Anxiety Disorder

1. Epidemiology
   1. Anxiety Disorder Incidence (U.S.): 16%
   2. Family physicians treat 90% of anxiety patients
      1. Refer <10% of patients to psychiatry
   3. Elderly have lower Incidence of anxiety
      1. Elderly women more affected than men
      2. Often associated with depression
2. Pathophysiology
   1. Hyperarousal state
   2. Begins in Brainstem reticular formation
      1. Locus Ceruleus (Secretes Norepinephrine)
      2. Dorsal and medial raphe nuclei (Secretes Serotonin)
3. Differential Diagnosis
   1. See Anxiety Secondary Causes
   2. Mania or Bipolar Disorder
   3. Personality Disorder (Anxious cluster)
      1. Obsessive Compulsive Personality disorder
      2. Avoidant Personality Disorder
      3. Dependent Personality disorder
      4. Passive-Aggressive Personality Disorder
   4. Anxiety Adjustment Disorder
      1. Appropriate response to a life stressor
   5. Schizophrenia
   6. Somatoform Disorder
4. Types: Primary Anxiety Disorder
   1. Generalized Anxiety Disorder
   2. Panic Disorder
   3. Obsessive Compulsive Disorder (OCD)
   4. Post-Traumatic Stress Disorder (PTSD)
   5. Social Phobia
5. Symptoms
   1. See Anxiety Symptoms
   2. Excessive Worry
   3. May affect relationships
6. Lab: Evaluation for Anxiety Secondary Causes
   1. Standard Studies
      1. Serum Chemistry profile
         1. Serum Glucose
         2. Serum Calcium
         3. Serum phosphate
      2. Thyroid Stimulating Hormone (TSH)
      3. Urine Drug Screen
   2. Studies if specifically indicated
      1. Serum Cortisol
      2. Urine Catecholamines
7. Diagnostics: Evaluation for Anxiety Secondary Causes
   1. Standard Studies
      1. Electrocardiogram
   2. Studies if specifically indicated
      1. Electroencephalogram (EEG)
      2. Vestibular testing
      3. Echocardiography
8. Evaluation
   1. See Anxiety Scales
9. Management
   1. See Anxiety Medications
   2. See Anxiety Non-pharmacologic Management
   3. Treatment is specific for the Anxiety Disorder
      1. Generalized Anxiety Disorder
      2. Panic Disorder
      3. Obsessive Compulsive Disorder (OCD)
      4. Post-Traumatic Stress Disorder (PTSD)
      5. Social Phobia
10. References
    1. Walley (1994) Am Fam Physician 50(8): 1745-53