Anxiety disorders are the most common psychiatric conditions, with a lifetime prevalence of approximately 30%. This article provides a clinical framework for recognition and treatment.
CLASSIFICATION OF ANXIETY DISORDERS
Generalized Anxiety Disorder (GAD)
- Excessive worry about multiple events/activities for ≥6 months
- Difficult to control worry
- ≥3 associated symptoms: restlessness, fatigue, concentration difficulty, irritability, muscle tension, sleep disturbance
Panic Disorder
- Recurrent unexpected panic attacks
- ≥1 month of concern about additional attacks or maladaptive behavioral change
Social Anxiety Disorder
- Marked fear of social situations with potential scrutiny
- Fear of embarrassment or humiliation
- Duration ≥6 months
Specific Phobias
- Marked fear of specific object or situation
- Immediate anxiety response
- Avoidance or endurance with intense distress
Agoraphobia
- Fear of ≥2 situations: public transport, open spaces, enclosed spaces, crowds, being outside the home alone
- Fear that escape might be difficult
NEUROBIOLOGY
Key circuits
- Amygdala hyperactivity
- Prefrontal cortex hypofunction
- HPA axis dysregulation
- GABAergic dysfunction
TREATMENT
Psychotherapy (Firstline for most)
- Cognitive Behavioral Therapy (CBT)
- Exposure therapy
- Acceptance and Commitment Therapy (ACT)
Pharmacotherapy
Firstline
- SSRIs (sertraline, escitalopram, paroxetine)
- SNRIs (venlafaxine, duloxetine)
Secondline
- Buspirone (GAD)
- Pregabalin (GAD)
- Benzodiazepines (short-term only)
Special Considerations
- Beta-blockers for performance anxiety
- Avoid benzodiazepine monotherapy
- Combine medication with therapy for best outcomes
PROGNOSIS
With appropriate treatment, 60-80% of patients achieve significant improvement. Chronic course without treatment.