Anxiety Disorder

By: Shima Ghavimi, MDPGY-1

According to ACPStudies show that 60% of patients

with panic and anxiety disorders are treated by primary care physicians. That means you have a tremendous opportunity to help these patients and make a major difference in their lives.

90% of all cases have been undiagnosed.

Generalized Anxiety Disorder

Generalized Anxiety Disorder

Life time prevalence of GAD in American adults is 5 %

Excessive worry and anxiety that is difficult to control

Symptoms occurs more days than not for at least 6 months and are bout a number of events

And activities

GAD3 or more of the following symptoms:

Restlessness or feeling keyed up or on edge, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance

Causes significant stress or impairment

Risk FactorsFemale Older agePositive family historyLess strong risk factors:Increase in stress, history of physical and emotional trauma and smoking

The prevalence of chronic medical illness including lung disease , DM , heart disease , HTN, arthritis is greater among those with anxiety

Is A/W being divorced or separatedBlacks, Latino and Asian have

decreased risk of GAD.

GAD and depression

According to DMS-IV a patient with diagnosed depression can only be diagnosed with anxiety once depression has undergone remission

Therefore when managing a patient with depression and anxiety we first treat the depression as anxiety often improves with treatment of depression.

Screening

Score: 5-9 = mild anxiety; 10-14 = moderate anxiety; 15-21 = severe anxiety.

GAD Treatment

Medications including buspirone, benzodiazepines, antidepressants (SSRIs, venlafaxine, imipramine)

Cognitive-behavioral therapy

 SSRIs: first-line treatment for chronic anxiety, while benzodiazepines are used for acute exacerbations. SNRIs are appropriate as an alternative to SSRIs, while an emerging literature indicates that pregabalin can be effective as an augmentive agent. Buspirone and bupropion are appropriate agents; sedative-hypnotics are not typically appropriate in the treatment of anxiety, except as symptomatic relief of insomnia.

A patient comes to you for discussion of treatment for GAD. She recently became dissatisfied with the care provided by her psychiatrist and would like to change her regimen under your care. She is on an SSRI, but finds that her anxiety symptoms are not sufficiently controlled. In addition, she has numerous episodes of acute anxiety exacerbation. Which of the following might be possible additions or alternations to her regimen?

a) Augmenting SSRI with bupropion or pregabalin

b) Adding a benzodiazepinec) Switching from an SSRI to an

SNRId) Increasing the dose of SSRIe) All of the above

a) Augmenting SSRI with bupropion or pregabalin

b) Adding a benzodiazepinec) Switching from an SSRI to an

SNRId) Increasing the dose of SSRIe) All of the above

Refrences: ACP Manual on Anxiety Disorder, 2015. Anxiety Disorders Association of America.

Anxiety disorders. Retrieved on April 28, 2009 from http://www.adaa.org/GettingHelp/Briefoverview.asp

National Institute of Mental Health. (2008). The Numbers Count: Mental disorders in America. Retrieved on September 1, 2008, from http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america.shtml#Anxiety