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 3 of 7)
In this video, Psych Congress Steering Committee member Rakesh Jain, MD, MPH, discusses the third of 7 habits which clinicians can develop to be highly effective at treating anxiety disorders.
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.
Go to the Expert Insights in Advanced Psychopharmacology page to learn about the other habits.
Read the transcript:
Hello, dear colleagues, and welcome to another habit we will discuss in this series called "The Seven Habits of a Highly Effective Anxiety Disorder Treating Clinician." My name is Rakesh Jain, and I am a member of the Steering Committee at Psych Congress.
Today, we're going to look at habit number 3, and that is know anxiety disorders travel in packs. They can masquerade as "medical conditions." Therefore, the habit of this highly effective clinician is to know that anxiety disorders are common with nearly all of the psychiatric disorders and medical disorders, and they can be very easily missed.
Let's look at some of the medical conditions that can mimic as anxiety disorders. The first group, and I've actually seen such patients with endocrine problems such as hyperthyroidism, pheochromocytoma—I remember seeing such a patient in my fourth year of medical school training—and of course, congenital adrenal hyperplasia.
Same is true with pulmonary diseases, such as asthma, chronic obstructive pulmonary disease. These patients are very prone to having anxiety disorders. Of course, patients with certain cardiac issues, such as supraventricular tachycardia. Sometimes myocardial infarction can present with panic attacks or anxiety.
Then, of course, there's a whole host of other medical conditions, such as hypercalcemia, hypoglycemia, Addison's disease, Cushing's syndrome, etc. As you can see, there's a number of medical conditions that can mimic anxiety disorders.
In terms of patients who already have an anxiety disorder such as GAD, panic disorders, social phobia, PTSD, are you noticing the odds ratio that they might have a physical disorder, such as hypertension, arthritis, asthma, ulcers, is actually strikingly high?
In other words, this overlap is seen whether the patient presents with an anxiety disorder or in this very large study, this global study, World Mental Health Survey with over 42,000 some patients. What they found is patients who have these disorders such as asthma to hypertension to arthritis to heart disease to chronic pains, the risk of having depression certainly, but anxiety also, and anxiety plus depression is quite high.
The habit number 3 is know anxiety disorders can masquerade as medical conditions. A few pearls I would like to offer you, clinical pearls, is to remember again anxiety disorders are commonly comorbid. Number 2, they cause significant disability by themselves and even more so in these comorbid conditions such as the medical conditions we just talked about. Anxiety disorders are often comorbid with both sets of difficulties, other mental health disorders, and physical health disorders including chronic pain.
I'm so glad you joined me in this conversation about the 7 habits of a highly effective anxiety disorder treating clinician. I look forward to continuing this conversation. Bye for now.