(a) Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance)
(b) The person finds it difficult to control the worry
(c) The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months). Note: Only one item is required in children
1. Restlessness or feeling keyed up or on edge
2. Being easily fatigued
3. Difficulty concentrating or mind going blank
4. With irritability
5. Muscle tension
6. Sleep disturbance (difficulty falling or staying asleep or restless unsatisfying sleep)
(d) The focus of the anxiety and worry is not confined to features of an axis I disorder, e.g., the anxiety or worry is not about having a panic attack (as in panic disorder), being embarrassed in public (as in social phobia), being contaminated (as in obsessive-compulsive disorder), being away from home or close relatives (as in separation anxiety disorder), gaining weight (as in anorexia nervosa), having multiple physical complaints (as in somatization), or having a serious illness (as in hypochondriasis), and the anxiety and worry do not occur exclusively during post-traumatic stress disorder
(e) The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
(f) The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism) and does not occur exclusively during a mood disorder, a psychotic disorder, or a pervasive developmental disorder
It is important to note that the diagnosis of GAD does not apply when the clinical picture can better be attributed to another diagnosis or when the clinical picture can be attributed to a medical condition, substance use, or substance withdrawal [1].
People with GAD have excessive anxiety about typical, everyday situations [1]. These patients may have a range of complaints including, but not limited to, sleep disturbances, restlessness, muscular tension, gastrointestinal complaints, and chronic headaches.
Panic disorder is defined as recurrent, unexpected panic attacks for more than 1 month in association with at least one of the following symptoms: persistent concern about having additional attacks, worry about the attacks’ implications and/or consequences, or a significant change in behavior as a result of the attacks [4]. At least one comorbid axis I disorder, such as major depressive disorder or another anxiety disorder, is commonly associated with panic disorder [5]. In addition, panic disorder is associated with low education and relatively low probability of working full time [5].
It is thought that anxiety is often a learned response to noxious or aversive stimuli [2]. Patients suffering from an anxiety disorder are more likely to have other medical issues, have longer hospital stays, undergo more procedures, incur higher health-care costs, suffer from failure at school or work, have lower-paying jobs, and are more often financially dependent on welfare [2]. In addition, anxiety disorders are the most prevalent mental disorder among American children and adolescents [3].
Identification of generalized anxiety disorder is of special importance to clinicians in both the emergent and non-emergent settings, because misdiagnosis can lead to costly, invasive, and/or harmful unnecessary medical testing.
26.2 Risk Factors for Anxiety
A genetic component plays a role in anxiety disorders.
The greatest association is in panic disorder, generalized anxiety disorder, and phobias.
Having involved, controlling, and rejecting parents
Female
Low education
Low socioeconomic status
Social disability
Family history of anxiety disorders
Introverted personality in early childhood
Traumatic life events
Sleep disturbances
Poor physical health
26.3 Differential Diagnosis
Anxiety is a diagnosis of exclusion. A thorough medical evaluation is needed to both rule out and alleviate the patient’s concern for serious medical conditions.
Medication side effects
Beta agonists
Caffeine
Digoxin toxicity
Levodopa
Nicotinic acid
SSRIs
Steroids
Stimulants
Theophylline
Synthetic thyroid hormone
Cardiovascular
Acute coronary syndrome
Congestive heart failure
Mitral valve prolapse
Dysrhythmias
Syncope
Hypertension
Pulmonary
Asthma
Chronic obstructive pulmonary disease
Hyperventilation
Pneumonia
Pneumothorax
Pulmonary edema
Pulmonary embolus
Endocrine
Hyperthyroidism
Hypothyroidism
Hyperadrenalism
Gastrointestinal
Gastroesophageal reflux disease
Irritable bowel syndrome
Colitis
Typically of a chronic nature
Ulcers
Neoplastic
Carcinoid syndrome
Pheochromocytoma
Insulinoma
Neurologic
Parkinsonism
Encephalopathy
Restless leg syndrome
Seizure
Vertigo
Brain tumor
Psychiatric
Affective disorders
Depression
Drug abuse
Drug dependence
Drug withdrawal
Both illicit and prescribed
Other conditions
Anaphylaxis
Anemia
Typically chronic
Electrolyte abnormalities
Occurring over time
Porphyria
Menopause
26.4 Types of Anxiety Disorders [2]
Specific phobia
18.4 % prevalence
Fear or anxiety about a specific object or situation (i.e., swimming in the ocean)
Social phobia
13.0 % prevalence
Fear or anxiety about one or more social situations where the individual is exposed to possible scrutiny by others
Post-traumatic stress disorder
10.1 % prevalence
Intrusive thoughts and flashbacks of traumatic events, avoidance of reminders, hypervigilance, and sleep disturbance leading to social and occupational dysfunction
Generalized anxiety disorder
9.0 % prevalenceRelated posts:
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