ANXIETYAND RELATEDDISORDERS EditedbyÁgnesSzirmai Anxiety and Related Disorders Edited by Ágnes Szirmai Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2011 InTech All chapters are Open Access articles distributed under the Creative Commons Non Commercial Share Alike Attribution 3.0 license, which permits to copy, distribute, transmit, and adapt the work in any medium, so long as the original work is properly cited. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published articles. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Davor Vidic Technical Editor Teodora Smiljanic Cover Designer Jan Hyrat Image Copyright yalayama, 2010. Used under license from Shutterstock.com First published August, 2011 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Anxiety and Related Disorders, Edited by Ágnes Szirmai p. cm. ISBN 978-953-307-254-8 free online editions of InTech Books and Journals can be found at www.intechopen.com Contents Preface IX Part 1 Nosology and Epidemiology 1 Chapter 1 Anxiety Disorders 3 Delia Marina Podea and Florina Ratoi Chapter 2 Epidemiological Patterns of Anxiety Disorders in Kenya 35 David M. Ndetei, Lincoln I. Khasakhala, Anne W. Mbwayo and Victoria Mutiso Chapter 3 Intergeneration Familial Risk and Psychosocial Correlates for Anxiety Syndromes in Children and Adolescents in a Developing Country 49 Jorge Javier Caraveo-Anduaga Part 2 Primary Care and Prevention 69 Chapter 4 Challenges and Opportunities in Diagnosis and Management of Generalized Anxiety Disorder in Primary Care 71 Mehtap Kartal Chapter 5 Prevention of Childhood Anxiety Disorders 87 Sarosh Khalid-Khan Part 3 Co-Morbidity and Somatic Symptoms of Anxiety Disorders 101 Chapter 6 Somatic Conditions Intrinsic to Anxiety Disorders 103 Antonio Bulbena and Guillem Pailhez Chapter 7 Generalised Anxiety Disorder, Mortality and Disease: A Stronger Predictor than Major Depressive Disorder 117 Anna C. Phillips VI Contents Chapter 8 Cardiac Diseases and Anxiety Disorders 139 Cicek Hocaoglu, Cagdas H.Yeloglu and Selim Polat Chapter 9 The Transformation of Post-Traumatic Stress Disorder: From Neurosis to Neurobiology 151 Tanja C. Mletzko and Boadie W. Dunlop Chapter 10 Anxiety in Vestibular Disorders 191 Agnes Szirmai Chapter 11 Significant Posturography Findings in Patients with Psychogenic Dizziness 211 Fumiyuki Goto, Kaoru Ogawa and Tomoko Tsutsumi Chapter 12 Anxiety Disorders in Epilepsy 217 Ozalp Ekinci Chapter 13 Disabling Osteoarthritis and Symptomatic Anxiety: Impact and Implications 227 Ray Marks Chapter 14 The Association Between Chronic Back Pain and Psychiatric Disorders; Results from a Longitudinal Population-Based Study 247 Hedda van ’t Land, Jacqueline Verdurmen, Margreet ten Have, Saskia van Dorsselaer and Ron de Graaf Part 4 Therapy of Anxiety Disorders 257 Chapter 15 The Differential Impact of Expectancies and Symptom Severity on Cognitive Behavior Therapy Outcome in Panic Disorder with Agoraphobia 259 Theodora E. Katerelos, Claude Bélanger, Michel Perreault Ghassan El-Baalbaki and John Pecknold Chapter 16 Mulungu – Rainforest Anxiolytic 281 Patocka Jiri Preface Whatdoweknowaboutanxiety? Anxiety is one of the most frequent nosologic entities encountered not only in psychiatric but in general practice as well. It was defined by Janet as “fear without object”. Anxiety, fright, fear, worry, dread, anguish, terror‐this is a long list of approximatesynonyms! The very fine difference s separatingthesenotionsmayoftengenerateconfusion:itis normaltofeel worriedorscared, butisitallright tobeanxious? Ifitis, thenthereis normal anxiety. What about anguish? On the other hand, could we live without anxiety? Anxiety disorders are one of the most common psychiatric disorders world wide. Before the 1980s, Generalized Anxiety Disorder (GAD) was labelled as ‘anxiety neuroses’.Anxietydisorderscoverseveraldifferentformsofabnormalandpathologicalfear and anxiety. Current psychiatric diagnostic criteria recognize a wide variety of anxiety disorders.Psychological conditions