Title

Diagnosis and Management of Anxiety in Adolescents in Primary Care

Document Type

Book Contribution

Publication Date

1-1-2019

Description

Anxiety and fear are normal responses to human events and do not require clinical intervention unless the fear is of unusual duration, intensity, content or frequency, according to the DSM-V criteria. There are several types of anxiety disorders according to the DSM-V: Generalized anxiety disorder, panic disorders, phobias and separation anxiety. The DSM-V separates out anxiety from obsessive-compulsive disorders and trauma and stress related disorders such as PTSD. The prevalence of anxiety disorders across all of adolescence approaches 36%. Youth experiencing anxiety may have a strong physiologic reaction to the stress that reinforces the feelings of anxiety. The effects of anxiety on adolescent well-being and function depend on the level of severity of the anxiety, from mild to severe, which can debilitate the adolescent in many areas of his/her life. Longitudinal data suggest that anxiety disorders in youth predict a range of psychiatric disorders later in life, including other anxiety disorders, substance use disorders and depression. The primary care provider has a very important role to play in screening for, diagnosing and treating anxiety in adolescents. Validated clinical screening tools exist and can help the clinician make a diagnosis. For mild anxiety, reassurance, encouragement and follow-up may be sufficient to address the anxiety. For moderate to severe anxiety, both evidence-based counseling, such as cognitive behavioral therapy (CBT) or action and commitment therapy (ACT) and anti-anxiety medications (primarily the SSRIs) can effectively treat anxiety. ACT, with its mindfulness approach and use of metaphors, may be easier to integrate into primary care.

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