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Risk Factors
Commonly Prescribed Drugs
Treatment and Management
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Anxiety is the subjective sense or personal feeling of unease, dread, fear, or that something bad will happen. Anxiety disorders are primary psychiatric conditions or a result of an underlying medical condition. Anxiety disorders are classified based on its duration and anxiety triggers.

Types of anxiety disorders:

  • Panic disorder is characterized by recurrent and unpredictable panic attacks felt as intense fear and discomfort. Panic disorder is diagnosed when the patient experiences concern or worry and a change in behavior regarding the panic attacks for at least 1 month. Panic attacks have a sudden onset but short duration.  Some patients acquire agoraphobia, an irrational fear of staying in places where the patient feels trapped. This leads to patients having a limited lifestyle and remains at home or with the company of other people.
  • Generalized anxiety disorder (GAD) presents with persistent, excessive and unrealistic concerns with physical symptoms. Patients worry excessively even on the little things eventually leading to disruption of daily life. GAD is most commonly diagnosed before age 20 and in patients with a history of childhood fears and difficulties in socializing. Patients with GAD usually have mood disorders like depression. This is also common in patients with a history of substance abuse such as the use of alcohol and sedative/hypnotics.
  • Phobic disorders cause a patient to have evident and persistent fear of certain objects or situations. Exposure to such objects or situations results in an immediate anxiety reaction. Avoidance of the patient’s phobia leads to disruption of occupational or social functioning. Some common phobias include fear of closed spaces, blood, heights, flying, and social or performance situations. Diagnosis of a phobia is confirmed in adulthood but avoidance of the object or situation can start from early childhood.
  • Stress disorders are developed after exposure to an extremely traumatic event. Anxiety can occur shortly after the event (acute stress disorder) or long after the trauma and recur (posttraumatic stress disorder or PTSD). Patients with stress disorder might forget some aspects of the traumatic event but the event is usually re-experienced through nightmares or flashbacks. Patients are at higher risk of developing other disorders associated with mood and substance abuse.
  • Obsessive-compulsive disorder (OCD) causes a person to have obsessive thoughts and compulsive behaviors that affect his/her daily life. OCD patients spend at least an hour each day trying to relieve the anxiety caused by the obsession. Usual behaviors include fear of contamination and germs, counting behaviors, and rechecking certain actions. Symptoms of OCD usually come and go, but some cases show a constant decline in psychosocial functioning.

Anxiety disorders are diagnosed through a psychological evaluation and assessment of the presented signs and symptoms. Direct and intensive questioning by the physician or mental health professional is needed to collect the information for its diagnosis.  Other tests are done on the patient to determine the presence of an underlying condition that might cause anxiety.


Panic disorder

At least 4 of the following symptoms develop suddenly and reach the maximum intensity within 10 minutes:

  • Palpitations, pounding heart or increased heart rate
  • Sweating
  • Trembling or shaking
  • Sensations of shortness of breath
  • Feeling of choking
  • Chest pain or discomfort
  • Nausea or GI disturbances
  • Dizziness, unsteadiness, lightheadedness
  • Feelings of unreality or being detached from oneself
  • Feeling of losing control or going crazy
  • Fear of dying
  • Numbness or tingling sensations
  • Chills or hot flushes

Generalized anxiety disorder

  • Excessive worry on events or activities that occur on most days for at least 6 months
  • Difficulty to control the worry

At least 3 of the following symptoms occur:

  • Restlessness or being on edge
  • Easily fatigued
  • Difficulty concentrating or mind going blank
  • Irritability
  • Muscle tension
  • Difficulty falling or staying asleep

Phobic disorder

  • Consistent fear of being exposed to a certain object or situation
  • Avoidance of the object or situation
  • Panic attacks triggered by the object or situation
  • Awareness of the unreasonable fear but unable to control it
  • Physical reactions such as sweating, rapid heartbeat, tight chest, and difficulty breathing

