উদ্বেগমূলক ব্যাধি: সংশোধিত সংস্করণের মধ্যে পার্থক্য

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১৪:২৩, ১১ ডিসেম্বর ২০১৮ তারিখে সংশোধিত সংস্করণ

টেমপ্লেট:Use dmy dates

উদ্বেগমূলক ব্যাধি
দ্য স্ক্রীম (নরওয়েজিয়ান: স্ক্রিক) একটি চিত্র নরওয়েজিয়ান শিল্পী এডোয়ার্ড মাঞ্চ[১]
বিশেষত্বমনোরোগবিদ্যা
লক্ষণদুশ্চিন্তা, দ্রুত হৃদস্পন্দন, অস্থিরতা[২]
রোগের সূত্রপাত15 -35 বছর বয়স[৩]
স্থিতিকাল> 6 মাস[২][৩]
কারণজিনগত ও পরিবেশগত কারণ[৪]
ঝুঁকির কারণশিশু নির্যাতন, পারিবারিক ইতিহাস, দারিদ্র্য[৩]
পার্থক্যমূলক রোগনির্ণয়হাইপারথাইরয়েডিজম; হৃদরোগ; ক্যাফিন, মদ, গাঁজা ব্যবহার; নির্দিষ্ট কিছু মাদক থেকে প্রত্যাহার[৩][৫]
চিকিৎসাজীবনযাত্রার পরিবর্তন, পরামর্শদান, ওষুধ[৩]
ঔষধঅবসাদবিরোধী ওষুধ, উদ্বেগ প্রশমনকারী ওষুধ, বিটা ব্লকার[৪]
সংঘটনের হার12% per year[৩][৬]

উদ্বেগমূলক ব্যাধি হল এক শ্রেণীর মানসিক ব্যাধি যার বৈশিষ্ট্য হল উদ্বেগ ও ভয়ের গুরুত্বপূর্ণ অনুভূতি।[২] উদ্বেগ হল ভবিষ্যতের ঘটনাগুলির বিষয়ে দুশ্চিন্তা আর ভয় হল বর্তমান ঘটনাগুলির ওপরে প্রতিক্রিয়া।[২] এই অনুভূতিগুলি শারীরিক লক্ষণ ঘটাতে পারে, যেমন দ্রুত হৃদস্পন্দন ও অস্থিরতা।[২] সাধারণ উদ্বেগমূলক ব্যাধি, সুনির্দিষ্ট ভীতি, সামাজিক উদ্বেগমূলক ব্যাধি, আলাদা হওয়ার উদ্বেগমূলক ব্যাধি, খোলা জায়গার প্রবল ভীতি, আতঙ্কজনিত ব্যাধি, ও সিলেক্টিভ মিউটিজম সহ অনেকগুলি উদ্বেগমূলক ব্যাধি আছে।[২] কিসের ফলস্বরূপ লক্ষণগুলি দেঝা দেয় সেই অনুযায়ী ব্যাধিটির পার্থক্য হয়।[২] মানুষের প্রায়ই একাধিক উদ্বেগমূলক ব্যাধি হয়।[২]

উদ্বেগমূলক ব্যাধিগুলির কারণ হল জিনগত ও পরিবেশগত কারণগুলির একটি সংমিশ্রণ।[৪] ঝুঁকির কারণগুলিতে অন্তর্ভুক্ত আছে শৈশবে নির্যাতন, মানসিক ব্যাধির পারিবারিক ইতিহাস ও দারিদ্র্য।[৩] উদ্বেগমূলক ব্যাধিগুলি প্রায়ই অন্যান্য মানসিক ব্যাধির সঙ্গে ঘটে, নির্দিষ্টরূপে গুরুতর অবসাদজনিত ব্যাধি, ব্যক্তিত্ব সংক্রান্ত ব্যাধি, ও নেশার জিনিস ব্যবহার সংক্রান্ত ব্যাধি।[৩] রোগনির্ণয় করার জন্য, সাধারণভাবে কমপক্ষে 6 মাস ধরে লক্ষণগুলি উপস্থিত থাকা প্রয়োজন, পরিস্থিতির জন্য যা প্রত্যাশিত তার চেয়ে বেশি হওয়া উচিত এবং কাজকর্ম কমে যাওয়া উচিত।[২][৩] অন্য যে সব সমস্যার ফলস্বরূপ একই রকম লক্ষণ দেখা দিতে পারে তার অন্তর্ভুক্ত হল হাইপারথাইরয়েডিজম; হৃদরোগ; ক্যাফিন, মদ, বা গাঁজা ব্যবহার; এবং সুনির্দিষ্ট কিছু মাদক থেকে প্রত্যাহার ইত্যাদি।[৩][৫]

চিকিৎসা ছাড়া উদ্বেগমূলক ব্যাধিগুলি থেকে যায়।[২][৪] চিকিৎসার মধ্যে অন্তর্ভুক্ত হতে পারে জীবনযাত্রার পরিবর্তন, পরামর্শদান, ও ওষুধ।[৩] সাধারণত এক ধরনের কগনিটিভ বিহেভিয়ারাল থেরাপির সঙ্গে পরামর্শদান করা হয়।[৩] অবসাদবিরোধী ওষুধ, বেঞ্জোডায়াজেপাইন, বা বিটা ব্লকারের মত ওষুধগুলি লক্ষণগুলির উন্নতি ঘটাতে পারে।[৪]

প্রায় 12% মানুষ কোনো এক বছরে উদ্বেগমূলক ব্যাধিতে আক্রান্ত হয়, এবং 5% থেকে 30% মানুষ জীবনের কোনো এক সময়ে এতে আক্রান্ত হয়।[৩][৬] এটা পুরুষদের তুলনায় নারীদের ক্ষেত্রে প্রায় দ্বিগুণ বেশি হয় এবং সাধারণভাবে 25 বছর বয়সের আগেই শুরু হয়।[২][৩] সবচেয়ে সাধারণ হল সু্নির্দিষ্ট কিছু ভীতি যা প্রায় 12% মানুষকে প্রভাবিত করে এবং সামাজিক উদ্বেগমূলক ব্যাধি যা 10% মানুষকে তাদের জীবনের কোনো এক মুহূর্তে প্রভাবিত করে।[৩] এগুলি 15 ও 35 বছরের মাঝামাঝি বয়সের মানুষদের সবচেয়ে বেশি প্রভাবিত করে এবং 55 বছর বয়সের পরে অনেক কম ঘটে।[৩] যুক্তরাষ্ট্র ও ইউরোপে এর হার উচ্চতর।[৩]

Classification

Facial expression of someone with chronic anxiety

Generalized anxiety disorder

মূল নিবন্ধ: Generalized anxiety disorder

Generalized anxiety disorder (GAD) is a common disorder, characterized by long-lasting anxiety that is not focused on any one object or situation. Those suffering from generalized anxiety disorder experience non-specific persistent fear and worry, and become overly concerned with everyday matters. Generalized anxiety disorder is "characterized by chronic excessive worry accompanied by three or more of the following symptoms: restlessness, fatigue, concentration problems, irritability, muscle tension, and sleep disturbance".[৭] Generalized anxiety disorder is the most common anxiety disorder to affect older adults.[৮] Anxiety can be a symptom of a medical or substance abuse problem, and medical professionals must be aware of this. A diagnosis of GAD is made when a person has been excessively worried about an everyday problem for six months or more.[৯] A person may find that they have problems making daily decisions and remembering commitments as a result of lack of concentration/preoccupation with worry.[১০] Appearance looks strained, with increased sweating from the hands, feet, and axillae,[১১] and they may be tearful, which can suggest depression.[১২] Before a diagnosis of anxiety disorder is made, physicians must rule out drug-induced anxiety and other medical causes.[১৩]

In children GAD may be associated with headaches, restlessness, abdominal pain, and heart palpitations.[১৪] Typically it begins around 8 to 9 years of age.[১৪]

Specific phobias

মূল নিবন্ধ: Specific phobia

The single largest category of anxiety disorders is that of specific phobias which includes all cases in which fear and anxiety are triggered by a specific stimulus or situation. Between 5% and 12% of the population worldwide suffer from specific phobias.[৯] Sufferers typically anticipate terrifying consequences from encountering the object of their fear, which can be anything from an animal to a location to a bodily fluid to a particular situation. Common phobias are flying, blood, water, highway driving, and tunnels. When people are exposed to their phobia, they may experience trembling, shortness of breath, or rapid heartbeat.[১৫] People understand that their fear is not proportional to the actual potential danger but still are overwhelmed by it.[১৬]

Panic disorder

মূল নিবন্ধ: Panic disorder

With panic disorder, a person has brief attacks of intense terror and apprehension, often marked by trembling, shaking, confusion, dizziness, nausea, and/or difficulty breathing. These panic attacks, defined by the APA as fear or discomfort that abruptly arises and peaks in less than ten minutes, can last for several hours.[১৭] Attacks can be triggered by stress, irrational thoughts, general fear or fear of the unknown, or even exercise. However sometimes the trigger is unclear and the attacks can arise without warning. To help prevent an attack one can avoid the trigger. This being said not all attacks can be prevented.

