Key Epidemiological Findings:

-Prevalence: Approximately 10–20% of the general population experiences an anxiety

disorder at some point in their lives.

- Gender Differences: Women are twice as likely as men to be diagnosed with anxiety
disorders, possibly due to biological, hormonal, and sociocultural factors.

- Age of Onset:

- Childhood/Adolescence: Separation anxiety, social anxiety, and specific phobias often

begin early.

- Early Adulthood: Generalized Anxiety Disorder (GAD) and Panic Disorder typically emerge
in the 20s–30s.

- Later Life: Anxiety can also develop in older adults, often comorbid with medical
conditions like cardiovascular disease or dementia.

- Comorbidity

- Frequently co-occurs with depression (50% of cases), substance use disorders, and chronic
medical illnesses.

- Physical Health Link: Chronic anxiety increases the risk of hypertension, irritable bowel
syndrome (IBS), and migraines.

- Global Burden:

- Anxiety disorders contribute significantly to disability-adjusted life years (DALYs).

- Low- and middle-income countries (LMICs) report high untreated rates due to stigma and
limited mental health services.

Etiology of Anxiety Disorders

Anxiety disorders arise from a complex interplay of biological, psychological, and

environmental factors.

1. Biological Factors

- Genetics:

- Family and twin studies suggest a 30–40% heritability rate for anxiety disorders.

- Key genes involve serotonin (5-HTTLPR polymorphism), dopamine, and GABA systems.

- Neurochemical Imbalances:

-Low serotonin (5-HT) and GABA deficiency (leading to hyperexcitability in the amygdala).

- Dysregulated norepinephrine (linked to panic attacks and hyperarousal).

- Brain Structure & Function:

- Hyperactive amygdala (fear processing) and prefrontal cortex dysfunction (impaired

emotion regulation).

- HPA Axis Dysregulation: Chronic stress → excess cortisol → heightened anxiety responses.

2. Psychological Factors

- Cognitive Theories:

- Maladaptive thought patterns e.g., catastrophizing, overgeneralization).

- Attentional Bias: Over-focusing on perceived threats.

- Behavioral Theories:

- Classical Conditioning (e.g., phobias from traumatic associations).

- Avoidance Reinforcement**: Temporary relief from avoiding feared situations worsens

long-term anxiety.

- Personality Traits:

- Neuroticism (high emotional reactivity) and behavioral inhibition (shyness, fear of

novelty).

3. Environmental & Social Factors

- Early Life Adversity:

- Childhood trauma (abuse, neglect) increases adult anxiety risk.

- Overprotective or highly critical parenting styles.

- Stressful Life Events:

- Job loss, divorce, financial strain, or chronic illness.

- Sociocultural Influences:

- Social isolation, discrimination, or high-pressure environments (e.g., academic/work

stress).

- Media Exposure: Constant news consumption (e.g., pandemics, wars) exacerbates health-
related anxiety.

4. Medical & Substance-Related Causes

- Medical Conditions:

- Hyperthyroidism, arrhythmias, COPD, or neurological disorders (e.g., epilepsy).

- Substance Use:

- Caffeine, stimulants(e.g., ADHD medications), and alcohol withdrawal can mimic or

worsen anxiety.

Clinical Features:

- GAD: A 28-year-old accountant reports constant worry about work deadlines, finances, and
health. She feels restless, has difficulty sleeping, and experiences muscle tension daily.
Despite reassurance, she finds it hard to control her worries, which have persisted for over
six months.

-SOCIAL ANXIETY: A 22-year-old college student avoids presentations and social gatherings
due to fear of embarrassment. She worries excessively about being judged, blushes easily,
and avoids eye contact.

- AGORAPHOBIA: A 35-year-old woman avoids public transport, shopping malls, and

crowded areas due to fear of being unable to escape if she has a panic attack. She prefers
staying home and only goes out with a trusted companion.

- SEPARATION ANXIETY: A 9-year-old boy refuses to go to school and cries excessively when
separated from his mother. He has nightmares about losing her and frequently complains of
stomach aches before school.

- PANIC ATTACK: A 40-year-old man suddenly experiences intense fear, palpitations,

sweating, shortness of breath, and dizziness while driving. He fears he is having a heart
attack. The episode peaks within 10 minutes and resolves within 30 minutes. Multiple ER
visits show no medical cause.

