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GENERAL CONSIDERATIONS

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.

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.

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.

The majority of individuals with mental disorders receive psychiatric care from primary care settings, whereas <20% receive care in specialized mental health settings. Anxiety disorder increases the risk of mortality (relative risk [RR] = 1.43; 95% confidence interval [CI], 1.24–1.64) with approximately 2.41 million deaths attributable to anxiety disorder per year. Even though their relative risk is significantly lower compared to psychosis (RR = 2.54; 95% CI, 2.35–2.75), the prevalence of anxiety disorder is high, and therefore, the emphasis on screening these patients in primary care is essential. There is some controversy that comorbid depression in patients with anxiety attributes to increased mortality, but patients with anxiety disorders are at increased risk of other medical comorbidities, contributing to around 26,500 disability-adjusted life-years (DALYs), accounting for approximately 15% of DALYs among mental disorders.

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PATHOGENESIS

A. Biomedical Influences

Because the symptoms of anxiety are so varied and prevalent, several etiologies exist to explain ...

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