Anxiety disorders in neurology practice

Abstract

Anxiety disorders are often encountered in the practice of a neurologist. These disorders are in various relationships with a neurological disease, based on which three groups of pathologies can be distinguished: anxiety disorders, manifested by somatic neurological symptoms arising from dysfunction the autonomic nervous system; anxiety disorders associated with major neurological diseases, such as epilepsy, migraine, and stroke; anxiety disorders resulting from side effects of therapy for the underlying somatic disease, including neurological one. In the first case, a neurologist must differentiate an anxiety disorder from a true nervous pathology, which is necessary in order to prescribe the correct therapy. In the second case, it is the responsibility of a neurologist to differentiate the symptoms of an anxiety disorder that occurs against the background of an underlying neurological disease from a progressive disease of the nervous system and prescribe specific therapy for a comorbid anxiety disorder. In the third case, a neurologist should take a detailed patient’s history to identify the relationship between the onset/intensification of manifestations and therapy. To assess the level of anxiety and its dynamics, it is necessary to use psychometric scales and symptomatic questionnaires. Therapy of anxiety disorders includes two areas: psychotherapy and psychopharmacotherapy; in order to achieve the maximum effect in severe cases of anxiety disorders, it is possible to combine these components. The preferred method of psychotherapy is cognitive behavioral therapy. Psychopharmacotherapy is represented by two lines. The first-line includes drugs from the group of selective serotonin reuptake inhibitors, while the second-line therapy involves increasing the dose of the drug or changing to serotonin and norepinephrine reuptake inhibitors.