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Chapter 7. Anxiety and stress-related disorders
Abstract
This chapter covers the anxiety and stress-related disorders. Associated disorders, including panic disorder, generalized anxiety disorder, hyperventilation syndrome, obsessive–compulsive disorder, phobias, and post-traumatic stress disorder (PTSD) are covered. Each has its clinical features described and diagnostic requirements defined. Management guidelines are presented for each case, and any controversies in the field are outlined.
... Like pain, fear is a highly stressful and unwelcome sensation, but a crucial one for human survival. Nonetheless, excess stress induces various mental disorders in humans, such as anxiety, depressive, and binge-eating disorders (Klatzkin et al., 2016;Semple and Smyth, 2013;Slavich and Irwin, 2014). Anxiolytic drugs are sometimes administered to prevent or ameliorate these diseases, and the effects of these drugs in humans can be evaluated using reliable animal models such as the elevated plus-maze, light-dark box, and open-field models (Campos et al., 2013). ...
... Anxiety-and stress-related disorders are also common, with estimated prevalences ranging from 2 to 20% in the general population. These disorders are characterized by excessive worry and irritability associated with symptoms of depression [53]. Depression/ anxiety causes not only psychiatric but also physical changes, including insomnia, anorexia, tachycardia, and sexual, bowel and bladder dysfunction [54]. ...
Detecting very early markers of neurodegeneration that predate the diagnosis of idiopathic Parkinson's disease (PD) is a crucial research topic for the development of disease-modifying therapeutic interventions. Recently (123)I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy has become widely used for this purpose, since this test shows high sensitivity and specificity in the diagnosis of PD, based on evidence that cardiac sympathetic nerve fibers are affected early and commonly in PD. We reviewed the literature to determine the role of MIBG myocardial scintigraphy for diagnosing pre-motor PD.
We performed a systematic review of the literature to identify the use of MIBG myocardial scintigraphy in relation to the constellation of pre-motor symptoms in PD.
Mild memory disorder, autonomic failure (constipation and postural hypotension), depression/anxiety, visual hallucination/psychosis (in the elderly), sleep disorder (REM sleep behavior disorder), and impaired olfaction are reported to appear as sole initial symptoms of PD. All clinical features except for impaired olfaction are accompanied by low MIBG uptake, suggestive of very early PD in situ.
Identifying persons with mild memory disorder, constipation/postural hypotension, depression/anxiety, visual hallucination/psychosis (in the elderly), and REM sleep behavior disorder associated with low MIBG uptake may provide a unique opportunity to detect very early PD in situ within a pre-clinical window. Future prospective studies to investigate further the findings of these early cases are warranted.
Depression and anxiety are common mental illnesses. It is recognized that depression/anxiety causes physical changes, including insomnia, anorexia, and bladder dysfunction. We aimed to delineate bladder dysfunction in patients with depression/anxiety by reviewing the literature. We performed a systematic review of the literature to identify the frequency, lower urinary tract symptoms (LUTS), urodynamic findings, putative underlying pathology, and management of bladder dysfunction in patients with depression/anxiety. From a recent survey of a depression cohort (at a psychiatry clinic), the frequency of bladder dysfunction in depression is lower (up to 25.9%) than that in Parkinson's disease (up to 75%) and stroke (up to 55%), whereas it is significantly higher than that in age-matched controls (around 10%). In both the depression cohort and the psychogenic bladder dysfunction cohort (at a urology clinic), the most common LUTS was overactive bladder (OAB), followed by difficult urination and infrequent voiding. Compared with severe LUTS, urodynamic findings were dissociated; i.e. urodynamic findings were normal except for increased bladder sensation without detrusor overactivity for OAB (50% of all patients), followed by underactive detrusor without post-void residual for difficult urination. The effectiveness of serotonergic or anti-cholinergic medication for ameliorating OAB in the patients awaits further study. In conclusion, although the frequency of LUTS among the depression cohort is not elevated, depression/anxiety is obviously a risk factor for OAB. This finding presumably reflects that the bladder is under emotional control. Amelioration of bladder dysfunction is an important target in treating patients with depression/anxiety.
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