Anxiety

  • Jerrold F. Rosenbaum
  • Alan J. Gelenberg

Abstract

Anxiety is a universal human response to routine stress and emotional conflict that is experienced both psychologically and physiologically. It is important to distinguish “normal” anxiety from “pathological” anxiety or anxiety disorder. Pathological anxiety may be distinguished from normal by its autonomy, intensity, duration, or associated behavior. When “autonomous,” anxiety appears to have a “life of its own,” with minimal basis in identifiable environmental stimuli. The “intensity” of symptomatic distress for pathological anxiety frequently exceeds the patient’s capacity to bear the discomfort; the experience, therefore, is unlikely to engender a healthy, adaptive response. When symptoms recur or persist over time, the duration of anxious suffering will typically indicate pathology. Finally, pathological anxiety may trigger such stereotyped behavioral responses as avoidance or lifestyle constriction .

Keywords

Anxiety Disorder Obsessive Compulsive Disorder Anxiety Symptom Generalize Anxiety Disorder Social Phobia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Charney D. S., Heninger G. R.: Noradrenergic function and the mechanism of action of antianxiety treatment. Arch Gen Psychiatry 42:458–481, 1985.PubMedCrossRefGoogle Scholar
  2. 2.
    Insel T. R., Ninan P. T., Aloi J., et al: A benzodiazepine receptor mediated model of anxiety: Studies in non-human primates and clinical implications. Arch Gen Psychiatry 41:741–750, 1984.PubMedCrossRefGoogle Scholar
  3. 3.
    Ballenger J. C.: Biological aspects of panic disorder. Am J Psychiatry 143:516–518, 1986.PubMedGoogle Scholar
  4. 4.
    Nemiah J. C.: Foundations of Psychopathology. New York, Oxford University Press, 1961, pp 100, 121.Google Scholar
  5. 5.
    Seligman M. E. P.: Phobias and preparedness. Behav Ther 2:307–320, 1971.CrossRefGoogle Scholar
  6. 6.
    Klein D.: Delineation of two drug responsive anxiety syndromes. Psychopharmacologia 5:397–408, 1964.PubMedCrossRefGoogle Scholar
  7. 7.
    Crowe R. R., Noyes R., Pauls D. L., et al: Family study of panic disorder. Arch Gen Psychiatry 40:1065–1069, 1983.PubMedCrossRefGoogle Scholar
  8. 8.
    Coryell W., Noyes R., Jr., Howe J. D. : Mortality among outpatients with anxiety disorders. Am J Psychiatry 143:508–510, 1983.Google Scholar
  9. 9.
    Jenike M. A., Baer L., Minichiello W. E.: Obsessive/Compulsive Disorders: Theory and Management. Littleton, MA, PSG Publishing, 1986.Google Scholar
  10. 10.
    Rosenbaum J. F.: The drug treatment of anxiety. N Engl J Med 306:401–404, 1982.PubMedCrossRefGoogle Scholar
  11. 11.
    Klerman G. L.: Psychotropic hedonism versus pharmacological Calvinism. Hastings Cen Rep 2:1–3, 1972.CrossRefGoogle Scholar
  12. 12.
    Ghoneim M. M., Mewaldt S. P., Beri J. L., et al: Memory and performance effects of single and three-week administration of diazepam. Psychopharmacology 73:147–151, 1981.PubMedCrossRefGoogle Scholar
  13. 13.
    Snyder S. H.: Benzodiazepine receptors. Psychiatr Ann 11:19–23, 1981.Google Scholar
  14. 14.
    Greenblatt D. J., Divoll M., Abernethy D. R., et al: Benzodiazepine kinetics: Implications for therapeutic pharmacogeriatrics. Drug Metab Rev 14:251–292, 1983.PubMedCrossRefGoogle Scholar
  15. 15.
    Greenblatt D. J., Shader R. I., Divoll M., et al: Benzodiazepines: A summary of pharmacokinetic properties. Br J Clin Pharmacol 11:11S-16S, 1981.CrossRefGoogle Scholar
  16. 16.
    Downing R. W., Rickels K.: Hostility conflict and the effect of chlordiazepoxide on change in hostility level. Compr Psychiatry 22:362–367, 1981.PubMedCrossRefGoogle Scholar
  17. 17.
    Jackson M. R., Harris P. A.: Diazepam and tumour promotion. Lancet 1:445, 1981.CrossRefGoogle Scholar
  18. 18.
    Finkle B. S., McCloskey K. L., Goodman L. S.: Diazepam and drug-associated deaths: A survey in the United States and Canada. JAMA 242:429–434, 1971.CrossRefGoogle Scholar
  19. 19.
    Greenblatt D. J., Allen M. D., Noel B. J., et al: Acute overdosage with benzodiazepine derivatives. Clin Pharmacol Ther 21:497–514, 1977.PubMedGoogle Scholar
  20. 20.
    Divoll M., Greenblatt D. J., Lacasse Y., et al: Benzodiazepine overdosage: Plasma concentrations and clinical outcome. Psychopharmacology 73:381–383, 1981.PubMedCrossRefGoogle Scholar
  21. 21.
    Gelenberg A. J.: Benzodiazepine use during pregnancy. Mass Gen Hosp Biol Ther Psychiatry Newslett 3:36, 1980.Google Scholar
  22. 22.
    Gelenberg, A. J.: Benzodiazepine withdrawal. Mass Gen Hosp Biol Ther Psychiatry Newslett 3:9–10, 1980.Google Scholar
  23. 23.
    Gelenberg A. J.: Short-acting benzodiazepines and cimetidine (Tagamet): No interaction. Mass Gen Hosp Biol Ther Psychiatry Newslett 4:23, 1981.Google Scholar
  24. 24.
    Goa K. L., Ward A.: Buspirone: A preliminary review of its pharmacological properties and therapeutic efficacy as an anxiolytic. Drugs 32:114–129, 1986.PubMedCrossRefGoogle Scholar
  25. 25.
    Schweizer E., Rickels K.: Failure of buspirone to manage benzodiazepine withdrawal. Am J Psychiatry 143:1590–1592, 1986.PubMedGoogle Scholar
  26. 26.
    Kahn R. J., McNair D. M., Lipman R. S., et al: Imipramine in chlordiazepoxide in depressive and anxiety disorders. II. Efficacy in anxious outpatients. Arch Gen Psychiatry 43:79–85, 1986.PubMedCrossRefGoogle Scholar
  27. 27.
    Ballenger J. C.: Pharmacotherapy of the panic disorders. J Clin Psychiatry 47 (6, Suppl):27–32, 1986.PubMedGoogle Scholar
  28. 28.
    Pollack M. H., Rosenbaum J. F.: Benzodiazepines in panic-related disorders. J Affect Dis 2:95–107, 1988.Google Scholar
  29. 29.
    Liebowitz M. R., Gorman J. M., Fyer A. J., et al: Pharmacotherapy of social phobia: An interim report of a placebo-controlled comparison of phenelzine and atenolol. J Clin Psychiatry 49:252– 257, 1988.PubMedGoogle Scholar
  30. 30.
    Tyrer P., Rutherford D., Huggett T. : Benzodiazepine withdrawal symptoms and propranolol. Lancet 1:520–522, 1981.PubMedCrossRefGoogle Scholar
  31. 31.
    Abernethy D. R., Greenblatt D. J., Shader R. I. : Treatment of diazepam withdrawal syndrome with propranolol. Ann Intern Med 94:354–355, 1981.PubMedGoogle Scholar
  32. 32.
    Shader R. I., Greenblatt D. J.: Clinical implications of benzodiazepine pharmacokinetics. Am J Psychiatry 134:652–656, 1977.PubMedGoogle Scholar
  33. 33.
    Winsnes M., Jeppsson R., Sjoberg B.: Diazepam adsorption to infusion sets and plastic syringes. Acta Anesthesiol Scand 25:95–96, 1981.CrossRefGoogle Scholar
  34. 34.
    Rees M., Dormandy J.: Accidental intra-arterial injection of diazepam. Br Med J 281:289–290, 1980PubMedCrossRefGoogle Scholar

