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AnxietydisorderDefinitions:Anxietydisorder:Disorderinwhichthepatienthasex__ssiveordisproportionatelylong-lastingfearandsu__ectivesufferingorimpedimentofdailyfunction.Panicattack:Intensefearduringalimitedperiodoftime.Panicdisorder:repeatedpanicattackswithfearofgettinganotherpanicattackinbetween.Agoraphobia:Fearand__oidan__ofsituationsfromwhichonethinksitwillbehardtogetawayorinwhichonewouldn’tbeabletogethelp.SpecificPhobia:Intenseandpersistentfearand__oidan__ofaspecifico__ectorsituation.SocialPhobia:Intenseandpersistentfearand__oidan__ofsituationsinwhichoneispossiblysu__ectedtothecriticaleyeofothers.Socialphobiacanbesubdividedintospecificformsinwhichthefearisconnectedtoaspecificsituationsuchasstagefrightandinageneralforminwhichthefear__nifestsinavarietyofsituations.ObsessiveCompulsiveDisorder:Recurrentandintrusivethoughtsimpulsesori__gesobsessionsorcompulsiveactscompulsions.PostTrau__ticStressDisorder:Re-experiencingofatrau__ticeventthe__oidan__ofstimulithatareassociatedwiththetrau__heightenedirritabilityexaggeratedstartleresponsemuscletensionandsleepdisturban__.GeneralizedAnxietyDisorder:Ex__ssivepersistentfearoranxietyaccompaniedbysymptomssuchasworryagitationfatiguecon__ntrationproblemsirritabilitymuscletensionandsleepdisturban__.Hypochondria:persistentunfoundedfearorconvictionofsufferingfromaseriousillness.Diagnosticguidelines:Anxietydisordershouldbeconsideredifthepatient:Comestoseethedoctoroftenwithvaryingcomplaints;Haspersistentnon-specificcomplaintssuchastensionirritabilityfeelingunstablecon__ntrationproblemslistlessnessorsleepingdisturban__s;Hascomplaintsabout‘hyperventilation’;Haspersistentfunctionalphysicalproblems;Requestssleepingpillsortranquilizers;Hasalcoholorsubstan__abuseproblems;Isdepressed.AnamnesisDoyoufeelafraidDoyouworryalot;Doyouthinkthisfearorworryisjustified;Dothesefeelingsh__eanegativeeffectonyourhomelifeyourjoboryourfreetimeIfyoususpectanxietydisorderaskabout:Durationanddevelopmentofthecomplaintscontinuouslyoroccurringinattacksdurationandfrequencyofpossibleattacksseverityofthecomplaintsdegreeofsuffering;Situationsthattriggerthefear;Possiblecausesoftheanxietydisorder;Accompanyingsymptoms:Palpitationstranspirationdizzinesstremblingtightnessofthechestpainssto__chcomplaintstinglingsensationsnumbnesssensationsofheatorcoldfeelingsofunrealityordepersonalizationrestlessnessbeingeasilyfatiguedcon__ntrationproblemsirritabilitysleepdisturban__s;Focusoftheanxiety:lossofcontrolgoingcrazydyingpanicdisorderhelplessnessincaseofbeingindisposedagoraphobiaspecifico__ectsorsituationsspecificphobianegativejudgmentbyotherssocialphobiavariousmiseriesthatcanhappeninlifegeneralizedanxietydisorderre-experiencingofatrau__ticeventposttrau__ticstressdisorderseriousphysicalillnesshypochondriacompulsivethoughtsobsessivecompulsivedisorder;Compulsiveactsobsessivecompulsivedisorder;Effectofthecomplaintsondailyfunctioning;Relationshipwithstressoverburdening__ritalorrelationshipproblemsworkproblems.Performacarefulanamnesiswhenspecificphysicalcomplaintsarepresent.Checkforotherpsychologicalcomplaintsdepressionhallucinationsordelusionsalcoholordrugproblems.PhysicalandAdditionalexaminationExaminefurtherifanamnesticindicatorspointtoso__ticpathology.EvaluationCheckifthepatientissufferingfromoneoftheanxietydisordersthatismentionedunder‘Definitions’.Forthedifferentialdiagnosistakeintoaccount:Reallifestress-relatedproblems;So__tizationdisorder:persistentfunctionalphysicalcomplaintsthatdonoth__efearasapri__rycomponent;Psychoticdisorderpsychoticdepressiondelirium:whenhallucinationsordelusionsarepresent;Personalitydisorder;PolicyguidelinesInfor__tion:Anxietydisordersarecommon.Prognosisisimprovedbysuitabletreatment.Explanationsoftheviciouscircletriggeringandenablingfactorscanhelpredu__thecomplaintsNon-phar____uticalandphar____uticaltreatment:Thechoi__oftreatmentdependson:typeofanxietydisorder;degreeofsuffering;presen__ofadepressivedisorder;thepatientswishesandthe__ailabilityofdifferenttreatments.Ingeneralitcanbesaidthatnon-phar____uticaltreatmentintheshapeofcognitive-beh__ioraltherapyaswellasphar____uticaltreatmentaregoodfirstchoi__s.SeeTable1formedicationappropriateforanxietydisorders.Additionallyintheinitialphaseofthetreatment:AbenzodiazepineDiazepam5-10mg/day__ximum40mg/day;Oxazepam30mg/day__ximum100-150mg/dayfor2–4weeks__ximum.Ex__ptionsare:Presen__ofadepressivedisorder:phar____uticaltreatmentoracombinationofphar____uticalandnon-phar____uticaltreatmentPhar____uticaltreatmentfirstfollowedbycognitive-beh__ioraltherapy;Specificformofsocialphobiasuchasstagefright:incidentalbeta-blockerspropanolol__ximum40mg;Panicdisorderwithoutagoraphobia;specificphobiaandfrequentoccurren__ofthespecificformofsocialphobia:cognitive-beh__ioraltreatment;Panicdisorderwithagoraphobiaandpost-trau__ticstressdisorder:acombinationofphar____uticalandnon-phar____uticaltreatment;Hypochondria:cognitive-beh__ioraltherapy.Table1Startingdoseduring2weeksmg/dayGradualincreasetotargetdose*mg/day__ximumdosemg/daySSRIFluvoxamine50a.n.100-150a.n.300a.n.Paroxetine10-20inthemorning20-40inthemorning60inthemorningTCAClomipramine25a.n.100-150a.n.250a.n.Imipramine25a.n.100-150a.n.300a.n.SSRI=selectiveserotoninreuptakeinhibitors;TCA=TricyclicAnti-Depressants*Thetargetdoseisthedosethathasbeenshowntobeeffectiveformostpatients.IfaSSRIoraTCAdoesnoth__ethedesiredeffectonageneralizedanxietydisordervenlafaxine75mgXR/day__ximum225mg/dayorbuspirone30mg/day__ximum50mg/daycanbeprescribed.FollowupandReferralInitiallycheckinwiththepatientonaweeklyorbimonthlybasis.Offerfollowupappointmentsatincreasinglylongerintervalsforchronicanxietydisorder.Preferablyreferpatientstotherapistswithexperien__incognitive-beh__ioraltherapy.Indicationsforconsultorreferralare:Diagnosticproblems;Insufficienteffectsofthephar____uticaltreatmentafter8to12weeks;Severecomplaintsorproblemsorseveresocialdysfunction;ObsessiveCompulsiveDisorder.。