Lifetime prevalence approximately 30% in USA

Gender: Female (2× more likely compared with male)

Environmental: Traumatic or stressful events

Age: Often develop in childhood and early adulthood; however, may occur any time after a stressful event

Medical conditions: Chronic mental or physical illness

Genetics: Family psychiatric history

Generalized anxiety disorder leads to chronic autonomic hyperactivity with increased risks for CAD and Htn.

Uncontrolled anxiety and fear may predispose pts to greater risk for acute postop pain and postop N/V.

Increased risk of periop complications due to impaired response to stress.

Generalized anxiety disorder leads to chronic autonomic hyperactivity with increased risks for CAD and Htn.

Uncontrolled anxiety and fear may predispose pts to greater risk for acute postop pain and postop N/V.

Increased risk of periop complications due to impaired response to stress.

Inadequately treated anxiety disorders affecting pt’s decision-making and communication capacities, which may complicate medical courses

Altered drug anesthetic requirements and drug metabolisms associated with psychiatric medications

Systemic side effects from psychiatric medications

Potential medication interactions with anesthetics

Signs/symptoms may overlap with other medical conditions (e.g., hyperparathyroidism) and drug-induced causes (e.g., alcohol, caffeine, nicotine, withdrawal), which could be life-threatening.

Types

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  Generalized anxiety disorder

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  Panic disorder

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  Social anxiety disorder

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  Specific phobias

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  PTSD

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  OCD

Characterized by excessive apprehension, physical tension, physiologic symptoms, dissociative anxiety, and fear leading to significant distress or impairment

Comorbidity with major depression (60%), other mental disorders, and substance abuse

Associated with a variety of chronic medical conditions

Genetics: ↑ norepinephrine metabolites, ↓ GABA level, ↓ postsynaptic alpha-2 adrenergic receptor sensitivity, and ↓ benzodiazepine binding sites on platelets and lymphocytes; altered central processing involving amygdala and nuclei of basolateral complex that play central roles in fear and anxiety responses

Stress

Drugs: Caffeine, alcohol, nicotine, and withdrawals