- NON-SPECIFIC ANXIETY: A 26-year-old woman experiences occasional episodes of

nervousness and tension without a clear pattern. Symptoms do not fully meet the criteria
for GAD, panic disorder, or any other specific anxiety disorder.

- ADJUSTMENT DISORDER: A 45-year-old woman reports feeling anxious, restless, and

overwhelmed after losing her job. She worries constantly but symptoms started within 3
months of job loss and are impairing her daily routine.

- GRIEF REACTION: A 50-year-old man lost his wife 2 months ago. He feels deep sadness, has
trouble sleeping, and frequently visits her grave. Despite distress, he remains connected to
others and does not have guilt or worthlessness.

- ACUTE STRESS REACTION: A 32-year-old man involved in a car accident 3 days ago feels
numb, detached, and hypervigilant. He experiences flashbacks and avoids driving but
symptoms started immediately after the trauma.
- PTSD: A 30-year-old war veteran has nightmares and flashbacks of combat. He avoids
discussing the war, startles easily, and struggles with emotional numbness and detachment.

DIFFERENTIAL DIAGNOSIS

RED FLAGS

- Cardiovascular (Seek Urgent Care): Exertional chest pain that does not resolve with rest;
Severe, crushing chest pain radiating to jaw/arm; Cold, clammy sweating with
dizziness/fainting; Irregular pulse or palpitations with syncope.

- Neurological & Other Causes: New-onset severe headache with weakness/numbness

(stroke symptoms); Seizure activity or loss of consciousness; Severe dizziness unrelated to
breathing.

- Respiratory (Seek Urgent Care): Worsening shortness of breath, low SpO₂ (<92%);
Hemoptysis (coughing blood); Wheezing/stridor or inability to speak in full sentences.

TREATMENT

PANIC DISORDER

- Acute Management:

- Benzodiazepines (short-term for severe distress only):

- Clonazepam 0.25–1 mg BID

- Lorazepam 0.5–2 mg TID

- Long-Term Management:

- SSRIs (First-line):

- Escitalopram 10–20 mg/day

- Paroxetine 10–40 mg/day

- Sertraline 25–200 mg/day

- SNRIs:

- Venlafaxine XR 37.5–225 mg/day

- Duloxetine 30–120 mg/day

GENERALIZED ANXIETY DISORDER

- Acute Management:
 - Short-term Benzodiazepines (if severe distress, for ≤2 weeks):

- Lorazepam 0.5–2 mg PRN

- Clonazepam 0.25–0.5 mg BID

- Long-Term Management (if persistent symptoms):

- SSRIs:

- Sertraline 25–100 mg/day

- Escitalopram 10–20 mg/day

- Beta-blockers (for situational anxiety, e.g., performance anxiety):

- Propranolol 10–40 mg PRN

ADJUSTMENT DISORDER

- Acute Management:

- Benzodiazepines (not preferred due to risk of dependence, use only short-term if

necessary):

- Clonazepam 0.5–2 mg/day

- Lorazepam 1–2 mg/day

- Long-Term Management:

- SSRIs (First-line, FDA-approved):

- Sertraline 25–200 mg/day

- Paroxetine 10–50 mg/day

- SNRIs (Second-line, if SSRIs not tolerated):

- Venlafaxine XR 37.5–300 mg/day

POST-TRAUMATIC STRESS DISORDER

- Long-Term Management:

- Prazosin (for PTSD-related nightmares and sleep disturbances):

- 1–10 mg at bedtime

- Atypical Antipsychotics (Adjunct in severe cases, hyperarousal, dissociation):

- Quetiapine 25–200 mg/day

 - Risperidone 0.5–2 mg/day

PHOBIA (SPECIFIC & SOCIAL ANXIETY DISORDER)

- Acute Management (for performance or situational anxiety):

- Beta-blockers (reduce physical symptoms like tremors, palpitations):

- Propranolol 10–40 mg PRN

- Benzodiazepines (if severe, occasional use only):

- Alprazolam 0.25–0.5 mg PRN

- Clonazepam 0.5–2 mg PRN

- Long-Term Management:

- SSRIs (First-line for Social Anxiety Disorder & severe phobia):

- Sertraline 25–200 mg/day

- Paroxetine 10–40 mg/day

- Escitalopram 10–20 mg/day

- SNRIs (Alternative if SSRIs not tolerated):

- Venlafaxine XR 37.5–225 mg/day