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Anxiety Amboss
Anxiety Amboss
Summary
Anxiety disorders cover a broad spectrum of conditions characterized by excessive and persistent
fear (an emotional response to imminent threats), anxiety (the anticipation of a future threat), worry
(apprehensive expectation), and/or avoidance behavior. The etiology of anxiety disorders is
multifactorial and may involve genetic, developmental, environmental, neurobiological, cognitive,
and psychosocial factors. Therapy typically consists of a combination of pharmacotherapy,
especially selective serotonin reuptake inhibitors (SSRIs), and psychotherapy, especially cognitive-
behavioral therapy (CBT).
For separation anxiety disorder and selective mutism, see the learning card on emotional and
behavioral disorders in children and adolescents
Neurobiological factors
Disruption of the serotonin system
Stress
Epidemiology
Lifetime prevalence: 5–10%
♀ > ♂(2:1)
Symptoms
Prolonged (≥ 6 months, occurring more days than not) and excessive anxiety
Treatment [1][2]
Pharmacotherapy: SSRIs/SNRI
Second-line
Buspirone: requires consistent, daily intake for at least two weeks because
of its delayed onset of action
Antipsychotics only for refractory cases
Differential diagnosis
Depressive disorders
References:[3][4][1][5][6]
Panic disorder
Epidemiology [7]
♀ > ♂ (2:1)
Associations
Agoraphobia
Substance use
Depression
Bipolar disorder
Symptoms
Recurrent panic attacks
Overstimulation of the sympathetic system
Sweating, palpitations
There is a concern about future attacks and their consequences, and/or a significant
change in behavior related to the attacks, for at least one month.
Treatment
Acute panic attack
Short-acting benzodiazepine (e.g. alprazolam)
Long-term management
CBT
Antidepressants: SSRIs, SNRIs, TCAs
References:[8][9]
Epidemiology
♀ > ♂ (2:1)
Types
Social anxiety disorder (SAD): fear/anxiety out of proportion to a social situation
where one may be scrutinized by others (e.g., meeting new people at a party, eating
in public, using public restrooms)
Symptoms
Treatment
First-line pharmacotherapy: SSRIs/SNRIs
References:[3][10][11][12]
Specific phobias
Epidemiology
Lifetime prevalence: approx. 5–10% of the population
♀ > ♂ (2:1)
Common phobias
Treatment
First-line: CBT
Alternative: benzodiazepine or SSRIs
References:[13][14][15]
Agoraphobia
Epidemiology
♀ > ♂ (2:1)
Clinical features
Treatment
CBT
SSRIs
References:[16][17][18][18][18]
Definition: prominent anxiety or panic attacks within 1 month of use of, or withdrawal from,
a substance/medication that is capable of inducing anxiety symptoms [19]
Causes [20][21]
Alcohol
Caffeine
Anticholinergics
Bronchodilators
Corticosteroids
Clinical features
Fear, anxiety, or panic attacks over a period of 1 month after taking or stopping the
substance/medication
Treatment
Antidepressants (e.g., SSRIs, SNRIs, TCAs, buspirone)