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see also p 239, 257
Summary points
Careful evaluation of an anxious patient will help to determine if thecause of the anxiety is organic or psychological
Use of herbal and over-the-counter substances should be determined becausesome herbal products (eg, ginseng, ma huang , and certain coughmedicines) contain stimulants that cause symptoms of anxiety
Anxiety is often associated with one or more other mood disorders that mayrequire management and treatment
Primary care practitioners should incorporate psychological techniques intheir medical management of Asian patients with anxiety
Ms M is a 60-year-old widowed Chinese woman with a 6-month history ofepisodic chest tightness, shortness of breath, pain that "moves all overmy body," and numbness in her legs. These attacks, which occur once ortwice weekly, occur suddenly, reaching peak intensity within a few minutes.During an attack, pain travels from her chest to her abdomen, groin, and legs.The pain is often accompenied by a sensation of intermittent "hotQi" (air) coming from her abdomen to her throat, making her believe thatshe is being choked. She also describes feeling as if she is in a closed roomor small space.
Ms M is anxious and frustrated about her symptoms and thinks she might havea serious medical problem. She has had frequent medical evaluations by herprimary care physician and second opinions from various specialists. Ms Mconsulted a doctor of traditional Chinese medicine and tried some herbalmedications, but has had no relief. She has refused to see a psychiatrist.
ANXIETY DISORDERS IN THE PRIMARY CARE SETTING
Anxiety disorders are a group of mental disturbances characterized byanxiety as a core symptom. In this article, we discuss anxiety disorderscommon to primary care, specifically panic disorder, generalized anxietydisorder (GAD), and posttraumatic stress disorder (PTSD).
DIAGNOSIS
The diagnosis is made when the constellation of symptoms are consistentwith the diagnostic criteria for each disease listed in the Diagnostic andStatistical Manual of Mental Disorders, 4th edition (DSM-IV) (see Tablelinked to this article on our web site). When symptoms of anxiety becomepervasive, have signs and symptoms consistent with DSM-IV criteria, and affectthe patient's ability to function, the presumed diagnosis is an anxietydisorder.
Which organic illnesses can cause anxiety symptoms?
Some of the disease states associated with prominent anxiety are shown in box 1 . These diseases, however,are rare explanations for anxiety and...