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Anxiety disorders linked to many medical conditions.

SEATTLE -- Anxiety disorders are associated with a wide range of physical health problems, even after adjusting for depression and other common mental disorders, Jitender Sareen, M.D., said in a poster presentation at the annual conference of the Anxiety Disorders Association of America.

"There have only been a few studies which have examined the relationship between anxiety disorders and medical conditions," said Dr. Sareen of the department of psychiatry at the University of Manitoba, Winnipeg.

"We have found that anxiety disorders are related to physical health, much in the same way that depression is," he said. "And what we are showing is that not only are they related, but they raise disability in the community."

The researchers used data from the U.S. National Comorbidity Survey, a national representative sample of 5,877 individuals aged 15-54 years, to examine the relationship between anxiety disorders and a wide range of medical conditions.

The investigators used the Composite International Diagnostic Interview to make DSM-III-R mental disorder diagnoses, and assessed general physical condition on the basis of self-report. Multiple logistic regression was used to analyze the relationship between a past-year anxiety disorder diagnosis and past-year chronic physical illness. Anxiety disorders diagnosed among the survey participants during the previous year included posttraumatic stress disorder, panic attacks, agoraphobia, generalized anxiety disorder, social phobia, and simple phobia.

Dr. Sareen and his associates looked at disability and functional impairment, and then controlled for factors such as depression, alcohol use, and pain. But even after adjusting for common mood and substance abuse disorders, pain, and sociodemographics, anxiety disorders remained associated with a high level of disability and greater role impairment.

Among the anxiety disorders, posttraumatic stress disorder was linked to the widest range of physical conditions, with the most prevalent being any type of metabolic or autoimmune condition (adjusted odds ratio 3.26). Neurologic conditions, including epilepsy, multiple sclerosis, and stroke, also were highly prevalent (adjusted odds ratio 2.84). Other associated disorders included vascular conditions, respiratory illnesses, gastrointestinal disease, bone or joint disorders, and diseases such as cancer and AIDS.

Subjects reporting a diagnosis of panic attacks and agoraphobia were highly likely to have a comorbid medical condition, especially a vascular disease or a bone or joint disorder. Dr. Sareen and his colleagues found that generalized anxiety disorder and social or simple phobias also were associated with physical illnesses, but the prevalence was lower.

There is a strong association between anxiety disorders and physical disorders, and in patients with physical disorders, the presence of an anxiety disorder may confer a greater level of disability, the researchers concluded.

"If you have someone who's presenting with physical health problems, you should carefully screen for anxiety and not just depression. Likewise, if you have a patient with an anxiety problem, you should assess if there is also an underlying physical health problem," Dr. Sareen said.

BY ROXANNE NELSON

Contributing Writer
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Title Annotation:Psychiatry
Author:Nelson, Roxanne
Publication:Internal Medicine News
Geographic Code:1USA
Date:Jul 15, 2005
Words:480
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