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CHAPTER SUMMARY FROM THE PHARMACOTHERAPY HANDBOOK

KEY CONCEPTS

KEY CONCEPTS

  • Image not available. Anxiety disorders are among the most common of mental disorders and are underdiagnosed and undertreated.

  • Image not available. The long-term goal in treatment of generalized anxiety disorder (GAD) is remission with minimal or no anxiety symptoms and no functional impairment.

  • Image not available. Antidepressants are the agents of choice for the management of GAD.

  • Image not available. Antidepressants have a lag time of 2 to 4 weeks or longer before antianxiety effects occur in GAD.

  • Image not available. When monitoring the effectiveness of antidepressants in panic disorder, it is important to allow an adequate amount of time (8-12 weeks) to achieve full therapeutic response.

  • Image not available. The optimal duration of panic therapy is unknown; 12 to 24 months of pharmacotherapy is recommended before gradual drug discontinuation over 4 to 6 months is attempted.

  • Image not available. Social anxiety disorder (SAD) is a chronic long-term illness requiring extended therapy. After improvement, at least a 6- to 12-month medication maintenance period is recommended.

  • Image not available. The selective serotonin reuptake inhibitors or venlafaxine are considered first-line pharmacotherapy for social anxiety disorder.

  • Image not available. An adequate trial of antidepressants in generalized SAD lasts at least 8 weeks, and maximal benefit may not be seen until 12 weeks.

  • Image not available. The three principal domains in which improvement should be observed in generalized SAD are symptoms, functionality, and well-being.

Anxiety is an emotional state commonly caused by the perception of real or perceived danger that threatens the security of an individual. It allows a person to prepare for or react to environmental changes. Everyone experiences a certain amount of nervousness and apprehension when faced with a stressful situation. This is an adaptive response and is transient in nature.

Anxiety can produce uncomfortable and potentially debilitating psychological (eg, worry or feeling of threat) and physiologic arousal (eg, tachycardia or shortness of breath) if it becomes excessive. Some individuals experience persistent, severe anxiety symptoms and possess irrational fears that significantly impair normal daily functioning. These persons often suffer from an anxiety disorder.1

Image not available. Anxiety disorders are among the most frequent mental disorders encountered in clinical practice and are often underdiagnosed and undertreated.2 Healthcare professionals often mistake anxiety disorders for physical illnesses, and only one quarter of patients receive appropriate treatment.3 Failure to diagnose and manage anxiety disorders results in negative outcomes including overuse of healthcare resources, increased risk for suicide and substance abuse.4 Individuals with anxiety disorders develop cardiovascular, cerebrovascular, gastrointestinal (GI), and respiratory disorders at a significantly higher rate than the general population.4

To treat anxiety appropriately, the clinician must make a reliable diagnosis. It is essential that the distinction between short-term symptoms of anxiety and anxiety disorders be understood. Common or situational anxiety is a normal response to a stressful circumstance. Although symptoms can be severe, they ...

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