Melvin J Stern, M.D., P.A.

5015 Cedar Croft Lane, Bethesda, MD 20814
Bethesda, MD 20814
301-928-9091

Anxiety

by Melvin J. Stern, M.D., P.A., FAPA

All of us at one time or another experience anxiety, particularly in dealing with new situations where the outcome is unknown. What differentiates an anxiety disorder from a normal response to life's stresses is the severity and duration of the symptoms. For those suffering from an anxiety disorder, their worries are generally out of proportion to the circumstances, and they persist. One worry follows another, even when things are going relatively well. Shakiness, fatigue, shortness of breath, palpitations, sweating, insomnia, irritability, atttention lapses, and lack of focus or concentration are present at one time or another. Frequent visits to the physician and a belief that a serious illness is being missed, despite negative test results and reassurance by the physician are not uncommon. Those experiencing anxiety for at least six months suffer from a Generalized Anxiety Disorder. Others who develop sudden, intense periods of shortness of breath frequently associated with dizziness, accelerated heart rate, chest pains, trembling, and nausea have a Panic Disorder.

Anxiety may occur as a result of endocrine problems, e.g., thyroid, hypoglycemia, hypertension or from caffeine or substance abuse. It frequently appears in conjunction with other psychiatric disorders, including depression and schizophrenia. The following case histories illustrate the many faces of anxiety.

THE HIGH BLOOD PRESSURE that WASN'T

Joan H., an attorney, had been seeing an internist and cardiologist on at least a weekly basis over a six-month period for diagnostic tests and treatment of palpitations and labile hypertension. She had been fearful of seeing a psychiatrist. A friend, who attended one of my lectures on treating medically ill patients, convinced Joan to see me.

TREATMENT: After an extended evlauation, I found Joan to be suffering from combined Panic Disorder and Generalized Anxiety Disorder. I placed her on Klonopin, a long-acting benzodiazepine, which quickly ameliorated her symptoms. Joan was able to taper her antihypertension medicine. She participated in short-term individual therapy where she enhanced her ability to express her feelings, including anger, and to assert herself. Her self-esteem improved, her marriage got better, and she was given more responsibility at work. She no longer called her cardiologist several times a week.

DOES this CASE SOUND FAMILIAR?

Mark S., a journalist, suffered a heart attack. He consistently monitored his bodily sensations and made frequent appointments with his internist because of his concern over having another heart attack.

TREATMENT: The initial diagnostic sessions showed that Mark was a highly driven, competitive person who could not stand feeling out of control. Having a heart attack "spooked" him. I chose to place Mark in group psychotherapy with other survivors of heart attacks. In this warm, supportive environment, Mark began to relax. He recognized that the other patients were also confronting the same fears of inadequacy and loss of control that plagued him. He saw them work to limit the factors in their lives that could trigger a further cardiac episode. Following their example provided him with a sense of freedom, an ability to modify his workload, and recreate his life in a new, fulfilling way. Over time, his physical symptoms dissipated and he no longer felt stressed. Had Mark not sought out therapy, he might well have become an anxious, withdrawn hypochondriac whose fears could have compelled him to retire earlier than he had planned.

I DON'T KNOW WHAT'S WRONG with ME

Phyllis G., an executive assistant, had seen many psychiatrists over the years. She picked my name out of the Washingtonian article, "Top Doctors: Physicians Name Specialists That They'd Go To." I spent three hours evaluating Phyllis. She was both anxious and depressed and had problems in relationships and on her jobs. In her relationships, she swung from being dependent to domineering. At work, she had trouble staying at any job for very long.

TREATMENT: I put Phyllis on Paxil and Depakote to elevate her spirits and reduce her irritability. This regimen was augmented by weekly psychotherapy for three months. Thereafter, I saw Phyllis every other week. Over time, Phyllis improved her self-esteem, learned new interpersonal skills, and enhanced her overall judgment. She held the same job for over a year and a half and received two promotions. She terminated a dysfunctional relationship she had been in upon entering therapy and moved on to a relationship with a healthy and supportive mate. Phyllis' feelings about therapy are echoed in the comment she made on her last visit to my office: "I wish that I had found you years ago."

WITH GOOD, EFFECTIVE TREATMENT, PATIENTS can BE HELPED

As these stories illustrate, active, rapid intervention can restore many anxious and emotionally distressed people to normal functioning. If you have patients whose symptoms don't appear to abate with treatment or who appear agitated, obsessive, or have mood swings, they may need psychiatric evaluation. If you have chronically ill patients who seem unable to cope or elderly people who are having trouble adjusting to the changes in their capabilities, they may need psychiatric help.

If you feel that you have patients who require psychiatric evaluation, please feel free to call or fax pertinent case information and I will follow up for an in-depth discussion of the issues.

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