Anxiety disorders are characterized by excessive fear and worry. Generalized anxiety disorder (GAD) and panic disorder (PD) are two of the most common anxiety disorders in the United States. GAD is defined as excessive worry and anxiety that occur on most days for at least 6 months that affect daily functioning. PD is defined by recurrent unexpected panic attacks. Patients with symptoms of GAD or PD should be assessed for conditions such as hyperthyroidism, hyperparathyroidism, and cardiac arrhythmia before confirmation of an anxiety disorder diagnosis. A U.S. Preventive Services Task Force (USPSTF) draft statement recommends screening for anxiety in adults 64 years and younger, including pregnant and postpartum women. A final statement recommends screening for anxiety in children and adolescents ages 8 to 18 years. Multiple self-report tools have been validated for GAD and PD screening. The 7-item Generalized Anxiety Disorder (GAD-7) scale is an option for screening for GAD. The Panic Disorder Severity Scale (PDSS) is a 7-item tool with excellent sensitivity and specificity in screening for PD. Management with selective serotonin reuptake inhibitors and selective norepinephrine reuptake inhibitors in combination with psychotherapy has been shown to be effective for GAD and PD. Research on alternative treatments, such as psychedelic-assisted psychotherapy, is ongoing.

Case 4. JN is a 24-year-old woman who is a graduate student at a local university. She has a history of irritable bowel syndrome, which was diagnosed 3 years ago. Today she reports worsening heart palpitations and worry as she progresses through her graduate program. She says she has experienced extreme worry since adolescence. As she has grown older, the worrying has become more frequent, occurring 4 to 5 days per week. Most recently, she has noticed physical symptoms, including palpitations, dizziness, and diarrhea. She says that some days the worry keeps her from going to class or spending time with friends.