Anxiety disorders cover a broad spectrum of conditions characterized by excessive and persistent fear (an emotional response to imminent threats), anxiety (the anticipation of a future threat), worry (apprehensive expectation), and/or avoidance behavior. The etiology of anxiety disorders is multifactorial and may involve genetic, developmental, environmental, neurobiological, cognitive, and psychosocial factors. Therapy typically consists of a combination of pharmacotherapy, especially selective serotonin reuptake inhibitors (SSRIs), and psychotherapy, especially cognitive-behavioral therapy (CBT).
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|Generalized anxiety disorder (GAD)||Panic disorder||Social anxiety disorder (SAD)||Specific phobias||Agoraphobia||Substance/medication-induced anxiety disorder|
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Risk and prognostic factors
- Higher rates of anxiety disorders are reported in women.
- Neurobiological factors
- Substance use (leading to substance/medication-induced anxiety disorder)
- Environmental and developmental factors
- Other medical conditions
- Definition: prolonged and excessive anxiety that is either unspecific or revolves around certain themes (e.g., health, work); not focused on a single specific fear
- Prolonged (≥ 6 months, occurring more days than not) and excessive anxiety
- Anxiety causes clinically significant distress
- Not caused by substance use, medication, or underlying medical condition
- Fatigue and muscle tension
- Restlessness and irritability
- Sleep disturbances and difficulty concentrating
- First-line: psychotherapy, pharmacotherapy, or both
- Panic disorder: Panic attacks may also occur in GAD.
- Depressive disorders
- SAD: Patients with GAD are usually comfortable in social situations and not particularly disturbed by the evaluation by others.
- Definition: recurrent spontaneous and unexpected panic attacks that often occur without a known trigger
- Epidemiology 
- Recurrent panic attacks
- There is a concern about future attacks and their consequences, and/or a significant change in behavior related to the attacks, for at least one month.
To remember the symptoms of a panic attack, think of “STUDENTS FEAR the 3Cs”: Sweating, Trembling, Unsteadiness (dizziness), Derealization, Elevated heart rate (palpitations), Nausea, Tingling, and Shortness of breath; FEAR of dying or going crazy; Chest pain, Choking, and Chills.
- Definition: pronounced anxiety lasting ≥ 6 months of social situations that might involve scrutiny by others
- Social anxiety disorder (SAD): fear/anxiety out of proportion to a social situation where one may be scrutinized by others (e.g., meeting new people at a party, eating in public, using public restrooms)
- Performance-only SAD: symptoms of fear/anxiety restricted only to public speaking or performing in front of crowds
- Blushing, palpitations, sweating during a social interaction
- Anticipatory anxiety (e.g., worrying weeks in advance about attending a social event)
- Anxiety driven by fear of embarrassment and others noticing the reaction
- Avoidance of the aforementioned triggers (e.g., not attending parties, refusing to attend school)
- In children: refusing to speak at social events, crying/throwing a tantrum, clinging to their caregiver
- CBT for SAD and performance-only SAD
- Pharmacotherapy for SAD
- Pharmacotherapy for performance-only SAD: (beta-blockers) or on an as-needed basis; taken 30–60 minutes before an anxiety-causing event
- Definition: persistent and intense fears of one or more specific situations or objects (phobic stimuli); always occurs during encounters with the phobic stimulus but may already surge in anticipation of an encounter
- Animal: spiders (arachnophobia), insects (entomophobia), dogs (cynophobia)
- Natural environment: heights (acrophobia), storms (astraphobia)
- Blood-injection-injury: blood (), needles (blenophobia), dental procedures (odontophobia), fear of injury (traumatophobia)
- Situational: enclosed places (claustrophobia), flying (aviophobia)
- Other: fear of vomiting (emetophobia), the number 13 (triskaidekaphobia), costumed characters (masklophobia), fear of clowns (coulrophobia)
- Definition: pronounced fear or anxiety of being in situations that are perceived as difficult to escape from or situations in which it might be difficult to seek help
Fear, anxiety, or even panic attacks over a period of ≥ 6 months in ≥ 2 of the following 5 situations:
- Using public transportation
- Being in open spaces
- Being in enclosed places
- Standing in line or being in a crowd
- Being outside of the home alone
- Active avoidance of these settings unless a companion is present
- Some patients can have comorbid panic disorder.
- Fear, anxiety, or even panic attacks over a period of ≥ 6 months in ≥ 2 of the following 5 situations:
- Definition: prominent anxiety or panic attacks within 1 month of use of, or withdrawal from, a substance/medication that is capable of inducing anxiety symptoms 
- Causes 
- Clinical features