Management of anxiety disorders: The added challenge of comorbidity

Patients with anxiety present with a wide variety of disorders that cause s ignificant impairment to their everyday lives. To complicate matters, patie nts seldom present with just one anxiety disorder. Such comorbidity, partic ularly where depression is also present, has important implications for bot h the patient and the physician. The patient typically suffers from a great er degree of everyday impairment, is more reliant on healthcare services, i n particular mental health services, and may be at a greater risk of attemp ting suicide. For tbe physician, comorbidity in anxiety disorders presents a challenge as the patient's symptoms are often more severe, present earlie r in life, and are frequently prolonged which makes their management more c omplex. This review will focus on the anxiety disorders: panic disorder obs essive-compulsive disorder, social anxiety disorder, and post-traumatic str ess disorder. The impact of co-existing multiple anxiety disorders, depress ion, or a history of substance abuse will be discussed with a view to choos ing the appropriate management strategy. Treatment options will be reviewed . (C) 2001 Wiley-Liss, Inc.