Effective Recognition and Treatment of Generalized Anxiety Disorder in Primary Care


scholarly articles on anxiety

Jul 05,  · Anxiety is an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure.. People with anxiety disorders usually have recurring intrusive thoughts or concerns. They may avoid certain situations out of worry. They may also have physical symptoms such as sweating, trembling, dizziness or a rapid heartbeat. Journal of Depression and Anxiety is an Open Access journal that aims to publish the most complete and reliable source of information on the discoveries and current developments in the mode of original articles, review articles, case reports, short communications, etc. in all areas of the field and making them available online without any. This clinical review focuses on the pathophysiologic basis for anxiety disorders. It provides brief overviews of panic disorder, generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, and posttraumatic stress disorder. It also summarizes Cited by:

Anxiety and Depression Together | Psychology Today

Anxiety disorders are the most prevalent mental health conditions, scholarly articles on anxiety. Although scholarly articles on anxiety are less visible than schizophrenia, depression, and bipolar disorder, they can be just as disabling. The diagnoses of anxiety scholarly articles on anxiety are being continuously revised. Both dimensional and structural diagnoses have been used in clinical treatment and research, and both methods have been proposed for the new classification in the Diagnostic and Statistical Manual of Mental Disorders IV DSM However, each of these approaches has limitations.

More recently, the emphasis in diagnosis has focused on neuroimaging and genetic research. This approach is based partly on the need for a more comprehensive understanding of how biology, stress, and genetics interact to shape the symptoms of anxiety. Anxiety disorders can be effectively treated with psychopharmacological and cognitive—behavioral interventions.

These inter ventions have different symptom targets; thus, logical combinations of these strategies need to be further studied in order to improve future outcomes. New developments are forthcoming in the field of alternative strategies for managing anxiety and for treatment-resistant cases, scholarly articles on anxiety.

Additional treatment enhancements should include the development of algorithms that can be easily used in primary care and with greater focus on managing functional impairment in patients with anxiety. Anxiety disorders are present in up to Anxiety disorders currently included in the Diagnostic and Statistical Manual of Mental Disorders, 4th ed.

Advances in anxiety research over the previous scholarly articles on anxiety are likely to be reflected in modifications of diagnostic criteria in the upcoming DSM-59 planned for publication in May In this article, we review the challenges to the diagnosis of anxiety disorders, provide a model that explains how anxiety symptoms occur and change over time, highlight the neurotransmitter systems affected by these disorders, and discuss the roles and relative efficacy of pharmacological and non-pharmacological interventions.

Within the past 10 years or so, epidemiological data have been used in the attempt to refine the boundaries of diagnostic categories of anxiety disorders. However, this effort has been hampered by the extensive presence of comorbidities in patients with anxiety, as revealed by the National Comorbidity Survey NCS.

This is particularly true for symptom overlap between different anxiety disorders, depression, and alcohol and drug abuse. A related phenomenon is the emergence of different disorders in the same patient over a lifetime.

For example, scholarly articles on anxiety, during an initial evaluation, the original diagnosis could be panic disorder that resolves after treatment, and then presents after a few years with symptoms more suitable to a diagnosis of OCD or GAD.

Whether this process reflects a primary diathesis or two distinct entities is uncertain. Another significant problem with the present classification of anxiety disorders is the absence of known etiological factors and of specific treatments scholarly articles on anxiety different diagnostic categories, scholarly articles on anxiety. Studying the genetic underpinnings of anxiety disorders using molecular biological techniques has failed to produce a single gene or a cluster of genes implicated as an etiologic factor for any single anxiety disorder, even though some genetic findings exist for OCD and panic disorder.

Despite these diagnostic ambiguities, the emergence of efficacious serotonergic medications that cut across a variety of categorical disorders e. Each of these dimensions can vary, depending on hypothetical, biological, or genetic factors, which may dictate separate biological or psychological treatment approaches.

So far, few genetic or neuro-circuitry investigations have validated this concept. However, diagnostic presentations in clinical practice occur in scholarly articles on anxiety treated sequentially and may therefore be better understood as part of a psychopathological process that unfolds over time.

For example, although a patient might meet criteria for OCD purely on the basis of obsessions or compulsions, the latter usually arise later in the disorder as if to counteract the threat and anxiety associated with obsessive thoughts. For instance, when the lungs are infected with the harmful organism Mycobacterium tuberculosisthey compensate by forming scars around the tissue.

