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==Overview== | ==Overview== | ||
'''Anxiety''' is a '''physiological''' state characterized by [[cognitive]], [[somatic]], [[emotion]]al, and [[behavior]]al components. These components combine to create the feelings that we typically recognize as [[fear]], apprehension, or worry. Anxiety is often accompanied by physical sensations such as [[heart palpitations]], [[nausea]], [[chest pain]], [[shortness of breath]], or [[tension headache|headache]]. | '''Anxiety''' is a '''physiological''' state characterized by [[cognitive]], [[somatic]], [[emotion]]al, and [[behavior]]al components. These components combine to create the feelings that we typically recognize as [[fear]], apprehension, or [[worry]]. [[Anxiety]] is often accompanied by [[Physical culture|physical]] sensations such as [[heart palpitations]], [[nausea]], [[chest pain]], [[shortness of breath]], or [[tension headache|headache]]. | ||
==Historical Perspective== | ==Historical Perspective== | ||
[[Sigmund Freud]] recognized anxiety as a "signal of danger" and a cause of "defensive behavior". He believed we acquire anxious feelings through classical conditioning and traumatic experiences. | [[Sigmund Freud]] recognized [[anxiety]] as a "signal of danger" and a [[Cause system|cause]] of "defensive behavior". He believed we acquire [[anxious]] feelings through [[classical conditioning]] and traumatic experiences. | ||
We maintain anxiety through operant conditioning; when we see or encounter something associated with a previous traumatic experience, anxious feelings resurface. We feel temporarily relieved when we avoid situations which make us anxious, but this only increases anxious feelings the next time we are in the same position, and we will want to escape the situation again and therefore will not make any progress against the anxiety. | We maintain [[anxiety]] through [[operant]] [[Conditioning regimens|conditioning]]; when we see or encounter something associated with a previous traumatic experience, [[anxious]] feelings resurface. We feel temporarily relieved when we avoid situations which make us [[anxious]], but this only increases [[anxious]] feelings the next time we are in the same position, and we will want to escape the situation again and therefore will not make any progress against the [[anxiety]]. | ||
==Classification== | ==Classification== | ||
According to DSM-5 [[Diagnostic criteria|diagnostic]] criteria, [[anxiety]] is classified as follows: | |||
*[[Generalized anxiety disorder]] | |||
*[[Panic disorder]] | |||
*[[Separation anxiety disorder]] | |||
*[[Selective mutism]] | |||
*[[Specific phobia]] | |||
*[[Agoraphobia]] | |||
*[[Social anxiety disorder]] | |||
*[[Anxiety]] disorder due to another [[Medical|medica]]<nowiki/>l condition | |||
* [[Substance]]/[[medication]] induced [[anxiety]] disorder | |||
*Unspecified anxiety disorder | |||
==Pathophysiology== | ==Pathophysiology== | ||
Various theories have been implicated in the [[Pathogenesis|pathogenesi<nowiki/>s]] of [[anxiety]] which are as follows: [[Biologic]]( increased [[Sympathetic nervous system|sympathetic]] tone and decreased [[GABA]]), [[psychoanalytic]] component([[Freud]] described that [[anxiety]] is developmentally related to childhood fears of disintegration that derive from the fear of actual or imagined loss of a love object or fear of bodily harm), [[Learning theory (statistics)|learning theory]] ( where [[anxiety]] is attributed to continuous exposure to [[stress]]), about 5% individuals with [[Anxiety|anxiet<nowiki/>y]] have [[polymorphic]] variant of the [[gene]] associated with [[serotonin]] [[transporter]] [[metabolism]]. | |||
==Causes== | ==Causes== | ||
[[Life threatening causes of back pain|Life threatening]] [[causes]] of [[anxiety]] include [[anaphylaxis]], [[acute coronary syndromes]], [[cardiogenic shock]], and [[myocardial infarction]]. Other [[Common-cause and special-cause|common]] causes of [[anxiety]] include [[anemia]], [[caffeine]], [[diabetes]], and [[hyperthyroidism]]. | |||
==Differential diagnosis== | ==Differential diagnosis== | ||
[[Anxiety]] must be differentiated from: Major [[ depressive]] disorder, [[bipolar disorder]], [[atypical psychosis]], [[schizophrenia]], [[substance]] related disorder, [[cognitive disorder]]. Some of the [[medical]] conditions similar to [[anxiety]] are [[myocardial infarction]]/[[angina pectoris]], [[ hyperventilation syndrome]], [[hypoglycemia]], [[hyperthyroidism]], [[carcinoid]]. | |||
==Epidemiology and demographics== | |||
