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GENERAL CONSIDERATIONS
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Anxiety is a diffuse, unpleasant, and often vague subjective feeling of apprehension accompanied by objective symptoms of autonomic nervous system (ANS) arousal. The experience of anxiety is associated with a sense of danger or a lack of control over events. The psychological component varies from individual to individual and is strongly influenced by personality and coping mechanisms.
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Many factors contribute to the experience of anxiety by individuals in our society. We live in a rapidly changing culture characterized by continuous technologic advancements, proliferation of increasingly refined information, and a mass media and entertainment industry saturated with violence and sexuality, all of which promote feelings of insecurity. In the workplace, downsizing, restructuring, mergers, and specialization are commonplace; transient work relationships and the elimination of benefits such as health insurance and retirement provisions increase the sense of insecurity.
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Anxiety is pathologic when it occurs in situations that do not call for fear or when the degree of anxiety is excessive for the situation. Anxiety may occur as a result of life events, as a symptom of a primary anxiety disorder, as a secondary response to another psychiatric disorder or medical illness, or as a side effect of a medication.
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The majority of individuals with mental disorders receive psychiatric care from primary care settings, whereas <20% receive care in specialized mental health settings. Among mental disorders, anxiety disorders have the highest overall lifetime morbidity risk: specific phobia (18.4%), social phobia (13.0%), posttraumatic stress disorder (10.1%), generalized anxiety disorder (9.0%), separation anxiety (8.7%), panic disorder 6.8%), agoraphobia 3.7%), obsessive-compulsive disorder (2.7%), and any anxiety disorder (41.7%), yet only 23–59% of anxious patients receive treatment. The estimated 1-year prevalence rate is 17% with a lifetime prevalence rate at 25%. Patients with anxiety disorders are at increased risk of other medical comorbidities, longer hospital stays, more procedures, higher overall health care costs, failure in school or at work, low-paying jobs, and financial dependence in the form of welfare or other government subsidies.
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Kessler
RC, Petukhova
M, Sampson
NA, Zaslavsky
AM, Wittchen
HU. Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. Int J Methods Psychiatr Res. 2012; 21(3):169.
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Lam
RM. Challenges in the treatment of anxiety disorders: beyond guidelines. Int J Psychiatr Clin Practice. 2006; 10(Suppl 3):18.
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Mendlowicz
MV, Stein
MB. Quality of life in individuals with anxiety disorders.
Am J Psychiatr. 2000; 157:669.
[PubMed: 10784456]
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A. Biomedical Influences
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Because the symptoms of anxiety are so varied and prevalent, several etiologies exist to explain them. A recent meta-analysis revealed a significant genetic component, especially for panic disorder, generalized anxiety, and phobias. Temperament, which has genetic roots, is a broad vulnerability factor for anxiety disorders.
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The inhibitory transmitter γ-aminobutyric acid (GABA) occupies ~40% of all ...