Anxiety Disorders

There has been much recent attention to the deleterious effects of natural disasters and war on children and adolescents.

Anxiety disorders are one of the most common psychiatric disorders in children and adolescents, but they often go undetected or untreated. Identification and effective treatment of childhood anxiety disorders can decrease the negative impact of these disorders on academic and social functioning in youth and their persistence into adulthood.

Since the time of Homer, warriors have returned from battle with wounds both physical and psychological, and healers from priests to physicians have tried to relieve the pain of injured bodies and tormented minds.1 The soldier’s heartache of the American Civil War and the shell shock of World War I both describe the human toll of combat that since Vietnam has been clinically recognized as posttraumatic stress disorder (PTSD).2 The veterans of Operation Iraqi Freedom (OIF) and of Operation Enduring Freedom (OEF) share with their brothers and sisters in arms the high cost of war. As of August 2009, there have been 4333 confirmed deaths of US service men and women and 31,156 wounded in Iraq. As of this writing, 796 US soldiers have died in the fighting in Afghanistan.3

As we begin this brief review of the neurobiology of major depressive disorder (MDD), we face these fundamental questions

Research emerging from the field of emotion science suggests that individuals who have anxiety and mood disorders tend to experience negative affect more frequently and more intensely than do healthy individuals, and they tend to view these experiences as more aversive, representing a common diathesis across anxiety and mood disorders.1-5 Deficits in the ability to regulate emotional experiences, resulting from unsuccessful efforts to avoid or dampen the intensity of uncomfortable emotions, have also been found across the emotional disorders and are a key target for therapeutic change.

Although depressive and anxiety disorders are classified as distinct groups of illnesses, studies document their frequent co-occurrence and provide evidence of a common biological substrate and a shared vulnerability.

An array of military-related presentations were given at this year’s American Psychiatric Association (APA) conference, addressing the rise of psychiatric issues in returning veterans and their families.

Social anxiety disorder (SAD), also referred to as social phobia, is a chronic and potentially disabling anxiety disorder characterized by the intense and persistent fear of being scrutinized or negatively evaluated by others. At its core, people with this disorder fear and/or avoid the scrutiny of others. Symptoms may occur only in circumscribed situations, such as a fear of speaking in formal or informal situations, or eating or drinking in front of others.

Generalized anxiety disorder (GAD) is a prevalent, chronic, debilitating mental illness associated with marked impairment in daily functioning.1 An ongoing evolution of the definition of GAD has resulted in a bifurcation of the historical anxiety neurosis designation.2 A diagnosis of GAD currently implies chronic, excessive worry lasting at least 6 months and 3 of the possible 6 somatic or psychological symptoms (restlessness, fatigue, muscle tension, irritability, difficulty concentrating, and sleep disturbance).3 GAD typically presents in an episodic pattern of moderate improvement or remission and relapse characterized by a chronic and complicated clinical course.

The cardiovascular properties of serotonin (5-HT) have been known for some time-its name reflects its presence in serum and its action in increasing vascular tone. Serotonergic medications are routinely used to treat depressive and anxiety disorders, and the association of depression with cardiovascular disease has become well established.2 Recent studies have confirmed the colloquial wisdom that anxiety (especially panic) and hypertension are linked.

The rationale for the use of anticonvulsants in anxiety disorders is supported by neurobiological underpinnings that make these compounds a likely alternative for short-term treatment.

Because numerous diseases- infectious, endocrinological, metabolic, and neurological, as well as connective-tissue disease-can induce psychiatric and/or behavioral symptoms, clinicians need to distinguish these neuropsychiatric masquerades from primary psychiatric disorders, warned José Maldonado, MD, the director of Stanford University’s Psychosomatic Medicine Service.

The 2 most common anxiety disorders are generalized anxiety disorder (GAD) and panic disorder. Approximately 5.7% of people in community samples will meet diagnostic criteria for GAD in their lifetime; the rate is about 4.7% for panic disorder (with or without agoraphobia).1 GAD-which is characterized by excessive and uncontrollable worry about a variety of topics (along with associated features such as trouble sleeping and impaired concentration)-is often chronic and is associated with significant costs to the individual and to society.

A combination of cognitive-behavioral therapy (CBT) and antidepressants to treat anxiety disorders in youngsters has yielded positive results in a government-funded study that was published online by the New England Journal of Medicine.1

One minute she's breathing room air and the next you're barking orders at a team wheeling in a crash cart. You review signs and symptoms you missed, the rough rhythm of her heart before she coded. You want to believe your reasoning was as elegant as a glass filled with cabernet, and you want to forget the bottle you imagine resting on a tray table at forty thousand feet, ready to tumble when the captain announces the plane is diving for an unscheduled stop. But I don't need images of air disasters to convince you doctors live somewhere between reason and panic: just flip open your laryngoscope, visualize the vocal chords, and forget you have fifteen seconds to thread the tube before the breathless body on the bed turns blue.

Older adults can present with anxiety or worries about physical health (illness, changes in vision or hearing), cognitive difficulties, finances, and changes in life status (widowhood, care-giving responsibilities, retirement). Clinicians need to be aware that older adults may deny psychological symptoms of anxiety (fear, worry) but endorse similar emotions with different words (worries, concerns).

Traumatic brain injury (TBI) is the major cause of death and disability among young adults. In spite of preventive measures, the incidence of a TBI associated with motor vehicle accidents, falls, assault, and high-contact sports continues to be alarmingly high and constitutes a major public health concern. In addition, the recent military operations in Iraq and Afghanistan have resulted in a large number of persons with blast injuries and brain trauma. Taking into account that cognitive and behavioral changes have a decisive influence in the recovery and community reintegration of patients with a TBI, there is a renewed interest in developing systematic studies of the frequency, mechanism, and treatment of the psychopathological alterations observed among these patients.

In this overview of pica, we review its causes and prevalence. In addition, we discuss some of the associated complications as well as current treatment strategies.

The ocurrence and severity of anxiety disorders have been correlated with fluctuations in female sex steroid levels in both epidemiological and experimental studies.1-5 Female reproductive hormones play a role not only in the development and course of anxiety disorders but also in treatment response.

Anxiety disorders are the most prevalent disorders among children and adolescents in both community and clinical settings. The high prevalence of anxiety disorders in children and adolescents leads to increased interest in the development and implementation of effective treatments.

Panic disorder with or without agoraphobia is a chronic, debilitating psychiatric illness that affects about 4.7% of the general US population.

Both cognitive-behavioral and pharmacological treatments for panic disorder have been found to be effective over the short term. Not all patients, however, can tolerate or fully respond to these approaches, and the effectiveness of these interventions over the long term remains unclear.

Anxiety disorders are some of the most common mental health problems that confront clinicians, either as a primary diagnosis or as comorbid conditions.

In part 1 of this column, I reviewed research findings of the most substantiated nonpharmacological and integrative treatments for anxiety, such as kava-kava, L-theanine, applied relaxation, yoga, meditation and mindfulness training, virtual reality graded exposure therapy, and biofeedback training.

A recent longitudinal study examined the potential relationship between social anxiety disorder during adolescence and young adulthood and the subsequent development of depression.1