In addition to recurrent unexpected panic attacks, a diagnosis of panic disorder requires that said attacks have chronic consequences: either worry over the attacks' potential implications, persistent fear of future attacks, or significant changes in behavior related to the attacks. As such, those suffering from panic disorder experience symptoms even outside specific panic episodes. Often, normal changes in heartbeat are noticed by a panic sufferer, leading them to think something is wrong with their heart or they are about to have another panic attack. In some cases, a heightened awareness (hypervigilance) of body functioning occurs during panic attacks, wherein any perceived physiological change is interpreted as a possible life-threatening illness (i.e., extreme hypochondriasis).

Agoraphobia

মূল নিবন্ধ: Agoraphobia

Agoraphobia is the specific anxiety about being in a place or situation where escape is difficult or embarrassing or where help may be unavailable.[১৮] Agoraphobia is strongly linked with panic disorder and is often precipitated by the fear of having a panic attack. A common manifestation involves needing to be in constant view of a door or other escape route. In addition to the fears themselves, the term agoraphobia is often used to refer to avoidance behaviors that sufferers often develop.[১৯] For example, following a panic attack while driving, someone suffering from agoraphobia may develop anxiety over driving and will therefore avoid driving. These avoidance behaviors can often have serious consequences and often reinforce the fear they are caused by.

Social anxiety disorder

মূল নিবন্ধ: Social anxiety disorder

Social anxiety disorder (SAD; also known as social phobia) describes an intense fear and avoidance of negative public scrutiny, public embarrassment, humiliation, or social interaction. This fear can be specific to particular social situations (such as public speaking) or, more typically, is experienced in most (or all) social interactions. Social anxiety often manifests specific physical symptoms, including blushing, sweating, and difficulty speaking. As with all phobic disorders, those suffering from social anxiety often will attempt to avoid the source of their anxiety; in the case of social anxiety this is particularly problematic, and in severe cases can lead to complete social isolation.

Social physique anxiety (SPA) is a subtype of social anxiety. It is concern over the evaluation of one's body by others.[২০] SPA is common among adolescents, especially females.

Post-traumatic stress disorder

মূল নিবন্ধ: Post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) was once an anxiety disorder (now moved to trauma- and stressor-related disorders in DSM-V) that results from a traumatic experience. Post-traumatic stress can result from an extreme situation, such as combat, natural disaster, rape, hostage situations, child abuse, bullying, or even a serious accident. It can also result from long-term (chronic) exposure to a severe stressor--[২১] for example, soldiers who endure individual battles but cannot cope with continuous combat. Common symptoms include hypervigilance, flashbacks, avoidant behaviors, anxiety, anger and depression.[২২] In addition, individuals may experience sleep disturbances.[২৩] There are a number of treatments that form the basis of the care plan for those suffering with PTSD. Such treatments include cognitive behavioral therapy (CBT), psychotherapy and support from family and friends.[৯]

Posttraumatic stress disorder (PTSD) research began with Vietnam veterans, as well as natural and non natural disaster victims. Studies have found the degree of exposure to a disaster has been found to be the best predictor of PTSD.[২৪]

Separation anxiety disorder

মূল নিবন্ধ: Separation anxiety disorder

Separation anxiety disorder (SepAD) is the feeling of excessive and inappropriate levels of anxiety over being separated from a person or place. Separation anxiety is a normal part of development in babies or children, and it is only when this feeling is excessive or inappropriate that it can be considered a disorder.[২৫] Separation anxiety disorder affects roughly 7% of adults and 4% of children, but the childhood cases tend to be more severe; in some instances, even a brief separation can produce panic.[২৬][২৭] Treating a child earlier may prevent problems. This may include training the parents and family on how to deal with it. Often, the parents will reinforce the anxiety because they do not know how to properly work through it with the child. In addition to parent training and family therapy, medication, such as SSRIs, can be used to treat separation anxiety.[২৮]

Situational anxiety

Situational anxiety is caused by new situations or changing events. It can also be caused by various events that make that particular individual uncomfortable. Its occurrence is very common. Often, an individual will experience panic attacks or extreme anxiety in specific situations. A situation that causes one individual to experience anxiety may not affect another individual at all. For example, some people become uneasy in crowds or tight spaces, so standing in a tightly packed line, say at the bank or a store register, may cause them to experience extreme anxiety, possibly a panic attack.[২৯] Others, however, may experience anxiety when major changes in life occur, such as entering college, getting married, having children, etc.

Obsessive–compulsive disorder

মূল নিবন্ধ: Obsessive–compulsive disorder

Obsessive–compulsive disorder (OCD) is not classified as an anxiety disorder by the DSM-5 but is by the ICD-10. It was previously classified as an anxiety disorder in the DSM-IV. It is a condition where the person has obsession|obsessions (distressing, persistent, and intrusive thoughts or images) and compulsions (urges to repeatedly perform specific acts or rituals), that are not caused by drugs or physical order, and which cause distress or social dysfunction.[৩০][৩১] The compulsive rituals are personal rules followed to relieve the anxiety.[৩১] OCD affects roughly 1-2% of adults (somewhat more women than men), and under 3% of children and adolescents.[৩০][৩১]

A person with OCD knows that the symptoms are unreasonable and struggles against both the thoughts and the behavior.[৩০][৩২] Their symptoms could be related to external events they fear (such as their home burning down because they forget to turn off the stove) or worry that they will behave inappropriately.[৩২]

It is not certain why some people have OCD, but behavioral, cognitive, genetic, and neurobiological factors may be involved.[৩১] Risk factors include family history, being single (although that may result from the disorder), and higher socioeconomic class or not being in paid employment.[৩১] Of those with OCD about 20% of people will overcome it, and symptoms will at least reduce over time for most people (a further 50%).[৩০]

Selective mutism

মূল নিবন্ধ: Selective mutism

Selective mutism (SM) is a disorder in which a person who is normally capable of speech does not speak in specific situations or to specific people. Selective mutism usually co-exists with shyness or social anxiety.[৩৩] People with selective mutism stay silent even when the consequences of their silence include shame, social ostracism or even punishment.[৩৪] Selective mutism affects about 0.8% of people at some point in their life.[৩]

Causes

Drugs

Anxiety and depression can be caused by alcohol abuse, which in most cases improves with prolonged abstinence. Even moderate, sustained alcohol use may increase anxiety levels in some individuals.[৩৫] Caffeine, alcohol, and benzodiazepine dependence can worsen or cause anxiety and panic attacks.[৩৬] Anxiety commonly occurs during the acute withdrawal phase of alcohol and can persist for up to 2 years as part of a post-acute withdrawal syndrome, in about a quarter of people recovering from alcoholism.[৩৭] In one study in 1988–1990, illness in approximately half of patients attending mental health services at one British hospital psychiatric clinic, for conditions including anxiety disorders such as panic disorder or social phobia, was determined to be the result of alcohol or benzodiazepine dependence. In these patients, an initial increase in anxiety occurred during the withdrawal period followed by a cessation of their anxiety symptoms.[৩৮]

There is evidence that chronic exposure to organic solvents in the work environment can be associated with anxiety disorders. Painting, varnishing and carpet-laying are some of the jobs in which significant exposure to organic solvents may occur.[৩৯]

Taking caffeine may cause or worsen anxiety disorders,[৪০][৪১] including panic disorder.[৪২][৪৩][৪৪] Those with anxiety disorders can have high caffeine sensitivity.[৪৫][৪৬] Caffeine-induced anxiety disorder is a subclass of the DSM-5 diagnosis of substance/medication-induced anxiety disorder. Substance/medication-induced anxiety disorder falls under the category of anxiety disorders, and not the category of substance-related and addictive disorders, even though the symptoms are due to the effects of a substance.[৪৭]

Cannabis use is associated with anxiety disorders. However, the precise relationship between cannabis use and anxiety still needs to be established.[৪৮][৪৯]

Medical conditions

Occasionally, an anxiety disorder may be a side-effect of an underlying endocrine disease that causes nervous system hyperactivity, such as pheochromocytoma[৫০][৫১] or hyperthyroidism.[৫২]

Stress

Anxiety disorders can arise in response to life stresses such as financial worries or chronic physical illness. Anxiety among adolescents and young adults is common due to the stresses of social interaction, evaluation, and body image. Anxiety is also common among older people who have dementia. On the other hand, anxiety disorder is sometimes misdiagnosed among older adults when doctors misinterpret symptoms of a physical ailment (for instance, racing heartbeat due to cardiac arrhythmia) as signs of anxiety.[৮]

Genetics

GAD runs in families and is six times more common in the children of someone with the condition.[৫৩]

While anxiety arose as an adaptation, in modern times it is almost always thought of negatively in the context of anxiety disorders. People with these disorders have highly sensitive systems; hence, their systems tend to overreact to seemingly harmless stimuli. Sometimes anxiety disorders occur in those who have had traumatic youths, demonstrating an increased prevalence of anxiety when it appears a child will have a difficult future.[৫৪] In these cases, the disorder arises as a way to predict that the individual–s environment will continue to pose threats.

