Anxiety and medical disorders

  • Jacqueline E. Muller
  • Liezl Koen
  • Dan J. Stein


Anxiety symptoms and disorders are associated with a range of general medical disorders. This association may be a physiologic consequence of the general medical disorder, a psychologic reaction to the experience of having a medical illness, a side effect of treatment, or a chance occurrence. This article briefly reviews the associations of panic disorder with seizure disorder, Klüver-Bucy syndrome, mitral valve prolapse, and respiratory disorders; of generalized anxiety disorder with chronic obstructive airway disease and cardiovascular and endocrine disorders; of social anxiety disorder with Parkinson’s disease; of obsessive-compulsive disorder with striatal disorders; and of posttraumatic stress disorder with head injury and pain. Such associations provide important clues for understanding the neurobiology of anxiety disorders.


Anxiety Disorder Generalize Anxiety Disorder Social Anxiety Disorder Panic Disorder Posttraumatic Stress Disorder 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References and Recommended Reading

  1. 1.
    McLaughlin T, Geissler EC, Wan GJ: Comorbidities and associated treatment charges in patients with anxiety disorders. Pharmacotherapy 2003, 23:1251–1256.PubMedCrossRefGoogle Scholar
  2. 2.
    Dew MA, Kormos RL, Roth LH, et al.: Early post-transplant medical compliance and mental health predict physical morbidity and mortality one to three years after heart transplantation. J Heart Lung Transplant 1999, 18:549–562.PubMedCrossRefGoogle Scholar
  3. 3.
    Aydin IO, Ulusahin A: Depression, anxiety comorbidity, and disability in pulmonary tuberculosis and chronic obstructive pulmonary disease patients: applicability of GHQ-12. Gen Hosp Psychiatry 2001, 23:87–93.CrossRefGoogle Scholar
  4. 4.
    Irvine EJ: Review article: patients’ fears and unmet needs in inflammatory bowel disease. Aliment Pharmacol Ther 2004, 20(Suppl 4):54–59.PubMedCrossRefGoogle Scholar
  5. 5.
    Shemesh E, Rudnik A, Kaluski E, et al.: A prospective study of posttraumatic stress symptoms and nonadherence in survivors of a myocardial infarction (MI). Gen Hosp Psychiatry 2001, 23:215–222.PubMedCrossRefGoogle Scholar
  6. 6.
    Kessler RC, McGonagle KC, Zhao S, et al.: Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey. Arch Gen Psychiatry 1994, 51:8–19.PubMedGoogle Scholar
  7. 7.
    Fleet RP, Dupuis G, Marchand A, et al.: Panic disorder in emergency department chest pain patients: prevalence, comorbidity, suicidal ideation, and physician recognition. Am J Med 1996, 101:371–380.PubMedCrossRefGoogle Scholar
  8. 8.
    American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC: American Psychiatric Association; 2000.CrossRefGoogle Scholar
  9. 9.
    Gaitatzis A, Trimble MR, Sander JW: The Psychiatric comorbidity of epilepsy. Acta Neurol Scand 2004, 110:207–220.PubMedCrossRefGoogle Scholar
  10. 10.
    Marsh L, Rao V: Psychiatric complications in patients with epilepsy: a review. Epilepsy Res 2002 Mar, 49(1):11–33.PubMedCrossRefGoogle Scholar
  11. 11.
    Jackson MJ, Turkington D: Depression and anxiety in epilepsy. J Neurol Neurosurg Psychiatry 2005, 76(Suppl 1):i45–47.PubMedCrossRefGoogle Scholar
  12. 12.
    Handal NM, Masand P, Weilburg JB: Panic disorder and complex partial seizures. A truly complex relationship. Psychosomatics 1995, 36:498–502.PubMedGoogle Scholar
  13. 13.
    Cendes FAFGP, Gambardella A, Lopez-Cendes I, et al.: Relationship between atrophy of the amygdala and ictal fear in temporal lobe epilepsy. Brain 1994, 117:739–746.PubMedCrossRefGoogle Scholar
  14. 14.
