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INTRODUCTION
• Anxiety is an emotional state commonly caused by the perception of real or perceived
danger that threatens the security of an individual. It allows a person to prepare for or
react to environmental changes.
• Everyone experiences a certain amount of nervousness and apprehension when faced
with a stressful situation. this is an adaptive response, and is transient in nature.
• Anxiety can produce uncomfortable and potentially debilitating psychological (e.g.,
worry or feeling of threat) and physiological arousal (e.g., tachycardia or shortness of
breath) if it becomes excessive.
• Some individuals experience persistent, severe anxiety symptoms and possess irrational
fears that significantly impair normal daily functioning. These persons often suffer from
an anxiety disorder
• To treat anxiety appropriately, the clinician must make a reliable diagnosis. It is
essential that the distinction between short-term symptoms of anxiety and
anxiety disorders be understood.
• Common or situational anxiety is a normal response to a stressful circumstance.
Although symptoms can be severe, they are temporary and usually last no more
than 2 or 3 weeks. While short-term, “as needed” treatment with an anxiolytic
agent such as a benzodiazepine is common and may provide some symptomatic
relief, prolonged drug therapy is unnecessary
EPIDEMIOLOGY
• In United States, the 1-year prevalence rate for anxiety disorders was
13.3% in persons aged 18 to 54 years and 10.6% in those over age 55
years
• Anxiety disorders are a group of heterogeneous illnesses that
develop before age 30 and are more common in women, individuals
with social issues, and those with a family history of anxiety and
depression.
ETIOLOGY
(1) Common Medical Illnesses Associated with Anxiety Symptoms
• Cardiovascular Neurologic
Dementia, Migraine, Parkinson’s
• Angina, Arrhythmias, Congestive Heart Failure, Ischemic Disease, Seizures, Stroke, Neoplasms,
Heart Disease, Poor Pain Control
• Myocardial Infarction Respiratory System
Asthma, Chronic Obstructive
• Endocrine And Metabolic
Pulmonary Disease, Pulmonary
• Cushing’s Disease, Hyperparathyroidism, Embolus,
Hyperthyroidism, Pneumonia
• Hypothyroidism, Hypoglycemia, Hyponatremia, Others
Hyperkalemia, Anemias, Systemic Lupus
Erythematosus, Vestibular
• Pheochromocytoma, Vitamin B12 Or Folate Deficiencies Dysfunction
(2) DRUGS ASSOCIATED WITH ANXIETY SYMPTOMS
• Anticonvulsants: Carbamazepine • Herbals: ma huang, ginseng, ephedra
• Nonsteroidal anti-inflammatory drugs:
• Antidepressants: Selective Serotonin
Reuptake Inhibitors, Tricyclic ibuprofen
• NORADRENERGIC MODEL
• The autonomic nervous system of anxious patients is hypersensitive and overreacts
to various stimuli. Many anxious patients clearly display symptoms of peripheral
autonomic hyperactivity.
• In response to threat or fearful situations, the LC serves as an alarm center, activating
NE release and stimulating the sympathetic and parasympathetic nervous systems.
• Chronic central noradrenergic overactivity downregulates α2-adrenoreceptors in
patients with GAD. This receptor is hypersensitive in some patients with panic
disorder. Patients with SAD appear to have a hyperresponsive adrenocortical
response to psychological stress.
Noradrenergic model continues……………..
• Psychoeducation,
• Short-term counseling,
• Stress management,
• Psychotherapy,
• Meditation, or
• Exercise.
PHARMACOLOGIC THERAPY
• The benzodiazepines are the most effective, safe, and commonly prescribed
drugs for the rapid relief of acute anxiety symptoms.
• Because of the lack of dependency and tolerable adverse effect profile,
antidepressants have emerged as the treatment of choice for the long-term
management of chronic anxiety, especially in the presence of comorbid
depressive symptoms.
• Buspirone is an additional anxiolytic option in patients without comorbid
depression or other anxiety disorders (e.g., panic disorder and SAD).
ANTIDEPRESSANT THERAPY