Anxiety disorders description

Barlow DH, Blanchard EB, Vermilyea JA, et al. Generalized anxiety and generalized anxiety disorder description and reconceptualization. Am J Psychiatry 1986 143 40-44. 

DSM-IV specifies a total of 12 anxiety disorders, but starts by defining panic attacks. Panic attacks are defined separately but are not considered as a separate diagnostic category because they may occur in many of the other anxiety disorders. Likewise, agoraphobia and panic disorder are not considered as specific anxiety diagnoses but rather their combination. In the following, a description of the clinical presentation will be given ... 

This principle is not applicable in biological psychiatry. One can and should not simply discard the possibility that a biological variable observed in a psychotic condition is linked to a concurrent depression or that one found in depression is in fact related to a comorbid anxiety disorder. The hierarchical principle is a deus ex machina that resolves the problem of comorbidity only in appearance. Comorbidity in itself is merely a descriptive, not an explanatory, term. The multiplicity of psychiatric disorders, as they are presently defined, in so many patients permits a variety of explanations (Van Praag 1996], and thus the term comorbidity conceals more than it discloses. 

In this chapter we have given clinical descriptions and have also explored the biological basis and a variety of treatments for numerous anxiety disorder subtypes, including obsessive-compulsive disorder, panic disorder, social phobia, and posttraumatic stress disorder. 

The key features of each anxiety disorder are given below, with a practical description of the preferred choice of medication, its dose and duration. 

Anxiety represents a state of heightened vigilance and fear, but pathological anxiety can be distinguished from fear in that it is inappropriately evoked and may persist in the absence of real threat or danger. The study of conditioned fear has provided detailed information on the neural circuitry and intracellular mechanisms that are important to fear responses and their long-term retention. The description of neural circuitry and the mechanisms underlying disorders of fear memory such as posttraumatic stress disorder (PTSD) may also be relevant to other anxiety states that share common neural substrates. 

Patients suffering from akathisia often use electrical metaphors or descriptions such as electricity going through my veins or shocks in my head. Words like excruciating, torture, and indescribable are commonly used. Patients often say that they would rather die than live with akathisia, and the disorder can cause suicidality. Unlike patients suffering from anxiety, these individuals seem to be describing physical phenomena as if they are being tortured from the inside out. 

CASE MAJOR DEPRESSIVE DISORDER, ANXIETY, AND GRIEF Case Description... 

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