMed: 34417991
DOI: 10.1007/s12325-021-01859-8 -
Dialogues in Clinical Neuroscience Sep 2015A large amount of research has accumulated on the efficacy and effectiveness of cognitive-behavioral therapy (CBT) for anxiety disorders including posttraumatic stress... (Review)
Review
A large amount of research has accumulated on the efficacy and effectiveness of cognitive-behavioral therapy (CBT) for anxiety disorders including posttraumatic stress disorder, obsessive-compulsive disorder, panic disorder, generalized anxiety disorder, social anxiety disorder, and specific phobia. The purpose of the current article is to provide an overview of two of the most commonly used CBT methods used to treat anxiety disorders (exposure and cognitive therapy) and to summarize and discuss the current empirical research regarding the usefulness of these techniques for each anxiety disorder. Additionally, we discuss the difficulties that arise when comparing active CBT treatments, and we suggest directions for future research. Overall, CBT appears to be both efficacious and effective in the treatment of anxiety disorders, but dismantling studies are needed to determine which specific treatment components lead to beneficial outcomes and which patients are most likely to benefit from these treatment components.
Topics: Anxiety Disorders; Cognitive Behavioral Therapy; Humans
PubMed: 26487814
DOI: 10.31887/DCNS.2015.17.3/akaczkurkin -
The Psychiatric Clinics of North America Sep 2009This review summarizes findings on the epidemiology and etiology of anxiety disorders among children and adolescents including separation anxiety disorder, specific... (Review)
Review
This review summarizes findings on the epidemiology and etiology of anxiety disorders among children and adolescents including separation anxiety disorder, specific phobia, social phobia, agoraphobia, panic disorder, and generalized anxiety disorder, also highlighting critical aspects of diagnosis, assessment, and treatment. Childhood and adolescence is the core risk phase for the development of anxiety symptoms and syndromes, ranging from transient mild symptoms to full-blown anxiety disorders. This article critically reviews epidemiological evidence covering prevalence, incidence, course, and risk factors. The core challenge in this age span is the derivation of developmentally more sensitive assessment methods. Identification of characteristics that could serve as solid predictors for onset, course, and outcome will require prospective designs that assess a wide range of putative vulnerability and risk factors. This type of information is important for improved early recognition and differential diagnosis as well as prevention and treatment in this age span.
Topics: Adolescent; Adolescent Development; Age of Onset; Anxiety; Anxiety Disorders; Child; Child Development; Diagnostic and Statistical Manual of Mental Disorders; Humans; International Classification of Diseases; Prevalence; Prognosis; Psychiatric Status Rating Scales; Risk Factors
PubMed: 19716988
DOI: 10.1016/j.psc.2009.06.002 -
BMC Psychiatry 2014Anxiety and related disorders are among the most common mental disorders, with lifetime prevalence reportedly as high as 31%. Unfortunately, anxiety disorders are... (Review)
Review
BACKGROUND
Anxiety and related disorders are among the most common mental disorders, with lifetime prevalence reportedly as high as 31%. Unfortunately, anxiety disorders are under-diagnosed and under-treated.
METHODS
These guidelines were developed by Canadian experts in anxiety and related disorders through a consensus process. Data on the epidemiology, diagnosis, and treatment (psychological and pharmacological) were obtained through MEDLINE, PsycINFO, and manual searches (1980-2012). Treatment strategies were rated on strength of evidence, and a clinical recommendation for each intervention was made, based on global impression of efficacy, effectiveness, and side effects, using a modified version of the periodic health examination guidelines.
RESULTS
These guidelines are presented in 10 sections, including an introduction, principles of diagnosis and management, six sections (Sections 3 through 8) on the specific anxiety-related disorders (panic disorder, agoraphobia, specific phobia, social anxiety disorder, generalized anxiety disorder, obsessive-compulsive disorder, and posttraumatic stress disorder), and two additional sections on special populations (children/adolescents, pregnant/lactating women, and the elderly) and clinical issues in patients with comorbid conditions.
CONCLUSIONS
Anxiety and related disorders are very common in clinical practice, and frequently comorbid with other psychiatric and medical conditions. Optimal management requires a good understanding of the efficacy and side effect profiles of pharmacological and psychological treatments.
Topics: Anxiety Disorders; Canada; Humans; Obsessive-Compulsive Disorder; Practice Guidelines as Topic; Stress Disorders, Post-Traumatic
PubMed: 25081580
DOI: 10.1186/1471-244X-14-S1-S1 -
Deutsches Arzteblatt International Sep 2018Anxiety disorders are the most common type of mental illness in Europe, with a 12-month prevalence of 14% among persons aged 14 to 65. Their onset is usually in...
BACKGROUND
Anxiety disorders are the most common type of mental illness in Europe, with a 12-month prevalence of 14% among persons aged 14 to 65. Their onset is usually in adolescence or early adulthood. The affected patients often develop further mental or somatic illnesses (sequential comorbidity).
METHODS
This review is based on pertinent publications retrieved by a selective search in PubMed.
RESULTS
The group of anxiety disorders includes generalized anxiety disorder (GAD), phobic disorders, panic disorders, and two disorders that are often restricted to childhood-separation anxiety and selective mutism. A comprehensive differential diag- nostic evaluation is essential, because anxiety can be a principal manifestation of other types of mental or somatic illness as well. Psychotherapy and treatment with psychoactive drugs are the therapeutic strategies of first choice. Of all types of psycho- therapy, cognitive behavioral therapy has the best documented efficacy. Modern antidepressants are the drugs of first choice for the treatment of panic disorders, agoraphobia, social phobia, and GAS; pregabalin is a further drug of first choice for GAS.
