eMedicine Specialties > Emergency Medicine > Psychosocial

Anxiety: Follow-up

Author: Lemeneh Tefera, MD, FAAEM, Attending Physician, Department of Emergency Medicine, Beth Israel Medical Center
Coauthor(s): Lauren Claire Tomao, MD, JD, Resident, Department of Emergency Medicine, Albert Einstein College of Medicine, Beth Israel Medical Center
Contributor Information and Disclosures

Updated: Nov 20, 2008

Follow-up

Further Inpatient Care

  • All anxious patients with suicidal ideation, homicidal ideation, or acute psychosis require emergent psychiatric consultation.

Complications

  • Some studies report the failure rate of diagnosing anxiety disorders at as high as 50%. This can result in overuse of health care resources and increased morbidity and mortality rates for anxiety disorders and comorbid medical conditions.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Anxiety states may be associated with increased prevalence of other physical illnesses.
  • Avoid falsely attributing the somatic symptoms of anxiety to other medical conditions.
  • Understand that anxiety can provoke or maintain other medical disorders. For example, the prevalence of hypertension has been found to be 13.6% in patients diagnosed with panic attacks compared to 4.4% in controls without panic attacks.
 


More on Anxiety

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

References

  1. American Psychiatric Association. Anxiety disorders. In: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington DC: American Psychiatric Association; 1994.

  2. Brawman-Mintzer O, Lydiard RB. Biological basis of generalized anxiety disorder. J Clin Psychiatry. 1997;58 Suppl 3:16-25; discussion 26. [Medline].

  3. Charney DS, Woods SW, Nagy LM, et al. Noradrenergic function in panic disorder. J Clin Psychiatry. Dec 1990;51 Suppl A:5-11. [Medline].

  4. Hales RE, Hilty DA, Wise MG. A treatment algorithm for the management of anxiety in primary care practice. J Clin Psychiatry. 1997;58 Suppl 3:76-80. [Medline].

  5. Helmus TC, Tancer M, Johanson CE. Reinforcing effects of diazepam under anxiogenic conditions in individuals with social anxiety. Exp Clin Psychopharmacol. Nov 2005;13(4):348-56. [Medline].

  6. Huffman JC, Pollack MH. Predicting panic disorder among patients with chest pain: an analysis of the literature. Psychosomatics. May-Jun 2003;44(3):222-36. [Medline].

  7. Johnson MR, Lydiard RB. The neurobiology of anxiety disorders. Psychiatr Clin North Am. Dec 1995;18(4):681-725. [Medline].

  8. Karlson BW, Herlitz J, Pettersson P, et al. Patients admitted to the emergency room with symptoms indicative of acute myocardial infarction. J Intern Med. Sep 1991;230(3):251-8. [Medline].

  9. Keller MB, Baker LA. The clinical course of panic disorder and depression. J Clin Psychiatry. Mar 1992;53 Suppl:5-8. [Medline].

  10. Kushner MG, Sher KJ, Beitman BD. The relation between alcohol problems and the anxiety disorders. Am J Psychiatry. Jun 1990;147(6):685-95. [Medline].

  11. Larkin GL, Claassen CA, Emond JA, et al. Trends in U.S. emergency department visits for mental health conditions, 1992 to 2001. Psychiatr Serv. Jun 2005;56(6):671-7. [Medline].

  12. Meuret AE, White KS, Ritz T, et al. Panic attack symptom dimensions and their relationship to illness characteristics in panic disorder. J Psychiatr Res. Sep 2006;40(6):520-7. [Medline].

  13. Pollack MH, Otto MW. Long-term pharmacological treatment of panic disorder. Psychiatr Ann. 1994;24:291-298.

  14. Rickels K, Schweizer E. The clinical presentation of generalized anxiety in primary-care settings: practical concepts of classification and management. J Clin Psychiatry. 1997;58 Suppl 11:4-10. [Medline].

  15. Rickels K, Rynn M, Iyengar M, et al. Remission of generalized anxiety disorder: a review of the paroxetine clinical trials database. J Clin Psychiatry. Jan 2006;67(1):41-7. [Medline].

