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anxiety

Fear or apprehension of impending danger or disaster accompanied by somatic & cognitive symptoms not accompanied by a clearly identifiable stimulus. * also see anxiety disorder Etiology: - fear - emotional psychosocial stress - hypoxia - aspartame at doses < 15% of FDA maximum daily allowance can fuel anxiety [12] Epidemiology: - leading cause of mental illness worldwide (4% of global population) [13] - 62% female Pathology: - mediated by 5HT-2A receptors in the cerebral cortex [2] Clinical manifestations: (also see anxiety disorder) 1) restlessness 2) tension 3) tachycardia 4) dyspnea Differential diagnosis: - agitation - prodrome for neurodegenerative disease in the elderly - stroke - Parkinson's disease - various dementias [5], including Alzheimer's disease [6] - other diagnosis consistent with somatic symptoms [5] Management: - see anxiety disorder - benzodiazepines can reduce anxiety in palliative care [10] - high levels of physical activity associated with 26% lower rates of new onset of anxiety disorder or symptoms [9] - more diagnostic testing does not lower patient anxiety [3] - non-pharmacologic approaches to anxiety may diminish adverse effects of psychoactive medications* including delirium, longer hospital & ICU stays [11] * sedatives, antipsychotics, opiates

Related

anxiety assessment screening for anxiety

Specific

anxiety disorder anxiety during pregnancy free-floating anxiety procedural anxiety separation anxiety situational anxiety worried well

General

sign/symptom

References

  1. Stedman's Medical Dictionary 27th ed, Williams & Wilkins, Baltimore, 1999
  2. Weisstaub NV et al, Cortical 5-HT2A receptor signaling modulates anxiety-like behaviors in mice. Science 2006, 313:536 PMID: 16873667
  3. Rolfe A and Burton C. Reassurance after diagnostic testing with a low pretest probability of serious disease: Systematic review and meta-analysis. JAMA Intern Med 2013 Feb 25 PMID: 23440131 http://archinte.jamanetwork.com/article.aspx?articleid=1656539 - Kroenke K. Diagnostic testing and the illusory reassurance of normal results. JAMA Intern Med 2013 Feb 25 PMID: 23440265 http://archinte.jamanetwork.com/article.aspx?articleid=1656535
  4. Prescriber's Letter 21(1): 2014 Natural Medicines in the Clinical Management of Anxiety Detail-Document#: 300111 (subscription needed) http://www.prescribersletter.com
  5. Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
  6. Wilson RS, Begeny CT, Boyle PA et al Vulnerability to stress, anxiety, and development of dementia in old age. Am J Geriatr Psychiatry. 2011 Apr;19(4):327-34. PMID: 21427641
  7. Alramadhan E, Hanna MS, Hanna MS et al Dietary and botanical anxiolytics. Med Sci Monit. 2012 Apr;18(4):RA40-8. Review. PMID: 22460105 Free PMC Article
  8. Sarris J, McIntyre E, Camfield DA. Plant-based medicines for anxiety disorders, Part 1: a review of preclinical studies. CNS Drugs. 2013 Mar;27(3):207-19. Review. PMID: 23436255 - Sarris J, McIntyre E, Camfield DA. Plant-based medicines for anxiety disorders, part 2: a review of clinical studies with supporting preclinical evidence. CNS Drugs. 2013 Apr;27(4):301-19. Review. PMID: 23653088
  9. Schuch FB, Stubbs B, Meyer J et al. Physical activity protects from incident anxiety: A meta-analysis of prospective cohort studies. Depress Anxiety 2019 Jun 17; PMID: 31209958 https://onlinelibrary.wiley.com/doi/abs/10.1002/da.22915
  10. Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  11. Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  12. Brooks M Can a Common Artificial Sweetener Fuel Anxiety? Medscape. Dec 20, 2022 https://www.medscape.com/viewarticle/985861
  13. Soreff S Rapid Review Quiz: Anxiety Medscape. Oct 10, 2022 https://reference.medscape.com/viewarticle/981713
  14. Herling SF, Greve IE, Vasilevskis EE et al Interventions for preventing intensive care unit delirium in adults. Cochrane Database Syst Rev. 2018 Nov 23;11(11):CD009783. PMID: 30484283 PMCID: PMC6373634 Free PMC article. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009783.pub2/full