Stress disorders

  • Re-experiencing traumatic event through nightmares and flashbacks
  • Inability to recall some aspects of the traumatic event
  • Avoidance of any activity, person, place or object associated with the event
  • Loss of interest
  • Lack of motivation
  • Poor concentration
  • Irritability
  • Insomnia
  • Feeling detached from family and friends
  • Feeling emotionally numb

Obsessive-compulsive disorder

Symptoms of OCD vary and depend on the certain obsession or the compulsive behavior to address the obsession

  • Repeating certain actions such as hand washing, counting of objects, locking the door, hair pulling
  • Intense stress
  • Avoidance of situations that trigger the obsession
  • Sore and reddened hands
Risk Factors
  • Family history. For panic disorder, GAD, and OCD
  • Psychiatric history and personality characteristics of high neuroticism and extroversion. Increased risk of PTSD if patient has long-term tendency to be in a negative emotional state and focuses more attention on others than himself/herself
  • Sex. OCD is more common in males while GAD and PTSD are more common in females
  • Trauma. Children who witnessed or experienced traumatic events are at higher risk
  • Stress due to an illness
  • Stress buildup
  • Substance abuse. Drug or alcohol abuse or withdrawal
Commonly Prescribed Drugs
  • Selective serotonin reuptake inhibitors (SSRIs) are the usual drugs of choice for anxiety disorders. SSRIs increase the level of serotonin in the brain. Drugs for panic disorder include fluoxetine, paroxetine, and sertraline. An additional drug for OCD is fluvoxamine. Side effects: agitation, GI disturbances, loss of appetite and weight
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs) are usually prescribed to patients who do not improve with a SSRI. SNRIs increase the levels of serotonin and norepinephrine in the brain. The SNRI approved for panic disorder is venlafaxine hydrochloride. Additionally, duloxetine is given for anxiety. Side effects: feeling sick, headache, drowsiness, increased blood pressure
  • Benzodiazepines are sedatives prescribed for the immediate relief of a panic attack or anxiety symptoms. Alprazolam and clonazepam are approved for panic disorder. Additionally, chlordiazepoxide, diazepam, and lorazepam are used for anxiety symptoms. Taking benzodiazepines for an extended period can lead to mental or physical dependence on the drug. Side effects: drowsiness, difficulty concentrating, vertigo, tremor
  • Pregabalin is an anticonvulsant given for anxiety when SSRIs and SNRIs do not work. Side effects: drowsiness, dizziness, increased appetite and weight, blurred vision
  • Buspirone is used for the continuous treatment of anxiety. Its effects become noticeable after several weeks of use.
  • Beta-blockers are used to manage cardiovascular symptoms of anxiety due to a phobia. These include high blood pressure and palpitations. Propranolol is a commonly used beta-blocker for anxiety. Side effects: GI disturbance, cold fingers, tiredness, sleep problems
Treatment and Management
  • Anxiety disorders are best managed with therapies. Medicines are often prescribed as a supplement to therapies.
  • Psychotherapy or talk therapy helps a patient understand and cope with his/her panic attacks and other anxiety symptoms. The therapist helps the patient realize that the panic symptoms are possible to overcome and not dangerous. During a therapy session, patients can be exposed to possible events that trigger a panic or anxiety attack to help them manage the symptoms. Cognitive behavioral therapy (CBT) is frequently used for anxiety disorders. This is the most effective psychotherapy for GAD. It involves education on specific skills that can help the patient do activities that were avoided due to anxiety. A type of CBT for patients with OCD is exposure and response prevention which involves gradual exposure to the feared object or situation or obsession and then learning healthy ways to cope with the anxiety.
  • For PTSD, eye movement desensitization and reprocessing (EMDR) is a new treatment that helps in reducing anxiety symptoms. The therapist instructs the patient to make side-to-side movements while recalling the traumatic event. It helps the patient change the negative thoughts towards the traumatic event.
  • Avoid caffeine, alcohol, smoking, and recreational drugs. Exposure to these can trigger or worsen a panic attack or anxiety symptoms.
  • Practice stress management and breathing exercises like yoga, deep breathing, and progressive muscle relaxation.
  • Incorporate regular physical activities in your daily life to improve your overall mood and well-being.
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