Anxiety Disorders and Comorbid Medical Illness

University of Washington School of Medicine, Seattle, WA 98195, USA.
General Hospital Psychiatry (Impact Factor: 2.61). 05/2008; 30(3):208-25. DOI: 10.1016/j.genhosppsych.2007.12.006
Source: PubMed


To provide an overview of the role of anxiety disorders in medical illness.
The Anxiety Disorders Association of America held a multidisciplinary conference from which conference leaders and speakers reviewed presentations and discussions, considered literature on prevalence, comorbidity, etiology and treatment, and made recommendations for research. Irritable bowel syndrome (IBS), asthma, cardiovascular disease (CVD), cancer and chronic pain were reviewed.
A substantial literature supports clinically important associations between psychiatric illness and chronic medical conditions. Most research focuses on depression, finding that depression can adversely affect self-care and increase the risk of incident medical illness, complications and mortality. Anxiety disorders are less well studied, but robust epidemiological and clinical evidence shows that anxiety disorders play an equally important role. Biological theories of the interactions between anxiety and IBS, CVD and chronic pain are presented. Available data suggest that anxiety disorders in medically ill patients should not be ignored and could be considered conjointly with depression when developing strategies for screening and intervention, particularly in primary care.
Emerging data offer a strong argument for the role of anxiety in medical illness and suggest that anxiety disorders rival depression in terms of risk, comorbidity and outcome. Research programs designed to advance our understanding of the impact of anxiety disorders on medical illness are needed to develop evidence-based approaches to improving patient care.

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    • "Moreover, we did not control for non-neurological medical illnesses in our sample. Medical illness are also associated with symptoms of anxiety and depression (Katon, 2003; Roy-Byrne et al., 2008) and also somatic symptoms as a consequence of the illness itself. As such, the elevating internalizing disorders and symptoms evident in the study may be a "
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    ABSTRACT: While the presence of externalizing behavioral problems following traumatic brain injury (TBI) has been well established in the literature, less is known regarding internalizing disorders, and more specifically anxiety disorders, in such a population. This study explored the presence, rate, and incidence of internalizing behavior problems, including anxiety, depression, somatic complaints, avoidant personality symptomatology, and overall internalizing behavior problems in university students aged 18-25 years. A convenience sample of 247 university students (197 non-TBI, 47 mild TBI, 2 moderate TBI, 1 severe TBI) aged 18-25 years was utilized. Participants completed a self-report measure on behavioral functioning, the Adult Self Report (ASR), to identify internalizing behaviors, and a questionnaire to identify TBI history. Raw scores of behavior indicated that participants with a history of childhood TBI reported significantly higher levels of withdrawal, somatic complaints, and internalizing behavioral problems than the non-TBI participants. When analyzing standardized T-scores for borderline and clinically elevated ASR syndromes and Diagnostic and Statistical Manual of Mental Disorders (DSM)-oriented scales, individuals in the TBI group were significantly more likely to have higher rates of borderline anxiety, somatic complaints, avoidant personality problems, and overall internalizing disorders, and clinically elevated somatic complaints. Adults with a history of childhood TBI were also significantly more likely to report at least 1 or more DSM disorders. These results clearly suggest that individuals with a childhood history of TBI are at a heightened risk for a range of internalizing disorders in early adulthood, which is particularly troubling in a university sample pursuing tertiary education.
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    • "Worldwide, the population of older adults, aged 65 and over, is expected to triple by 2050 (WHO, 2011). This increase in population comes along with an increased need for research and advancements in improved mental health for seniors considering the negative impact of mental health issues on quality of life, functionality , cognition as well as physical health, the latter presenting a suggested bidirectional effect with common mental health problems , such as depression and anxiety (Ramasubbu et al., 2012; Roy-Byrne et al., 2008; Rugulies, 2002; Skoog et al., 1993). Large population based studies in developed countries have reported rates of depression and anxiety ranging from 2.6% to 27% in older adults (Blazer et al., 1987; Scott et al., 2008; Mosier et al., 2010; Kessler et al., 2010). "
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    ABSTRACT: Screening tools that appropriately detect older adults׳ mental disorders are of great public health importance. The present study aimed to establish cutoff scores for the 10-item Kessler Psychological Distress (K10) and the 7-item Generalized Anxiety Disorder (GAD-7) scales when screening for depression and anxiety. We used data from participants (n=1811) in the Enquête sur la Santé des Aînés-Service study. Depression and anxiety were measured using DSM-V and DSM-IV criteria. Receiver operating characteristic (ROC) curve analysis provided an area under the curve (AUC) of 0.767 and 0.833 for minor and for major depression when using K10. A cutoff of 19 was found to balance sensitivity (0.794) and specificity (0.664) for minor depression, whereas a cutoff of 23 was found to balance sensitivity (0.692) and specificity (0.811) for major depression. When screening for an anxiety with GAD-7, ROC analysis yielded an AUC of 0.695; a cutoff of 5 was found to balance sensitivity (0.709) and specificity (0.568). No significant differences were found between subgroups of age and gender. Both K10 and GAD-7 were able to discriminate between cases and non-cases when screening for depression and anxiety in an older adult population of primary care service users. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    No preview · Article · Apr 2015
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    • "Covariates included age, gender, years of education attained, number of somatic illnesses and the presence of a comorbid depressive disorder. Previous research indicated that these covariates are associated with anxiety and disability (Ansseau et al., 2008; Roy-Byrne et al., 2008). Number of somatic illnesses was assessed using self-reports which ascertained the presence of coronary artery disease, cardiac arrhythmia, heart failure, stroke, chronic lung disease, diabetes mellitus, thyroid disease, epilepsy, migraine or other headache, multiple sclerosis, neuropathy , osteoarthritis, rheumatoid arthritis, intestinal disorders, ulcer, and cancer, for which participants were currently under physician control or currently treated. "
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    ABSTRACT: Background This study compares disability levels between different anxiety disorders and healthy controls. We further investigate the role of anxiety arousal and avoidance behaviour in disability, and whether differences in these symptom patterns contribute to disability differences between anxiety disorders. Methods Data were from 1826 subjects from the Netherlands Study of Depression and Anxiety (NESDA). The Composite Interview Diagnostic Instrument was used to diagnose anxiety disorders. The World Health Organization Disability Assessment Schedule II was used to measure disability in six domains (cognition, mobility, selfcare, social interaction, life activities, participation). Severity of anxiety arousal and avoidance behaviour symptoms was measured using the Beck Anxiety Inventory and the Fear Questionnaire. Results All anxiety disorders were associated with higher disability. Disability was generally highest in multiple anxiety disorder (e.g. mean disability in cognition=33.7) and social anxiety disorder (mean=32.7), followed by generalized anxiety disorder (mean=27.2) and panic disorder with agoraphobia (mean=26.3), and lowest in panic disorder without agoraphobia (mean=22.1). Anxiety arousal was more associated with disability in life activities (B=8.5, p<0.001) and participation (B=9.9, p<0.001) whereas avoidance behaviour was more associated with disability in cognition (B=7.4, p<0.001) and social interaction (B=8.6, p<0.001). Different disability patterns between anxiety disorders were not completely explained by anxiety arousal and avoidance behaviour. Limitations The cross-sectional study design precludes any causal interpretations. In order to examine the full range of comorbidity among anxiety, a greater range of anxiety disorders would have been preferable. Conclusions Disability is highest in social anxiety disorder and multiple anxiety disorder. Both anxiety arousal and avoidance behaviour are associated with higher disability levels but do not fully explain the differences across anxiety disorders.
    Full-text · Article · Sep 2014 · Journal of Affective Disorders
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