Anxiety is a common, normal emotion; most people experience occasional trepidation, fear, nervousness, "jitters," or 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, about 25% will experience an anxiety disorder at some time in their life, making anxiety more common than depressive disorders. At over $50 billion per year, 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.
The major anxiety disorders are shown in Table 23–1. They 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 tend to present to general medical or specialist settings, rather than to the specialty mental health sector, as they generally complain of the prominent physical symptoms of the anxiety disorder rather than its emotional symptoms.
Table 23–1. DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition) anxiety disorders. |Favorite Table|Download (.pdf)
Table 23–1. DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition) anxiety disorders.
|Anxiety Disorder||Prevalence in Primary Care|
|Adjustment disorder with anxiety||4.5–9.2%|
|Anxiety disorder due to a general medical condition||14–66%|
|Substance-induced anxiety disorder||Unknown prevalence|
|Anxiety disorder not otherwise specified (NOS)||Unknown|
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 23–2).
Table 23–2. Selected medical conditions that can simulate an anxiety disorder. |Favorite Table|Download (.pdf)
Table 23–2. 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 and other mental disorders, and can be used to evaluate treatment response. Several instruments have been developed to aid in recognition of an anxiety disorder. A two-question screener, the GAD-2 subscale of the GAD-7, has ...