Combining pharmacotherapy with psychotherapy in the treatment of anxiety disorder.

Anxiety disorders are more prevalent than any other mental health problem in the USA, but afflicted patients are often untreated or treated only by a primary care physician. Anxiety disorders can be understood in the context of the interplay of biological, psychosocial, and behavioral factors. Psychiatry has defined effective treatment that integrates education, psychotherapy and psychopharmacology. A combination of treatment approaches may be beneficial. Anxiety related symptoms, other than a true anxiety disorder, may be precipitated by normal stresses of daily life. These patients may also benefit from treatments used in anxiety disorders. Anxiety can also occur secondary to medical disorders and medications, as well as being present as part of other psychiatric syndromes. Diagnosis requires a history, physical examination and laboratory tests. Anxiety disorders, although common, are easily overlooked because patients may present with somatic complaints rather than admit to having emotional problems. Anxiety disorders are divided into seven categories in DSM IV, with each allowing for a differential treatment approach. Non-pharmacological treatments are the first line of treatment, and may include behavior therapy and cognitive therapy. The physician-patient relationship is itself a powerful treatment tool. Key areas in which the psychiatrist can help the patient cope are outlined. Benefits and risks of drug treatment for anxiety disorders are discussed.