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Generalized Anxiety Disorder
Generalized anxiety disorder (GAD), the most common of the anxiety disorders, is characterized by unrealistic or excessive anxiety and worry about two or more life circumstances for at least six months.
Chronic worry is a prominent feature of GAD as opposed to the intermittent terror that characterizes panic disorder. Patients may report that they "can't stop worrying," which may revolve around valid life concerns including money, job, marriage, health, and safety of children. Other features of GAD include insomnia, panic attack, stress irritability, trembling, dry mouth, and a heightened startle reflex.
The presence of depression should be assessed because 30-50% of patients with anxiety disorders will also meet the criteria for major depression. Drugs and alcohol may contribute to anxiety disorders.
Panic Disorder
Patients with panic disorder report panic attack, panic discrete periods of intense terror and doom.
DSM IV Criteria Characteristics of Panic Attacks
Dizziness, unsteadiness, panic attack, panic light-headedness, or faintness
Chest pain or discomfort
Chills or hot flushes
Choking sensations
Derealization or depersonalization
Fear of dying
Fear of losing control or "going crazy"
Nausea or other abdominal distress
Palpitations, pounding, or racing heart
Sweating, trembling or shaking
Paresthesias
Smothering sensations or shortness of breath
The panic episode generally resolves within 10-30 minutes. This first panic attack generally is precipitated by a major life event. Agoraphobia may develop, with anticipatory anxiety and phobic avoidance.
Panic disorder is diagnosed only when panic attacks are unexpected and cannot be attributed to other conditions.
Panic attacks may occur in postraumatic stress disorder, and social phobia, and in some medical disorders (hyperthyroidism, pheochromocytoma).
Medical Disorders Causing Panic-like Symptoms
Hyperthyroidism may cause anxiety, tachycardia, palpitations, sweating, dyspnea.
Cardiac rhythm disturbances and mitral valve prolapse may cause panic symptoms.
Substance abuse or dependence