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Chapter 12. Anxiety Disorders

Eric Hollander, M.D.; Daphne Simeon, M.D.
DOI: 10.1176/appi.books.9781585623402.294126

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Excerpt

Anxiety disorders are the most common of all psychiatric illnesses and result in considerable functional impairment and distress. Recent research developments have had a broad impact on our understanding of the underlying mechanisms of illness and treatment response. Working with patients who have an anxiety disorder can be highly gratifying for the informed psychiatrist, because these patients, who are in considerable distress, often respond to proper treatment and return to a high level of functioning. The major anxiety disorders presented in this chapter are panic disorder, generalized anxiety disorder (GAD), social anxiety disorder, specific phobias, obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD). Table 12–1 presents a summary overview of the prevalence, gender ratio, and comorbidities of the major anxiety disorders.

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FIGURE 12–1. Diagnostic decision tree for anxiety disorders.Patients may have more than one disorder and thus must be evaluated for each disorder.

FIGURE 12–2. Development of agoraphobia.After onset of unexpected panic attacks (solid bars), patient develops acute help-seeking behavior (X), then apprehension culminating in chronic anxiety (shaded areas), and finally agoraphobic behavior (black blocks).
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TABLE 12–1. Approximate lifetime prevalence, gender ratio, and common comorbidities for the major anxiety disorders
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TABLE 12–2. DSM-IV-TR diagnostic criteria for panic attacks
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TABLE 12–3. DSM-IV-TR diagnostic criteria for panic disorder with or without agoraphobia
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TABLE 12–4. Biological models of panic disorder
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TABLE 12–5. Course and prognosis of panic disorder
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TABLE 12–6. Differential diagnosis of panic disorder
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TABLE 12–7. Comparison of symptoms of mitral valve prolapse and panic disorder
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TABLE 12–8. Pharmacological treatment of panic disorder
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TABLE 12–9. Cognitive and behavioral approaches to treating panic disorder
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TABLE 12–10. DSM-IV-TR diagnostic criteria for generalized anxiety disorder
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TABLE 12–11. Biological models of generalized anxiety disorder
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TABLE 12–12. Differential diagnosis of generalized anxiety disorder
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TABLE 12–13. Pharmacological treatment of generalized anxiety disorder
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TABLE 12–14. Cognitive and behavioral approaches to treating generalized anxiety disorder
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TABLE 12–15. DSM-IV-TR diagnostic criteria for social phobia
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TABLE 12–16. Risk factors for social anxiety
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TABLE 12–17. Biological models of social anxiety disorder
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TABLE 12–18. Course and prognosis of social anxiety disorder
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TABLE 12–19. Differential diagnosis of social anxiety disorder
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TABLE 12–20. Pharmacological treatment of social anxiety disorder
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TABLE 12–21. Cognitive and behavioral approaches to treating social anxiety disorder
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TABLE 12–22. DSM-IV-TR diagnostic criteria for specific phobia
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TABLE 12–23. DSM-IV-TR diagnostic criteria for obsessive-compulsive disorder
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TABLE 12–24. Biological models of obsessive-compulsive disorder
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TABLE 12–25. Course and prognosis of obsessive-compulsive disorder
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TABLE 12–26. Differential diagnosis of obsessive-compulsive disorder
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TABLE 12–27. Pharmacological treatment of obsessive-compulsive disorder
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TABLE 12–28. Cognitive and behavioral approaches to treating obsessive-compulsive disorder
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TABLE 12–29. DSM-IV-TR diagnostic criteria for posttraumatic stress disorder
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TABLE 12–30. Risk factors for posttraumatic stress disorder (PTSD)
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TABLE 12–31. Biological models of posttraumatic stress disorder
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TABLE 12–32. Course and prognosis of posttraumatic stress disorder (PTSD)
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TABLE 12–33. Differential diagnosis of posttraumatic stress disorder (PTSD)
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TABLE 12–34. Pharmacotherapy of posttraumatic stress disorder (PTSD)
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TABLE 12–35. Cognitive and behavioral approaches to treating posttraumatic stress disorder
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Anxiety disorders are prevalent in the general population, with lifetime prevalence ranging from about 2%–3% for panic disorder and OCD to 15% for social anxiety disorder.

Anxiety disorders are highly treatable: medication and CBT constitute first-line treatments for all these disorders.

The "neurocircuitry of fear" has been implicated in all anxiety disorders except for OCD, in which there is evidence of a hyperactive orbitofrontal-limbic-basal ganglia-thalamic circuitry.

Serotonin reuptake inhibitors are the first-line treatment for all anxiety disorders.

Exposure, relaxation, and cognitive restructuring are the main types of psychotherapies helpful in treating the anxiety disorders.

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