The [[prevalence]] of [[anxiety]] is estimated to 28800 per 100,000 (28.8%) individuals. The [[female]] to [[male]] ratio is 3 to 2. | |||
==Risk factors== | ==Risk factors== | ||
[[Common-cause and special-cause|Common]] [[risk factors]] in the development of [[anxiety]] are: [[Depression]], [[Alcohol]], low socio-economic status, [[bipolar disorder]], urbanization, [[stress]], [[family history]] of[[ anxiety]], unemployment,[[ substance abuse]] | |||
==Natural history, complications and prognosis== | ==Natural history, complications and prognosis== | ||
If left untreated, [[anxiety]] may cause consequences such as [[depression]], [[suicide]], [[substance abuse]], [[insomnia]], compromised [[immune system]]. | |||
==Diagnosis== | |||
[[Anxiety disorder history and symptoms|History and Symptoms]] | [[Anxiety disorder physical examination|Physical Examination]] | [[Anxiety disorder laboratory findings|Laboratory Findings]] | [[Anxiety disorder other imaging findings|Imaging Findings]] | |||
===History and symptoms=== | |||
The most common [[symptoms]] of [[anxiety]] is inappropriate worry about [[Multiple-complex Developmental Disorder|multiple]] factors, [[restlessness]], [[fatigue]], [[insomnia]], and impairment in functioning of the individual. The symptoms must be persistent for at least a duration of six months. | |||
===Physical examination=== | |||
The following are the some of the [[Physical Culture|physical]] [[examination]] [[Findings on urinalysis|findings]] associated with [[ anxiety]] :[[Tachycardia]], [[tremors]], [[sweating]], [[restlessness]], twitches, [[shortness of breath]]. | |||
===Lab tests=== | |||
The [[diagnosis]] of [[anxiety]] is mostly [[clinical]], based on a thorough [[History and Physical examination|history]] and [[Physical examination|physica]]<nowiki/>l exam. [[Lab coat|Lab]] tests are done to rule out other [[medical]] causes that cause [[anxiety]]. Some of the [[Lab-on-a-chip|lab]] tests that could help [[differentiate]] [[anxiety]] causing conditions are as follows: CBC, [[BMP]], urine analysis, urine [[drug]] screen, [[thyroid]] function tests, urine [[catecholamines]] | |||
===Electrocardiogram=== | |||
The EKG in [[anxiety]] is characterized by [[Sinus tachycardia|sinus]] [[tachycardia]]. | |||
===Imaging studies=== | |||
The [[diagnosis]] of [[anxiety]] is mostly [[Clinical|clinica]]<nowiki/>l, based on a thorough [[History and Physical examination|history]] and [[Physical Culture|physical exam]]. [[Imaging studies|Imaging]] [[Studies on Hysteria|studies]] should not be routinely done, but rather be guided by pertinent findings in the [[History and physical examination for atrial fibrillation|history and physical exam]] and ruling out [[secondary]] causes. | |||
==Treatment== | |||
[[Anxiety medical therapy|Medical Therapy]] | [[Anxiety primary prevention|Primary Prevention]] | [[Anxiety secondary prevention|Secondary Prevention]] | [[Anxiety cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Anxiety future or investigational therapies|Future or Investigational Therapies]] | |||
===Medical therapy=== | |||
The mainstay of [[therapy]] for [[anxiety]] is the administration of [[pharmacotherapy]] and [[psychotherapy]], pharmacotherapy includes treatment with [[benzodiazepine]], [[buspirone]], [[tricyclic antidepressant]], [[SSRI]] . [[Cognitive-behavioral therapy|Cognitive behavioral therapy]] is the main stay of [[psychotherapy]] | |||
== | ===Primary prevention=== | ||
There is no established method for the [[prevention]] of [[anxiety]]. Although there is no proven way to prevent anxiety, early identification of stressors, getting help to cope with crisis situations and avoiding substances that can induce [[anxiety]] to some extent can minimize severity of [[symptoms]]. | |||
===Secondary prevention=== | |||
The [[secondary prevention]] of [[anxiety]] is same as its [[primary prevention]]. | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
{{WH}} | |||
{{WS}} | |||
[[Category:Needs content]] | [[Category:Needs content]] | ||
[[Category:Psychiatry]] | [[Category:Psychiatry]] | ||
Latest revision as of 20:26, 29 July 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Vindhya BellamKonda, M.B.B.S [2]
Overview
Anxiety is a physiological state characterized by cognitive, somatic, emotional, and behavioral components. These components combine to create the feelings that we typically recognize as fear, apprehension, or worry. Anxiety is often accompanied by physical sensations such as heart palpitations, nausea, chest pain, shortness of breath, or headache.