Persistence of anxiety

At a low level, anxiety is not a bad thing. In fact, the hormonal response to anxiety has evolved as a benefit, as it helps humans react to dangers. Researchers in evolutionary medicine believe this adaptation allows humans to realize there is a potential threat and to act accordingly in order to ensure greatest possibility of protection. It has actually been shown that those with low levels of anxiety have a greater risk of death than those with average levels. This is because the absence of fear can lead to injury or death.[৫৪] Additionally, patients with both anxiety and depression were found to have lower morbidity than those with depression alone.[৫৫] The functional significance of the symptoms associated with anxiety includes: greater alertness, quicker preparation for action, and reduced probability of missing threats.[৫৫] In the wild, vulnerable individuals, for example those who are hurt or pregnant, have a lower threshold for anxiety response, making them more alert.[৫৫] This demonstrates a lengthy evolutionary history of the anxiety response.

Evolutionary mismatch

It has been theorized that high rates of anxiety are a reaction to how the social environment has changed from the Paleolithic era. For example, in the Stone Age there was greater skin-to-skin contact and more handling of babies by their mothers, both of which are strategies that reduce anxiety.[৫৪] Additionally, there is greater interaction with strangers in present times as opposed to interactions solely between close-knit tribes. Researchers posit that the lack of constant social interaction, especially in the formative years, is a driving cause of high rates of anxiety.

Many current cases are likely to have resulted from an evolutionary mismatch, which has been specifically termed a "psychopathogical mismatch". In evolutionary terms, a mismatch occurs when an individual possesses traits that were adapted for an environment that differs from the individual–s current environment. For example, even though an anxiety reaction may have been evolved to help with life-threatening situations, for highly sensitized individuals in Westernized cultures simply hearing bad news can elicit a strong reaction.[৫৬]

An evolutionary perspective may provide insight into alternatives to current clinical treatment methods for anxiety disorders. Simply knowing some anxiety is beneficial may alleviate some of the panic associated with mild conditions. Some researchers believe that, in theory, anxiety can be mediated by reducing a patient–s feeling of vulnerability and then changing their appraisal of the situation.[৫৬]

Mechanisms

Biological

Low levels of GABA, a neurotransmitter that reduces activity in the central nervous system, contribute to anxiety. A number of anxiolytics achieve their effect by modulating the GABA receptors.[৫৭][৫৮][৫৯]

Selective serotonin reuptake inhibitors, the drugs most commonly used to treat depression, are frequently considered as a first line treatment for anxiety disorders.[৬০]

Amygdala

The amygdala is central to the processing of fear and anxiety, and its function may be disrupted in anxiety disorders.[৬১] Sensory information enters the amygdala through the nuclei of the basolateral complex (consisting of lateral, basal, and accessory basal nuclei). The basolateral complex processes sensory-related fear memories and communicates their threat importance to memory and sensory processing elsewhere in the brain, such as the medial prefrontal cortex and sensory cortices.

Another important area is the adjacent central nucleus of the amygdala, which controls species-specific fear responses, via connections to the brainstem, hypothalamus, and cerebellum areas. In those with general anxiety disorder, these connections functionally seem to be less distinct, with greater gray matter in the central nucleus. Another difference is that the amygdala areas have decreased connectivity with the insula and cingulate areas that control general stimulus salience, while having greater connectivity with the parietal cortex and prefrontal cortex circuits that underlie executive functions.[৬১]

The latter suggests a compensation strategy for dysfunctional amygdala processing of anxiety. Researchers have noted "Amygdalofrontoparietal coupling in generalized anxiety disorder patients may ... reflect the habitual engagement of a cognitive control system to regulate excessive anxiety."[৬১] This is consistent with cognitive theories that suggest the use in this disorder of attempts to reduce the involvement of emotions with compensatory cognitive strategies.

Clinical and animal studies suggest a correlation between anxiety disorders and difficulty in maintaining balance.[৬২][৬৩][৬৪][৬৫] A possible mechanism is malfunction in the parabrachial area, a brain structure that, among other functions, coordinates signals from the amygdala with input concerning balance.[৬৬]

Anxiety processing in the basolateral amygdala has been implicated with dendritic arborization of the amygdaloid neurons. SK2 potassium channels mediate inhibitory influence on action potentials and reduce arborization. By overexpressing SK2 in the basolateral amygdala, anxiety in experimental animals can be reduced together with general levels of stress-induced corticosterone secretion.[৬৭]

Diagnosis

Anxiety disorders are often severe chronic conditions, which can be present from an early age or begin suddenly after a triggering event. They are prone to flare up at times of high stress and are frequently accompanied by physiological symptoms such as headache, sweating, muscle spasms, tachycardia, palpitations, and hypertension, which in some cases lead to fatigue.

In casual discourse the words "anxiety" and "fear" are often used interchangeably; in clinical usage, they have distinct meanings: "anxiety" is defined as an unpleasant emotional state for which the cause is either not readily identified or perceived to be uncontrollable or unavoidable, whereas "fear" is an emotional and physiological response to a recognized external threat.[৬৮] The term "anxiety disorder" includes fears (phobias) as well as anxieties.[চিকিৎসাবিদ্যার তথ্যসূত্র প্রয়োজন]

The diagnosis of anxiety disorders is difficult because there are no objective biomarkers, it is based on symptoms,[৬৯] which typically need to be present at least six months, be more than would be expected for the situation, and decrease functioning.[২][৩] Several generic anxiety questionnaires can be used to detect anxiety symptoms, such as the State-Trait Anxiety Inventory (STAI), the Generalized Anxiety Disorder 7 (GAD-7), the Beck Anxiety Inventory (BAI), the Zung Self-Rating Anxiety Scale, and the Taylor Manifest Anxiety Scale.[৭০] Other questionnaires combine anxiety and depression measurement, such as the Hamilton Anxiety Rating Scale, the Hospital Anxiety and Depression Scale (HADS), the Patient Health Questionnaire (PHQ), and the Patient-Reported Outcomes Measurement Information System (PROMIS).[৭০] Examples of specific anxiety questionnaires include the Liebowitz Social Anxiety Scale (LSAS), the Social Interaction Anxiety Scale (SIAS), the Social Phobia Inventory (SPIN), the Social Phobia Scale (SPS), and the Social Anxiety Questionnaire (SAQ-A30).[৭১]

Anxiety disorders often occur along with other mental disorders, in particular depression, which may occur in as many as 60% of people with anxiety disorders. The fact that there is considerable overlap between symptoms of anxiety and depression, and that the same environmental triggers can provoke symptoms in either condition, may help to explain this high rate of comorbidity.[৭২]

Studies have also indicated that anxiety disorders are more likely among those with family history of anxiety disorders, especially certain types.[৭৩]

Sexual dysfunction often accompanies anxiety disorders, although it is difficult to determine whether anxiety causes the sexual dysfunction or whether they arise from a common cause. The most common manifestations in individuals with anxiety disorder are avoidance of intercourse, premature ejaculation or erectile dysfunction among men and pain during intercourse among women. Sexual dysfunction is particularly common among people affected by panic disorder (who may fear that a panic attack will occur during sexual arousal) and posttraumatic stress disorder.[৭৪]

Differential diagnosis

The diagnosis of an anxiety disorder requires first ruling out an underlying medical cause.[৫][৬৮] Diseases that may present similar to an anxiety disorder, including certain endocrine diseases (hypo- and hyperthyroidism, hyperprolactinemia),[৩][৫][৬৮][৭৫] metabolic disorders (diabetes),[৫][৭৬] deficiency states (low levels of vitamin D, B2, B12, folic acid),[৫] gastrointestinal diseases (celiac disease, non-celiac gluten sensitivity, inflammatory bowel disease),[৭৭][৭৮][৭৯] heart diseases,[৩][৫] blood diseases (anemia),[৫] and brain degenerative diseases (Parkinson's disease, dementia, multiple sclerosis, Huntington's disease).[৫][৮০][৮১][৮২]

Also, several drugs can cause or worsen anxiety, whether in intoxication, withdrawal, or from chronic use. These include alcohol, tobacco, cannabis, sedatives (including prescription benzodiazepines), opioids (including prescription pain killers and illicit drugs like heroin), stimulants (such as caffeine, cocaine and amphetamines), hallucinogens, and inhalants.[৩][৮৩]

