The anxious patient

Anxiety disorders are among the most common psychiatric conditions worldwide, and persons with anxiety disorders consume a substantial portion of health services, including emergency services. In one study, anxiety disorders constituted 36% of psychiatric diagnoses made in the emergency department (ED), but only a minority of these patients required emergency psychiatric consultation. Patients tended to be referred for emergency psychiatric evaluation only when they had comorbid depression, absence of medical illness, or when a triage nurse elicited psychiatrically relevant information. An understanding of the heterogeneity of disorders that can present with a significant anxiety component is essential to those who practice in acute care environments. In EDs and many other settings, anxiety-related presentations often receive lower priority than other conditions. Emergency physicians tend not to view anxiety as a condition that is life or limb threatening and thus, are likely to provide only reassurance and small amounts of benzodiazepines or antihistamines to anxious patients who have a comorbid medical illness. However, anxiety sufficient to cause an ED visit is likely to be extremely distressing to the patient. Thus, an understanding of anxiety-related disorders is critical in providing the appropriate treatment, which in some cases, may be to avoid certain medications, including benzodiazepines.