    Vazquez B, Devinsky O: Epilepsy and anxiety. Epilepsy Behav 2003, 4(Suppl 4):S20–25.PubMedCrossRefGoogle Scholar
  15. 15.
    Klüver H, Bucy PC: Prelimanary analysis of functions of the temporal lobe in monkeys. Arch Neurol Psychiatry 1939, 42:979–1000.Google Scholar
  16. 16.
    Ketter TA, Post RM, Theodore WH: Positive and negative psychiatric effects of antiepileptic drugs in patients with seizure disorders. Neurology 1999, 53(Suppl 2):S53–67.PubMedGoogle Scholar
  17. 17.
    Boylan LS: Peri-ictal behavioral and cognitive changes. Epilepsy Behav 2002 Feb, 3:16–26.PubMedCrossRefGoogle Scholar
  18. 18.
    Van Ameringen M, Mancini C, Pipe B, et al.: Antiepileptic drugs in the treatment of anxiety disorders: role in therapy. Drugs 2004, 64:2199–2220.PubMedCrossRefGoogle Scholar
  19. 19.
    Klein DF: False suffocation alarms, spontaneous panics, and related conditions: an integrative hypothesis. Arch Gen Psychiatry 1993, 50:306–317.PubMedGoogle Scholar
  20. 20.
    Perna G, Gabriele A, Caldirola D, et al.: Hypersensitivity to inhalation of carbon dioxide and panic attacks. Psychiatry Res 1995, 57:267–273.PubMedCrossRefGoogle Scholar
  21. 21.
    Porzelius J, Vest M, Nochomovitz M: Respiratory function, cognitions, and panic in chronic obstructive pulmonary patients. Behav Res Ther 1992, 30:75–77.PubMedCrossRefGoogle Scholar
  22. 22.
    Katon WJ, Richardson L, Lozano P, et al.: The relationship of asthma and anxiety disorders. Psychosom Med 2004, 66:349–355.PubMedCrossRefGoogle Scholar
  23. 23.
    Northcott CJ, Stein MB: Panic disorder in pregnancy. J Clin Psychiatry 1994, 55:539–542.PubMedGoogle Scholar
  24. 24.
    Pine DS, Weese-Mayer DE, Silvestri JM, et al.: Anxiety and congenital hypoventilation syndrome. Am J Psychiatry 1994, 151:864–870.PubMedGoogle Scholar
  25. 25.
    Perna G, Bertani A, Caldirola D, et al.: Modulation of hyperreactivity to 35% CO2 after one week of treatment with paroxetine and reboxetine: a double-blind, randomized study. J Clin Psychopharmacol 2004, 24:277–282.PubMedCrossRefGoogle Scholar
  26. 26.
    Bertani A, Perna G, Arancio C, et al.: Pharmacologic effect of imipramine, paroxetine, and sertraline on 35% carbon dioxide hypersensitivity in panic patients: a double-blind, random, placebo-controlled study. J Clin Psychopharmacol 1997, 17:97–101.PubMedCrossRefGoogle Scholar
  27. 27.
    Pols HJ, Hauzer RC, Meijer JA, et al.: Fluvoxamine attenuates panic induced by 35% CO2 challenge. J Clin Psychiatry 1996, 57:539–542.PubMedGoogle Scholar
  28. 28.
    Fahrenfort JJ, Wilterdink AM, van der Veen EA: Long-term residual complaints and psychosocial sequel after remission of hyperthyroidism. Psychoneuroendocrinology 2000, 25:201–211.PubMedCrossRefGoogle Scholar
  29. 29.
    Tukel R, Kora K, Hekim N, et al.: Thyrotropin stimulating hormone response to thyrotropin releasing hormone in patients with panic disorder. Psychoneuroendocrinology 1999, 24:155–160.PubMedCrossRefGoogle Scholar
  30. 30.
    Kikuchi M, Komuro R, Oka H, et al.: Relationship between anxiety and thyroid function in patients with panic disorder. Prog Neuropsychopharmacol Biol Psychiatry 2005, 29:77–81.PubMedCrossRefGoogle Scholar
  31. 31.
    Freed LA, Lewy D, Levine RA, et al.: Prevalence and clinical outcome of mitral valve prolapse. N Engl J Med 1999, 341:1–7.PubMedCrossRefGoogle Scholar
  32. 32.
