Anxiety

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Miguel Nunez, MD

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Joseph Poole, FNP


Anxiety is defined as “fear or nervousness about what might happen” (Merrium-Webster, 2016). The condition of anxiety can include fear, nervousness, jitters and even panic. Anxiety is so prevalent, it is said that 25% of all adults will experience it one time in their lives, making it more common than depression (Satterfield, Feldman, 2014). The types of anxiety seen in clinic are exhibited in the following table:
Anxiety Disorder Prevalence in Primary Care (%)

  • Acute stress disorder 3–5
  • Agoraphobia 1–3
  • Generalized Anxiety Disorder 4–9
  • Obsessive Compulsive Disorder 1–2
  • Panic Disorder 1–6
  • Post-traumatic Stress Disorder 2–12
  • Social phobia 3–7
  • Specific phobia 8–13
  • Adjustment disorder with anxiety 4.5–9.2
  • Anxiety disorder due to a general medical condition 14–66
  • Substance-induced anxiety disorder Unknown prevalence
  • Anxiety disorder not otherwise specified (NOS) Unknown (Table 1 Satterfield, Feldman, 2014).

Did you notice that Anxiety disorders due to a general medical condition rate 14-66% in primary care? Make no mistake, it can be overwhelming to learn that you or a loved one has a newly diagnosed medical condition, or to even suspect it.

Some of the leading medical conditions that can give rise to anxiety disorders include the following:

  • Cardiac – Ischemic heart disease, mitral valve prolapse, arrhythmias
  • Endocrine/metabolic – Hyperthyroidism, hypoglycemia, pheochromocytoma, carcinoid
  • Gynecologic – Menopause, premenstrual syndrome
  • Neurologic – Transient ischemic attacks, seizure disorders
  • Pharmacological – Caffeine, alcohol, sympathomimetic agents, amphetamines, corticosteroids, theophylline, illicit drugs
  • Respiratory – Asthma, chronic obstructive pulmonary disease (Table 2 Satterfield, Feldman, 2014).

So, now we know that medical conditions can cause anxiety what else can?

For starters, some people are just prone to worrying. Worrying day in and day out that interferes with daily activities can develop into a syndrome called Generalized Anxiety Disease.

Some people have what is called a panic disorder. This is associated with rapid heart rates, a rush of fear, anxiety and nervousness all triggered by different stressors.

Some people are afraid of open spaces with crowds (agoraphobia).

Some have obsessive compulsive disorder which can be characterized by unpleasant or horrible thoughts that keep repeating over and over. Some people with this condition feel the need to continue repetitive behaviors such as frequently washing their hands, over and over.

Another anxiety disorder that we’ve been seeing a lot of press about recently is Post Traumatic Stress Disorder (PTSD) and Acute Stress Disorder. This is related to people that may have seen a traumatic event where they thought their lives were in grave danger, and their ability to cope with the past event has become strained or mal adapted.

How do we diagnose anxiety?
In office screening for anxiety can be achieved utilizing questionnaires that have been developed to detect anxiety and other mental disorders. Some of the screening formulas have sensitivity levels of 94% (Satterfield, Feldman, 2014).

How do we treat anxiety?

Non pharmacologic
Sometimes, education can be extremely beneficial to the patient to formulate a basic understanding of what is occurring. Education can provide information and reassurance. Another non pharmacologic treatment could be behavioral therapy where the patient is gradually exposed to the stimuli that they are afraid of. Relaxation techniques include relaxation therapy, hypnosis and biofeedback meditation.

Pharmacologic
When a patient’s symptoms are severe enough to significantly interfere with functioning and the benefits outweigh the risks of medication, it may be time to consider pharmacologic therapy. First line therapy for most anxiety related conditions include the use of SSRIs or Selective Serotonin Reuptake Inhibitors. Some common names of these medications include Prozac and Lexapro (Satterfield, Feldman, 2014).

Come see us today to get your Anxiety levels screened and treated and to get on the path to health and wellness.

Miguel Nunez, MD; Joseph Poole, FNP
17448 Highway 3, Suite 200
Webster, TX 77598
(832) 505-1748

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