eMedicine Specialties > Psychiatry > Adult

Anxiety Disorders: Follow-up

Author: William R Yates, MD, MS, Research Psychiatrist, Laureate Institute for Brain Research; Professor of Research, Department of Psychiatry, University of Oklahoma College of Medicine at Tulsa
Contributor Information and Disclosures

Updated: Oct 26, 2009

Follow-up

Further Inpatient Care

  • Inpatient care rarely is needed for the management of anxiety disorders unless complicated by comorbid conditions such as affective or substance abuse disorders or general medical conditions.
  • Inpatient care should be considered if suicide is a risk or detoxification is needed for comorbid substance dependence.

Further Outpatient Care

  • Anxiety disorders often are chronic and require ongoing medical/psychiatric care, including psychosocial therapies and medication (pharmacotherapy).
  • Psychosocial interventions in anxiety disorder
    • Cognitive-behavioral therapy often is efficacious and is the treatment of choice for specific phobias. It often is used alone or in combination with pharmacotherapy in the treatment of OCD and panic disorder.
    • Other psychotherapeutic approaches, such as interpersonal therapy or psychodynamic therapy, also may be helpful in the treatment of anxiety disorders.
    • Marital therapy, family therapy, or group therapy may be helpful adjunct therapies in the long-term management of severe anxiety disorders. Educating families and friends enables them to cope with their loved one's disease.
    • Leichsenring et al found that short-term psychodynamic psychotherapy is beneficial for patients with generalized anxiety disorder. In a randomized controlled trial of 57 patients who received either psychodynamic psychotherapy or cognitive-behavioral therapy for up to 30 weekly sessions, both treatment methods yielded comparable improvement in Hamilton Anxiety Rating Scale scores. However, in measures of trait anxiety, worry, and depression, cognitive-behavioral therapy was found to be superior.4

Inpatient & Outpatient Medications

  • See Medication for recommendations for specific anxiety disorders.
    • Generalized anxiety disorder
    • Panic disorder
    • OCD
    • Simple phobia
    • Social phobia
    • PTSD
    • Adjustment disorder with anxious mood

Complications

  • Agoraphobia
  • Major depression
  • Suicide
  • Homicide (especially in patients with PTSD)
  • Alcohol abuse and dependence
  • Sedative abuse and dependence
  • Social dysfunction and withdrawal
  • Occupational impairment
  • Marital and familiar dysfunction, divorce

Prognosis

  • Anxiety disorders can range from mild and transient to severe and chronic.
  • Early treatment improves prognosis and limits social and occupational impairment.

Patient Education

  • Education can be obtained through books, newsletters, support groups, and the Internet. Some useful Web sites are as follows:
  • Family members should receive information about the effect of anxiety disorders on mood, behavior, and relationships. Family members can assist in care by reinforcing the need for medical treatment and supervision. Family members may also assist by providing a collaborative resource for monitoring the severity of the patient's anxiety symptoms and response to treatment interventions. 

Miscellaneous

Medicolegal Pitfalls

  • Failure to identify a medical or psychiatric cause for anxiety
  • Unnecessary and invasive diagnostic testing for physical symptoms caused by anxiety
  • Benzodiazepine prescription use in those with comorbid alcohol or drug dependence
  • Failure to recognize cognitive and motor impairment related to chronic high-dose benzodiazepine use
  • Failure to recognize factitious disorder with psychological symptoms or malingering to obtain benzodiazepine prescription
 


More on Anxiety Disorders

Overview: Anxiety Disorders
Differential Diagnoses & Workup: Anxiety Disorders
Treatment & Medication: Anxiety Disorders
Follow-up: Anxiety Disorders
Multimedia: Anxiety Disorders
References
[ CLOSE WINDOW ]

References

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text Revision. Washington, DC: American Psychiatric Association; 2000.

  2. Kessler RC, McGonagle KA, Zhao S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry. Jan 1994;51(1):8-19. [Medline].

  3. Sinclair LI, Christmas DM, Hood SD, Potokar JP, Robertson A, Isaac A, et al. Antidepressant-induced jitteriness/anxiety syndrome: systematic review. Br J Psychiatry. Jun 2009;194(6):483-90. [Medline].

  4. Leichsenring F, Salzer S, Jaeger U, Kächele H, Kreische R, Leweke F, et al. Short-term psychodynamic psychotherapy and cognitive-behavioral therapy in generalized anxiety disorder: a randomized, controlled trial. Am J Psychiatry. Aug 2009;166(8):875-81. [Medline].

  5. [Guideline] American Psychiatric Association. Practice guideline for the treatment of patients with panic disorder. Work Group on Panic Disorder. American Psychiatric Association. Am J Psychiatry. May 1998;155(5 Suppl):1-34. [Medline].

  6. [Guideline] Bandelow B, Zohar J, Hollander E, Kasper S, Möller HJ, Zohar J, et al. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the pharmacological treatment of anxiety, obsessive-compulsive and post-traumatic stress disorders - first revision. World J Biol Psychiatry. 2008;9(4):248-312. [Medline].

  7. [Best Evidence] Bisson J, Andrew M. Psychological treatment of post-traumatic stress disorder (PTSD). Cochrane Database Syst Rev. 2005;CD003388. [Medline].