    Katerndahl DA: Panic and prolapse, meta-analysis. J Nerv Ment Dis 1993, 181:539–544.PubMedCrossRefGoogle Scholar
  33. 33.
    Tamam L, Ozpoyraz N, San M, et al.: Association between idiopathic mitral valve prolapse and panic disorder. Croat Med J 2000 Dec, 41:410–416.PubMedGoogle Scholar
  34. 34.
    Toren P, Eldar S, Cendorf D, et al.: The prevalence of mitral valve prolapse in children with anxiety disorders. J Psychiatr Res 1999, 33:357–361.PubMedCrossRefGoogle Scholar
  35. 35.
    Sullivan GM, Kent JM, Kleber M, et al.: Effects of hyperventilation on heart rate and QT variability in panic disorder pre- and post-treatment. Psychiatry Res 2004, 125:29–39. Dysregulation of the autonomic nervous system has been implicated in panic disorder. Therefore, this study investigates heart rate and QT variability in patients treated for panic disorder, reflecting on the agents’ potential cardioprotective effects.PubMedCrossRefGoogle Scholar
  36. 36.
    Yeragani VK, Tancer M, Uhde T: Heart rate and QT interval variability: abnormal alpha-2 adrenergic function in patients with panic disorder. Psychiatry Res 2003, 121:185–196.PubMedCrossRefGoogle Scholar
  37. 37.
    Kochiadakis GE, Parthenakis FI, Zuridakis EG, et al.: Is there increased sympathetic activity in patients with mitral valve prolapse? Pacing Clin Electrophysiol 1996, 19:1872–1876.PubMedCrossRefGoogle Scholar
  38. 38.
    Bulbena A, Duro JC, Porta M, et al.: Anxiety disorders in joint hypermobility syndrome. Psychiatry Res 1993, 46:59–68.PubMedCrossRefGoogle Scholar
  39. 39.
    Mishra MB, Ryan P, Atkinson P, et al.: Extra-articular features of benign joint hypermobility syndrome. Br J Rheumatol 1996, 35:861–866.PubMedCrossRefGoogle Scholar
  40. 40.
    Gratacos M, Nadal M, Martin-Santos R, et al.: A polymorphic genomic duplication on human chromosome 15 is a susceptibility factor for panic and phobic disorders. Cell 2001, 106:367–379. Although results are inconsistent, these findings contribute to data on a genetic substrate for anxiety in medical disorders.PubMedCrossRefGoogle Scholar
  41. 41.
    Tabiner M, Youings S, Dennis N, et al.: Failure to find DUP25 in patients with anxiety disorders, in control individuals, or in previously reported positive control cell lines. Am J Hum Genet 2003, 72:535–538. See reference [40].PubMedCrossRefGoogle Scholar
  42. 42.
    Gulpek D, Bayraktar E, Akbay SP, et al.: Joint hypermobility syndrome and mitral valve prolapse in panic disorder. Prog Neuropsychopharmacol Biol Psychiatry 2004, 28:969–973.PubMedCrossRefGoogle Scholar
  43. 43.
    Bulbena A, Agullo A, Pailhez G, et al.: Is joint hypermobility related to anxiety in a nonclinical population also? Psychosomatics 2004, 45:432–437.PubMedCrossRefGoogle Scholar
  44. 44.
    Wittchen HU, Zhao S, Kessler RC, et al.: DSM-III-R generalized anxiety disorder in the National Comorbidity Survey. Arch Gen Psychiatry 1994, 51:355–364.PubMedGoogle Scholar
  45. 45.
    Grigsby AB, Anderson RJ, Freedland KE, et al.: Prevalence of anxiety in adults with diabetes. A systematic review. J Psychosom Res 2002, 53:1053–1060.PubMedCrossRefGoogle Scholar
  46. 46.
    Sonino N, Navarrini C, Ruini C, et al.: Persistent psychological distress in patients treated for endocrine disease. Psychother Psychosom 2004, 73:78–83.PubMedCrossRefGoogle Scholar
  47. 47.