Prevention

Focus is increasing on prevention of anxiety disorders.[৮৪] There is tentative evidence to support the use of cognitive behavior therapy[৮৪] and mindfulness therapy.[৮৫][৮৬] As of 2013, there are no effective measures to prevent GAD in adults.[৮৭]

Treatment

Treatment options include lifestyle changes, therapy, and medications. There is no clear evidence as to whether therapy or medication is more effective; the choice of which is up to the person with the anxiety disorder and most choose therapy first.[৮৮] The other may be offered in addition to the first choice or if the first choice fails to relieve symptoms.[৮৮]

Lifestyle and diet

Lifestyle changes include exercise, for which there is moderate evidence for some improvement, regularizing sleep patterns, reducing caffeine intake, and stopping smoking.[৮৮] Stopping smoking has benefits in anxiety as large as or larger than those of medications.[৮৯] Omega-3 polyunsaturated fatty acids (such as fish oil) may reduce anxiety, particularly in those with more significant symptoms.[৯০]

Therapy

Cognitive behavioral therapy (CBT) is effective for anxiety disorders and is a first line treatment.[৮৮][৯১][৯২][৯৩][৯৪] CBT appears to be equally effective when carried out via the internet.[৯৪] While evidence for mental health apps is promising it is preliminary.[৯৫]

Self-help books can contribute to the treatment of people with anxiety disorders.[৯৬]

Mindfulness based programs also appear to be effective for managing anxiety disorders.[৯৭][৯৮] It is unclear if meditation has an effect on anxiety and transcendental meditation appears to be no different than other types of meditation.[৯৯]

Medications

Medications include SSRIs or SNRIs are first line choices for generalized anxiety disorder.[৮৮][১০০] There is no good evidence for any member of the class being better than another, so cost often drives drug choice.[৮৮][১০০] If they are effective, it is recommend that they be continued for at least a year.[১০১] Stopping these medications results in a greater risk of relapse.[১০২]

Buspirone, quetiapine and pregabalin are second line treatments for people who do not respond to SSRIs or SNRIs; there is also evidence that benzodiazepines including diazepam and clonazepam are effective but have fallen out of favor due to the risk of dependence and abuse.[৮৮]

Medications need to be used with care among older adults, who are more likely to have side effects because of coexisting physical disorders. Adherence problems are more likely among older people, who may have difficulty understanding, seeing, or remembering instructions.[৮]

In general medications are not seen as helpful in specific phobia but a benzodiazepine is sometimes used to help resolve acute episodes; as 2007 data were sparse for efficacy of any drug.[১০৩]

Alternative medicine

Many other remedies have been used for anxiety disorder. These include kava, where the potential for benefit seems greater than that for harm with short-term use in those with mild to moderate anxiety.[১০৪][১০৫] The American Academy of Family Physicians (AAFP) recommends use of kava for those with mild to moderate anxiety disorders who are not using alcohol or taking other medicines metabolized by the liver, and who wish to use "natural" remedies.[১০৬] Side effects of kava in the clinical trials were rare and mild.

Inositol has been found to have modest effects in people with panic disorder or obsessive-compulsive disorder.[১০৭] There is insufficient evidence to support the use of St. John's wort, valerian or passionflower.[১০৭]

Aromatherapy has shown some tentative benefits for anxiety reduction in people with cancer when done with massages, although it not clear whether it could just enhance the effect of massage itself.[১০৮]

Children

Both therapy and a number of medications have been found to be useful for treating childhood anxiety disorders.[১০৯] Therapy is generally preferred to medication.[১১০]

Cognitive behavioral therapy (CBT) is a good first therapy approach.[১১০] Studies have gathered substantial evidence for treatments that are not CBT based as being effective forms of treatment, expanding treatment options for those who do not respond to CBT.[১১০] Like adults, children may undergo psychotherapy, cognitive-behavioral therapy, or counseling. Family therapy is a form of treatment in which the child meets with a therapist together with the primary guardians and siblings.[১১১] Each family member may attend individual therapy, but family therapy is typically a form of group therapy. Art and play therapy are also used. Art therapy is most commonly used when the child will not or cannot verbally communicate, due to trauma or a disability in which they are nonverbal. Participating in art activities allows the child to express what they otherwise may not be able to communicate to others.[১১২] In play therapy, the child is allowed to play however they please as a therapist observes them. The therapist may intercede from time to time with a question, comment, or suggestion. This is often most effective when the family of the child plays a role in the treatment.[১১১][১১৩]

If a medication option is warranted, antidepressants such as SSRIs and SNRIs can be effective.[১০৯] Minor side effects with medications, however, are common.[১০৯]

Prognosis

The prognosis varies on the severity of each case and utilization of treatment for each individual. [১১৪]

If these children are left untreated, they face risks such as poor results at school, avoidance of important social activities, and substance abuse. Children who have an anxiety disorder are likely to have other disorders such as depression, eating disorders, attention deficit disorders both hyperactive and inattentive.

Epidemiology

Globally as of 2010 approximately 273 million (4.5% of the population) had an anxiety disorder.[১১৫] It is more common in females (5.2%) than males (2.8%).[১১৫]

In Europe, Africa and Asia, lifetime rates of anxiety disorders are between 9 and 16%, and yearly rates are between 4 and 7%.[১১৬] In the United States, the lifetime prevalence of anxiety disorders is about 29%[১১৭] and between 11 and 18% of adults have the condition in a given year.[১১৬] This difference is affected by the range of ways in which different cultures interpret anxiety symptoms and what they consider to be normative behavior.[১১৮][১১৯] In general, anxiety disorders represent the most prevalent psychiatric condition in the United States, outside of substance use disorder.[১২০]

Children

Like adults, children can experience anxiety disorders; between 10 and 20 percent of all children will develop a full-fledged anxiety disorder prior to the age of 18,[১২১] making anxiety the most common mental health issue in young people. Anxiety disorders in children are often more challenging to identify than their adult counterparts owing to the difficulty many parents face in discerning them from normal childhood fears. Likewise, anxiety in children is sometimes misdiagnosed as an attention deficit disorder or, due to the tendency of children to interpret their emotions physically (as stomach aches, head aches, etc.), anxiety disorders may initially be confused with physical ailments.[১২২]

Anxiety in children has a variety of causes; sometimes anxiety is rooted in biology, and may be a product of another existing condition, such as autism or Asperger's disorder.[১২৩] Gifted children are also often more prone to excessive anxiety than non-gifted children.[১২৪] Other cases of anxiety arise from the child having experienced a traumatic event of some kind, and in some cases, the cause of the child's anxiety cannot be pinpointed.[১২৫]

Anxiety in children tends to manifest along age-appropriate themes, such as fear of going to school (not related to bullying) or not performing well enough at school, fear of social rejection, fear of something happening to loved ones, etc. What separates disordered anxiety from normal childhood anxiety is the duration and intensity of the fears involved.[১২২]

A small child will usually experience separation anxiety, for example, but he or she will generally grow out of it by about the age of 6, whereas in an anxious child it may linger for years longer, hindering the child's development.[১২৬] Similarly, most children will fear the dark or losing their parents at some point, but this fear will dissipate over time without interfering a great deal in that child's normal day-to-day activities. In a child with an anxiety disorder, fearing the dark or loss of loved ones may grow into a lasting obsession which the child tries to deal with in compulsive ways which erode his or her quality of life.[১২৬] The presence of co- occurring depressive symptoms in anxiety disorders may mark the transition to a more severe and detrimental and impairing disorder in preschool and early school age.[১২৭]

Children, similar to adults, may suffer from a range of different anxiety disorders, including:

Generalized anxiety disorder: The child experiences persistent anxiety regarding a wide variety of situations, and this anxiety may adapt to fit each new situation that arises or be based largely on imagined situations which have yet to occur. Reassurance often has little effect.[১২২][১২৬]

Separation anxiety disorder: A child who is older than 6 or 7 who has an extremely difficult time being away from his or her parents may be experiencing Separation Anxiety Disorder. Children with this disorder often fear that they will lose their loved ones during times of absence. As such, they frequently refuse to attend school.[১২৮]

Social anxiety disorder should not be confused with shyness or introversion; shyness is frequently normal, especially in very young children. Children with social anxiety disorder often wish to engage in social activity (unlike introverts) but find themselves held back by obsessive fears of being disliked. They often convince themselves they have made a poor impression on others, regardless of evidence to the contrary. Over time, they may develop a phobia of social situations.[১২৯] This disorder affects older children and preteens more often than younger children. Social phobia in children may also be caused by some traumatic event, such as not knowing an answer when called on in class.[১৩০]

