Clinical anxiety and its treatment

Anxiety occurs as a normal phenomenon and as a symptom of numerous psychiatric and physical illnesses, while it is the dominant feature of generalised anxiety, panic and phobic disorders. The relationship between these and other disorders is not as straightforward as diagnostic classifications suggest, and this is at least in part due to previous research having been carried out on atypical cases referred to hospital rather than patients in the real world of general practice and the general community. There are particular difficulties in distinguishing anxiety disorders from depressive illnesses, somatisation disorder and some cases of substance abuse and dependence. There may also be difficulty in deciding to what extent anxiety is related to stress or to the underlying personality of the patient. There are many reasons for these difficulties, including limitations in our basic knowledge of anxiety, preconceived notions of the clinician and the difficulty that some patients have in describing their experiences. Numerous different psychological and pharmacological treatments have been used throughout history. They include various forms of psychotherapy, behaviour and cognitive therapies and anti-anxiety drugs. Many patients receive supportive psychotherapy, while more specialised techniques currently being investigated include exposure therapy and cognitive therapy. By far the most widely used drugs are the benzodiazepines, but because of concern over dependence increasing interest is being shown in the use of alternatives, including antidepressants, and in the development of new compounds which, it is hoped, will turn out to be free from the problem of dependence.