Anxiety medical diseases associated with

Many elderly persons, whether demented or cognitively intact, have medical conditions that disrupt sleep. Untreated insomnia and daytime sleepiness have been associated with nursing home placement and mortality. Medically ill older adults admitted to acute care hospitals are particularly vulnerable to sleep disruptions, which appear to be created as much by the various treatments and procedures, unfamiliar routines, and environmental conditions, as by the pain, anxiety, and discomfort associated with their underlying medical condition. Medical conditions especially likely to disrupt sleep are congestive heart failure, chronic obstructive pulmonary disease, Parkinson s disease, gastroesophageal reflux disease, arthritis, and nocturia. 

Oral hydroxyzine (50 to 100 mg q.i.d.) is indicated for symptomatic relief of anxiety and tension associated with psychoneurosis and as an adjunct in organic disease states in which anxiety is manifest. Hydroxyzine is used for the management of pruritus due to allergic conditions such as chronic urticaria, atopic and contact dermatoses, and in histamine-mediated pruritus. It is also used as a sedative, as a preanesthetic medication, and following general anesthesia. 

Anxiety disorders and insomnia represent relatively common medical problems within the general population. These problems typically recur over a person s lifetime (3,4). Epidemiological studies in the United States indicate that the lifetime prevalence for significant anxiety disorders is about 15%. Anxiety disorders are serious medical problems affecting not only quaUty of life, but additionally may indirecdy result in considerable morbidity owing to association with depression, cardiovascular disease, suicidal behavior, and substance-related disorders. 

The question of insomnia effects on morbidity is more difficult. Since insomnia complaints are associated with depression, anxiety, neuroticism, and a wide variety of medical illnesses (44,49,54,55), it may be difficult to distinguish effects of insomnia from effects of the comorbid processes. In some cases, medications taken by insomniacs may be responsible for impairment. One attempt to assess disability related to insomnia found no association meeting Bonferroni criteria, after adjustment for age, gender, chronic disease, and major depression (56). It is possible that the trend for association would have been entirely eliminated had control been done for subthreshold depression, which was prevalent in the sample. Although sleep symptoms do predict future depression, they are less... 

Anxiety symptoms are an inherent part of the initial clinical presentation of several diseases, thus complicating the distinction between anxiety disorders and medical disorders. If the anxiety symptoms are secondary to a medical illness, they usually will subside as the medical situation stabilizes. However, the knowledge that one has a physical illness (e.g., cancer and diabetes) can trigger anxious feelings and further complicate therapy. Persistent anxiety subsequent to a physical illness requires further assessment for an anxiety disorder. Symptoms of anxiety frequently present in medical disorders include palpitations, tachycardia, chest pain or tightness, shortness of breath, and hyperventilation. Medical disorders most closely associated with anxiety are listed in Table 69-1. " About 50% of patients with GAD have irritable bowel syndrome. ... 

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