Anxiety disorders are common and disabling conditions and as a group are the most common disorders seen in the general medical setting. Anxiety is a common, normal emotion; most people experience occasional trepidation, fear, nervousness, “jitters,” or at times, even panic. Mild anxiety may aid mental sharpness as uncertainty or pressure mounts. For some individuals, however, anxiety occurs as part of an anxiety disorder that is a prominent, persistent, and disruptive aspect of their daily lives. Among the general population in the United States, lifetime prevalence of an anxiety disorder is up to 29%, making anxiety more common than depressive disorders. Because these disorders often present first during childhood or adolescence, early identification and treatment is important to prevent unnecessary morbidity and decreased quality of life. In addition, the direct and indirect annual costs associated with anxiety disorders in the United States are similar to, and may even surpass, the economic burdens attributed to mood disorders.
Anxiety disorders are often comorbid with depression and with one another (e.g., panic disorder [PD] and agoraphobia). Similar to depression, patients with an unrecognized anxiety disorder often present to general medical or specialist settings rather than to specialty mental health. As up to half of patients present with somatic complaints associated with the anxiety disorder rather than its emotional symptoms, many patients are undiagnosed and untreated.
It is important to distinguish among the various anxiety disorders and identify possible comorbidities because of differences in treatment, complications, and prognoses. Although cross-cultural epidemiologic research has shown that anxiety disorders are present in all cultures, ethnicities, and age groups, providers also must be alert to a variety of common medical conditions and medication side effects that can have symptoms resembling an anxiety disorder (Table 27-1).
Table 27-1.Selected medical conditions that can simulate an anxiety disorder. |Favorite Table|Download (.pdf) Table 27-1. Selected medical conditions that can simulate an anxiety disorder.
Ischemic heart disease, mitral valve prolapse, arrhythmias
Hyperthyroidism, hypoglycemia, pheochromocytoma, carcinoid
Menopause, premenstrual syndrome
Transient ischemic attacks, seizure disorders
Caffeine, alcohol, sympathomimetic agents, amphetamines, corticosteroids, theophylline, illicit drugs
Asthma, chronic obstructive pulmonary disease
Office-based screening instruments can improve the detection of anxiety disorders and can be used to evaluate treatment response. The Generalized Anxiety Disorder-7 (GAD-7) is the most common screener used in primary care and has been validated for generalized anxiety disorder (GAD) as well as for panic disorder (Figure 27-1). A two-question screener, the GAD-2 subscale of the GAD-7, performs well as a rapid screening tool for GAD. The GAD-2 questions consist of the first two questions of the GAD-7: Over the last 2 weeks how often have you been bothered by the following problems: (1) Feeling nervous, anxious, or on edge; and (2) Not being able to stop or ...