Do we need a new diagnosis of "acute anxiety disorder"?

Patient F, a 42-year-old male, complains that he has always been a very anxious person who has a great
impact on daily life.
Even so, Mr.
F's anxiety has reached unprecedented levels over the past month: as a result of taking on a new job assignment and his son's diagnosis of lupus, he has developed into a "24-hour, 7-day-a-week" worry
.
This concern has made it difficult for Mr.
F to focus on his work and is planning to call in sick
.

Mr.
F's wife reported that she was also frustrated
to see Mr.
F isolating himself from family and friends.
Mr.
F himself acknowledges the above facts and attributes them to overwhelming anxiety
.

Mr.
F has chronic anxiety, muscle tone, and anxiety-related irritability, all of which have worsened
significantly in the last month.
Mr.
F admits that he occasionally wonders recently whether he would be more relaxed if he didn't live, but denied that there were problems with energy or motivation, saying that he was just very anxious and not depressed
.
Mr.
F drinks one glass of wine a week, but has no other substance use problems; Overweight with slightly elevated cholesterol but no other serious physical problems; Melatonin products used to aid sleep, without prescription medications
.

"Acute anxiety disorder"?

Based on the limited information above, Mr.
F appears to be experiencing a worsening
of chronic generalized anxiety disorder (GAD).
However, the authors propose a new diagnostic concept, called "acute anxiety disorder
.
" This term covers acute exacerbations of anxiety disorders that are already suffered, with GAD or panic disorder being more common
.

The proposed diagnostic criteria for "acute anxiety disorder" proposed by the authors are as follows:

A.
Extreme anxiety persists for ≥ 2 weeks, significantly changed
from baseline.

B.
Anxiety symptoms cause significant social, occupational, and/or other important areas of functional impairment
.

C.
An anxiety attack is a worsening
of an anxiety disorder that is already suffered.

D.
Anxiety attacks cannot be directly attributed to the physiological effects of a substance or to a physical illness
.

E.
Anxiety episodes cannot be better explained
by the presence of psychotic disorders.

There is already such a statement as "acute exacerbation of chronic anxiety disorder", why is there still the concept of "acute anxiety disorder", is it redundant? In the author's view, this new concept can suggest that patients are experiencing a sharp deterioration in baseline function, which is meaningful for emphasizing the severity of the disease, guiding treatment, and follow-up research.

Severity of the disease

Anxiety disorders, such as GAD, although they are deeply disturbing to many patients, are often not considered a serious category of diseases
in traditional beliefs.
A diagnosis of "acute anxiety disorder" can isolate the patient's current state from a relatively mild chronic condition – the patient is going through a difficult special period in which functional impairment is quite severe
.
Of course, "acute anxiety disorder" will not turn anxiety into a serious illness such as the possibility of applying for long-term subsidies, but it is expected to bring short-term convenience
to patients in difficulty.

treat

At present, the mainstream treatment for anxiety disorders is SSRIs and SNRIs antidepressants
.
However, these drugs can cause transient anxiety exacerbations early in use, and patients with acute anxiety are particularly sensitive to these side effects and therefore need to be increased
slowly.
This may be different from other anxious patients
.
At the same time, given the overall slow onset of response to SSRIs and SNRIs, the treatment of patients with "acute anxiety disorder" may be possible to go beyond the usual and use drugs that act faster, such as benzodiazepines or sedative sleep aids (eg, zolpidem), but also need to take into account the risks
.
In addition, although neither mirtazapine nor pregabalin have formal indications for anxiety, they have a relatively rapid onset of action and can improve both anxiety and sleep, and can be considered
if necessary.

study

In patients with acute anxiety, it is necessary to assess which treatments are more effective, and to try to develop relevant psychotherapies
.
Some evidence suggests that esketamine or ketamine may be effective for this condition and can be further investigated
.

Source: Adriel Gerard, MD.
Proposal for a new diagnosis: Acute anxiety disorder.
Current Psychiatry.
2022 September; 21(9):e1-e3 | doi: 10.
12788/cp.
0285