In the short run, this may be effective in walling off the infection and may even elude clinical detectionbut the strategy fails when pushed to the extreme, leading to respiratory compromise in some cases. In recent years, scientists and clinicians have begun to realize that the processes underlying anxiety and fear might be similar among the various disorders. This has resulted in the implementation of uniform scholarly articles on anxiety regimens in primary care 25 and in the development of the unified theory of anxiety.

Understanding how emotional reactivity, core beliefs, and coping strategies interact in time should lead to more precise diagnoses and better management of anxiety disorders. We recently applied a mathematical model using nonlinear dynamics to describe these processes 27 and further developed this model to cover diagnostic presentations and their underlying processes. In this model, a variety of triggering events can elicit responses at the levels of A larm sensations, B eliefs, and associated C oping ABC strategies, including behaviors.

Each of these processes originates in discrete brain circuits that are functionally connected. Over time, this perpetuates a vicious circle, shaping the presentation of a variety of anxiety disorders. Alarms A are emotional sensations or physiological reactions to a trigger situation, sensation, or thought. A well-defined set of brain circuits rapidly processes information about the alarm. The ensuing decision to act is made on the basis of beliefs B that rely heavily on previous experiences, personal and cultural background, and the information that is perceived by the sensory organs.

Patients with anxiety disorders appear to process information about a supposedly dangerous situation with more focused attention compared with individuals without the disorder. These processes evolve over time, forming a complex picture of a particular anxiety disorder.

This event activates circuits that process information about danger and, when coupled with personal beliefs about the event, leads scholarly articles on anxiety increased concern about personal health and safety.

This in turn leads to a specific attempt to decrease the danger of the situation e. Unfortunately, because no absolute safety is to be found, these behaviors become more extensive and chronic in the attempt to alleviate anxiety. The fact that anxiety persists induces more worry and eventually distress, thus perpetuating the vicious circle of the disorder recurrent panic attacks. If the pattern is uninterrupted, it eventually leads to even more inappropriate coping behavior, such as avoidance of any potential triggers of panic agoraphobiaand can result in comorbid despair and depression.

Most of the anxiety disorders follow this process even though different stages may predominate in different disorders; that is, ritualistic behavior is more characteristic of OCD, and avoidance predominates in social anxiety disorder. We have found that patients quickly recognize and interpret their symptom patterns within the Scholarly articles on anxiety model. We effectively incorporate this pattern with medication and behavioral techniques, as described in the previous studies.

Using scholarly articles on anxiety model, residents are able to understand and to begin administering cognitive—behavioral therapy CBT within relatively few sessions. In order to treat an anxiety disorder effectively, clinicians should understand how these conditions emerge and which factors are involved in maintaining them. In recent years, we have gained a better understanding of the interplay between genetic, biological, and stress factors that shape the presentation of the disorder, although it is not clear which factors are inherited.

One possibility is that abnormal cognition could be the inherited factor. Most cognitive strategies for treatment and research were developed in earlier years, scholarly articles on anxiety. The ABC model focuses on the interaction of information processing and emotional and cognitive processes that are controlled by overlapping circuits and compete for the same brain resources. In most anxiety disorders, patients usually process fear-inducing information in excessive detail that overwhelms their ability to scholarly articles on anxiety it properly.

As a result, they consider the worst-case scenario i, scholarly articles on anxiety. Stress also plays a major role in the pathology of anxiety disorders. For example, PTSD is a condition in which stress is considered the main etiological factor, although there is a high degree of co-occurring stress reported by these patients.

Nevertheless, patients with any anxiety disorder scholarly articles on anxiety pinpoint the onset of their disorder in relation to a striking stressful event or to a continuous persistent stressor. Whether a cause or a consequence, increased stress reactivity sometimes accounts for relapses in chronic anxiety conditions like GAD.

According to some studies, a stressful event or a persistent and chronic disorder can even cause secondary biological changes in specific brain structures. Although stressors are separately identified along Axis IV of the multiaxial system, the context for the patient is unclear. With this approach, we might be better able to capture the landscape and dynamic of the stress.

For example, panic disorder resulting from exposure to catastrophic combat may differ clinically from panic disorder that results from a persistent work-related stress or separation from family. Exploration of how stress affects biology and the course of anxiety disorders is clearly needed. Biological factors are of primary importance in anxiety disorders. Anxiety disorders can occur in the context of medical illness, 33 and the clinician should consider an intricate relationship between medical illnesses and anxiety disorders.

