Worry-Prone Patient

1. See Also
   1. Anxiety Disorder
   2. Anxiety Secondary Cause
   3. Anxiety Symptoms
   4. Generalized Anxiety Disorder
   5. Obsessive Compulsive Disorder
   6. Body Dysmorphic Disorder
   7. Panic Disorder
   8. Social Anxiety Disorder (Social Phobia)
   9. Acute Stress Disorder
   10. Post-Traumatic Stress Disorder
   11. Anxiety Non-pharmacologic Management
   12. Anxiety Pharmacologic Management
2. Pathophysiology
   1. Worry is a normal short-term response to uncertainty
   2. If Worry persists it becomes maladaptive, dysfunctional
      1. Provoked by sense that worry prevents serious events
      2. Also may be coping mechanism, blocking other emotions
3. Symptoms: Presentations
   1. Presentation for worry itself is uncommon
      1. Patients will admit to worry if asked
   2. Patients usually present for other secondary concerns
      1. Insomnia
      2. Irritable Bowel Syndrome
      3. Fibromyalgia
4. Signs: Distorted assumptions
   1. Belief that over-thinking issue offers benefits
      1. Certainty or sureness
      2. Relief of pain or discomfort
      3. Prevents bad events
      4. Worry shows that I care
   2. Sense of guilt, lack of control that led to mistakes
   3. Feels need to be hypervigilant about every thought
5. Differential Diagnosis
   1. Generalized Anxiety Disorder
   2. Hypochondriasis
   3. Major Depression
   4. Dysthymia
   5. Obsessive-Compulsive Disorder
   6. Panic Disorder
   7. Post-Traumatic Stress Disorder
   8. Social Phobia
6. Management
   1. Medications (start at half dose and increase slowly)
      1. Selective Serotonin Reuptake Inhibitors
      2. Venlafaxine (Effexor)
   2. Cognitive Behavioral Strategies
      1. Worry is not an effective warning or control method
         1. Re-evaluate: What is the real risk of bad events?
         2. Re-frame: Will this matter to me in a month?
         3. Perspective: I do not have control over most events
      2. Frequent search for reassurance is temporary relief
         1. Ask others to withhold reassurance and break cycle
      3. Worry does not need constant and immediate attention
         1. Set appointments to deal with worry and concerns
            1. Do not try to suppress worries or emotions
            2. Spend 20 minutes focusing on concern
            3. Follow appointment with Exercise or social time
         2. Learn strategies to handle over-powering episodes
            1. See Relaxation Training
            2. Meditation
            3. Breathing Exercises
            4. Relaxation Techniques
            5. Write down worry, address at "worry appointment"
      4. Recognize worry as a problem to resolve
         1. Worry causes tension, stress, and somatic symptoms
         2. Worry is an unhealthy habit
7. References
   1. Hudson (2005) Pediatr Ann 34(2):91-106 [PubMed]
   2. Pigott (2003) Pyschiatr Clin North Am 26(3):621-72 [PubMed]
   3. Shearer (2006) Am Fam Physician 73:1049-56 [PubMed]