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Anxiety and Anxiety Disorders

Dr. Stefano Pallanti is an Expert in Anxiety for the World Health Organization and one of the world's earliest pioneers ― since 2005 ― in the use of Neuromodulation Therapies for the treatment of Anxiety Disorders.

The Istituto di Neuroscienze offers the most advanced and innovative therapeutic options for the treatment of these disorders.

Anxiety and Anxiety Disorders

Common symptoms of an Anxiety Disorder include excessive anxiety or fear, distinguished by various behavioral manifestations that differ according to the specific stimulus causing the anxiety response.

However, the presence of anxiety symptoms does not necessarily indicate an immediate diagnosis of Anxiety Disorder. This is because there is no direct one-to-one correspondence between a specific symptom and its cause.

In fact, the same symptom, as reported by the patient, may be an expression of different etiological mechanisms, that is, different diseases. For this reason, numerous diagnoses can be found under the broad umbrella of "Anxiety", reflecting different underlying causes and, consequently, the malfunctioning of different brain circuits. For this reason, each disorder, although belonging to the same diagnostic group, must be treated specifically by targeting not the formal diagnosis of the disorder, but the underlying cause of the presented symptomatology.

The broad category of Anxiety Disorders includes the following disorders:

  • Separation Anxiety Disorder (SAD);

  • Selective Mutism;

  • Specific Phobias;

  • Social Anxiety Disorder (Social Phobia);

  • Panic Disorder;

  • Agoraphobia;

  • Generalized Anxiety Disorder (GAD);

  • Other Anxiety Disorders: anxiety disorders induced by substances and/or medical conditions, other specified anxiety disorder, unspecified anxiety disorder.

Within the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), Obsessive-Compulsive Disorder and related disorders have been separated from Anxiety Disorders.

Screening

Screening for anxiety disorders is based on the finding of the particular characteristics associated with each disorder: for example, in social phobia the finding of a marked fear related to public speaking and the subsequent avoidance of the situation caused by anxiety.

Key concepts

  • Anxiety disorders have in common excessive anxiety or fear, while they are distinguished by heterogeneous behavioral manifestations based on the specific anxiety stimulus.

  • Compared with DSM-IV, OCD (Obsessive-Compulsive Disorder) and traumatic event-related disorders, such as PTSD, have been removed from this chapter and two diagnoses with generally childhood onset (i.e., Separation Anxiety and Selective Mutism) have been added. This is due to the finding of peculiar neurobiological correlates that distinguish these disorders from anxiety disorders, and a different response to pharmacological therapy.

  • Generally speaking, treatment is based on the use of Cognitive-Behavioral Psychotherapy (especially in Specific Phobias) and SSRI antidepressants, while benzodiazepines are used in augmentation or under special conditions and on a short-term basis.

Separation Anxiety Disoder (SAD)

Separation Anxiety Disorder is characterized by excessive fear and anxiety related to separation from attachment figures or from home. Separation anxiety is a common phenomenon in children from 6-7 months to 3 years of age, and is a developmental milestone. In SAD, anxiety is higher than is typical for the person's developmental level and age, and reaches an excessive and inappropriate level.

Selective Mutism

Selective mutism is characterized by the inability to speak in a range of social situations or with specific people.

Specific Phobias

A phobia is a fear elicited by a specific object or situation, which almost always causes an immediate anxiety response or panic attack even when the patient recognizes that the fear is excessive or unreasonable.

Social Anxiety Disorder (Social Phobia)

In social phobia, patients are characterized by a persistent fear of being humiliated or embarrassing themselves in front of others.

Panic Disorder

Panic disorder is characterized by the presence of recurrent and unexpected panic attacks, followed by a month of persistent anticipatory anxiety and behavioral changes.

Agoraphobia

In DSM-5, agoraphobia has taken on an independent character from panic disorder and is therefore classified as a separate disorder.

