Anxiety & Stress Disorders

Anxiety disorders occur in 18% to 28% of the US general population during any 12-month period. In anxiety disorder, there is a 33% to 45% 12-month prevalence rate for a comorbid substance use disorder (SUD).

In this article, we attempt to leverage state-of-the-art research findings to provide empirically informed perspectives and practices related to these issues.

Exposure-based therapies are highly effective for patients with anxiety disorders, to the extent that exposure should be considered a first-line, evidence-based treatment for such patients. In clinical practice, however, these treatments are underutilized, which highlights the need for additional dissemination and training.

Treatment of anxiety can be a challenge, since the mainstay of treatment may adversely affect the course of bipolar disorder.

In 2009, Maj Matthew P. Houseal, a psychiatrist, was in Iraq attempting to help suicidal soldiers when a fellow soldier killed him, a clinical social worker and 3 others at a combat stress center near Bagdad. Paradoxically, Houseal’s accused killer, US Army Sgt John Russell, had earlier threatened to take his own life, according to witnesses’ testimony during a recent investigative Article 32 hearing.

Most military families successfully adapt to a service member's deployments for military duties. Nevertheless, almost a decade of wartime stress associated with the current wars in Iraq and Afghanistan has presented unprecedented challenges for military families.

The United States has often been characterized as a nation of hypochondriacs. This is patently not true but TV bombardment by pharmaceutical advertisements stirs anxiety and illness fears in the many worried well in our midst.

Patients with anxiety disorders who self-medicate with alcohol or drugs may be increasing their risk for developing incident substance use disorders, according to a study presented at the American Psychiatric Association’s recent annual meeting.

The thing to remember that there is not a pill for every worry or life problem and that pills can sometimes make things worse.

Is violent behavior a proxy indicator for the relationship between severity of substance abuse and suicide risk? What has the strongest influence in promoting doubt about a delusion in a patient with schizophrenia? These questions and more.

Contrary to the popular belief that quitting increases anxiety, a recent study reports that stopping smoking can lift depression, decrease anxiety, and give quitters a sense of accomplishment during the period of abstinence.

Do patients with the personality trait alexithymia have trouble understanding the written language? What percentage of patients with dementia have at least one psychiatric comorbidity? These and more in this quiz.

The latest information released by the US Army reveals that last year American soldiers attempted suicide at the rate of about 5 /day. There were 160 successful suicides last year and during June the rate was 1/day. Military research has reported that one in 10 Iraq veterans may develop a severe case of PTSD.

Consider the predicament of Mrs M-a 38-year old premenopausal mother of two. Mrs M tells her primary care physician, “I just don’t have a strong desire for sex."

Insurance restrictions sometimes make for strange bedfellows. My story begins with a phone call from a man about to lose his job. He said that he had been placed on probation and was about to be fired. He asked if he could see me. We met the following day.

It is safe to say that few authors of mental health–related books would introduce themselves by presenting these credentials:

Allen Frances, MD, identifies a number of concerns about the draft DSM5 revisions.1 Not mentioned in his commentary, but of significant concern, is a proposal that might subsume tic disorders under a new category called “Anxiety and Obsessive-Compulsive Disorders.”

For both depression and anxiety disorders in youths, there is increasing evidence of clinical benefit from cognitive-behavioral therapy (CBT).

Obesity has emerged as a significant threat to public health throughout the developed world. The World Health Organization defines overweight as a body mass index of 25.0 to 29.9 kg/m2 and obesity as a BMI of 30.0 kg/m2 or greater.1 Nearly two-thirds of Americans are overweight or obese according to these criteria.2 Numerous health problems, including diabetes, cardiovascular disease, arthritis, and cancer, are associated with obesity. In addition, overweight and obese persons are more likely than their normal-weight peers to have a variety of psychiatric disorders.

There has been much recent attention to the deleterious effects of natural disasters and war on children and adolescents.

Anxiety disorders are one of the most common psychiatric disorders in children and adolescents, but they often go undetected or untreated. Identification and effective treatment of childhood anxiety disorders can decrease the negative impact of these disorders on academic and social functioning in youth and their persistence into adulthood.

Since the time of Homer, warriors have returned from battle with wounds both physical and psychological, and healers from priests to physicians have tried to relieve the pain of injured bodies and tormented minds.1 The soldier’s heartache of the American Civil War and the shell shock of World War I both describe the human toll of combat that since Vietnam has been clinically recognized as posttraumatic stress disorder (PTSD).2 The veterans of Operation Iraqi Freedom (OIF) and of Operation Enduring Freedom (OEF) share with their brothers and sisters in arms the high cost of war. As of August 2009, there have been 4333 confirmed deaths of US service men and women and 31,156 wounded in Iraq. As of this writing, 796 US soldiers have died in the fighting in Afghanistan.3

As we begin this brief review of the neurobiology of major depressive disorder (MDD), we face these fundamental questions

Although depressive and anxiety disorders are classified as distinct groups of illnesses, studies document their frequent co-occurrence and provide evidence of a common biological substrate and a shared vulnerability.

An array of military-related presentations were given at this year’s American Psychiatric Association (APA) conference, addressing the rise of psychiatric issues in returning veterans and their families.

Social anxiety disorder (SAD), also referred to as social phobia, is a chronic and potentially disabling anxiety disorder characterized by the intense and persistent fear of being scrutinized or negatively evaluated by others. At its core, people with this disorder fear and/or avoid the scrutiny of others. Symptoms may occur only in circumscribed situations, such as a fear of speaking in formal or informal situations, or eating or drinking in front of others.

Generalized anxiety disorder (GAD) is a prevalent, chronic, debilitating mental illness associated with marked impairment in daily functioning.1 An ongoing evolution of the definition of GAD has resulted in a bifurcation of the historical anxiety neurosis designation.2 A diagnosis of GAD currently implies chronic, excessive worry lasting at least 6 months and 3 of the possible 6 somatic or psychological symptoms (restlessness, fatigue, muscle tension, irritability, difficulty concentrating, and sleep disturbance).3 GAD typically presents in an episodic pattern of moderate improvement or remission and relapse characterized by a chronic and complicated clinical course.

The cardiovascular properties of serotonin (5-HT) have been known for some time-its name reflects its presence in serum and its action in increasing vascular tone. Serotonergic medications are routinely used to treat depressive and anxiety disorders, and the association of depression with cardiovascular disease has become well established.2 Recent studies have confirmed the colloquial wisdom that anxiety (especially panic) and hypertension are linked.

The rationale for the use of anticonvulsants in anxiety disorders is supported by neurobiological underpinnings that make these compounds a likely alternative for short-term treatment.