While uncommon in children, OCD can occur. Rates are between two and four percent.[১৩১] Like adults, children rely on "magical thinking" in order to allay their anxiety, i.e., he or she must perform certain rituals (often based in counting, organizing, cleaning, etc.) in order to "prevent" the calamity he or she feels is imminent. Unlike normal children, who can leave their magical thinking-based activities behind when called upon to do so, children with OCD are literally unable to cease engaging in these activities, regardless of the consequences.[১২৬][১৩২]

Panic disorder is more common in older children, though younger children sometimes also suffer from it. Panic disorder is frequently mistaken for a physical illness by children suffering from it, likely due to its strongly physical symptoms (a racing heartbeat, sweating, dizziness, nausea, etc.) These symptoms are, however, usually accompanied by extreme fear, particularly the fear of dying. Like adults with Panic Disorder, children may attempt to avoid any situation they feel is a "trigger" for their attacks.[১২৬]

References

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  20. ↑ The Oxford Handbook of Exercise Psychology। Oxford University Press। ২০১২। পৃষ্ঠা 56। আইএসবিএন 9780199930746। 
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  28. ↑ Mohatt, Justin; Bennett, Shannon M.; Walkup, John T. (২০১৪-০৭-০১)। "Treatment of Separation, Generalized, and Social Anxiety Disorders in Youths"। American Journal of Psychiatry। 171 (7): 741–748। আইএসএসএন 0002-953X। ডিওআই:10.1176/appi.ajp.2014.13101337। 
  29. ↑ Situational Panic Attacks. (n.d.). Retrieved from "Archived copy"। ১০ জুন ২০১২ তারিখে মূল থেকে আর্কাইভ করা। সংগ্রহের তারিখ ২৮ মার্চ ২০১৩। 
  30. ↑ ক খ গ ঘ National Collaborating Centre for Mental Health, (UK) (২০০৬)। "Obsessive-Compulsive Disorder: Core Interventions in the Treatment of Obsessive-Compulsive Disorder and Body Dysmorphic Disorder,"। NICE Clinical Guidelines (31)। পিএমআইডি 21834191। ২৯ মে ২০১৩ তারিখে মূল থেকে আর্কাইভ করা। সংগ্রহের তারিখ ২১ নভেম্বর ২০১৫। 
  31. ↑ ক খ গ ঘ ঙ Soomro, GM (১৮ জানুয়ারি ২০১২)। "Obsessive compulsive disorder."। BMJ clinical evidence। 2012। পিএমআইডি 22305974। পিএমসি 3285220 অবাধে প্রবেশযোগ্য। 
  32. ↑ ক খ Institute for Quality and Efficiency in Health Care (IQWiG)। "Obsessive-compulsive disorder: overview"। PubMed Health। Institute for Quality and Efficiency in Health Care (IQWiG)। সংগ্রহের তারিখ ২১ নভেম্বর ২০১৫। 
  33. ↑ Viana, A. G.; Beidel, D. C.; Rabian, B. (২০০৯)। "Selective mutism: A review and integration of the last 15 years"। Clinical Psychology Review। 29 (1): 57–67। ডিওআই:10.1016/j.cpr.2008.09.009। পিএমআইডি 18986742। 
  34. ↑ "The Child Who Would Not Speak a Word" ওয়েব্যাক মেশিনে আর্কাইভকৃত ৩ এপ্রিল ২০১৫ তারিখে
  35. ↑ Evans, Katie; Sullivan, Michael J. (১ মার্চ ২০০১)। Dual Diagnosis: Counseling the Mentally Ill Substance Abuser (2nd সংস্করণ)। Guilford Press। পৃষ্ঠা 75–76। আইএসবিএন 978-1-57230-446-8। 
  36. ↑ Lindsay, S.J.E.; Powell, Graham E., সম্পাদকগণ (২৮ জুলাই ১৯৯৮)। The Handbook of Clinical Adult Psychology (2nd সংস্করণ)। Routledge। পৃষ্ঠা 152–153। আইএসবিএন 978-0-415-07215-1। 
  37. ↑ Johnson, Bankole A. (২০১১)। Addiction medicine : science and practice। New York: Springer। পৃষ্ঠা 301–303। আইএসবিএন 978-1-4419-0337-2। ১ ডিসেম্বর ২০১৫ তারিখে মূল থেকে আর্কাইভ করা। 
  38. ↑ Cohen SI (ফেব্রুয়ারি ১৯৯৫)। "Alcohol and benzodiazepines generate anxiety, panic and phobias"। J R Soc Med। 88 (2): 73–77। পিএমআইডি 7769598। পিএমসি 1295099 অবাধে প্রবেশযোগ্য। 
  39. ↑ Morrow LA; ও অন্যান্য (২০০০)। "Increased incidence of anxiety and depressive disorders in persons with organic solvent exposure"। Psychosomat Med। 62 (6): 746–750। ডিওআই:10.1097/00006842-200011000-00002। পিএমআইডি 11138992। ৭ ফেব্রুয়ারি ২০০৯ তারিখে মূল থেকে আর্কাইভ করা। 
  40. ↑ Scott, Trudy (২০১১)। The Antianxiety Food Solution: How the Foods You Eat Can Help You Calm Your Anxious Mind, Improve Your Mood, and End Cravings। New Harbinger Publications। পৃষ্ঠা 59। আইএসবিএন 1-57224-926-9। সংগ্রহের তারিখ ৭ অক্টোবর ২০১২। 
  41. ↑ Winston AP (২০০৫)। "Neuropsychiatric effects of caffeine"। Advances in Psychiatric Treatment। 11 (6): 432–439। ডিওআই:10.1192/apt.11.6.432। 
  42. ↑ Hughes RN (জুন ১৯৯৬)। "Drugs Which Induce Anxiety: Caffeine"। New Zealand Journal of Psychology। 25 (1): 36–42। ৯ ফেব্রুয়ারি ২০১৩ তারিখে মূল থেকে আর্কাইভ করা। 
  43. ↑ Vilarim MM, Rocha Araujo DM, Nardi AE (আগস্ট ২০১১)। "Caffeine challenge test and panic disorder: a systematic literature review"। Expert Rev Neurother। 11 (8): 1185–95। ডিওআই:10.1586/ern.11.83। পিএমআইডি 21797659। 
  44. ↑ Vilarim, Marina Machado; Rocha Araujo, Daniele Marano; Nardi, Antonio Egidio (২০১১)। "Caffeine challenge test and panic disorder: A systematic literature review"। Expert Review of Neurotherapeutics। 11 (8): 1185–95। ডিওআই:10.1586/ern.11.83। পিএমআইডি 21797659। 
  45. ↑ Bruce, Malcolm; Scott, N; Shine, P; Lader, M (১৯৯২)। "Anxiogenic Effects of Caffeine in Patients with Anxiety Disorders"। Archives of General Psychiatry। 49 (11): 867–9। ডিওআই:10.1001/archpsyc.1992.01820110031004। পিএমআইডি 1444724। ২৩ নভেম্বর ২০১২ তারিখে মূল থেকে আর্কাইভ করা। 
  46. ↑ Nardi, Antonio E.; Lopes, Fabiana L.; Valença, Alexandre M.; Freire, Rafael C.; Veras, André B.; De-Melo-Neto, Valfrido L.; Nascimento, Isabella; King, Anna Lucia; Mezzasalma, Marco A.; Soares-Filho, Gastão L.; Zin, Walter A. (২০০৭)। "Caffeine challenge test in panic disorder and depression with panic attacks"। Comprehensive Psychiatry। 48 (3): 257–63। ডিওআই:10.1016/j.comppsych.2006.12.001। পিএমআইডি 17445520। 
  47. ↑ American Psychiatric Association (২০১৩)। Diagnostic and Statistical Manual of Mental Disorders (DSM-5)। American Psychiatric Publishing। পৃষ্ঠা 226–230। আইএসবিএন 978-0-89042-555-8। 
  48. ↑ Kedzior, Karina Karolina; Laeber, Lisa Tabata (২০১৪-০৫-১০)। "A positive association between anxiety disorders and cannabis use or cannabis use disorders in the general population- a meta-analysis of 31 studies"। BMC Psychiatry। 14: 136। আইএসএসএন 1471-244X। ডিওআই:10.1186/1471-244X-14-136। পিএমআইডি 24884989। পিএমসি 4032500 অবাধে প্রবেশযোগ্য। 