Selected Reading

  1. 1.
    Rosenbaum J. F., Pollack M. H.: Anxiety, in Hackett T. P., Cassem N. H. (eds): Massachusetts General Hospital Handbook of General Hospital Psychiatry, ed 2. Littleton, MA, PSG Publishing, 1987, pp 154–183. Good overall review of anxiety as a syndrome, with particular attention to both psychiatric and medical differential diagnosis and anxiety in the medical setting.Google Scholar
  2. 2.
    Salzman L., Thaler F. H.: Obsessive compulsive disorders: A review of the literature. Am J Psychiatry 138:286–296, 1981. Overview of recent developments regarding obsessive compulsive disorder.PubMedGoogle Scholar
  3. 3.
    Baldessarini, R. J.: Drugs and the treatment of psychiatric disorders, in Gilman A. G., Goodman L. S., Gilman A. (eds): Goodman and Gilman’s The Pharmacological Basis of Therapeutics, ed 6. New York, Macmillan, 1980, pp 391–447. Review of preclinical pharmacology of antianxiety agents.Google Scholar
  4. 4.
    Petursson H., Lader M. H.: Benzodiazepine dependence. Br J Addict 76:133–145, 1981. Review of important topic.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1991

Authors and Affiliations

  • Jerrold F. Rosenbaum
    • 1
    • 2
  • Alan J. Gelenberg
    • 3
  1. 1.Clinical Psychopharmacology UnitMassachusetts General HospitalBostonUSA
  2. 2.Department of PsychiatryHarvard Medical SchoolBostonUSA
  3. 3.Department of PsychiatryUniversity of Arizona Health Sciences CenterTucsonUSA

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