Anxiety

Published on 31/05/2015 by admin

Filed under Obstetrics & Gynecology

Last modified 31/05/2015

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Chapter 13 Anxiety

INTRODUCTION

Description: Anxiety is a common acute or chronic emotion associated with physical symptoms, and it is two to three times more common in women. Subtypes include situational anxiety, adjustment disorders, panic disorders, phobias, and post-traumatic stress disorder. Obsessive-compulsive disorders are often classified in this group as well.
Prevalence: Eighteen percent of women, 40 million Americans.
Predominant Age: 20 to 45.
Genetics: Increased risk of panic disorders within monozygotic twins. Panic disorder, social phobia, and obsessive-compulsive disorders have a genetic base.

ETIOLOGY AND PATHOGENESIS

Causes: Psychosocial stressors, abnormality of the neurotransmitter system (serotonin, norepinephrine, γ-aminobutyric acid) involving the amygdala and hippocampus.
Risk Factors: Social, family or financial stress, medical illness, family history, and a lack of social support network.

CLINICAL CHARACTERISTICS

Signs and Symptoms (Vary with Subtype)

• Unrealistic or excessive worry
• Sense of impending doom
• Nervousness or instability
• Palpitations or tachycardia
• Hyperventilation or sense of suffocation
• Systemic systems (nausea, abdominal pain, paresthesias, diaphoresis, chest tightness, dizziness, muscle tension, headaches, and backaches)

DIAGNOSTIC APPROACH

Differential Diagnosis

• Cardiovascular (ischemic heart disease, valvular disease, cardiomyopathies, arrhythmias, mitral valve prolapse)
• Respiratory (asthma, emphysema, pulmonary embolism)
• Central nervous system (transient ischemia, psychomotor epilepsy, essential tremor)
• Metabolic (hyperthyroidism, adrenal insufficiency, pheochromocytoma, Cushing’s syndrome, hypoglycemia, hypokalemia, hyperparathyroidism, myasthenia gravis)
• Nutritional (thiamine, pyridoxine, or folate deficiency)
• Medication/drugs (caffeinism, alcohol, cocaine, sympathomimetics, amphetamine)

Associated Conditions:

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