    Bunevicius R, Velickiene D, Prange AJ: Mood and anxiety disorders in women with treated hyperthyroidism and opthalmopathy caused by Graves’ disease. Gen Hosp Psychiatry 2005, 27:133–139.PubMedCrossRefGoogle Scholar
  48. 48.
    Stern RA, Robinson B, Thorner AR, et al.: A survey study of neuropsychiatric complaints in patients with Graves’ disease. J Neuropsychiatry Clin Neurosci 1996, 8:181–185.PubMedGoogle Scholar
  49. 49.
    Lainscak M, Keber I: Patient’s view of heart failure: from the understanding to the quality of life. Eur J Cardiovasc Nur 2003, 2:275–281.CrossRefGoogle Scholar
  50. 50.
    De Jong MJ, Chung ML, Roser LP, et al.: A five-country comparison of anxiety early after acute myocardial infarction. Eur J Cardiovasc Nurs 2004, 3:129–134.PubMedCrossRefGoogle Scholar
  51. 51.
    Moser DK, Dracup K: Is anxiety early after myocardial infarction associated with subsequent ischeamic and arrhythmic events? Psychosom Med 1996, 58:395–401.PubMedGoogle Scholar
  52. 52.
    Sirois BC, Burg MM: Negative emotion and coronary heart disease. A review. Behav Modif 2003, 27:83–102.PubMedCrossRefGoogle Scholar
  53. 53.
    Kawachi I, Sparrow D, Vokonas PS, et al.: Symptoms of anxiety and risk of coronary heart disease. The Normative Aging Study. Circulation 1994, 90:2225–2229.PubMedGoogle Scholar
  54. 54.
    Kawachi I, Sparrow D, Vokonas PS, et al.: Decreased heart rate variability in men with phobic anxiety (data from The Normative Aging Study). Am J Cardiol 1995, 75:882–885.PubMedCrossRefGoogle Scholar
  55. 55.
    Richard IH, Schiffer RB, Kurlan R: Anxiety and Parkinson’s disease. J Neuropsych Clin Neurosci 1996, 8:383–392.Google Scholar
  56. 56.
    Schneier FR, Liebowitz MR, Abi-Dargham A: Low dopamine D2 receptor binding potential in social phobia. Am J Psychiatry 2001, 157:457–459.CrossRefGoogle Scholar
  57. 57.
    Stein DJ, Ipser JC, Balkom AJ: Pharmacotherapy for social phobia. Cochrane Database Syst Rev 2004, 4:CD001206.PubMedGoogle Scholar
  58. 58.
    Lauterbach EC, Freeman A, Vogel RL: Differential DSM-III psychiatric disorder prevalence profiles in dystonia and Parkinson’s disease. J Neuropsychiatry Clin Neurosci 2004, 16:29–36.PubMedGoogle Scholar
  59. 59.
    Nuti A, Ceravolo R, Piccinni A, et al.: Psychiatric comorbidity in a population of Parkinson’s disease patients. Eur J Neurol 2004 May, 11(5):315–320.PubMedCrossRefGoogle Scholar
  60. 60.
    Vazquez A, Jimenez-Jimenez FJ, Garcia-Ruiz P, et al.: "Panic attacks" in Parkinson’s disease. A long-term complication of levodopa therapy. Acta Neurol Scand 1993, 87:14–18.PubMedCrossRefGoogle Scholar
  61. 61.
    Menza MA, Palermo B, DiPaola R, et al.: Depression and anxiety in Parkinson’s disease: possible effect of genetic variation in the serotonin transporter. Geriatr Psychiatry Neurol 1999, 12:49–52.CrossRefGoogle Scholar
  62. 62.
    Marsh L, Williams JR, Rocco M, et al.: Psychiatric comorbidities in patients with Parkinson’s disease and psychosis. Neurology 2004, 63:293–300.PubMedGoogle Scholar
  63. 63.
    Menza M, Marin H, Kaufman K, et al.: Citalopram treatment of depression in Parkinson’s disease: the impact on anxiety, disability, and cognition. Neuropsychiatry Clin Neurosci 2004, 16:315–319.Google Scholar
  64. 64.
