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 be the best professional for the patient to consult.
| Presentations of Untreated Anxiety Disorder |
| All of these people worked and went to school…not very successfully and they seldom enjoyed the things that they used to like. They all avoided events and people, while wondering, “What’s wrong with me?” All had an untreated anxiety disorder. All were initially reluctant to seek treatment.
A 19-year-old university student who drinks before class so she won’t experience sudden shortness of breath, palpitations, choking and dizziness, which can occur unpredictably throughout the day… A 56-year-old president of a bank who can’t focus, concentrate, and worries over the smallest things, all of which are starting to affect his performance at his job… A 29-year-old bright lawyer who can’t present his case on the stand for fear of “freezing up”… A 32-year-old woman who wants to attend nursing school, has been accepted three times, but can’t go to the first day of class and drops out for fear of embarrassment and humiliation when she “says something stupid”… A 21-year-old student who misses classes at the college because she is in her dorm room cleaning the bathroom every morning and trying to get everything arranged “correctly”… A 46-year-old postal delivery person who can only “work alone” for fear of sudden episodes of tingling and shortness of breath, which require her to “stop whatever” she is doing for about 3-5 minutes, regardless of where she is on her route. In addition she now worries about “everything” and wishes at times she “wasn’t alive”… A 28-year-old stonemason who has been to the emergency room so many times for a “heart attack” he knows the physicians’ and nurses’ names and believes they think he is “silly and a hypochondriac”… A 29-year-old receptionist and bookkeeper at a small hotel who has difficulty settling a client’s bill because he must check the addition repeatedly to make sure there are no errors and he has “done everything just right”… A 39-year-old woman who lived at the beach and survived Hurricane Hugo, but still 11 years after the event, “breaks out in a sweat,” gets nauseous, has shortness of breath and “feels like I’m about to die” whenever the weather is discussed or she hears a weather report… Fortunately, all responded positively in some aspect to the point their lives were much more enjoyable and more successful following a specific pharmacologic treatment intervention. Seeing people’s lives change dramatically and being a part of this process can be one of the most rewarding aspects of providing pharmaceutical care. |
Treatment for anxiety disorders often involves a combination of pharmacologic and psychological approaches. Nonpharmacologic interventions and therapies are essential at some point of treatment, and pharmacists need to be familiar with these approaches. Once an accurate diagnosis of the anxiety disorder is made by physical and/or laboratory assessment, any drugs or substances that the patient may be taking that exacerbates the anxiety disorder need to be identified and stopped. Treatment should start with bibliotherapy–essentially giving large doses of information about the nature, etiology, presentation, and treatment of the anxiety disorder. (See TABLE 5.)
| Table 5. Literature and Patient Information on Anxiety Disorders Publications |
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| Internet |
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This patient education should be followed by effective pharmacologic treatment to stop the panic attacks and to help with anticipatory anxiety around having another panic attack or anxiety symptoms. Once the actual physical anxiety events are eliminated, a wide variety of cognitive, behavioral and supportive psychotherapies are available to help reshape the behavioral effects of the disorder. This will allow patients to make changes in their lives and resume the social, occupational, and day-to-day activities that have been impaired by the anxiety disorder.