Anxiety Disorders in Children/Adolescents with Medical Illnesses

Children/adolescents with medical illnesses can be diagnosed with the entire spectrum of anxiety of disorders including acute stress disorder, post-traumatic stress disorder, generalized anxiety disorder, anxiety disorder due to general medical condition, substance-induced anxiety disorder, anxiety disorder not otherwise specified, panic disorder, specific and social phobias, and obsessive compulsive disorder.

Anxiety disorders in children with a medical illness have comorbid psychiatric and physical conditions where it is difficult to separate the physiological and psychological components of anxiety. Richardson et al (2006) looked at the relationship between asthma and anxiety. During the two week study period, youth ages 11–17 years with anxiety and/or depressive disorders had significantly more asthma symptom days and higher levels of both asthma symptoms and other physical symptoms such as headaches compared to youths without diagnoses of anxiety and/or depression, even when controlling for asthma severity. Chronic worry and stress/anxiety may decrease immune function, making an individual more susceptible to infections, increasing the severity of the pre-existing physical illness. Of note, adjustment to most chronic illnesses is not always predicted by the severity of the specific chronic illness but by other psychosocial factors such as parental adjustment, social support, intelligence etc. Somatic symptoms related to an actual physical illness may also lead to more frequent triggers for panic attacks and anxiety disorders. Also, illnesses, such as asthma, diabetes, or epilepsy, that may need close medical monitoring and can result in a medical crisis may also make a child more anxious about being away from home and their caregivers and contribute to increased rates of separation anxiety in children with medical illnesses.
Electro Convulsive therapy is not associated with dementia
Electroconvulsive therapy (ECT) can effectively treat severe mood episodes but often causes short-term memory loss. Although the risk of long-term cognitive impairment is not clear, the evidence suggests that the risk is small to non-existent. In a national registry study of over 162,000 patients with a first-time diagnosis of a mood disorder, nearly 6000 of whom received ECT, the subsequent risk of dementia was comparable for patients treated with and those not treated with ECT, including patients aged 70 years or older at baseline .Thus, we continue to recommend ECT for severe episodes of treatment-resistant unipolar major depression and bipolar disorder, including patients with late-life disorders.
A new method for administering Transcranial magnetic stimulation for major depression
Repetitive Transcranial magnetic stimulation (TMS) is indicated for patients with treatment-resistant depression. However, TMS is time consuming; each treatment session lasts 30 to 40 minutes, and treatment is administered five days/week for four to six weeks. An experimental form of TMS called theta burst TMS takes only three minutes/session and may be equally efficacious. In a four-week open-label, randomized trial comparing theta burst TMS with conventional TMS in over 400 patients with treatment-resistant unipolar major depression, remission in the two groups was comparable (32 and 27 percent) Nevertheless, theta burst TMS is an investigational treatment and conventional TMS remains the standard of care. 


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