Anxiety Disorders
Anxiety disorders are a group of relatively common psychological problems, which used to be known collectively as neuroses. The main psychological feature of anxiety disorders is the unhappiness, the tension, and the excessive anxiety believed by their sufferers. Except for their symptomatic behavior individuals with anxiety disorders usually respond appropriately to their surroundings, both cognitively, and emotionally. They are aware that something is wrong, but they are generally able to cope without hospitalization. Their main characteristic is what mental health professionals may call personal distress. The most common anxiety disorders are phobic disorder and generalized anxiety disorder (Phillipchalk & McConnell, 1994). The less common are panic and obsessive-compulsive. These will be discussing ahead next to its causes, symptoms, and treatments according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000) recommendations. Each anxiety disorder has different symptoms, but can alter the life of the individual who suffers those. It is possible to have more than one type of anxiety disorder at the same time or simultaneously. Individuals can also have an anxiety disorder with other mental health problems like depression and substance abuse among others. Generalized Anxiety Disorder
Generalized anxiety disorder is much more than what a common person with anxiety may experience in his daily live. Acquiring this disorder means always to anticipate a disaster, however most of the times the root of the worries are hard to distinguish or to locate. People with general anxiety disorder may not seem to shake their worries, even when they think that their anxiety is more intense than the situation warrants (Phillipchalk & McConnell, 1994). They also seem unable to relax. It is estimated that general anxiety disorder is affecting approximately 5.7% of population in the United States (Hofmann, Smits, 2008). Causes
Genes and stress contribute to the development of general anxiety disorder. The majority of people with general anxiety disorder say they have been presenting anxiety symptoms for as long as they can remember. The general anxiety disorder is most common in women than in men or children and it has no specific threat (Phillipchalk & McConnell, 1994).
Symptoms
The most common symptom is the constant tension and concerns, even when there is no cause or when nothing seems to provoke those. Family, personal relationships, work issues, money, and health are some examples among others. Even when individuals are aware that their concerns or fears are stronger and not necessary, individuals with generalized anxiety disorder still has problems controlling those.
Symptoms such as concentration problems, irritability, fatigue, dizziness, trouble when falling, or staying asleep. However, sleep is often not satisfactory repair or restlessness, and often is easily startled. Along with the concerns and anxieties may also be present many physical symptoms, such as muscle tension (headache) and stomach problems like nausea or diarrhea among others.
Treatment
The combination of medication and cognitive behavioral therapy works better (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000). Medications are an essential part of the treatment and may include: selective inhibitors of serotonin reuptake inhibitors, which are usually the first choice drugs (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000). The patient can use other antidepressants and some anti-seizure drugs in severe cases. Benzodiazepines such as Xanax, Klonopin, and Ativan may be used if antidepressants do not help enough with the symptoms; however, prolonged dependence of these drugs is a concern (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000). Cognitive behavioral therapies help the individual to understand conducts and how the individual may control his behaviors. The patient will have up to 20 visits during many weeks. The individual will learn how to control his distorted views of life stressors like the behavior of other people among other positive results during therapy. Panic Disorder
Panic disorders involve recurrent episodes of unbearably intense anxiety called panic attacks. Between an attack and other there is this dread and anxiety that they will return. Trying to escape these feelings of panic can be exhausting. Sadly a 4.7% of population in the United States is affected by panic disorder (Stein, Goin, Pollack, Roy-Byrne, Sareen, and Simon, 2009).
Symptoms
In an attack, physical symptoms, such as pounding heart, dizziness, and trembling, accompany feelings of dread or terror and thoughts of impending disaster, such as death, or going crazy. These attacks seems to come out of nowhere with no obvious cause. When they subside they leave the victim wondering when the next one will occur. Palpitations, chest pains, nausea or stomach problems, hot flashes or chills, shortness of breath or a feeling of suffocation, tingling or numbness, shaking or tremors, feelings of unreality, feeling of lack of control, fear of dying, and sweating are other common symptoms.

Causes
There is no specific list of triggers for panic attacks because they depend on the characteristics and perceptions of each individual. Professionals can identify some situations and conditions, which are common to many people, such as genetics, or environmental factors. Biological causes include generalized anxiety disorder, obsessive-compulsive disorder, post-traumatic stress, hypoglycemia, hyperthyroidism, mitral valve prolapsed, pheochromocytoma, inner ear disturbances and deficiency of vitamin B: are biological and can be treated (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000). Triggers that cause short-term are significant personal loss, profound changes in the individual’s daily life, excessive consumption of caffeine, nicotine, marijuana, or other drugs, such as Ritalin, or certain antidepressants.
