Diagnosis and Management of Anxiety in Adolescents in Primary Care

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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.