arehighlyprevalentamongadultsingeneral , and amongadultswithchronicdiseases,inparticular. Many aspects of anxiety can be observed; epidemiological and genetics, biological bases, cognitive neuroscience, co‐morbid mental and physical disorders, treatment resistance, biochemical and animal studies, experimental and behavioral aspects. Advancement has been made in the development of medication and psy chosocial treatment strategies, butmanypatientsstillremainsymptomatic. General Anxiety Disorder falling into the category of anxiety disorders with symptoms of anxiety, worry and apparent alertness, displays a fairly constant prevalence(5‐6.5%)inthegeneralpopulation. Anxiouspatientsoftenconsultprimarycarephysiciansfortheirtreatment,butinmost cases they do not accept th e diagnosis of anxiety disorder. The anxiety disorder diagnosis could result in a longer period of hospitalization, more frequent use of diagnostic tests and medication, and therefore, a heavy financial burden.This decreases the quality of life, and provokes serious family problems and prolonged absencefromwork. X Preface Anxietyisasymptomthatcanbeseeninmanyorganicdisordersandcanaccompany almost any psychiatric disorder. Anxiety disorders are frequent and are associated with significant distress and dysfunction. The dominant symptoms are variable but include complaints of persistent nervousness, trembling, muscular tensions, sweating, light‐ headedness, palpitations, dizziness, and e pigastrial discomfort. Anxiety disorders represent a disabling condition and a social disability as severe as chronic somatic disorders such as arthritis, hypertension, asthma, or diabetes. Mo stly, patients complainofsomaticandsleepingproblems.Accompanyingsymptomsincludemuscle tension, headache, muscle aches, restlessness, irritability, gastrointestinal symptoms, and difficulty in concentrating, fatigue, and insom nia. Fears that the patient or a relativewillshortlybecomeillorhaveanaccidentareoftenexpressed. Stigmatizationisanimportantfactorininsufficientdiagnosisandthiscanaccountfor whyasignificantnumberofpatientsdoesnotexpresstheemotionalproblemstotheir physicians. The relationship between anxiety and cardiovascular system is known since the 19th century.Weoftensay,whenwehaveanxiety,thatitisaheartaache,andweoftenuse theterm“brokenheart”afteraseveresorrow,oranxiousperiod. Ineverydaymedicalpracticeco‐morbidityandconsecutiveanxietydisordercouldbe often seen in patients with mod erate to severe osteoarthritis, which is a painful disablingjointdisease. Inoureveryday life theeatingisavery importantthing,notonlyforsupportingour body, but we might enjoy every meal. Theeatingdisorders couldalso be dangerous. Nowadays, obesity is recognized to be one of the greate st public health problems worldwide.Aconnectionbetweenanxietydisordersandobesity is observed.Obesity isconsideredtobeamoderndisease.Itseemsthat itisrapidlyspreadingworldwide, as is the anxiety. The disorders of eating, like anorexia and bulimia, could be connectednotonlytothefa shionmodels,butthepsychiatricdisorders,likeanxiety. Research in the past 20 years has shown that the patients with epilepsy commonly have coexisting psychiatric conditions including mood disorders, anxiety disorders, andpsychoticdisorders. The balance system is often affected. Anxious patients often say: “I’ve lost my balance”. A fr equent question in neurootological expertise is whether the vertigo of psychiatric patients suffering from anxiety disorders is caused by vestibular dysfunction or the vertigo is originated from psychiatric disease. A high degree of psychiatric disorders has repeatedly been described among patients with organic vertigosyndromesandattributedtovestibulardysfunction.Thedifferentialdiagnosis canonlybe a ttainedbyacarefulinterdisciplinarywayofthinkingandactivity,given the fact that the vestibular, neurological and psychiatric disorders‐considered as pathogenicfactors‐arebeingpresentsimultaneouslyintriggeringthesymptoms,and therecanbeoverlapsbetweencertainpathologicalprocesses.