Epidemiology

Etiology

Classifications

• Social anxiety disorder (social phobia)
  • Anxiety restricted to social & performance situations, fear of scrutiny & embarrassment
• Panic disorder
  • Recurrent, unexpected panic attacks
  • Abrupt onset of characteristic physical symptoms that resolve within minutes and a negative medical workup should raise suspicion for panic disorder.
  • Both panic disorder and somatic symptom disorder feature multiple physical symptoms and high health care use.  In somatic symptom disorder, patients experience physical symptoms persistently (eg, daily, unrelenting fatigue) whereas in panic disorder, physical symptoms are unexpected, episodic, and of short duration, typically lasting <10 minutes.
• Specific phobia
  • Persistent (≥ 6 months) and intense fears of one or more specific situations or objects (phobic stimuli)
    • Animal: spiders (arachnophobia)
    • Blood-injection-injury: blood (hematophobia), needles (belonephobia)
    • Situational: enclosed places (claustrophobia), flying (aviophobia)
• Generalized anxiety disorder
  • Chronic multiple worries, anxiety, tension
• Agoraphobia
  • Using public transportation
  • Being in open spaces
  • Being in enclosed places
  • Standing in line or being in a crowd
  • Being outside of the home alone

Clinical features

Diagnostics

Treatment

Psychotherapy

• CBT (preferred)

Pharmacotherapy

• First-line agents
  • SSRIs
  • SNRIs
• Alternative agents
  • Buspirone
  • Benzodiazepines for short-term use only
  • TCAs, e.g., imipramine