15 - Pharmacological treatment of paediatric anxiety

Summary

Introduction

Anxiety is a universal human experience associated with the anticipation of danger (Allen, Leonard & Swedo, 1995). It can be an adaptive trait which serves as a protective response to environmental stressors or potential threats. Children and adolescents typically experience anxiety at predictable points in their development as they attempt to negotiate normal developmental hurdles. Mastery of this anxiety and related fears gives rise to more adaptive defence mechanisms resulting in new areas of competency and a decrease in anxiety levels. However, if the anxiety is persistent, or causes intense distress, it may represent symptoms of psychiatric or other medical illnesses.

Anxiety generally presents as an uncomfortable emotional state associated with feelings of uneasiness and apprehension. Physical manifestations include palpitations, subjective shortness of breath, dizziness, tremor, flushing, perspiration and nausea. Anxious youth may also display other problems, including restlessness, decreased concentration, impulsivity, tantrums and aggression. An anxiety disorder is diagnosed when persistent, intense anxiety predominates, and is associated with significant impairment and distress. Anxiety disorders are the most prevalent psychiatric illnesses in children and adolescents. Symptoms of anxiety may be quite persistent and are associated with significant academic and social problems (Ialongo et al., 1994, 1995; AACAP, 1997). At least one-third of youth with one anxiety disorder have two or more anxiety disorders (AACAP, 1997). Anxiety disorders are also associated with mood and behaviour disorders, including major depression and attention-deficit hyperactivity disorder. Therefore, any child with significant anxiety symptoms needs to have a thorough psychiatric assessment. Treatment planning needs to account for both the primary anxiety problem, as well as other comorbid disorders.