Anxiety

Introduction

• Description: Anxiety is a common acute or chronic emotion that is associated with physical symptoms. It is two to three times more common in women. Subtypes of anxiety include situational anxiety, adjustment disorders, panic disorders, phobias, and post-traumatic stress disorder. Moreover, obsessive–compulsive disorders are often classified in this group.

• Prevalence: 18% of women; 40 million Americans.

• Predominant Age: 20–45 years.

• Genetics: Increased risk of panic disorders within monozygotic twins (data inconsistent). Panic disorder, social phobia, and obsessive–compulsive disorders have a genetic base.

Etiology And Pathogenesis

• Causes: Psychosocial stressors (eg, pregnancy loss or breast cancer), abnormality of neurotransmitter systems (serotonin, norepinephrine, and γ-aminobutyric acid), involving the amygdala and hippocampus.

• Risk Factors: Social, family, or financial stress (poverty); medical illness or adverse life event; family history; and a lack of social support network.

Signs And Symptoms (Vary With Subtype)

• Unrealistic or excessive worry. (Diagnosis generally requires at least 6 months of excessive and persistent worrying that is hard to control, causes significant distress, and occurs on more days than not.)

• Sense of impending doom

• Nervousness or instability

• Palpitations or tachycardia

• Hyperventilation or sense of suffocation

• Systemic systems (nausea, abdominal pain, paresthesias, diaphoresis, chest tightness, dizziness, muscle tension, headaches, and backaches)

Diagnostic Approach