Historical Perspective
Sigmund Freud recognized anxiety as a "signal of danger" and a cause of "defensive behavior". He believed we acquire anxious feelings through classical conditioning and traumatic experiences.
We maintain anxiety through operant conditioning; when we see or encounter something associated with a previous traumatic experience, anxious feelings resurface. We feel temporarily relieved when we avoid situations which make us anxious, but this only increases anxious feelings the next time we are in the same position, and we will want to escape the situation again and therefore will not make any progress against the anxiety.
Classification
According to DSM-5 diagnostic criteria, anxiety is classified as follows:
- Generalized anxiety disorder
- Panic disorder
- Separation anxiety disorder
- Selective mutism
- Specific phobia
- Agoraphobia
- Social anxiety disorder
- Anxiety disorder due to another medical condition
- Substance/medication induced anxiety disorder
- Unspecified anxiety disorder
Pathophysiology
Various theories have been implicated in the pathogenesis of anxiety which are as follows: Biologic( increased sympathetic tone and decreased GABA), psychoanalytic component(Freud described that anxiety is developmentally related to childhood fears of disintegration that derive from the fear of actual or imagined loss of a love object or fear of bodily harm), learning theory ( where anxiety is attributed to continuous exposure to stress), about 5% individuals with anxiety have polymorphic variant of the gene associated with serotonin transporter metabolism.
Causes
Life threatening causes of anxiety include anaphylaxis, acute coronary syndromes, cardiogenic shock, and myocardial infarction. Other common causes of anxiety include anemia, caffeine, diabetes, and hyperthyroidism.
Differential diagnosis
Anxiety must be differentiated from: Major depressive disorder, bipolar disorder, atypical psychosis, schizophrenia, substance related disorder, cognitive disorder. Some of the medical conditions similar to anxiety are myocardial infarction/angina pectoris, hyperventilation syndrome, hypoglycemia, hyperthyroidism, carcinoid.
Epidemiology and demographics
The prevalence of anxiety is estimated to 28800 per 100,000 (28.8%) individuals. The female to male ratio is 3 to 2.
Risk factors
Common risk factors in the development of anxiety are: Depression, Alcohol, low socio-economic status, bipolar disorder, urbanization, stress, family history ofanxiety, unemployment,substance abuse
Natural history, complications and prognosis
If left untreated, anxiety may cause consequences such as depression, suicide, substance abuse, insomnia, compromised immune system.
Diagnosis
History and Symptoms | Physical Examination | Laboratory Findings | Imaging Findings
History and symptoms
The most common symptoms of anxiety is inappropriate worry about multiple factors, restlessness, fatigue, insomnia, and impairment in functioning of the individual. The symptoms must be persistent for at least a duration of six months.
Physical examination
The following are the some of the physical examination findings associated with anxiety :Tachycardia, tremors, sweating, restlessness, twitches, shortness of breath.
Lab tests
The diagnosis of anxiety is mostly clinical, based on a thorough history and physical exam. Lab tests are done to rule out other medical causes that cause anxiety. Some of the lab tests that could help differentiate anxiety causing conditions are as follows: CBC, BMP, urine analysis, urine drug screen, thyroid function tests, urine catecholamines
Electrocardiogram
The EKG in anxiety is characterized by sinus tachycardia.
Imaging studies
The diagnosis of anxiety is mostly clinical, based on a thorough history and physical exam. Imaging studies should not be routinely done, but rather be guided by pertinent findings in the history and physical exam and ruling out secondary causes.
Treatment
Medical Therapy | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies
Medical therapy
The mainstay of therapy for anxiety is the administration of pharmacotherapy and psychotherapy, pharmacotherapy includes treatment with benzodiazepine, buspirone, tricyclic antidepressant, SSRI . Cognitive behavioral therapy is the main stay of psychotherapy
Primary prevention
There is no established method for the prevention of anxiety. Although there is no proven way to prevent anxiety, early identification of stressors, getting help to cope with crisis situations and avoiding substances that can induce anxiety to some extent can minimize severity of symptoms.
Secondary prevention
The secondary prevention of anxiety is same as its primary prevention.