    Murray CJL, Lopez AD: Global Burden of Disease: A Comprehensive Assessment of Mortality and Morbidity from Diseases, Injuries and Risk Factors in 1990 and projected to 2020. Vol I. Harvard, MA: World Health Organization; 1996.Google Scholar
  65. 65.
    Cheyette SR, Cummings JL: Encephalitis lethargica: lessons for contemporary neuropsychiatry. J Neuropsychiatry Clin Neurosci 1995, 7:125–134.PubMedGoogle Scholar
  66. 66.
    Stein DJ, Hollander E, Cohen L: Neuropsychiatry of obsessivecompulsive disorder. In Current Insights in Obsessive-compulsive Disorder. Edited by Hollander E, Zohar J, Marazitti D, Olivier B. Chichester: Wiley; 1994.Google Scholar
  67. 67.
    Hugo F, van Heerden B, Zungu-Dirwayi N, et al.: Functional brain imaging in obsessive-compulsive disorder secondary to neurological lesions. Depress Anxiety 1999, 10:129–136.PubMedCrossRefGoogle Scholar
  68. 68.
    Zungu-Dirwayi N, Hugo F, van Heerden BB, et al.: Are musical obsessions a temporal lobe phenomenon? J Neuropsychiatry Clin Neurosci 1999, 11:398–400.PubMedGoogle Scholar
  69. 69.
    Swedo SE, Leonard HL, Garvey M, et al.: Pediatric autoimmune Neuropsychiatric disorders associated with streptococcal infections: clinical description of the first 50 cases. Am J Psychiatry 1998, 155:264–271.PubMedGoogle Scholar
  70. 70.
    Dale RC, Heyman I, Surtees RAH, et al.: Dyskinesias and associated psychiatric disorders following streptococcal infections. Arch Dis Child 2004, 89:604–610.PubMedCrossRefGoogle Scholar
  71. 71.
    Mercadante MT, Busatto GF, Lombroso PJ, et al.: The psychiatric symptoms of rheumatic fever. Am J Psychiatry 2000, 157:2036–2038.PubMedCrossRefGoogle Scholar
  72. 72.
    Swedo SE, Grant PJ: Annotation: PANDAS: a model for human autoimmune disease. J Child Psychol Psychiatry 2005, 46:227–234.PubMedCrossRefGoogle Scholar
  73. 73.
    Giedd JN, Rapoport JL, Leonard HL, et al.: Case study: acute basal ganglia enlargement and obsessive-compulsive symptoms in an adolescent boy. J Am Acad Child Adolesc Psychiatry 1996, 35:913–915.PubMedCrossRefGoogle Scholar
  74. 74.
    Singer HS: PANDAS and immunomodulatory therapy. Lancet 1999, 354:1137–1138.PubMedCrossRefGoogle Scholar
  75. 75.
    Snider LA, Lougee L, Slattery M, et al.: Antibiotic prophylaxis with azithromycin or penicillin for childhood-onset neuropsychiatric disorders. Biol Psychiatry 2005, 57:788–792.PubMedCrossRefGoogle Scholar
  76. 76.
    Garvey MA, Perlmutter SJ, Allen AJ, et al.: A pilot study of penicillin prophylaxis for neuropsychiatric exacerbations triggered by streptococcal infections. Biol Psychiatry 1999, 45:1564–1571.PubMedCrossRefGoogle Scholar
  77. 77.
    Church AJ, Cardoso F, Dale RC, et al.: Anti-basal ganglia antibodies in acute and persistent Sydenham’s chorea. Neurology 2002, 59:227–231.PubMedGoogle Scholar
  78. 78.
    Singer HS, Loiselle CR, Lee O, et al.: Anti-basal ganglia antibodies in PANDAS. Mov Disord 2004, 19:406–415.PubMedCrossRefGoogle Scholar
  79. 79.
    Singer HS, Loiselle CR, Lee O, et al.: Anti-basal ganglia antibody abnormalities in Sydenham chorea. J Neuroimmunol 2003, 136:154–161.PubMedCrossRefGoogle Scholar
  80. 80.
    Tedstone JE, Tarrier N: Posttraumatic stress disorder following medical illness and treatment. Clin Psychol Rev 2003, 23:409–448.PubMedCrossRefGoogle Scholar
  81. 81.
