Identifying and Treating Anxiety Disorders

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1 June 2015 NEWS Identifying and Treating Anxiety Disorders From being afraid of the dark to getting nervous before major exams, some anxiety is a normal part of childhood and adolescence. But when worries and fears impair functioning, cause significant distress and persist over time, they may indicate an anxiety disorder. Anxiety disorders are the most common psychiatric condition seen in children and adolescents, affecting approximately 10 to 30 percent of this population, reports Elizabeth Pinsky, MD, director of the outpatient Massachusetts General Hospital (MGH) Child and Adolescent Medical Psychiatry (ChAMP) clinic and a member of the MCPAP MGH team. Anxiety disorders are more common in girls than boys. Continued on page 2 In this Issue: MCPAP Launches Refreshed Website Winners of Gift Card Announced Free Parent s Guide is Now Available Leadership: John Straus, MD Founding Director Barry Sarvet, MD Medical Director Marcy Ravech, MSW Director Washington St., Suite 310 Boston, MA mcpap@valueoptions.com MCPAP is funded by the Massachusetts Department of Mental Health

2 Identifying and Treating Anxiety Disorders Continued from page 1 2 While anxiety can emerge at a young age, anxiety disorders are more commonly diagnosed in adolescents because they are more likely to present for psychiatric care, says Dr. Pinsky. Anxiety is an under-treated condition: according to the Anxiety and Depression Association of % of children and adolescents are affected with some form of anxiety disorder America, 80 percent of children and adolescents with a diagnosable anxiety disorder do not get treatment. Treating anxiety, preferably as early as possible, is critical to preventing school performance and social difficulties, low self-esteem, alcohol and drug use and adult anxiety disorders. Anxiety disorders cause children and adolescents great discomfort and suffering. When they receive treatment, they are happier and have improved school performance and relationships with family and friends, says Dr. Pinsky. Types of Anxiety Disorders The following anxiety disorders can present in children and adolescents: Generalized anxiety disorder chronic, excessive anxiety about multiple areas, such as family, school, social situations and health. Separation anxiety excessive fear of being separated from a child s home or caretakers. Children may cling to parents and have difficulty sleeping. Phobias extreme fear about a specific thing or situation, such as dogs, needles or storms. Social anxiety anxiety in social situations or performance situations; fear of meeting and talking to people. Panic disorder brief unexpected episodes of intense anxiety that can be accompanied by increased heart rate, shortness of breath, dizziness and nausea. Obsessive-compulsive disorder repetitive thoughts or performing repetitive acts such as hand washing or arranging and rearranging objects to alleviate anxiety caused by disturbing thoughts, impulses or images (obsessions). This pattern can be very hard to break. Post-traumatic stress disorder develops following exposure to a traumatic event such as physical or sexual abuse, being a victim of or witnessing violence or living through a disaster such as a bombing or hurricane. Children or adolescents may have flashbacks, nightmares and an exaggerated startle response. Generalized anxiety disorder and OCD are the most common anxiety disorders in the pediatric population. Children and adolescents may have more than one type of anxiety disorder and also depression. Continued on page 3

3 Identifying and Treating Anxiety Disorders Continued from page 2 Risk Factors The following can predispose a child to anxiety: Family history studies suggest that having a parent with an anxiety disorder increases a child s chances of having an anxiety disorder. Parenting style if a parent tends to be worried and anxious, it can create anxiety in children. Temperament children who are innately cautious, quiet and shy may be more likely to develop an anxiety disorder Severe or significant disruption death, divorce or separation from parent due to military service or illness. Neglect or abuse children who experience this treatment can develop PTSD. Brain activity may also play a role in the development of 3 80 % of children and adolescents with a diagnosble anxiety disorder do not get treatment anxiety. The National Institute of Mental Health reports that recent imaging studies have found that anxious adolescents have heightened activity in brain centers associated with fear processing and emotional regulation compared to normal controls. Continued on page 4 New MCPAP Website! MCPAP.ORG has been redesigned and is now live! Please take a few minutes to explore the new site. MCPAP staff are still working on edits and adding content to the new website and we welcome your feedback and ideas! Please send edits or ideas for content that you would like to see on our website to MCPAP s Project Coordinator, Mary Houghton, at mary.houghton@valueoptions.com.

