Anxiety disorders include panic disorder (PD), generalized anxiety disorder (GAD), social anxiety disorder (SAD), and specific phobic disorders. Until the publication of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) were classified as anxiety disorders. Now, OCD and PTSD are classified separately from anxiety disorders; however, they will be discussed in this chapter due to significant overlap in medications used to treat these disorders. Specific phobias will not be addressed in this chapter, because pharmacotherapy has only a limited role in phobia treatment. For patients to be diagnosed with an anxiety disorder, the symptoms must cause significant impairment in social or occupational functioning and cannot be due to a general medical condition or substance.
A panic attack is an abrupt and intense period of fear or discomfort, and characterized by somatic or cognitive symptoms such as chest pain, palpitations, sweating, shortness of breath, fear of dying, dizziness, or hot flashes. Symptoms appear suddenly, peak within a few minutes, and last about 10 minutes. Patients can have multiple panic attacks in their lifetime; however, panic attacks alone do not constitute a diagnosis of PD. PD is characterized by recurrent unexpected panic attacks with associated worry about having another panic attack and/or a change in behavior in a maladaptive way (eg, avoiding places or situations that may provoke panic symptoms) for at least 1 month.
Generalized Anxiety Disorder
GAD is characterized by chronic excessive uncontrollable worry and anxiety for at least 6 months. The anxiety and worry are associated with at least three of the following: feeling on edge, poor concentration, restlessness, irritability, muscle tension, sleep disturbance, or fatigue. A high incidence of comorbidity exists with major depressive disorder.
Patients with OCD have obsessions, compulsions, or both. Obsessions are marked by recurrent and persistent thoughts that are intrusive and cause significant anxiety. Compulsions are characterized by repetitive behaviors that a person feels driven to perform to reduce anxiety. Adults with obsessions or compulsions recognize these feelings are excessive, but they are unable to control these thoughts or actions. To meet criteria for a diagnosis of OCD, the symptoms must cause significant distress and must be time-consuming (more than 1 hour per day).
Posttraumatic Stress Disorder
PTSD is characterized by symptoms that occur after exposure to a traumatic event such as military combat or violent personal attack. Symptoms must be present for at least 1 month and include the following types of indicators: re-experiencing (flashbacks, dreams), avoidance (of activities or people associated with the trauma), and increased arousal (sleep disturbance, exaggerated startle response). Most symptoms of PTSD occur within 3 months of exposure to the trauma, but they can appear at any time during a ...