Expert Insights in Advanced Psychopharmacology is an ongoing video series featuring members of the Psych Congress Steering Committee and Faculty. The series, which highlights key psychopharmacology topics, is designed to provide mental health clinicians with practical guidance to maximize the effectiveness of treatments.
(Part 2 of 7)
In this video, Psych Congress Steering Committee member Rakesh Jain, MD, MPH, discusses the second of 7 habits which clinicians can develop to be highly effective at treating anxiety disorders. Learn about the first habit here.
Dr. Jain is Clinical Professor, Department of Psychiatry, Texas Tech University School of Medicine, Austin. He will co-present a session on the 7 habits at Psych Congress 2020, being held virtually Sept. 10-13, 2020, with a preconference on Sept. 9, 2020.
Read the transcript:
Hello, dear colleagues. I'm so glad you're here to continue the conversation about "The Seven Habits of a Highly Effective Anxiety Disorder Treating Clinician." My name is Rakesh Jain, and I'm a proud member of the Steering Committee at Psych Congress.
This is habit number 2. As I said before, there's a total of 7 that are important, and we're covering each one in different segments. Today is habit number 2.
Know anxiety disorders come early. They stay late. This effective clinician recognizes that anxiety disorders tend to start early in life and cause significant functional impairment.
Let me show you a little bit of evidence that actually supports that statement rather strongly. Here's database we have had for a long time that shows that the lifetime prevalence of anxiety disorders is actually the highest of any other type of psychiatric disorder cluster.
In fact, 28 percent or so of individuals have suffered from it sometime in their lifetime, and 18 percent have a 12‑month prevalence. That's pretty bad news. That's nearly 1 out of 20 in any given year as a diagnosable and impairing anxiety disorder.
About 4 percent actually have a disorder that we call severe, which means about 14 percent have mild, moderate, and about 4 percent severe. The worst news in many ways, as if this is not bad enough, is that the average age of onset of anxiety disorders in America is 11 years old. This is not an overstatement. Anxiety disorders are common, and they're often present early in life.
Let's just look at adults for a second. What kind of distribution do we see? Again here too, we see a wide distribution. There doesn't appear to be an age range that is immune from difficulties with anxiety disorders.
Look at this, individuals in the age group of 18 to 19, high rates, oh my goodness, even higher in those up to 59, and then sadly even those who are 60 years old or older have very high rates of anxiety disorders.
Not only that, as I said before, impairment is significant. I'm going to use generalized anxiety disorder as an example to compare its impairment with major depression. The problem is it is on par with major depression.
Look at the yellow section in the pie. That's when a person has no particular impairment at work. That'll be zero days.
As you watch major depression or generalized anxiety disorder, are you noticing about a quarter of people have at least 1 or 2 days of impairment and many of them have even more? The worst, sadly, is reserved for patients who have an anxiety disorder along with another condition.
So far what we learned is the following. Anxiety disorders are common. They're present during multiple age ranges. Average age of onset appears to be 11. They cause a lot of impairment, particularly if they co‑occur with other conditions.
Habit number 2, know anxiety disorders come early. They stay late. Let me offer you a few clinical pearls.
All ages, as I have said before, are prone to anxiety disorders. Number 2, the presentations can be subtle and easily confused with other psychiatric conditions or other medical conditions. We will have to be on guard to not let that happen.
A person's age can really influence the presentation. It really can. A child may be too early to verbalize it. A person who is perhaps in the predementia states may have the same challenges in communication. We have to be very careful not to miss an anxiety disorder.
The final key point here is let's remember there is no age that is immune from having an anxiety disorder.
Thank you for joining me during this conversation about the seven habits of a highly effective anxiety disorder treating clinician. We will have further habits to discuss in future episodes. Thank you.