Brain Facts

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Anxiety In Medical Patients

It is difficult to neatly compartmentalize organically induced from psychogenically induced anxiety symptoms in medically ill patients, as anxiety symptoms are ubiquitous in medical outpatient clinics and in patients admitted to hospital with severe disease. Estimates of significant anxiety in an outpatient clinic range from 10 to 20% of patients. Wells et al found that more than 11% of persons with chronic medical conditions experienced a recent anxiety disorder. These findings were drawn from conclusions based on the review of a sample of 2554 patients with one of eight chronic medical conditions. These researchers found that patients with chronic medical conditions had a significantly higher adjusted lifetime prevalence of anxiety disorder than did those without. Their results were statistically significant for the presence of recent anxiety disorders at the P<0.005 level. In trying to determine whether an underlying medical illness physiologically causes the patient's psychiatric symptoms as compared to the anxiety symptoms representing a reaction to the stress of the illness, Schuckit applied some of the criteria noted above. He found that between 10 and 40% of medical patients with anxiety disorder had what he considered to be an organic etiology for their psychiatric symptoms.

In their study of 2554 patients, Wells et al were able to show that "The only psychiatric disorders uniquely associated with current, active, chronic medical conditions were anxiety disorders, suggesting that the association between anxiety disorders and chronic medical conditions develops more quickly than associations between medical conditions and other psychiatric disorders." In reviewing data from other studies Wells et al suggests that a careful evaluation for underlying physical disorders, particularly diabetes and heart disease be undertaken in patients with primary anxiety disorders.

Sherbourne et al studied a group of 2,494 patients with hypertension, diabetes, and heart disease, assessing the group for depressive disorders, lifetime panic disorders, phobia, and general anxiety disorder. They found that medical patients with depression had higher rates of panic disorder than did non-depressed medical patients, 17% vs. 10.9%. They also noted that concurrent phobia and generalized anxiety disorder were elevated in both groups, but were more common among the depressed patients than the medically ill patients without depression, 25% vs. 10.4%. They noted that 14% to 66% of the primary care patients had at least one concurrent anxiety disorder. Between 54.6% and 72.9% of the patients reported an unmet need for care of their personal and emotional problem when seen in family practice clinics.

Meredith et al in reviewing data from 2,189 general medical patients with and without co-morbid anxiety disorders who were seen in medical clinic and who were part of the medical outcome study, noted that patients with co-morbid anxiety disorders and primary medical conditions were more likely to receive treatment for their anxiety disorder than were patients who presented with anxiety disorders without accompanying medical problems. The use of psychosocial counseling and psychotropic medication was greater for patients with depression and anxiety than for patients without depression who had chronic medical conditions. The authors concluded that anxiety disorders co-occurring with another disease (a medical illness or depression) increased the likelihood that the patient would receive counseling or be treated with a psychotropic medication when seen in the general medical sector.

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