Anxiety disorders recurrence

Anxiety disorders are characterized as chronic in nature with low rates of spontaneous symptom remission and high rates of relapse. Research illustrates that symptoms of anxiety disorders tend to wax and wane, with less than a third of patients remitting spontaneously.7 In a 12-year follow-up study of anxiety disorder patients, recurrence rates were similar between PD with and without agoraphobia (56% and 58%, respectively) despite great differences seen in reported rates of remission (48% and 82% with treatment, respectively).8 Fifty-eight percent of treated GAD patients experienced symptom remission, with 55% experiencing recurrence during the follow-up period. While individuals with SAD had the lowest remission rate with treatment (37%), those who did respond had the lowest rate of recurrence (39%) compared with patients with other anxiety disorders. 

As you might expect, the diagnostic criteria for panic disorder requires the presence of recurrent panic attacks, but panic attacks alone are not sufficient for the diagnosis of panic disorder. Those with other anxiety disorders, for example, can experience panic attacks when confronted by the situation or object that they fear. 

Anxiety Disorder Due to a General Medical Condition with Panic Attacks. Many medical illnesses are associated with anxiety and even recurrent panic attacks. These include endocrine disorders, such as hyperthyroidism, hyperparathyroidism, hypoglycemia, and pheochromocytomas, inner ear (vestibular) dysfunction, seizure disorders, and cardiac (heart) disorders such as supraventricular tachycardia, mitral valve prolapse, and various arrhythmias, and carcinoid. A general physical examination, routine laboratory studies including electrolytes and... 

The terms social phobia or social anxiety disorder refer to a pattern of recurrent fear and apprehension in social situations or scenarios where an individual may be scrutinized. Before modifications in the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV), identification of social phobia in childhood was limited by having the condition closely aligned to both... 

Panic attacks are the common symptom for many of the anxiety disorders. A panic attack is a brief and intense experience of fear or distress accompanied by some of the symptoms listed in Table 4.4 (DSM-IV-TR requires four or more symptoms for this diagnosis but acknowledges that patients can be severely anxious with fewer than four different symptoms). A panic attack—or even several panic attacks—is not by itself a disorder. Many people have a panic attack at some point in their lives. However, about 4% of individuals develop recurrent panic attacks, and 3.5% actually meet DSM-IV-TR criteria for panic disorder. 

The duration of treatment is often a controversial issue. Anxiety disorders (apart from the self-limiting acute stress reaction) are chronic conditions and may require treatment for as long as that used in depression. In a first episode, patients may need medication for at least 6 months, withdrawing over a further 4-8 weeks if they are well. Those with recurrent illness may need treatment for 1-2 years to enable them to learn and put into place psychological approaches to their problems. In many cases the illnesses are lifelong and chronic maintenance... 

Depersonalization—change in an individual s self-awareness, during anxiety disorder, such that one feels detached from his or her own experiences, with the self, body, and mind seeming alien or distant Persistent or recurrent experiences as if one is an outside observer of one s mental processes or body (e.g., feeling hke one is in a dream). 

Growing evidence base for physical and mental health problems, e.g. chronic pain, recurrent depression, anxiety disorders... 

Panic attacks are terrifying, and often mistaken for medical emei encies. Once medical causes are excluded, your role is to contain Linda s anxiety and offer psychoeducation. Panic attacks can be one-off events, recurrent (panic disorder), or denote severity in another anxiety disorder (Ch.22). 

Mauri, M., Sarno, N., Rossi, V. M., Armani, A., et al., Personality disorders associated with generalized anxiety, panic, and recurrent depressive disorders. Journal of Personality Disorders 6(2), 162-167, 1992. 

Anticonvulsant As adjunctive therapy in the management of partial seizures (clorazepate) adjunctively in status epilepticus and severe recurrent convulsive seizures (diazepam IV) adjunctively in convulsive disorders (diazepam oral). Preoperative For preoperative apprehension and anxiety (chlordiazepoxide, diazepam IV) prior to cardioversion for the relief of anxiety and tension and to diminish patient s recall (diazepam IV) adjunctively prior to endoscopic procedures for apprehension, anxiety, or acute stress reactions and to diminish patient s recall (diazepam) ... 

A typical example of diagnostic splintering provides the group of mood disorders. One reads about major depression, minor depression, double depression, dysthymia, unipolar and bipolar depression, depressive personality, depression not otherwise specified, brief recurrent depression, subsyndromal symptomatic depression, mixed anxiety depression disorder, seasonal depression, and adjustment disorder with depressive mood. 

Panic disorder, therefore, is the presence of recurrent unexpected panic attacks followed by at least a 1 -month period of persistent anxiety or concern about recurrent attacks or consequences of attacks, or by significant behavioral changes related to the attacks. The presence of persistent anxiety or behavioral changes is important, because approximately 10% of the normal population report having had panic attacks at some time in their lives however, since they do not develop persistent anxiety and do not modify their behavior, they do not develop panic disorder. 

Treatment guidelines for depression and anxiety increasingly emphasize the value of longer-term maintenance treatment with antidepressants in order to prevent recurrence of illness. It is therefore important to assess the adverse effects burden of longer-term medication. The change in adverse effects profile over 1 year of treatment has been studied in a double-blind, placebo-controlled study of maintenance treatment with imipramine (average daily dose 160 mg) in 53 patients with panic disorder (15). Adverse effects of imipramine, such as sweating, dry mouth, and increased heart rate, persisted over the year... 

Though most persons who do not have bipolar disorder may consider the manic episodes to be beneficial and a positive experience, given the increased energy and euphoric mood, many patients with bipolar disorder find manic episodes to be very unpleasant, characterized by high levels of irritability and anxiety. Bipolar cUsorder, like major depressive cUsorder, is an episodic, recurrent convvcUtion, and in between episodes, the bipolar person may have function and behavior that appear completely normal. 

Obsessive-compulsive disorder (OCD) involves recurrent obsessions and compulsions, which are severe enough to cause marked distress and major functional impairment. The sufferer is aware that the obsessions and com-pulsionsare unreasonable, but is powerless to stop them. Obsessions are recurrent, unwanted thoughts or images, whereas compulsions are repetitive acts or rituals. The individual typically feels compelled to perform compulsions to alleviate the anxiety associated with an obsession, or to prevent the occurrence of some dreaded event. The lifetime prevalence of OCD is estimated at 2.3% (14). 

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