anxiety is a normal and universal emotion
! occurs frequently in patients with physical disease
! includes a continuous clinical spectrum ranging from normal to psychiatric
abnormal (maladaptive) anxiety is distinguished from normal anxiety by
! anxiety out of proportion to the stress
! persistence of symptoms for more than two weeks
! severe physical symptoms or recurrent panic attacks
! disruption to normal functioning
Clinical spectrum
! normal anxiety
o in response to the stress and crises associated with disease
o more frequent in the terminal phases of the disease
! reactive anxiety—adjustment disorder with anxious mood
o lasts longer than expected (more than 2 weeks)
o exceeds the level that is regarded as normal and adaptive
o follows a defined incident or stress
o depressive symptoms frequently coexist
! generalized anxiety disorder
o characterized by chronic unrealistic worries with autonomic
hyperactivity, apprehension and hypervigilance
o the anxiety is more pervasive and persistent, occurring in many
different situations
o patients have more severe and disabling symptoms, which appear
inappropriate or out of proportion to the medical situation
! panic disorder
o repeated sudden, unpredictable attacks of intense fear and physical
discomfort
o attacks follow a crescendo pattern, reaching a maximum in a few
minutes
o may occur in many different situations.
! phobic anxiety
o anxiety provoked by exposure to a specific feared object or
situation
o usually results in an avoidance response.
! organic anxiety syndromes
o uncontrolled pain
o hypoxia, respiratory distress
o hypoglycaemia
o any uncontrolled or severe physical symptoms
o acute confusional state or delirium
o drug adverse effects: corticosteroids, metoclopramide,
bronchodilators
o drug withdrawal: opioids, barbiturates, benzodiazepines, alcohol,
nicotine
Treatment
! treat the cause of organic anxiety syndrome, if present
! exclude adverse effects of drugs and drug interactions
! treat other factors that may cause or aggravate anxiety
o pain, other physical symptoms, social, cultural, spiritual
! treat depression, if present
! general support (see Depression)
! brief, supportive psychotherapy (see Depression)
! psychological behavioural therapies
o relaxation training, hypnosis, cognitive-behavioural therapy,
biofeedback
! distraction therapies
o music therapy, art therapy, socialization
! drug therapy: anxiolytics, hypnotics, antidepressants, neuroleptics