Persistent causes may include environmental, constant negative thoughts, have a poor image of them, have constant doubts or negative beliefs and feelings held or lack of assertiveness. Treatment
Prozac, Zoloft, and Paxil are medication used to treat this disorder. Other medications that may be used include antidepressants as inhibitors of norepinephrine reuptake inhibitors
Anticonvulsants are used in severe cases. Benzodiazepines are a form of treatment for this disorder; Valium, Xanax, Klonopin, and Ativan. The symptoms should improve in few weeks but in a slow manner (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000). The individual should consult to his mental health provide if this does not happen. He should not stop taking his medications without talking to his doctor. In the other hand the cognitive behavioral therapy helps people understand their behavior and how to change inadequate behaviors. He must be able to meet the mental health provider for up to 20 visits over many weeks. The individual while in therapy will learn how to understand his distorted views and stressful situations in life, as the behavior of other people or life events among others. The individual will also recognize and at the same time replace his panic-causing thoughts and lessen helplessness feelings among other positive results. Obsessive-Compulsive Disorder
Obsessive-compulsive disorder belongs to the so-called anxiety disorders, and it is characterized by the presence of compulsions and obsessions that interfere in the daily life of the sufferer. The frequency of the disorder is unknown because most are mild and patients are never consulted for their symptoms but is estimated to affect approximately 2% of the population, equal proportion of men than women (Taylor, Pollack, LeBeau, Simon, 2008). Some studies suggest that there is more single than married, although it is difficult to determine this is because the consequences of the symptoms. It also seems to be more common in higher social classes and in people with high IQ but not entirely proven.
The age at which symptoms first appear is always difficult to pin down because they can be confused with personality traits but is between 20 and 40 years, most clinical cases show active before age 20 and only 15% exceeded 35 (Taylor, Pollack, LeBeau, Simon, 2008).
Causes
There are many theories to explain the cause of the disorder, so the individual think he may have a combination of several. People know that there are important genetic factors, which are involved in its development but the mode of transmission is still unknown.
In many cases there is an event that can act as a trigger, such as relationship problems, illnesses, or the death loved ones among others. Individuals can have an important role of education received in childhood, especially if it is too rigid ways of educating.
There are abnormalities in the frontal lobe of the brain, changes in information processing and changes in substances, such as serotonin may also be involved in the disorder.
The truth is that no one knows exactly which the specific cause is, but the combination of biological and social factors may explain the alterations that have been found. Symptoms
These are the most common symptoms of obsessive compulsive disorders: obsessive thoughts. Intrusive thoughts or images are repetitive and persistent that the patient recognizes as absurd. These obsessions may manifest in many, such as obsessive impulses, fears, and phobias.
The most frequent topics of obsessive thoughts are hypochondriacal concerns (constant and unjustified fear any illness), pollution (the people individuals relate in their environment or in public places will infect them or transmit a disease) and doubts. Treatment
Usually the treatment of obsessive-compulsive disorder will be a combination of techniques with psychotherapeutic drug. Antidepressants are used, selective inhibitors of serotonin reuptake inhibitors are the most used and best tolerated and also the used of clomipramine is more powerful (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000). The association of both drugs is indicated in cases in which there is intolerance to high doses of Clomipramine. They are usually required high doses of these drugs and the response to them tends to be delayed a few weeks. Because the disease is a chronic treatment should be maintained for long periods. Psychotherapy is often used behavioral techniques, so that the patient is exposed to obsession and is taught to prevent the response usually is used to improve the compulsions.
Psychosurgery: used only in severe cases unresponsive to other treatment.
The treatment failures occur in patients who fail to implement the instructions in severe depressive and eager patients, consumers of alcohol or other drugs, impaired relationships with others, in patients who have little motivation with alterations in personality or low intellectual level. Conclusion
Anxiety disorders are present in every place and United States is not the difference. Even when the causes vary people who suffer anxiety may experience different types of symptoms. In some individuals these ones could be worse than in others and psychological treatment next to medication should be necessary to obtain a healthy mental state. In Puerto Rico there are many centers to help mentally ill people, but there are two that are the most recognized ones, the Psychotherapy Institute of Puerto Rico and the Panamerican Hospital. Both centers help people who suffer the disorders mentioned above and have been proved to be responsible for their patients in every aspect. The most important in every treatment is the desire of the individual to become mentally stable. If medication, therapy, and positivism are all combine the patient for sure will have a positive result.

References
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (Revised 4th ed.). Washington, DC: Author.
Hofmann SG, Smits JA. Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. J Clin Psychiatry. 2008; 69:621-632.
Taylor CT, Pollack MH, LeBeau RT, Simon NM. Anxiety disorders: Panic, social anxiety, and generalized anxiety. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier; 2008: chap 32.
Phillipchalk, R. & McConnell, J. (1994). Understanding Human Behavior (8th ed.). Texas: Holt.
Pollack MH, Kinrys G, Delong H, Vasconcelos e Sá D, Simon NM. The pharmacotherapy of anxiety disorders. Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier; 2008: chap 41.
Stein MB, Goin MK, Pollack MH, Roy-Byrne P, Sareen J, Simon NM, et al. Practice guideline for the treatment of patients with panic disorder. Arlington, VA: American Psychiatric Association, 2009.