4 Identifying and Treating Anxiety Disorders Continued from page 3 4 Signs of Anxiety Disorders Patients with anxiety disorders often present with somatic symptoms, such as headaches or stomach aches, says Dr. Pinsky. They may also avoid school, have changes in school performance and have difficulty separating at bedtime or sleeping on their own. Treatment The following are evidence-based treatments for anxiety: Psychotherapy the first-line treatment for anxiety disorders, it is effective in patients of all ages. Patients with anxiety should be referred to therapy. Cognitive-behavioral therapy focuses on identifying negative thinking patterns and behaviors and replacing them with positive ones. Medication when therapy alone isn t enough to treat anxiety or for severe anxiety, patients can be treated with SSRIs, including fluoxetine, sertraline, escitalopram and citalopram. Medication is usually needed for OCD, reports Dr. Pinsky. $100 Amazon.com Gift Card Winners! Thank you to those who completed our 2015 Annual Provider Experience survey. We had a record response with 662 surveys returned! As promised, two survey responders were randomly selected to receive a $100 Amazon.com Gift Card as our way of thanking those who completed the survey. The winners of the two Amazon.com Gift Cards are: Dr. David Scheff from Roslindale Pediatrics and Robert Ledwith, PA at Wareham Pediatrics. Thank you again for your continued support and interest in MCPAP. Look for the highlights from our survey in the August edition of MCPAP News. Continued on page 5 Anxiety disorders cause children and adolescents great discomfort and suffering. When they receive treatment, they are happier and have improved school performance and relationships with family and friends. Elizabeth Pinsky, MD, Director of the outpatient Massachusetts General Hospital Child and Adolescent Medical Psychiatry Clinic

5 Identifying and Treating Anxiety Disorders Continued from page 4 The following family interventions may also be helpful: Parent education and training teaches parents ways to support their anxious child and reinforce coping skills. Family therapy addresses issues in the family that may be contributing to the child s anxiety and also the strain on family members when a child has an anxiety disorder. In addition, the child s school can provide a supportive environment which can include a safe space, an identified safe adult to talk to when the child is anxious and a scheduled daily check-in with the school nurse to report any symptoms. Some children need more than one type of treatment to address their anxiety. Dr. Pinsky worked with a 10-year-old girl who presented with severe needle phobia while receiving the HPV vaccine. After eight sessions of cognitivebehavioral therapy, she was able tolerate the injections. Later, she developed generalized anxiety that impaired her functioning at school and social anxiety. She used cutting to cope. A combination of therapy and medication with sertraline enabled her to perform well in junior high school. How MCPAP Can Help Many providers contact MCPAP for assistance in dealing with anxious patients, reports Dr. Pinsky. MCPAP can help clarify the diagnosis, including distinguishing anxiety and ADHD; provide faceto-face evaluations; advise on complex cases; provide referrals to community-based resources for therapy; and offer guidance on prescribing medications. 5 Parent s Guide to Protecting Teens The Massachusetts Department of Public Health Bureau of Substance Abuse Services recently updated the 7 Ways to Protect Your Teen from Alcohol and Other Drugs brochure. This booklet may be helpful for parents and guardians who want to help their teens make healthy choices. MDPH/BSAS has incorporated the best tips from both the science and the practice of prevention. The ideas range from how to keep teens well rounded, to ways to communicate with them to keep them safer. You can download or order this NEW version through this link: These brochures are now available in bulk quantities free of charge through the Massachusetts Health Promotion Clearinghouse website.