A COMBINED TREATMENT APPROACH TO ANXIETY IN THE MEDICALLY ILL

Anxiety occurs frequently in patients who are medically ill. A proper search for the underlying cause of the anxiety is essential if the cli nician is to make a correct diagnosis and initiate appropriate treatme nt. Two aspects of the patient's history are particularly important du ring assessment: the duration and severity of medical illness (and tre atments) and the duration and severity of anxiety symptoms. When acute anxiety is encountered, the clinician must rule out a rapidly worseni ng medical condition, substance-induced anxiety (toxicity or withdrawa l), and a psychological reaction to stressors associated with the medi cal illness. During evaluation of medically ill individuals with chron ic anxiety, the clinician must rule out medical disorders that can mim ic anxiety disorders, psychiatric disorders associated with anxiety sy mptoms, and poor adjustment to the medical illness. it is also worth r emembering that anxiety disorders occur at an increased frequency in i ndividuals who have chronic medical illness.