  49. ↑ Crippa, José Alexandre; Zuardi, Antonio Waldo; Martín-Santos, Rocio; Bhattacharyya, Sagnik; Atakan, Zerrin; McGuire, Philip; Fusar-Poli, Paolo (১ অক্টোবর ২০০৯)। "Cannabis and anxiety: a critical review of the evidence"। Human Psychopharmacology: Clinical and Experimental (ইংরেজি ভাষায়)। 24 (7): 515–523। আইএসএসএন 1099-1077। ডিওআই:10.1002/hup.1048। পিএমআইডি 19693792। ১ ফেব্রুয়ারি ২০১৬ তারিখে মূল থেকে আর্কাইভ করা। 
  50. ↑ Kantorovich V, Eisenhofer G, Pacak K (২০০৮)। "Pheochromocytoma: an endocrine stress mimicking disorder"। Ann. N. Y. Acad. Sci.। 1148: 462–8। ডিওআই:10.1196/annals.1410.081। পিএমআইডি 19120142। পিএমসি 2693284 অবাধে প্রবেশযোগ্য। 
  51. ↑ Guller U, Turek J, Eubanks S, Delong ER, Oertli D, Feldman JM (২০০৬)। "Detecting pheochromocytoma: defining the most sensitive test"। Ann. Surg.। 243: 102–7। ডিওআই:10.1097/01.sla.0000193833.51108.24। পিএমআইডি 16371743। পিএমসি 1449983 অবাধে প্রবেশযোগ্য। 
  52. ↑ "Archived copy"। ৮ মে ২০১৬ তারিখে মূল থেকে আর্কাইভ করা। সংগ্রহের তারিখ ২৮ এপ্রিল ২০১৬। 
  53. ↑ Patel, G; Fancher, TL (৩ ডিসে ২০১৩)। "In the clinic. Generalized anxiety disorder."। Annals of Internal Medicine। 159 (11): ITC6–1, ITC6–2, ITC6–3, ITC6–4, ITC6–5, ITC6–6, ITC6–7, ITC6–8, ITC6–9, ITC6–10, ITC6–11; quiz ITC6–12। ডিওআই:10.7326/0003-4819-159-11-201312030-01006। পিএমআইডি 24297210। 
  54. ↑ ক খ গ Grinde, B (২০০৫)। "An approach to the prevention of anxiety-related disorders based on evolutionary medicine" (পিডিএফ)। Preventive Medicine। 40 (6): 904–909। ডিওআই:10.1016/j.ypmed.2004.08.001। পিএমআইডি 15850894। ১৯ অক্টোবর ২০১৩ তারিখে মূল (পিডিএফ) থেকে আর্কাইভ করা। 
  55. ↑ ক খ গ Bateson, M; B. Brilot; D. Nettle (২০১১)। "Anxiety: An evolutionary approach" (পিডিএফ)। Canadian Journal of Psychiatry। 56 (12): 707–715। ১৯ অক্টোবর ২০১৩ তারিখে মূল (পিডিএফ) থেকে আর্কাইভ করা। 
  56. ↑ ক খ Price, John S. (সেপ্টেম্বর ২০০৩)। "Evolutionary aspects of anxiety disorders"। Dialogues in Clinical Neuroscience। 5 (3): 223–236। পিএমআইডি 22033473। পিএমসি 3181631 অবাধে প্রবেশযোগ্য। 
  57. ↑ Lydiard RB (২০০৩)। "The role of GABA in anxiety disorders"। J Clin Psychiatry। 64 (Suppl 3): 21–27। পিএমআইডি 12662130। 
  58. ↑ Nemeroff CB (২০০৩)। "The role of GABA in the pathophysiology and treatment of anxiety disorders"। Psychopharmacol Bull। 37 (4): 133–146। পিএমআইডি 15131523। 
  59. ↑ Enna SJ (১৯৮৪)। "Role of gamma-aminobutyric acid in anxiety"। Psychopathology। 17 (Suppl 1): 15–24। ডিওআই:10.1159/000284073। পিএমআইডি 6143341। 
  60. ↑ Dunlop BW, Davis PG (২০০৮)। "Combination treatment with benzodiazepines and SSRIs for comorbid anxiety and depression: a review"। Prim Care Companion J Clin Psychiatry। 10 (3): 222–228। ডিওআই:10.4088/PCC.v10n0307। পিএমআইডি 18615162। পিএমসি 2446479 অবাধে প্রবেশযোগ্য। 
  61. ↑ ক খ গ Etkin A, Prater KE, Schatzberg AF, Menon V, Greicius MD (২০০৯)। "Disrupted amygdalar subregion functional connectivity and evidence of a compensatory network in generalized anxiety disorder"। Arch Gen Psychiatry। 66 (12): 1361–1372। ডিওআই:10.1001/archgenpsychiatry.2009.104। পিএমআইডি 19996041। 
  62. ↑ Kalueff AV, Ishikawa K, Griffith AJ (১০ জানুয়ারি ২০০৮)। "Anxiety and otovestibular disorders: linking behavioral phenotypes in men and mice"। Behav. Brain Res.। 186 (1): 1–11। ডিওআই:10.1016/j.bbr.2007.07.032। পিএমআইডি 17822783। 
  63. ↑ Nagaratnam N, Ip J, Bou-Haidar P (মে–জুন ২০০৫)। "The vestibular dysfunction and anxiety disorder interface: a descriptive study with special reference to the elderly"। Arch Gerontol Geriatr। 40 (3): 253–264। ডিওআই:10.1016/j.archger.2004.09.006। পিএমআইডি 15814159। 
  64. ↑ Lepicard EM, Venault P, Perez-Diaz F, Joubert C, Berthoz A, Chapouthier G (২০ ডিসেম্বর ২০০০)। "Balance control and posture differences in the anxious BALB/cByJ mice compared to the non anxious C57BL/6J mice"। Behav. Brain Res.। 117 (1–2): 185–195। ডিওআই:10.1016/S0166-4328(00)00304-1। পিএমআইডি 11099772। 
  65. ↑ Simon NM, Pollack MH, Tuby KS, Stern TA (জুন ১৯৯৮)। "Dizziness and panic disorder: a review of the association between vestibular dysfunction and anxiety"। Ann Clin Psychiatry। 10 (2): 75–80। ডিওআই:10.3109/10401239809147746। পিএমআইডি 9669539। 
  66. ↑ Balaban CD, Thayer JF (জানুয়ারি–এপ্রিল ২০০১)। "Neurological bases for balance-anxiety links"। J Anxiety Disord.। 15 (1–2): 53–79। ডিওআই:10.1016/S0887-6185(00)00042-6। পিএমআইডি 11388358। 
  67. ↑ Mitra R, Ferguson D, Sapolsky RM (১০ ফেব্রুয়ারি ২০০৯)। "SK2 potassium channel overexpression in basolateral amygdala reduces anxiety, stress-induced corticosterone secretion and dendritic arborization"। Mol. Psychiatry। 14 (9): 847–855, 827। ডিওআই:10.1038/mp.2009.9। পিএমআইডি 19204724। পিএমসি 2763614 অবাধে প্রবেশযোগ্য। 
  68. ↑ ক খ গ World Health Organization (২০০৯)। Pharmacological Treatment of Mental Disorders in Primary Health Care (পিডিএফ)। Geneva। আইএসবিএন 978-92-4-154769-7। ২০ নভেম্বর ২০১৬ তারিখে মূল (পিডিএফ) থেকে আর্কাইভ করা। 
  69. ↑ Rose M, Devine J (২০১৪)। "Assessment of patient-reported symptoms of anxiety"। Dialogues Clin Neurosci (Review)। 16 (2): 197–211 (Table 1)। পিএমআইডি 25152658। পিএমসি 4140513 অবাধে প্রবেশযোগ্য। উন্মুক্ত প্রবেশাধিকারযুক্ত প্রকাশনা - বিনামূল্যে পড়া যাবে
  70. ↑ ক খ Rose M, Devine J (২০১৪)। "Assessment of patient-reported symptoms of anxiety"। Dialogues Clin Neurosci (Review)। 16 (2): 197–211 (Table 1)। পিএমআইডি 25152658। পিএমসি 4140513 অবাধে প্রবেশযোগ্য। উন্মুক্ত প্রবেশাধিকারযুক্ত প্রকাশনা - বিনামূল্যে পড়া যাবে
  71. ↑ Rose M, Devine J (২০১৪)। "Assessment of patient-reported symptoms of anxiety"। Dialogues Clin Neurosci (Review)। 16 (2): 197–211 (Table 2)। পিএমআইডি 25152658। পিএমসি 4140513 অবাধে প্রবেশযোগ্য। উন্মুক্ত প্রবেশাধিকারযুক্ত প্রকাশনা - বিনামূল্যে পড়া যাবে
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  83. ↑ American Psychiatric Association (২০১৩)। Diagnostic and statistical manual of mental disorders, fifth edition.। Arlington, VA: American Psychiatric Association। আইএসবিএন 978-0890425558। 
  84. ↑ ক খ Bienvenu, OJ; Ginsburg, GS (ডিসেম্বর ২০০৭)। "Prevention of anxiety disorders"। International review of psychiatry (Abingdon, England)। 19 (6): 647–54। ডিওআই:10.1080/09540260701797837। পিএমআইডি 18092242। 
