Concluding Comments

Anxiety is a particularly common experience in the medical setting for pediatric patients and their family members. When assessing and treating pediatric anxiety in these settings, the clinician needs to consider the context in which the symptoms present and the environment in which symptoms are maintained due to the strong degree of overlap between symptoms of anxiety and certain medical disorders. Anxiety symptoms may be present as part of a primary or preexisting psychological disorder, as a psychological reaction to a physical illness, or as the result of an organic etiology. In addition to the more familiar DSM-IV-TR-based anxiety disorders, medical traumatic stress has emerged as a relatively common set of symptoms. Medical conditions such as cancer, gastrointestinal disorders, heart disease, hormone-secreting tumors, stroke, pulmonary disease, seizure disorders, transplantation, traumatic brain injury, and thyroid disease may be associated with anxiety symptoms for pediatric patients. In addition, a range of medications and substances should be considered as potential contributors to anxiety symptoms presenting in the medical setting. The evaluation of anxiety in the pediatric setting should be approached in a systematic fashion that takes into account the role of preexisting primary anxiety disorders as well as anxiety symptoms arising as a result of a psychological or physiological reaction to an organic condition. Treatment of anxiety disorders in the medical setting follows many of the same principles as treatment occurring in other settings, although a brief problem-focused approach is often necessary. Strong empirical evidence supports the use of individual and group CBT for anxiety as a first-line treatment; however, patients in the inpatient medical setting often require pharmacological treatment of anxiety, at least temporarily, to help alleviate acute distress while treatment providers develop a more comprehensive approach to treating particular anxiety issues.

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