CONCLUSION
In general, anxiety disorders can now be effectively treated. Patients should be informed of the therapeutic options and should be involved in treatment planning. Current research efforts are centered on individualized and therefore, it is hoped, even more effective treatment approaches than are available at present.
Topics: Adolescent; Adult; Aged; Antidepressive Agents; Anxiety Disorders; Child; Cognitive Behavioral Therapy; Female; Humans; Male; Middle Aged; Phobic Disorders; Sex Factors; Treatment Outcome
PubMed: 30282583
DOI: 10.3238/arztebl.2018.0611 -
The Primary Care Companion For CNS... Jan 2019Anxiety complaints are common among older people. Specific phobia is characterized by exaggerated fear to a specific object or situation. Fear of falling is one example... (Review)
Review
Anxiety complaints are common among older people. Specific phobia is characterized by exaggerated fear to a specific object or situation. Fear of falling is one example and occurs in about 50% of older persons who have fallen recently. Polypharmacy heightens fall risks. Generalized anxiety disorder is characterized by chronic uncontrollable worry that interferes with functioning and is accompanied by restlessness and disturbed sleep. Panic disorder refers to recurrent, unexpected surges of intense fear that evidence physical and cognitive dysfunction. Cognitive behavior therapy has efficacy among psychotherapies for older anxious adults. In treating anxiety, medications that might be anxiogenic are reduced in dosage or discontinued. It is essential to monitor for suicidal ideation and symptom change. The first-selected pharmacotherapy for people with most anxiety disorders is selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors. The risk-benefit ratio of benzodiazepine pharmacotherapy in elderly patients is not favorable.
Topics: Aged; Anxiety Disorders; Humans
PubMed: 30806999
DOI: 10.4088/PCC.18nr02335 -
Clinical Psychology Review Dec 2022Virtual reality (VR) technologies are playing an increasingly important role in the diagnostics and treatment of mental disorders. (Review)
Review
BACKGROUND
Virtual reality (VR) technologies are playing an increasingly important role in the diagnostics and treatment of mental disorders.
OBJECTIVE
To systematically review the current evidence regarding the use of VR in the diagnostics and treatment of mental disorders.
DATA SOURCE
Systematic literature searches via PubMed (last literature update: 9 of May 2022) were conducted for the following areas of psychopathology: Specific phobias, panic disorder and agoraphobia, social anxiety disorder, generalized anxiety disorder, posttraumatic stress disorder (PTSD), obsessive-compulsive disorder, eating disorders, dementia disorders, attention-deficit/hyperactivity disorder, depression, autism spectrum disorder, schizophrenia spectrum disorders, and addiction disorders.
ELIGIBILITY CRITERIA
To be eligible, studies had to be published in English, to be peer-reviewed, to report original research data, to be VR-related, and to deal with one of the above-mentioned areas of psychopathology.
STUDY EVALUATION
For each study included, various study characteristics (including interventions and conditions, comparators, major outcomes and study designs) were retrieved and a risk of bias score was calculated based on predefined study quality criteria.
RESULTS
Across all areas of psychopathology, k = 9315 studies were inspected, of which k = 721 studies met the eligibility criteria. From these studies, 43.97% were considered assessment-related, 55.48% therapy-related, and 0.55% were mixed. The highest research activity was found for VR exposure therapy in anxiety disorders, PTSD and addiction disorders, where the most convincing evidence was found, as well as for cognitive trainings in dementia and social skill trainings in autism spectrum disorder.
CONCLUSION
While VR exposure therapy will likely find its way successively into regular patient care, there are also many other promising approaches, but most are not yet mature enough for clinical application.
REVIEW REGISTRATION
PROSPERO register CRD42020188436.
FUNDING
The review was funded by budgets from the University of Bonn. No third party funding was involved.
Topics: Humans; Autism Spectrum Disorder; Phobic Disorders; Anxiety Disorders; Virtual Reality Exposure Therapy; Virtual Reality; Dementia
PubMed: 36356351
DOI: 10.1016/j.cpr.2022.102213 -
Dialogues in Clinical Neuroscience Sep 2015Anxiety disorders, including panic disorder with or without agoraphobia, generalized anxiety disorder, social anxiety disorder, specific phobias, and separation anxiety...
Anxiety disorders, including panic disorder with or without agoraphobia, generalized anxiety disorder, social anxiety disorder, specific phobias, and separation anxiety disorder, are the most prevalent mental disorders and are associated with immense health care costs and a high burden of disease. According to large population-based surveys, up to 33.7% of the population are affected by an anxiety disorder during their lifetime. Substantial underrecognition and undertreatment of these disorders have been demonstrated. There is no evidence that the prevalence rates of anxiety disorders have changed in the past years. In cross-cultural comparisons, prevalence rates are highly variable. It is more likely that this heterogeneity is due to differences in methodology than to cultural influences. Anxiety disorders follow a chronic course; however, there is a natural decrease in prevalence rates with older age. Anxiety disorders are highly comorbid with other anxiety disorders and other mental disorders.
Topics: Age of Onset; Anxiety Disorders; Global Health; History, 17th Century; History, 21st Century; Patient Acceptance of Health Care; Psychiatric Status Rating Scales; Sex Characteristics
PubMed: 26487813
DOI: 10.31887/DCNS.2015.17.3/bbandelow