  85. ↑ Khoury B, Lecomte T, Fortin G, ও অন্যান্য (আগস্ট ২০১৩)। "Mindfulness-based therapy: a comprehensive meta-analysis"। Clin Psychol Rev। 33 (6): 763–71। 
  86. ↑ Sharma M, Rush SE (জুলাই ২০১৪)। "Mindfulness-based stress reduction as a stress management intervention for healthy individuals: a systematic review"। J Evid Based Complementary Altern Med। 19 (4): 271–86। ডিওআই:10.1177/2156587214543143। পিএমআইডি 25053754। 
  87. ↑ Patel, G; Fancher, TL (৩ ডিসেম্বর ২০১৩)। "In the clinic. Generalized anxiety disorder." (পিডিএফ)। Annals of Internal Medicine। 159 (11): ITC6–1, ITC6–2, ITC6–3, ITC6–4, ITC6–5, ITC6–6, ITC6–7, ITC6–8, ITC6–9, ITC6–10, ITC6–11; quiz ITC6–12। ডিওআই:10.7326/0003-4819-159-11-201312030-01006। পিএমআইডি 24297210। ৪ জানুয়ারি ২০১৫ তারিখে মূল (পিডিএফ) থেকে আর্কাইভ করা। currently there is no evidence on the effectiveness of preventive measures for GAD in adult 
  88. ↑ ক খ গ ঘ ঙ চ ছ Stein, MB; Sareen, J (১৯ নভেম্বর ২০১৫)। "Clinical Practice: Generalized Anxiety Disorder."। The New England Journal of Medicine। 373 (21): 2059–68। ডিওআই:10.1056/nejmcp1502514। পিএমআইডি 26580998। 
  89. ↑ Taylor, G.; McNeill, A.; Girling, A.; Farley, A.; Lindson-Hawley, N.; Aveyard, P. (১৩ ফেব্রুয়ারি ২০১৪)। "Change in mental health after smoking cessation: systematic review and meta-analysis"। BMJ। 348 (feb13 1): g1151–g1151। ডিওআই:10.1136/bmj.g1151। পিএমআইডি 24524926। পিএমসি 3923980 অবাধে প্রবেশযোগ্য। 
  90. ↑ Su, Kuan-Pin; Tseng, Ping-Tao; Lin, Pao-Yen; Okubo, Ryo; Chen, Tien-Yu; Chen, Yen-Wen; Matsuoka, Yutaka J. (২০১৮)। "Association of Use of Omega-3 Polyunsaturated Fatty Acids With Changes in Severity of Anxiety Symptoms"। JAMA Network Open। 1 (5): e182327। আইএসএসএন 2574-3805। ডিওআই:10.1001/jamanetworkopen.2018.2327। 
  91. ↑ Cuijpers, P; Sijbrandij, M; Koole, S; Huibers, M; Berking, M; Andersson, G (মার্চ ২০১৪)। "Psychological treatment of generalized anxiety disorder: A meta-analysis."। Clinical Psychology Review। 34 (2): 130–140। ডিওআই:10.1016/j.cpr.2014.01.002। পিএমআইডি 24487344। 
  92. ↑ Otte, C (২০১১)। "Cognitive behavioral therapy in anxiety disorders: current state of the evidence."। Dialogues in clinical neuroscience। 13 (4): 413–21। পিএমআইডি 22275847। পিএমসি 3263389 অবাধে প্রবেশযোগ্য। 
  93. ↑ Pompoli, A; Furukawa, TA; Imai, H; Tajika, A; Efthimiou, O; Salanti, G (১৩ এপ্রিল ২০১৬)। "Psychological therapies for panic disorder with or without agoraphobia in adults: a network meta-analysis."। The Cochrane Database of Systematic Reviews। 4: CD011004। ডিওআই:10.1002/14651858.CD011004.pub2। পিএমআইডি 27071857। 
  94. ↑ ক খ Olthuis, JV; Watt, MC; Bailey, K; Hayden, JA; Stewart, SH (১২ মার্চ ২০১৬)। "Therapist-supported Internet cognitive behavioural therapy for anxiety disorders in adults."। The Cochrane Database of Systematic Reviews। 3: CD011565। ডিওআই:10.1002/14651858.cd011565.pub2। পিএমআইডি 26968204। 
  95. ↑ Donker, T; Petrie, K; Proudfoot, J; Clarke, J; Birch, MR; Christensen, H (১৫ নভেম্বর ২০১৩)। "Smartphones for smarter delivery of mental health programs: a systematic review."। Journal of medical Internet research। 15 (11): e247। ডিওআই:10.2196/jmir.2791। পিএমআইডি 24240579। পিএমসি 3841358 অবাধে প্রবেশযোগ্য। 
  96. ↑ Warren Mansell (১ জুন ২০০৭)। "Reading about self-help books on cognitive-behavioural therapy for anxiety disorders"। Pb.rcpsych.org। ১৮ নভেম্বর ২০১১ তারিখে মূল থেকে আর্কাইভ করা। সংগ্রহের তারিখ ২০ ফেব্রুয়ারি ২০১২। 
  97. ↑ Roemer L, Williston SK, Eustis EH (নভে ২০১৩)। "Mindfulness and acceptance-based behavioral therapies for anxiety disorders"। Curr Psychiatry Rep। 15 (11): 410। ডিওআই:10.1007/s11920-013-0410-3। 
  98. ↑ Lang AJ (মে ২০১৩)। "What mindfulness brings to psychotherapy for anxiety and depression"। Depress Anxiety। 30 (5): 409–12। ডিওআই:10.1002/da.22081। 
  99. ↑ Krisanaprakornkit, T; Krisanaprakornkit, W; Piyavhatkul, N; Laopaiboon, M (২৫ জানুয়ারি ২০০৬)। "Meditation therapy for anxiety disorders."। The Cochrane Database of Systematic Reviews (1): CD004998। ডিওআই:10.1002/14651858.CD004998.pub2। পিএমআইডি 16437509। 
  100. ↑ ক খ Baldwin, David S; Anderson, Ian M; Nutt, David J; Allgulander, Christer; Bandelow, Borwin; Boer, Johan A den; Christmas, David M; Davies, Simon; Fineberg, Naomi (২০১৪-০৪-০৮)। "Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: A revision of the 2005 guidelines from the British Association for Psychopharmacology"। Journal of Psychopharmacology (ইংরেজি ভাষায়)। 28 (5): 403–439। ডিওআই:10.1177/0269881114525674। 
  101. ↑ Batelaan, Neeltje M; Bosman, Renske C; Muntingh, Anna; Scholten, Willemijn D; Huijbregts, Klaas M; van Balkom, Anton J L M (১৩ সেপ্টেম্বর ২০১৭)। "Risk of relapse after antidepressant discontinuation in anxiety disorders, obsessive-compulsive disorder, and post-traumatic stress disorder: systematic review and meta-analysis of relapse prevention trials"। BMJ: j3927। ডিওআই:10.1136/bmj.j3927। 
  102. ↑ Batelaan, NM; Bosman, RC; Muntingh, A; Scholten, WD; Huijbregts, KM; van Balkom, AJLM (১৩ সেপ্টেম্বর ২০১৭)। "Risk of relapse after antidepressant discontinuation in anxiety disorders, obsessive-compulsive disorder, and post-traumatic stress disorder: systematic review and meta-analysis of relapse prevention trials."। BMJ (Clinical research ed.)। 358: j3927। পিএমআইডি 28903922। 
  103. ↑ Choy, Y; Fyer, AJ; Lipsitz, JD (এপ্রিল ২০০৭)। "Treatment of specific phobia in adults."। Clinical Psychology Review। 27 (3): 266–86। ডিওআই:10.1016/j.cpr.2006.10.002। পিএমআইডি 17112646। 
  104. ↑ Pittler MH, Ernst E (২০০৩)। Pittler MH, সম্পাদক। "Kava extract for treating anxiety"। Cochrane Database of Systematic Reviews (1): CD003383। ডিওআই:10.1002/14651858.CD003383। পিএমআইডি 12535473। 
  105. ↑ Witte S, Loew D, Gaus W (মার্চ ২০০৫)। "Meta-analysis of the efficacy of the acetonic kava-kava extract WS1490 in patients with non-psychotic anxiety disorders"। Phytother Res। 19 (3): 183–188। ডিওআই:10.1002/ptr.1609। পিএমআইডি 15934028। 
  106. ↑ Saeed SA, Bloch RM, Antonacci DJ (আগস্ট ২০০৭)। "Herbal and dietary supplements for treatment of anxiety disorders"। Am Fam Physician। 76 (4): 549–556। পিএমআইডি 17853630। 
