Current diagnosis and treatment of anxiety disorders

Abstract

Anxiety disorders are the most prevalent mental health conditions. Although they are less visible than schizophrenia, depression, and bipolar disorder, they can be just as disabling. The diagnoses of anxiety disorders are being continuously revised. Both dimensional and structural diagnoses have been used in clinical treatment and research, and both methods have been proposed for the new classification in the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-5). However, each of these approaches has limitations. More recently, the emphasis in diagnosis has focused on neuroimaging and genetic research. This approach is based partly on the need for a more comprehensive understanding of how biology, stress, and genetics interact to shape the symptoms of anxiety. Anxiety disorders can be effectively treated with psychopharmacological and cognitive-behavioral interventions. These inter ventions have different symptom targets; thus, logical combinations of these strategies need to be further studied in order to improve future outcomes. New developments are forthcoming in the field of alternative strategies for managing anxiety and for treatment-resistant cases. Additional treatment enhancements should include the development of algorithms that can be easily used in primary care and with greater focus on managing functional impairment in patients with anxiety.

Figure 1

Schematic detailing the “ABC” model of anxiety. In this model, a variety of triggering events can elicit responses at the levels of Alarm sensations, Beliefs, and associated Coping (ABC) strategies, including behaviors. Each of these processes originates in discrete brain circuits that are functionally connected. Over time, this perpetuates a vicious circle, shaping the presentation of a variety of anxiety disorders.

Figure 2

Stepped-care treatment algorithm. AD = antidepressant therapy; CBT = cognitive–behavioral therapy; MED = medication; rTMS = repetitive transcranial magnetic stimulation; SSRI = selective serotonin reuptake inhibitor. (Adapted from Roy-Byrne, et al. Arch Gen Psychiatry 2005;62[3]:290–298; and Roy-Byrne et al. JAMA 2010;303[19]:1921–1928.25)