ANXIETY DISORDERS IN PATIENTS WITH HIVAIDS.pdf

1 CHAPTER 8: ANXIETY DISORDERS IN PATIENTS WITH HIV/AIDS Anxiety is a common symptom in HIV-infected patients. When anxiety symptoms are severe or persistent, patients may have an anxiety disorder. These disorders include panic disorder, generalized anxiety disorder, obsessive-compulsive disorder, and post-traumatic stress disorder (PTSD) (see Chapter 9: Trauma and Post-Traumatic Stress Disorder in Patients With HIV/AIDS). A recent study has shown that among HIV-infected patients receiving medical care, 20.3% have an anxiety disorder, with 12.3% meeting the criteria for panic disorder, 10.4% for PTSD, and 2.8% having generalized anxiety disorder.1 Patients with other psychiatric disorders, such as adjustment disorders, major depression, psychosis, or substance use disorders, can also present with significant anxiety. To help patients receive optimal care, clinicians need to be aware of the differences among these specific disorders. Furthermore, patients with histories of anxiety or mood disorders are susceptible to recurrence of anxiety symptoms during the course of HIV illness. Key Point: Patients with limited social support may be particularly susceptible to developing anxiety symptoms. I. CLINICAL PRESENTATION RECOMMENDATION: Clinicians should consider the diagnosis of an anxiety disorder when a patient presents with common somatic symptoms, such as chest pain, diaphoresis, dizziness, gastrointestinal disturbances, and/or headache, for which no underlying medical etiology can be established. Anxiety can present with a wide range of physiological manifestations, such as shortness of breath, chest pain, racing/pounding heart, dizziness, diaphoresis, numbness or tingling, nausea, or the sensation of choking. When patients present with these somatic symptoms, for which no underlying medical etiology can be established, clinicians should consider an anxiety disorder as the cause. In addition to somatic complaints, patient