Executive Editor:   Publisher & Managing Editor: Contributing Editors: Design/Copy Editor:   CHRISTOPHER PEREZ     KENDALL KIRSCH   JILL SHUMAN,   MICHELLE OSTRANDER   CAROLYN CROWN What do you want to see in Clinical Compass? ASK THE EDITORS   Last Issue - 04.10.07   Next Issue - 05.08.07   www.neuroscienceCME.com
		Subscribe to Clinical Compass™			VOLUME 2, ISSUE 9 - APRIL 24, 2007
		FROM THE CLINICAL KNOWLEDGE CENTER In Recognition of National Anxiety Disorders Screening Day by Michelle Ostrander, PhD Wednesday, May 2, 2007, has been designated National Anxiety Disorders Screening Day. This national screening day, which is coordinated by Freedom from Fear and is sponsored by more than 15 national mental health agencies, offers people an opportunity to receive a free and anonymous screening for anxiety and depressive disorders at numerous locations throughout the United States and Canada. To better understand the scope of anxiety disorders in general within the United States, consider the following statistics from the Anxiety Disorders Association of America (ADAA) and National Institute of Mental Health: • Anxiety disorders are among the most common mental illnesses in the U.S., affecting 40 million adults, or 18% of the U.S. population, each year • Anxiety disorders are an enormous economic burden, costing the U.S. more than $42 billion per year -- nearly one third of the total national mental health bill • More than half of these costs ($23 billion) are due to the repeated use of healthcare services, as people with anxiety disorders often present with somatic symptoms that frequently mimic symptoms of physical ailments • People with an anxiety disorder are at least three times more likely to see a physician and six times more likely to be hospitalized for psychiatric illnesses than non-sufferers Anxiety disorders include generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), panic disorder (PD), posttraumatic stress disorder (PTSD), social anxiety disorder and specific phobias. Although the symptoms of anxiety disorders may vary according to the particular anxiety disorder, excessive and irrational fear is common to all. Anxiety disorders frequently co-occur with other mental or physical illnesses, such as major depression and alcohol or substance abuse. Because comorbid physical and mental illnesses may mask or exacerbate symptoms of anxiety disorders, proper screening is crucial for prompt and effective treatment. In addition, gender differences in the prevalence of anxiety disorders are common; women are more likely than men to be afflicted with certain anxiety disorders, such GAD, PD, PTSD, and specific phobias. Results from a NIMH-funded study published in the February, 2007 issue of the American Journal of Psychiatry indicate that adults with anxiety disorders frequently have a juvenile history of psychiatric disorders, and particularly anxiety disorders. In this study, researchers examined the psychiatric histories of 1,037 adults diagnosed with one or more of seven anxiety disorders (GAD, OCD, PTSD, PD, agoraphobia, specific phobia, social phobia). More than half of the 232 adults with an anxiety disorder exhibited symptoms of some type of psychiatric disorder by age 15; over one-third of these adults had been diagnosed with an anxiety disorder prior to age 15. Childhood depression was also common in adults with anxiety disorders; there was a significant association between juvenile depression and all types of anxiety disorders except specific phobias and PD. In addition, adults with PTSD were more likely to have histories of extreme defiance and conduct disorders in childhood. In general, the results from this study suggest distinct etiologies for different anxiety disorders, and emphasize the importance of early diagnosis and treatment of anxiety disorders. Several straightforward and validated screening tools are available to identify those patients who may have an anxiety disorder. The Hamilton Anxiety Scale (HAM-A) is an interviewer-administered and rated scale developed to quantify the severity of anxiety symptomatology. This screening tool provides measures of overall anxiety, psychic anxiety (mental agitation and psychological distress), and somatic anxiety (physical complaints related to anxiety). The HAM-A consists of 14 items, each defined by a series of symptoms. Seven of the test items are targeted at assessing psychic anxiety whereas the remaining seven items address somatic anxiety. Each item is rated on a 5-point scale, ranging from 0 (not present) to 4 (severe). Zung's Self-rating Anxiety Scale (SAS) is another rating scale that was developed for use as a self-reporting instrument in patients being evaluated for anxiety-associated symptoms. The patient answers 20 questions related to the frequency of various symptoms. You may want to consider screening your patients for an anxiety disorder if they complain of any of the following: • Constant worrying and difficulty controlling it • Difficulty sleeping • Somatic symptoms such as rapid heart beat, chills and/or sweating, nausea, headaches, shakiness, and respiratory difficulties • Difficulty concentrating • Panic or anxiety attacks • Severe anxiety in social situations • Phobias • Obsessive thought patterns or adherence to repetitive rituals • Feeling sad or hopeless The recent tragic events at Virginia Tech are an unfortunate reminder that mental health problems frequently manifest during the college years as young adults face a variety of life challenges without familiar sources of support. The ADAA recently released an analysis of counseling and mental health services available at America's top colleges and universities. This report indicates that: • Nearly seven percent of American college students report symptoms of an anxiety disorder within the past year • Numerous barriers impede students from obtaining treatment for anxiety disorders including stigma, lack of knowledge of treatment options or services available, financial concerns, and self-medication with alcohol and/or other drugs • Symptoms of anxiety disorders may precede suicidal behavior in young adults • Utilization of counseling and mental health services by college students is the rise For more information about anxiety disorders: Anxiety Disorders Association of America National Institutes of Mental Health Do you have feedback for the author? Click here to send us an email. References Anxiety Disorders. National Institute of Mental Health, 2006. Anxiety Disorders on Campus: The Growing Need for College Mental Health Services. Anxiety Disorders Association of America, 2007. Greenberg PE, Sisitsky T, Kessler RC, et al. The economic burden of anxiety disorders in the 1990s. J Clin Psychiatry 1999;60:427-435. Gregory AM, Caspi A, Moffitt TE, et al. Juvenile mental health histories of adults with anxiety disorders. Am J Psychiatry 2007;164:301-308. Zung WW. A rating instrument for anxiety disorders. Psychosomatics 1971;12:371-379.
		©2007 CME Outfitters, LLC