  8. Burdick A, Goodman WK, Foote KD. Deep brain stimulation for refractory obsessive-compulsive disorder. Front Biosci. Jan 1 2009;14:1880-90. [Medline].

  9. [Best Evidence] [Guideline] Connolly SD, Bernstein GA. Practice parameter for the assessment and treatment of children and adolescents with anxiety disorders. J Am Acad Child Adolesc Psychiatry. Feb 2007;46(2):267-83. [Medline].

  10. Connolly SD, Bernstein GA,. Practice parameter for the assessment and treatment of children and adolescents with anxiety disorders. J Am Acad Child Adolesc Psychiatry. Feb 2007;46(2):267-83. [Medline].

  11. Jenike MA. Clinical practice. Obsessive-compulsive disorder. N Engl J Med. Jan 15 2004;350(3):259-65. [Medline].

  12. [Guideline] Koran LM, Hanna GL, Hollander E, Nestadt G, Simpson HB. Practice guideline for the treatment of patients with obsessive-compulsive disorder. Am J Psychiatry. Jul 2007;164(7 Suppl):5-53. [Medline].

  13. Kroenke K, Spitzer RL, Williams JB, Monahan PO, Löwe B. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med. Mar 6 2007;146(5):317-25. [Medline].

  14. Rubin KH, Coplan RJ, Bowker JC. Social withdrawal in childhood. Annu Rev Psychol. 2009;60:141-71. [Medline].

  15. [Best Evidence] Stein DJ, Ipser J, McAnda N. Pharmacotherapy of posttraumatic stress disorder: a review of meta-analyses and treatment guidelines. CNS Spectr. Jan 2009;14(1 Suppl 1):25-31. [Medline].

  16. Stein MB, Simmons AN, Feinstein JS, Paulus MP. Increased amygdala and insula activation during emotion processing in anxiety-prone subjects. Am J Psychiatry. Feb 2007;164(2):318-27. [Medline].

  17. Torres AR, Prince MJ, Bebbington PE, Bhugra D, Brugha TS, Farrell M. Obsessive-compulsive disorder: prevalence, comorbidity, impact, and help-seeking in the British National Psychiatric Morbidity Survey of 2000. Am J Psychiatry. Nov 2006;163(11):1978-85. [Medline].

  18. Weissman MM, Bland RC, Canino GJ, et al. The cross-national epidemiology of panic disorder. Arch Gen Psychiatry. Apr 1997;54(4):305-9. [Medline].

  19. Yates WR. Phenomenology and epidemiology of panic disorder. Ann Clin Psychiatry. Apr-Jun 2009;21(2):95-102. [Medline].

  20. Yehuda R, Flory JD, Southwick S, Charney DS. Developing an agenda for translational studies of resilience and vulnerability following trauma exposure. Ann N Y Acad Sci. Jul 2006;1071:379-96. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

generalized anxiety disorder, panic disorder, phobia, agoraphobia, obsessive-compulsive disorder, OCD, stress, anxiety neurosis, nervousness, posttraumatic stress disorder, PTSD, substance-induced anxiety disorder, specific phobias, social phobia, adjustment disorder, acute stress disorder

major depression, separation anxiety, substance abuse disorder, recurrent distressing dreams, recurrent distressing nightmares, difficulty staying asleep, exaggerated startle response, hypervigilance, difficulty concentrating, anger outbursts, irritability, difficulty falling asleep, sweaty palms, restlessness

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

William R Yates, MD, MS, Research Psychiatrist, Laureate Institute for Brain Research; Professor of Research, Department of Psychiatry, University of Oklahoma College of Medicine at Tulsa
William R Yates, MD, MS is a member of the following medical societies: American Academy of Family Physicians and American Psychiatric Association
Disclosure: Nothing to disclose.

Medical Editor

Denis F Darko, MD, Executive Director, Clinical Research and Development, Global Neuroscience, AstraZeneca
Denis F Darko, MD is a member of the following medical societies: American College of Physicians and American Psychiatric Association
Disclosure: AstraZeneca Salary Management position

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Eduardo Dunayevich, MD, Adjunct Assistant Professor, Department of Psychiatry, University of Cincinnati; Clinical Research Physician, Neuroscience, Lilly Research Laboratories
Eduardo Dunayevich, MD is a member of the following medical societies: American Psychiatric Association
Disclosure: Nothing to disclose.

CME Editor

Harold H Harsch, MD, Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry and Department of Medicine, Froedtert Hospital, Medical College of Wisconsin
Harold H Harsch, MD is a member of the following medical societies: American Psychiatric Association
Disclosure: lilly Honoraria Speaking and teaching; Forest Labs Honoraria Speaking and teaching; AstraZeneca Honoraria Speaking and teaching; Pfizer Grant/research funds Speaking and teaching; Northstar Grant/research funds Research; Novartis Grant/research funds research; Pfizer  Speaking and teaching; Sanofi-avetis Grant/research funds research; Otsuke Grant/research funds reseach; GlaxoSmithKline Grant/research funds research

Chief Editor

Stephen Soreff, MD, President of Education Initiatives, Nottingham, NH; Faculty, Metropolitan College of Boston University, Boston, MA
Stephen Soreff, MD is a member of the following medical societies: American College of Mental Health Administration and American Psychosomatic Society
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.