Anxiety in medical patients
BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7357.207 (Published 27 July 2002) Cite this as: BMJ 2002;325:207- Allan House,
- Dan Stark
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.
What is anxiety?
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
Anxiety out of proportion to the level of threat
Persistence or deterioration without intervention (> 3 weeks)
Symptoms that are unacceptable regardless of the level of threat, including
Recurrent panic attacks
Severe physical symptoms
Abnormal believes such as thoughts of sudden death
Disruption of usual or desirable functioning
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Anxiety out of proportion to the level of threat
Persistence or deterioration without intervention (>3 weeks)
Symptoms that are unacceptable regardless of the level of threat,including
Recurrent panic attacks
Severe physical symptoms
Abnormal beliefs such as thoughts of sudden death
Disruption of usual or desirable functioning.
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, …
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