  107. ↑ ক খ Saeed, SA; Bloch, RM; Antonacci, DJ (১৫ আগস্ট ২০০৭)। "Herbal and dietary supplements for treatment of anxiety disorders"। American Family Physician। 76 (4): 549–56। পিএমআইডি 17853630। 
  108. ↑ Fellowes, D.; Barnes, K.; Wilkinson, S. (২০০৪-০১-০১)। "Aromatherapy and massage for symptom relief in patients with cancer"। The Cochrane Database of Systematic Reviews (2): CD002287। আইএসএসএন 1469-493X। ডিওআই:10.1002/14651858.CD002287.pub2। পিএমআইডি 15106172। 
  109. ↑ ক খ গ Wang, Zhen; Whiteside, Stephen P. H.; Sim, Leslie; Farah, Wigdan; Morrow, Allison S.; Alsawas, Mouaz; Barrionuevo, Patricia; Tello, Mouaffaa; Asi, Noor; Beuschel, Bradley; Daraz, Lubna; Almasri, Jehad; Zaiem, Feras; Larrea-Mantilla, Laura; Ponce, Oscar J.; LeBlanc, Annie; Prokop, Larry J.; Murad, Mohammad Hassan (৩১ আগস্ট ২০১৭)। "Comparative Effectiveness and Safety of Cognitive Behavioral Therapy and Pharmacotherapy for Childhood Anxiety Disorders"। JAMA Pediatrics। ডিওআই:10.1001/jamapediatrics.2017.3036। 
  110. ↑ ক খ গ Higa-McMillan, CK; Francis, SE; Rith-Najarian, L; Chorpita, BF (১৮ জুন ২০১৫)। "Evidence Base Update: 50 Years of Research on Treatment for Child and Adolescent Anxiety."। Journal of Clinical Child and Adolescent Psychology: 1–23। ডিওআই:10.1080/15374416.2015.1046177। পিএমআইডি 26087438। 
  111. ↑ ক খ Creswell, Cathy; Cruddace, Susan; Gerry, Stephen; Gitau, Rachel; McIntosh, Emma; Mollison, Jill; Murray, Lynne; Shafran, Rosamund; Stein, Alan। "Treatment of childhood anxiety disorder in the context of maternal anxiety disorder: a randomised controlled trial and economic analysis"। Health Technology Assessment (ইংরেজি ভাষায়)। 19 (38): 1–184। ডিওআই:10.3310/hta19380। পিএমআইডি 26004142। পিএমসি 4781330 অবাধে প্রবেশযোগ্য। ২৪ ফেব্রুয়ারি ২০১৭ তারিখে মূল থেকে আর্কাইভ করা। 
  112. ↑ Kozlowska K.; Hanney L. (১৯৯৯)। "Family assessment and intervention using an interactive are exercise"। Australia and New Zealand Journal of Family Therapy। 20 (2): 61–69। ডিওআই:10.1002/j.1467-8438.1999.tb00358.x। 
  113. ↑ Bratton, S.C., & Ray, D. (2002). Humanistic play therapy. In D.J. Cain (Ed.), Humanistic psychotherapies: Handbook of research and practice (pp. 369-402). Washington, DC: American Psychological Association.
  114. ↑ Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences। "Principles and Practice of Geriatric Psychology, Second Edition"। Principles and Practice of Geriatric Psychiatry। Pamela J. Swales, Erin L. Cassidy. Javaid I. Sheikh: 555–557। ডিওআই:10.1002/0470846410.ch101। ২৮ মার্চ ২০১৩ তারিখে মূল থেকে আর্কাইভ করা। সংগ্রহের তারিখ ১৩ ফেব্রুয়ারি ২০১২। 
  115. ↑ ক খ Vos, T; Flaxman, AD; Naghavi, M; Lozano, R; Michaud, C; Ezzati, M; Shibuya, K; Salomon, JA; Abdalla, S; ও অন্যান্য (১৫ ডিসে ২০১২)। "Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010"। Lancet। 380 (9859): 2163–96। ডিওআই:10.1016/S0140-6736(12)61729-2। পিএমআইডি 23245607। 
  116. ↑ ক খ Simpson, Helen Blair, সম্পাদক (২০১০)। Anxiety disorders : theory, research, and clinical perspectives (1. publ. সংস্করণ)। Cambridge, UK: Cambridge University Press। পৃষ্ঠা 7। আইএসবিএন 978-0-521-51557-3। ৬ মে ২০১৬ তারিখে মূল থেকে আর্কাইভ করা। 
  117. ↑ Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE (জুন ২০০৫)। "Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication"। Arch. Gen. Psychiatry। 62 (6): 593–602। ডিওআই:10.1001/archpsyc.62.6.593। পিএমআইডি 15939837। 
  118. ↑ Brockveld, Kelia C.; Perini, Sarah J.; Rapee, Ronald M. (২০১৪)। "6"। Hofmann, Stefan G.; DiBartolo, Patricia M.। Social Anxiety: Clinical, Developmental, and Social Perspectives (3 সংস্করণ)। Elsevier। আইএসবিএন 978-0-12-394427-6। 
  119. ↑ Hofmann, Stefan G.; Asnaani, Anu (ডিসেম্বর ২০১০)। "Cultural Aspects in Social Anxiety and Social Anxiety Disorder"। Depress Anxiety। 27 (12): 1117–1127। ডিওআই:10.1002/da.20759। পিএমআইডি 21132847। পিএমসি 3075954 অবাধে প্রবেশযোগ্য। 
  120. ↑ Fricchione, Gregory (১২ আগস্ট ২০০৪)। "Generalized Anxiety Disorder"। New England Journal of Medicine। 351 (7): 675–682। ডিওআই:10.1056/NEJMcp022342। 
  121. ↑ Essau, Cecilia A. (২০০৬)। Child and Adolescent Psychopathology: Theoretical and Clinical Implications। 27 church road, Hove, East Sussex: Routledge। পৃষ্ঠা 79। 
  122. ↑ ক খ গ AnxietyBC। "GENERALIZED ANXIETY"। AnxietyBC। AnxietyBC। ১২ জুন ২০১৫ তারিখে মূল থেকে আর্কাইভ করা। সংগ্রহের তারিখ ১১ জুন ২০১৫। 
  123. ↑ Merrill, Anna। "Anxiety and Autism Spectrum Disorders"। Indiana Resource Center for Autism। Indiana Resource Center for Autism। ১১ জুন ২০১৫ তারিখে মূল থেকে আর্কাইভ করা। সংগ্রহের তারিখ ১০ জুন ২০১৫। 
  124. ↑ Guignard, Jacques-Henri; Jacquet, Anne-Yvonne; Lubart, Todd I.। "Perfectionism and Anxiety: A Paradox in Intellectual Giftedness?"। PLOS One। 7: e41043। ডিওআই:10.1371/journal.pone.0041043। পিএমআইডি 22859964। পিএমসি 3408483 অবাধে প্রবেশযোগ্য। 
  125. ↑ Rapee, Ronald M.; Schniering, Carolyn A.; Hudson, Jennifer L.। "Anxiety Disorders During Childhood and Adolescence: Origins and Treatment" (পিডিএফ)। Annual Review of Clinical Psychology। ১১ জুন ২০১৫ তারিখে মূল (পিডিএফ) থেকে আর্কাইভ করা। 
  126. ↑ ক খ গ ঘ ঙ Shenfield, Tali। "A Primer on Child and Adolescent Anxiety"। Advanced Psychology। ১১ জুন ২০১৫ তারিখে মূল থেকে আর্কাইভ করা। 
  127. ↑ Klitzing K von, White LO, Otto Y, Fuchs S, Egger HL, Klein AM: Depressive comorbidity in preschool anxiety disorder. J Child Psychol Psychiatr 2014; 55: 1107–16.
  128. ↑ "Separation Anxiety in Children"। WebMD। WebMD। ১৬ জুন ২০১৫ তারিখে মূল থেকে আর্কাইভ করা। সংগ্রহের তারিখ ১১ জুন ২০১৫। 
  129. ↑ "SOCIAL ANXIETY DISORDER"। AnxietyBC। AnxietyBC। ১২ জুন ২০১৫ তারিখে মূল থেকে আর্কাইভ করা। সংগ্রহের তারিখ ১১ জুন ২০১৫। 
  130. ↑ Biegel, D.E. (1995). Caregiver burden. In G.E. Maddox (Ed.), The encyclopedia of aging (2d ed., pp. 138-141). New York: Springer
  131. ↑ Boileau, B (২০১১)। "A review of obsessive-compulsive disorder in children and adolescents."। Dialogues in clinical neuroscience। 13 (4): 401–11। পিএমআইডি 22275846। পিএমসি 3263388 অবাধে প্রবেশযোগ্য। 
  132. ↑ Harvard Medical School (২০০৪a)। "December). Children's fears and anxieties"। Harvard Mental Health Letter। 21 (6): 1–3। 

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