  16. Sheikh JI, Salzman C. Anxiety in the elderly. Course and treatment. Psychiatr Clin North Am. Dec 1995;18(4):871-83. [Medline].

  17. Sramek JJ, Tansman M, Suri A, et al. Efficacy of buspirone in generalized anxiety disorder with coexisting mild depressive symptoms. J Clin Psychiatry. Jul 1996;57(7):287-91. [Medline].

  18. Sussman N. The uses of buspirone in psychiatry. J Clin Psychiatry. 1994;12:3-19.

  19. Swinson RP, Soulios C, Cox BJ, et al. Brief treatment of emergency room patients with panic attacks. Am J Psychiatry. Jul 1992;149(7):944-6. [Medline].

  20. Zajecka J. Importance of establishing the diagnosis of persistent anxiety. J Clin Psychiatry. 1997;58 Suppl 3:9-13; discussion 14-5. [Medline].

  21. Zun LS. Panic disorder: diagnosis and treatment in emergency medicine. Ann Emerg Med. Jul 1997;30(1):92-6. [Medline].

  22. Antai-Otong D. The art of prescribing: social anxiety disorder: characteristics, course, and pharmacological management prevalence. Perspect Psychiatr Care. Jan 2008;44(1):48-53. [Medline].

  23. Baldwin DS, Anderson IM, Nutt DJ, et al. Evidence-based guidelines for the pharmacological treatment of anxiety disorders: recommendations from the British Association for Psychopharmacology. J Psychopharmacol. Nov 2005;19(6):567-96. [Medline].

  24. Demiryoguran NS, Karcioglu O, Topacoglu H, et al. Anxiety disorder in patients with non-specific chest pain in the emergency setting. Emerg Med J. Feb 2006;23(2):99-102. [Medline].

  25. Hidalgo RB, Tupler LA, Davidson JR. An effect-size analysis of pharmacologic treatments for generalized anxiety disorder. J Psychopharmacol. Nov 2007;21(8):864-72. [Medline].

  26. Milrod B, Leon AC, Busch F, et al. A randomized controlled clinical trial of psychoanalytic psychotherapy for panic disorder. Am J Psychiatry. Feb 2007;164(2):265-72. [Medline].

  27. Sareen J, Jacobi F, Cox BJ, et al. Disability and poor quality of life associated with comorbid anxiety disorders and physical conditions. Arch Intern Med. Oct 23 2006;166(19):2109-16. [Medline].

  28. Weisberg RB, Dyck I, Culpepper L, et al. Psychiatric treatment in primary care patients with anxiety disorders: a comparison of care received from primary care providers and psychiatrists. Am J Psychiatry. Feb 2007;164(2):276-82. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

anxiety, anxiety disorder, panic attack, panic disorder, generalized anxiety disorder, GAD, phobic disorder, obsessive-compulsive disorder, apprehension, fear, worry, agoraphobia, tension, tremulousness, shaking, insomnia, irritability, restlessness, cold clammy hands, dry mouth, socialphobia, post-traumatic stress disorder, PTSD

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Lemeneh Tefera, MD, FAAEM, Attending Physician, Department of Emergency Medicine, Beth Israel Medical Center
Lemeneh Tefera, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Lauren Claire Tomao, MD, JD, Resident, Department of Emergency Medicine, Albert Einstein College of Medicine, Beth Israel Medical Center
Lauren Claire Tomao, MD, JD is a member of the following medical societies: American Bar Association
Disclosure: Nothing to disclose.

Medical Editor

Edward Bessman, MD, Chairman, Department of Emergency Medicine, John Hopkins Bayview Medical Center; Assistant Professor, Department of Emergency Medicine, Johns Hopkins University
Edward Bessman, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

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

Managing Editor

Robert Harwood, MD, MPH, FACEP, FAAEM, Program Director, Department of Emergency Medicine, Advocate Christ Medical Center; Assistant Professor, Department of Emergency Medicine, University of Illinois at Chicago College of Medicine
Robert Harwood, MD, MPH, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Council of Emergency Medicine Residency Directors, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School
Jonathan Adler, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
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.