Anxiety in medical patients

Doctors often consider anxiety to be a normal response to physical illness. Yet, anxiety afflicts only a minority of patients and tends not to be prolonged. Any severe or persistent anxious response to physical illness merits further assessment. William Cullen (1710-90) coined the term neurosis (though the term as he used it bears little resemblance to modern concepts of anxiety disorders) Anxiety is a universal and generally adaptive response to a threat, but in certain circumstances it can become maladaptive. Characteristics that distinguish abnormal from adaptive anxiety include Recurrent panic attacks Severe physical symptoms Abnormal believes such as thoughts of sudden death View this table: Somatic and psychological symptoms of anxiety disorders Recurrent panic attacks Severe physical symptoms Abnormal beliefs such as thoughts of sudden death Unfortunately, there are few studies of the natural course of anxiety in physically ill patients, so it can be difficult to judge the distinction between normal and abnormal anxiety. In particular, some of the criteria used can be difficult to apply when a patient is experiencing a real threat of disease. A more reliable basis for diagnosing morbid anxiety is often that it causes unacceptable and disruptive problems in its own right. ### Distinguishing features of anxiety disorders #### Anxious adjustment disorder Prevalence in general population— Not known Cardinal features Onset of symptoms within 1 month of an identifiable stressor No specific situation or response #### Generalised anxiety disorder Prevalence in general population— 31 cases/1000 adults Cardinal features Period of 6 months with prominent tension, …