Risk
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Lifetime prevalence approximately 30% in USA
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Gender: Female (2× more likely compared with male)
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Environmental: Traumatic or stressful events
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Age: Often develop in childhood and early adulthood; however, may occur any time after a stressful event
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Medical conditions: Chronic mental or physical illness
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Genetics: Family psychiatric history
Perioperative Risks
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Generalized anxiety disorder leads to chronic autonomic hyperactivity with increased risks for CAD and Htn.
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Uncontrolled anxiety and fear may predispose pts to greater risk for acute postop pain and postop N/V.
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Increased risk of periop complications due to impaired response to stress.
Perioperative Risks
- •
Generalized anxiety disorder leads to chronic autonomic hyperactivity with increased risks for CAD and Htn.
- •
Uncontrolled anxiety and fear may predispose pts to greater risk for acute postop pain and postop N/V.
- •
Increased risk of periop complications due to impaired response to stress.
Worry About
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Inadequately treated anxiety disorders affecting pt’s decision-making and communication capacities, which may complicate medical courses
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Altered drug anesthetic requirements and drug metabolisms associated with psychiatric medications
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Systemic side effects from psychiatric medications
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Potential medication interactions with anesthetics
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Signs/symptoms may overlap with other medical conditions (e.g., hyperparathyroidism) and drug-induced causes (e.g., alcohol, caffeine, nicotine, withdrawal), which could be life-threatening.
Overview
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Types
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Generalized anxiety disorder
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Panic disorder
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Social anxiety disorder
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Specific phobias
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PTSD
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OCD
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Characterized by excessive apprehension, physical tension, physiologic symptoms, dissociative anxiety, and fear leading to significant distress or impairment
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Comorbidity with major depression (60%), other mental disorders, and substance abuse
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Associated with a variety of chronic medical conditions
Etiology
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Genetics: ↑ norepinephrine metabolites, ↓ GABA level, ↓ postsynaptic alpha-2 adrenergic receptor sensitivity, and ↓ benzodiazepine binding sites on platelets and lymphocytes; altered central processing involving amygdala and nuclei of basolateral complex that play central roles in fear and anxiety responses
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Stress
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Drugs: Caffeine, alcohol, nicotine, and withdrawals
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