Anxiety disorders are characterized by anxiety, anxiety or fear. These feelings interfere with daily life very much and prevent an appropriate reaction to certain situations. Anxiety can lead to physical symptoms. The diagnosis is made clinically. Treatment includes behavior therapy and medication, usually selective serotonin reuptake inhibitors (SSRIs).
A certain amount of anxiety is part of a normal development to as shown in the following examples:
Anxiety disorders are characterized by anxiety, anxiety or fear. These feelings interfere with daily life very much and prevent an appropriate reaction to certain situations. Anxiety can lead to physical symptoms. The diagnosis is made clinically. Treatment includes behavior therapy and medication, usually selective serotonin reuptake inhibitors (SSRIs). A certain amount of anxiety is part of a normal development on how to see the following examples: Most toddlers are anxious when they are separated from their mother, especially in an unfamiliar environment. Afraid of the dark, of monsters, insects and spiders is common in 3-4-year-olds. Shy children can react to new situations with fear and retreat. Fear of death or injury is more common in older children. Older children and young people are often afraid if they need to hold a book presentation to the class. These difficulties should not be considered an indication of an anxiety disorder. However, if the manifestations of fear are so exaggerated that it affects the daily lives of children severely or cause severe stress and / or avoidance behavior, an anxiety disorder should be considered. Anxiety disorders often come up during childhood and adolescence. Approximately 10-15% of children will experience at some point of their childhood anxiety disorders (eg. As generalized anxiety, separation, social anxiety disorder, obsessive compulsive disorder, specific phobias, panic attacks, acute and post-traumatic stress disorder). Children with an anxiety disorder have an increased risk of depressive and anxiety disorders later in life. Anxiety disorders include generalized anxiety disorder (generalized anxiety disorder in children and adolescents), social anxiety disorder (social anxiety disorders in childhood and adolescence), separation anxiety (separation anxiety), panic disorder (panic disorder in children and adolescents) and agoraphobia (agoraphobia in children and adolescents). Etiology findings suggest that anxiety disorders imply a dysfunction in the parts of the limbic system and the hippocampus, regulate emotions and responding to fear. Heritabilitätsstudien suggest a role of genetic and environmental factors. No specific genes have been identified; There are probably many genetic variants involved. Anxious parents seem to have anxious children, which unfortunately can lead to the child’s problem is worse than it actually would be otherwise. Even a normal child find it hard to stay calm and relaxed in the presence of an anxious parent. this is more difficult for a child who has a genetic predisposition to an anxiety disorder. In 30% of cases, it pays to treat parental anxiety at the same time with the child’s anxiety (treatment of anxiety disorders in adults; overview of anxiety disorders). Symptoms and signs The most common manifestation is perhaps the truancy. Truancy has replaced the term school phobia. A proper school phobia is rare. Most children who refuse to go to school, have separation anxiety, social anxiety disorder, panic or a combination thereof. Some suffer from a specific phobia. The possibility that the child is being bullied at school, should also be considered. Some children complain directly through their fear and describe them with expressions of concern. For example: “I’m afraid to see you no more” (separation anxiety) or “I’m afraid that the children laugh at me” (social anxiety disorder). Some children hide their discomfort behind somatic complaints: “I can not go to school because I have a stomach ache.” This can sometimes cause confusion because the child often telling the truth. Abdominal pain, nausea and headache can develop in children with great anxiety often. confirm several long-term follow-up studies have shown that many children have somatic complaints, especially abdominal pain is an underlying anxiety disorder. Diagnosis The diagnosis is made clinically. A thorough psychosocial history may confirm the diagnosis usually. The physical symptoms caused by anxiety in children can complicate the diagnosis. In many children consuming physical tests are carried out before an anxiety disorder is considered. Prognosis The prognosis depends on the severity of the disease, the availability of specialized treatment and the toughness of the child. Many children struggle with anxiety into her adult life and on. With early treatment, however, many children learn to control their fear. Treatment behavioral therapy (exposure-based cognitive behavioral therapy) parent-child and family interventions medication with behavioral therapy (usually SSRI for long-term treatment and sometimes benzodiazepines to relieve acute symptoms childhood anxiety disorders are based on the model of the “exposure-response prevention” ) treated, sometimes in conjunction with a drug therapy. In the exposure-based cognitive behavioral therapy the child is systematically exposed to the situation that causes anxiety in varying degrees. By helping the child to complain of anxiety provoking situation (fear avoidance), the child gradually desensitized, and the fear is reduced. Behavioral therapy is most successful when an experienced therapist with knowledge of child development applies these principles individually. In mild cases behavioral therapy alone is sufficient, in severe cases, or if not an experienced behavioral therapist is available for children, but drug therapy may be necessary. SSRIs are usually the drugs of choice for long-term treatment (see table: drugs for long-term treatment of anxiety and related disorders). Benzodiazepines are better for acute anxiety (eg. As a result of a medical procedure), but are not preferred for long-term treatment. Benzodiazepines with a short half-life (z. B. lorazepam 0.05 mg / kg to a maximum of 2 mg in a single dose) are the best choice. Medication for long-term treatment of anxiety and related disorders drug applications initial dose * dose range Comments / Precautions citalopram OCD 10 mg 10-40 mg / day – Escitalopram Major Depression 5 mg 5-20 mg daily – fluoxetine OCD, GAD, separation anxiety, social anxiety disorder, major depressive disorder in children> 7 years 10 mg 10-40 mg / day long half-life of fluvoxamine GAD, separation anxiety, social anxiety disorder, OCD in children> 8 years 25 mg (if required upward titrated) § 50-200 mg / day – Paroxetine OCD in children ? 6 years 10 mg 10-40 mg / day Increased weight sertraline OCD, GAD, separation anxiety, social anxiety 25 mg 25-200 mg / day – venlafaxine GAD 37.5 mg from 37.5 to 225 mg / day – * starting dose is only increased if necessary. The dosage instructions are approximate. The inter-individual variability in therapeutic efficacy and side effects is significant. This table is not a substitute for full drug information. Behavioral side effects (eg. As disinhibition, agitation) are common but are usually mild to moderate. Normally eliminated or a reduction of the dosage of medication or switching to another drug reduces these effects. Rarely are such effects severe (eg. As aggression, suicidal tendencies). Behavioral side effects are idiosyncratic and can occur with any antidepressant and at any time during treatment. Therefore have children and young people who are taking these medications be closely monitored. fluoxetine and paroxetine are potent inhibitors of liver enzymes that many other drugs (eg. B. ?-clonidine, lidocaine) are metabolize. §Wenn fluvoxamine dose is more than 50 mg / day, they should be divided into 2 doses / day with a higher dose is given at bedtime. GAD = generalized anxiety disorder; OCD OCD. Most children tolerate the SSRI without side effects. Sometimes stomach pain, diarrhea, insomnia or weight gain may occur. Some children may also conduct side effects (eg. As disinhibition, restlessness Depression in Children and Adolescents).