Are there underlying physical factors? Many physical diseases present with depressive symptoms or complicate depressive illness (Table 2). Some of these illnesses remain undetected for years and account for an apparent treatment-resistant depression (TRD). Normal thyroid function is particularly important; even mild or subclinical hypothyroidism can impair response to antidepressants. Hypothyroidism can be induced by lithium therapy, and many drugs, both medical and nonmedical, can cause depression or complicate treatment (Table ... Read More

More than 20% of patients with major depression have not recovered after 2 years and, of those who do initially recover, 20% suffer a relapse 1 year later. Most studies have shown that 60% to 70% of patients respond to the first antidepressant used and a further 10% to 15% respond either to a second antidepressant or to electroconvulsive therapy (ECT). About 15% of patients fail to recover even with ... Read More

Diagnosis of uncomplicated anxiety disorders may be made by competent physicians in many specialties who have a thorough understanding of the etiology, signs and symptoms, impact and treatment of anxiety disorders. The accepted guidebook in making a diagnosis is the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). However, as mentioned earlier, psychiatrists have the most expertise in diagnosing and treating anxiety disorders, and in some cases may ... Read More

Post-traumatic Stress Disorder (PTSD) Post-traumatic Stress Disorder (PTSD) has become much more recognized and appreciated following the traumatic events of September 11th. The estimated lifetime prevalence for PTSD is almost 8%. This anxiety disorder centers on a person re-experiencing an extremely traumatic event, such as a natural disaster, war, crime, rape, or abuse, whether the abuse is physical, mental or sexual in nature. Because of this experience, a person may have ... Read More

Once thought to be a rather uncomplicated and mild form of anxiety, generalized anxiety disorder (GAD) has been found to be a much more significant psychiatric disorder. An effective analogy to illustrate the severity uses a respiratory disease model in which GAD is akin not to the common cold, which is mild, inconveniencing and will shortly go away. Instead, generalized anxiety disorder (GAD) is more like chronic obstructive pulmonary disease, ... Read More

Obsessions are recurrent, distressing thoughts that a person experiences without the ability to control the frequency and intensity of these intrusive thoughts. These thoughts cause marked anxiety and distress (panic symptoms) when they occur and occupy a marked amount of the patient's day. A common example concerns the possibility of contamination or having a disturbing aggressive thought. A compulsion is a behavior or action that the patient believes he or ... Read More

Nearly one-half of patients with panic attacks do not seek care for their problem. Patients may endure symptoms for years before they seek treatment. For others, it may take years for their symptoms and disorder to be correctly diagnosed and adequately treated. One study reported that it routinely takes more than 10 years for the correct diagnosis of an anxiety disorder to be made.Early studies found that 70% of patients ... Read More

Where Patients Seek Treatment A large number of patients with an anxiety disorder never seek treatment. These reasons will be discussed in depth in the next section. Those who do seek help often turn to practitioners in acute care clinics or emergency departments. As many as 28% to 57% of patients with panic attacks will seek treatment in the emergency room of a hospital. This is the most logical place for ... Read More

Of the adrenergic nervous system's many functions, one, the "fight or flight" response, has served humans well. This response occurs whenever one encounters a dangerous situation in which one's survival depends upon either an aggressive stance or a more passive stance, such as fleeing the scene. Both situations call for the potential for a great deal of strenuous, physical work to be done. For an organism to complete either of ... Read More

A common component of an anxiety disorder is the panic attack. A panic attack may be a familiar experience to many, as 15% of people have reported the occurrence of one over their lifetime. It is defined as a discrete period of intense fear or discomfort in the absence of real danger that is accompanied by 4 of 13 somatic or cognitive symptoms. This attack can occur suddenly and peak ... Read More