Generalized Anxiety Disorder (GAD

Generalized anxiety disorder is a chronic condition. The key feature is the presence of persistent anxiety with excessive and therefore dysfunctional worry for at least 6 months associated with the presence of multiple physical symptoms.

(Adapted from Psichiatria Elementare Oltre il DSM-5, Stefano Pallanti, 2016, italian ed.)

Treatment of Anxiety Disorders

There is no one-to-one correspondence between symptom and cause. Thus, there is no one-to-one correspondence between the symptom and a specific medicine. Unfortunately, there is not yet a widespread culture of consensus on these issues; therefore, unfortunately, medications are too often prescribed using standardized criteria from the guidelines without thoroughly investigating which brain circuit is involved in the observed symptomatology.

The treatment of anxiety disorders cannot be properly successful if anxiety symptoms are addressed solely and exclusively through the indications provided by standardized guidelines, which, based solely on diagnostic labels and not on the mechanisms underlying the specific symptoms, are unable to provide targeted and effective treatments.

For these reasons, in order to carry out an effective treatment, an accurate diagnosis is required that goes beyond a simple description of the behavior and takes into consideration numerous factors involved in the disorder presented by the patient.

To achieve effective treatment, it then becomes necessary to consider:

  • Medical comorbidities (e.g., metabolic disorders or other diseases);

  • Psychiatric comorbidities (e.g. ADHD, depression, addictions, eating disorders, mood disorders, obsessive compulsive disorder);

  • Patient preferences;

  • Patient's age and gender;

  • Potential pregnancy;

  • Genetics of the patient.

Once the patient's condition has been assessed, Dr. Stefano Pallanti establishes with the patient the priority and hierarchy of treatment goals. Often, a sequential adaptation is necessary during treatment: for example, the patient might present with a severe state of anxiety, making it necessary as the first main objective to start treatment for these symptoms; subsequently, an underlying depressive symptomatology might emerge that facilitated the onset of the anxious one: in this case, the treatment might need to be modified; finally, once the anxious and depressive symptoms have been eliminated, attention and concentration problems might also emerge, requiring, again, a change in therapeutic objective and modification of the treatment protocols.

Multimodal multidisciplinary treatments

Neuromodulation Therapies

Neuromodulation Therapies represent an advantageous alternative to traditional medical treatments because they can be combined with each other and associated with additional medical and psychological therapies in order to achieve a highly personalized treatment.

Moreover, they are free of side effects. Read more in this page!

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Transcranial Magnetic Stimulation (TMS)

The different types of Transcranial Magnetic Stimulation (TMS) represent non-invasive and non-pharmacological therapies that use magnetic field to stimulate or inhibit specific brain areas, proving to be highly effective for the treatment of many disorders, including Resistant Depression and Obsessive-Compulsive Disorder (OCD).

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Transcranial Direct-Current Stimulation (tDCS)

tDCS is a completely painless neuromodulation therapy that is particularly suitable for children because of the high degree of freedom of movement it allows, used in numerous treatment and rehabilitation settings.

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Photo-Bio-Modulation (PBM)

The latest technology for treating the Central Nervous System and particularly suitable for children, which uses increased cerebral blood flow to stimulate brain metabolism and promote neuroplasticity processes.

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Non-invasive Vagus Nerve Stimulation (VNS)

Non-invasive Vagus Nerve Stimulation (VNS) activates the nerve that connects several neurophysiological pathways that regulate neuroinflammation processes, enabling the improvement of essential body functions.

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Dr. Pallanti's Credentials

Dr. Pallanti is one of the top World Expert in Anxiety.

Since 2014, Dr. Pallanti is an Expert in Anxiety for the World Health Organization.

Moreover, from 2005 to 2007, Dr. Pallanti held the positions of Member of the OCD Spectrum Workgroup, the Impulse Control Disorders Taskforce and the International Advisory Board of the American Psychiatric Association (APA) for DSM-5 (The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; Chair D.J. Kupfer).