    McMillan TM: Post-traumatic stress disorder and severe head injury. Br J Psychiatry 1991, 159:431–433.PubMedCrossRefGoogle Scholar
  82. 82.
    Lyons DM, Yang C, Sawyer-Glover AM, et al.: Early life stress and inherited variation in monkey hippocampal volumes. Arch Gen Psychiatry 2001, 58:1145–1151.PubMedCrossRefGoogle Scholar
  83. 83.
    Seedat S, van der Westhuizen S, Matthey M, et al.: Temporal lobe structural lesion in a case of posttraumatic stress disorder. J Neuropsychiatry Clin Neurosci 2002, 14:240–241.PubMedGoogle Scholar
  84. 84.
    Asmundson GJG, Norton GR, Allerdings MD, et al.: Posttaumatic stress disorder and work-related injury. J Anxiety Disord 1998, 12:57–69.PubMedCrossRefGoogle Scholar
  85. 85.
    Asmundson GJG, Wright KD, Stein MB: Pain and PTSD symptoms in female veterans. Eur J Pain 2004, 8:345–350.PubMedCrossRefGoogle Scholar
  86. 86.
    Sharp TJ, Harvey AG: Chronic pain and posttraumatic stress disorder: mutual maintenance? Clin Psychol Rev 2001, 21:857–877.PubMedCrossRefGoogle Scholar
  87. 87.
    Asmundson GJG, Coons MJ, Taylor S, et al.: PTSD and the experience of pain: research and clinical implications of shared vulnerability and mutual maintenance models. Can J Psychiatry 2002, 47:930–937.PubMedGoogle Scholar
  88. 88.
    Asmundson GJG, Wright KD, McCreary DR, et al.: Dimensionality of post-traumatic stress symptoms in military peace keepers. Cog Behav Ther 2003, 32:26–37.CrossRefGoogle Scholar
  89. 89.
    Roy-Byrne P, Smith WR, Goldberg J, et al.: Post-traumatic stress disorder among patients with chronic pain and chronic fatigue. Psychol Med 2004 Feb, 34:363–368.PubMedCrossRefGoogle Scholar
  90. 90.
    Raphael KG, Janal MN, Nayak S: Comorbidity of fibromyalgia and posttraumatic stress disorder symptoms in a community sample of women. Pain Med 2004, 5:33–41.PubMedCrossRefGoogle Scholar
  91. 91.
    Kelly B, Raphael B, Judd F, et al.: Posttraumatic stress disorder in response to HIV infection. Gen Hosp Psychiatry 1998, 20:345–352.PubMedCrossRefGoogle Scholar
  92. 92.
    Kimerling R, Calhoun KS, Forehand R, et al.: Traumatic stress in HIV-infected women. AIDS Educ Prev 1999, 11:321–330.PubMedGoogle Scholar
  93. 93.
    Smith MY, Egert J, Winkel G, et al.: The impact of PTSD on pain experience in persons with HIV/AIDS. Pain 2002, 98:9–17.PubMedCrossRefGoogle Scholar
  94. 94.
    Tsao JCI, Dobalian A, Naliboff BD: Panic disorder and pain in a national sample of persons living with HIV. Pain 2004, 109:172–180. This novel study reflects on the association between anxiety and pain in subjects with HIV.PubMedCrossRefGoogle Scholar
  95. 95.
    Barrett JE, Barret JA, Oxman TE, et al.: The prevalence of psychiatric disorders in primary care practice. Arch Gen Psychiatry 1988, 45:1100–1106.PubMedGoogle Scholar
  96. 96.
    Wise TN: Part IX: Anxiety disorders in special populations. In Textbook of Anxiety Disorders. Edited by Stein DJ and Hollander E. Washington, DC: American Psychiatric Publishing; 2002.Google Scholar

Copyright information

© Current Science Inc 2005

Authors and Affiliations

  • Jacqueline E. Muller
    • 1
  • Liezl Koen
  • Dan J. Stein
  1. 1.Department of PsychiatryMedical Research Council Unit on Anxiety DisordersTygerbergSouth Africa

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