This relationship could be manifold. First, metabolic or autonomic abnormalities caused by the illness can produce the syndrome of anxiety i. The symptom of medical illness can be a trigger for anxiety i. Sometimes medical illness can mimic the anxiety disorder i. Finally, scholarly articles on anxiety, medical illness and an anxiety disorder can simply coexist in the same patient. One of the most interesting interactions between medical illness and anxiety disorders is pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections PANDASwhich has been reported in a subset of OCD patients.

Over the previous two decades, the main thrust of biological research in anxiety disorders has shifted from peripheral measures of autonomic and neurochemical parameters to identifying reactivity and neurochemistry of the living brain directly through advances in neuroimaging technology.

Anxiety disorders are an appropriate target for neuroimaging research because it is easy to provoke specific symptoms in many cases. Much of the research on neural circuits has focused on models of anxiety and fear proposed earlier by basic scientists, 3536 and a synthesis of current data has been attempted for panic disorder 37 and OCD.

There have been some excellent reviews of neuroimaging experiments in anxiety, 3940 but the picture remains incomplete, in part because of a lack of clinical trials addressing the long-term integration of threat responses.

As in the dynamical model, every anxiety disorder may be viewed as an interplay of anxious feelings, abnormal processing of information, and inadequate coping strategies.

In accordance with this model of anxiety, overlapping neuronal circuits are responsible for alarm reactions, processing of perceived threats, and behavioral coping see Figure 1. This model attempts to simplify complex brain circuitry that needs to be studied over the next several decades before we can truly understand how the brain processes threats over time.

For simplicity we identify Alarm circuits Ain which the amygdala is the structure of primary importance. These circuits also include periaqueductal gray matter and multiple nuclei in the brainstem, scholarly articles on anxiety. These circuits are possibly responsible for the quick response to a scholarly articles on anxiety. Abnormalities in Coping C should be governed by distributed cortical networks and are difficult to tease apart.

Thus, a convenient mnemonic explaining these circuits could be A Alarm, amygdalaB Beliefs, basal gangliaand C Coping, cortex. Neuronal circuits are governed by multiple neurotransmitter systems; the most extensive of these are gamma-aminobutyric acid GABA and glutamate.

The neural systems of the three major neurotransmitter systems—serotonin, dopamine, and norepinephrine—have been extensively studied in normal and pathological anxiety states. However, anxiety disorders are not simply a deficiency of one neurotransmitter or another. The networks governed by these transmitters have extensive interrelationships, scholarly articles on anxiety, multiple scholarly articles on anxiety mechanisms, and complex receptor structures.

Research involving other neurotransmitter systems has been fruitful in elucidating their scholarly articles on anxiety in anxiety but thus far has failed to produce new treatments, scholarly articles on anxiety.

The primary neurotransmitter and receptor systems implicated in the pathogenesis of anxiety disorders are discussed next. The primary serotonergic pathways originate in the raphe nuclei and project widely to numerous targets throughout the forebrain. There are also numerous serotonin receptor subtypes whose roles may vary, depending on location.

For example, the serotonin-1a receptor serves as both a mediator and an inhibitor of serotonergic neurotransmission, depending on whether it is located on the presynaptic or the postsynaptic neuron.

Despite this complexity, it is recognized that medications that inhibit the reuptake of serotonin, presumably increasing serotonergic neurotransmission, result in a reduction in symptoms of anxiety for many patients. Increases in GABA neurotransmission mediate the anxiolytic effect of barbiturates and benzodiazepines. Although modulation of Scholarly articles on anxiety pathways can reduce anxiety almost immediately, compensatory mechanisms associated with these circuits and the use of barbiturates and benzodiazepines can result in tolerance and potentially fatal withdrawal.


Diagnosis and Management of Anxiety Disorders | The Journal of the American Osteopathic Association


scholarly articles on anxiety


This clinical review focuses on the pathophysiologic basis for anxiety disorders. It provides brief overviews of panic disorder, generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, and posttraumatic stress disorder. It also summarizes Cited by: Jun 01,  · There are several types of anxiety disorder like panic disorder, social anxiety disorder, specific phobias and generalized anxiety disorder Scholarly peer review is the process of subjecting an author's scholarly work, research, or ideas to the scrutiny of others who are experts in the same field, before a paper describing this work is. Journal of Depression and Anxiety is an Open Access journal that aims to publish the most complete and reliable source of information on the discoveries and current developments in the mode of original articles, review articles, case reports, short communications, etc. in all areas of the field and making them available online without any.